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Issa ME, Takhsha FS, Chirumamilla CS, Perez-Novo C, Vanden Berghe W, Cuendet M. Epigenetic strategies to reverse drug resistance in heterogeneous multiple myeloma. Clin Epigenetics 2017; 9:17. [PMID: 28203307 PMCID: PMC5303245 DOI: 10.1186/s13148-017-0319-5] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 01/26/2017] [Indexed: 12/31/2022] Open
Abstract
Multiple myeloma (MM) is a hematological malignancy, which remains incurable because most patients eventually relapse or become refractory to current treatments. Due to heterogeneity within the cancer cell microenvironment, cancer cell populations employ a dynamic survival strategy to chemotherapeutic treatments, which frequently results in a rapid acquisition of therapy resistance. Besides resistance-conferring genetic alterations within a tumor cell population selected during drug treatment, recent findings also reveal non-mutational mechanisms of drug resistance, involving a small population of "cancer stem cells" (CSCs) which are intrinsically more refractory to the effects of a variety of anticancer drugs. Other studies have implicated epigenetic mechanisms in reversible drug tolerance to protect the population from eradication by potentially lethal exposures, suggesting that acquired drug resistance does not necessarily require a stable heritable genetic alteration. Clonal evolution of MM cells and the bone marrow microenvironment changes contribute to drug resistance. MM-CSCs may not be a static population and survive as phenotypically and functionally different cell types via the transition between stem-like and non-stem-like states in local microenvironments, as observed in other types of cancers. Targeting MM-CSCs is clinically relevant, and different approaches have been suggested to target molecular, metabolic and epigenetic signatures, and the self-renewal signaling characteristic of MM CSC-like cells. Here, we summarize epigenetic strategies to reverse drug resistance in heterogeneous multiple myeloma.
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Affiliation(s)
- Mark E Issa
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Rue Michel-Servet 1, CH-1211 Geneva 4, Switzerland
| | - Farnaz Sedigheh Takhsha
- Laboratory of Protein Science, Proteomics and Epigenetic Signaling (PPES), Department of Biomedical sciences, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, Wilrijk, Belgium
| | - Chandra Sekhar Chirumamilla
- Laboratory of Protein Science, Proteomics and Epigenetic Signaling (PPES), Department of Biomedical sciences, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, Wilrijk, Belgium
| | - Claudina Perez-Novo
- Laboratory of Protein Science, Proteomics and Epigenetic Signaling (PPES), Department of Biomedical sciences, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, Wilrijk, Belgium
| | - Wim Vanden Berghe
- Laboratory of Protein Science, Proteomics and Epigenetic Signaling (PPES), Department of Biomedical sciences, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, Wilrijk, Belgium
| | - Muriel Cuendet
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Rue Michel-Servet 1, CH-1211 Geneva 4, Switzerland
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102
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Shin SY, Eom HS, Sohn JY, Lee H, Park B, Joo J, Jang JH, Lee MN, Kim JK, Kong SY. Prognostic Implications of Monosomies in Patients With Multiple Myeloma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2016; 17:159-164.e2. [PMID: 28089441 DOI: 10.1016/j.clml.2016.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 11/21/2016] [Accepted: 12/14/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Cytogenetic analysis aides in risk stratification for patients with multiple myeloma (MM). Although several cytogenetic aberrations have been reported to be prognostic, less is known about the association between the presence of monosomies and prognosis. The present study evaluated the prevalence and prognostic implications of monosomies in patients with MM. MATERIALS AND METHODS Karyotypes were determined using conventional cytogenetics and fluorescence in situ hybridization (FISH). The prognostic effect of monosomies was evaluated by comparison with the clinical factors in MM patients with normal karyotypes. RESULTS Karyotypes were successfully determined in 167 of the 170 patients with MM. Of these 167 patients, 52 (31.1%) had abnormal karyotypes. Univariable analyses showed that a normal karyotype, hypodiploidy, monosomies of chromosomes 13 and 16, deletion or monosomy of 13q14, and loss of X detected by metaphase analysis were each associated with reduced progression-free survival (P < .05 for each). Univariable analyses showed that a normal karyotype, hypodiploidy, monosomies of chromosomes 13 and 16, deletion or monosomy of 13q14 detected by metaphase analysis and FISH-determined RB1 (13q)/TP53 (17p) deletion were each associated with reduced overall survival (P < .05 for each). Multivariable analysis showed that hypodiploidy detected by metaphase analysis was independently prognostic of shorter progression-free survival (P < .05 for each) and that hypodiploidy, monosomy 16, and loss of Y chromosome and FISH-determined TP53 (17p) deletion were associated with reduced overall survival (P < .05 for each). CONCLUSION In addition to known cytogenetic abnormalities, such as monosomy 13, hypodiploidy, and TP53 (17p) deletion, monosomy 16 and loss of the Y chromosome have adverse prognostic implications in patients with MM.
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Affiliation(s)
- Sang-Yong Shin
- Department of Laboratory Medicine, Center for Diagnostic Oncology and Translational Epidemiology Research Branch, Hospital and Research Institute, National Cancer Center, Goyang, Korea
| | - Hyeon-Seok Eom
- Department of Hematology-Oncology, Center for Hematologic Malignancy, National Cancer Center, Goyang, Korea; Department of System Cancer Science, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Ji Yeon Sohn
- Department of Laboratory Medicine, Center for Diagnostic Oncology and Translational Epidemiology Research Branch, Hospital and Research Institute, National Cancer Center, Goyang, Korea
| | - Hyewon Lee
- Department of Hematology-Oncology, Center for Hematologic Malignancy, National Cancer Center, Goyang, Korea; Hematologic Malignancy Branch, Research Institute, National Cancer Center, Goyang, Korea
| | - Boram Park
- Biometric Research Branch, Research Institute, National Cancer Center, Goyang, Korea
| | - Jungnam Joo
- Biometric Research Branch, Research Institute, National Cancer Center, Goyang, Korea
| | | | - Mi-Na Lee
- Green Cross Laboratories, Yongin, Korea
| | - Jung Kwon Kim
- Department of Laboratory Medicine, Center for Diagnostic Oncology and Translational Epidemiology Research Branch, Hospital and Research Institute, National Cancer Center, Goyang, Korea
| | - Sun-Young Kong
- Department of Laboratory Medicine, Center for Diagnostic Oncology and Translational Epidemiology Research Branch, Hospital and Research Institute, National Cancer Center, Goyang, Korea; Department of Hematology-Oncology, Center for Hematologic Malignancy, National Cancer Center, Goyang, Korea; Department of System Cancer Science, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea; Translational Epidemiology Research Branch, Research Institute, National Cancer Center, Goyang, Korea.
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103
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Hofman IJF, van Duin M, De Bruyne E, Fancello L, Mulligan G, Geerdens E, Garelli E, Mancini C, Lemmens H, Delforge M, Vandenberghe P, Wlodarska I, Aspesi A, Michaux L, Vanderkerken K, Sonneveld P, De Keersmaecker K. RPL5 on 1p22.1 is recurrently deleted in multiple myeloma and its expression is linked to bortezomib response. Leukemia 2016; 31:1706-1714. [PMID: 27909306 PMCID: PMC5380219 DOI: 10.1038/leu.2016.370] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 11/03/2016] [Accepted: 11/28/2016] [Indexed: 12/31/2022]
Abstract
Chromosomal region 1p22 is deleted in ≥20% of multiple myeloma (MM) patients, suggesting the presence of an unidentified tumor suppressor. Using high-resolution genomic profiling, we delimit a 58 kb minimal deleted region (MDR) on 1p22.1 encompassing two genes: ectopic viral integration site 5 (EVI5) and ribosomal protein L5 (RPL5). Low mRNA expression of EVI5 and RPL5 was associated with worse survival in diagnostic cases. Patients with 1p22 deletion had lower mRNA expression of EVI5 and RPL5, however, 1p22 deletion status is a bad predictor of RPL5 expression in some cases, suggesting that other mechanisms downregulate RPL5 expression. Interestingly, RPL5 but not EVI5 mRNA levels were significantly lower in relapsed patients responding to bortezomib and; both in newly diagnosed and relapsed patients, bortezomib treatment could overcome their bad prognosis by raising their progression-free survival to equal that of patients with high RPL5 expression. In conclusion, our genetic data restrict the MDR on 1p22 to EVI5 and RPL5 and although the role of these genes in promoting MM progression remains to be determined, we identify RPL5 mRNA expression as a biomarker for initial response to bortezomib in relapsed patients and subsequent survival benefit after long-term treatment in newly diagnosed and relapsed patients.
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Affiliation(s)
- I J F Hofman
- KU Leuven - University of Leuven, Department of Oncology, LKI - Leuven Cancer Institute, Leuven, Belgium
| | - M van Duin
- Department of Hematology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - E De Bruyne
- Department of Hematology and Immunology, Myeloma Center Brussels, Vrije Universiteit Brussels (VUB), Brussels, Belgium
| | - L Fancello
- KU Leuven - University of Leuven, Department of Oncology, LKI - Leuven Cancer Institute, Leuven, Belgium
| | - G Mulligan
- Takeda Pharmaceuticals International Co., Cambridge, MA, USA
| | - E Geerdens
- Center for Human Genetics, KU Leuven - University of Leuven, Center for Human Genetics, LKI - Leuven Cancer Institute, Leuven, Belgium.,Center for the Biology of Disease, VIB Center for the Biology of Disease, Leuven, Belgium
| | - E Garelli
- Dipartimento Scienze della Sanità Pubblica e Pediatriche, Univ.Torino, Torino, Italy
| | - C Mancini
- Dipartimento di Scienze Mediche, Univ.Torino, Torino, Italy
| | - H Lemmens
- Center for Human Genetics, University Hospitals Leuven, Leuven, Belgium
| | - M Delforge
- Department of Hematology, University Hospital Leuven, Leuven, Belgium
| | - P Vandenberghe
- Center for Human Genetics, University Hospitals Leuven, Leuven, Belgium
| | - I Wlodarska
- Center for Human Genetics, KU Leuven - University of Leuven, Center for Human Genetics, LKI - Leuven Cancer Institute, Leuven, Belgium
| | - A Aspesi
- Department of Health Sciences, Universita' del Piemonte Orientale, Novara, Italy
| | - L Michaux
- Center for Human Genetics, University Hospitals Leuven, Leuven, Belgium
| | - K Vanderkerken
- Department of Hematology and Immunology, Myeloma Center Brussels, Vrije Universiteit Brussels (VUB), Brussels, Belgium
| | - P Sonneveld
- Department of Hematology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - K De Keersmaecker
- KU Leuven - University of Leuven, Department of Oncology, LKI - Leuven Cancer Institute, Leuven, Belgium
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104
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Chaudhary S, Gothwal A, Khan I, Srivastava S, Malik R, Gupta U. Polypropyleneimine and polyamidoamine dendrimer mediated enhanced solubilization of bortezomib: Comparison and evaluation of mechanistic aspects by thermodynamics and molecular simulations. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2016; 72:611-619. [PMID: 28024628 DOI: 10.1016/j.msec.2016.11.122] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 11/13/2016] [Accepted: 11/27/2016] [Indexed: 10/20/2022]
Abstract
Bortezomib (BTZ) is the first proteasome inhibitor approved by the US-FDA is majorly used for the treatment of newly diagnosed and relapsed multiple myeloma including mantle cell lymphoma. BTZ is hydrophobic in nature and is a major cause for its minimal presence as marketed formulations. The present study reports the design, development and characterization of dendrimer based formulation for the improved solubility and effectivity of bortezomib. The study also equally focuses on the mechanistic elucidation of solubilization by two types of dendrimers i.e. fourth generation of poly (amidoamine) dendrimers (G4-PAMAM-NH2) and fifth generation of poly (propylene) imine dendrimers (G5-PPI-NH2). It was observed that aqueous solubility of BTZ was concentration and pH dependent. At 2mM G5-PPI-NH2 concentration, the fold increase in bortezomib solubility was 1152.63 times in water, while approximately 3426.69 folds increase in solubility was observed at pH10.0, respectively (p<0.05). The solubility of the drug was increased to a greater extent with G5-PPI-NH2 dendrimers because it has more hydrophobic interior than G4-PAMAM-NH2 dendrimers. The release of BTZ from G5-PPI-NH2 complex was comparatively slower than G4-PAMAM-NH2. The thermodynamic treatment of data proved that dendrimer drug complexes were stable at all pH with values of ΔG always negative. The experimental findings were also proven by molecular simulation studies and by calculating RMSD and intermolecular hydrogen bonding through Schrodinger software. It was concluded that PPI dendrimers were able to solubilize the drug more effectively than PAMAM dendrimers through electrostatic interactions.
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Affiliation(s)
- Sonam Chaudhary
- Department of Pharmacy, School of Chemical Sciences and Pharmacy, Central University of Rajasthan, Bandarsindri, Ajmer, Rajasthan 305817, India
| | - Avinash Gothwal
- Department of Pharmacy, School of Chemical Sciences and Pharmacy, Central University of Rajasthan, Bandarsindri, Ajmer, Rajasthan 305817, India
| | - Iliyas Khan
- Department of Pharmacy, School of Chemical Sciences and Pharmacy, Central University of Rajasthan, Bandarsindri, Ajmer, Rajasthan 305817, India
| | - Shubham Srivastava
- Department of Pharmacy, School of Chemical Sciences and Pharmacy, Central University of Rajasthan, Bandarsindri, Ajmer, Rajasthan 305817, India
| | - Ruchi Malik
- Department of Pharmacy, School of Chemical Sciences and Pharmacy, Central University of Rajasthan, Bandarsindri, Ajmer, Rajasthan 305817, India
| | - Umesh Gupta
- Department of Pharmacy, School of Chemical Sciences and Pharmacy, Central University of Rajasthan, Bandarsindri, Ajmer, Rajasthan 305817, India.
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105
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Issa ME, Cuendet M. Withaferin A induces cell death and differentiation in multiple myeloma cancer stem cells. MEDCHEMCOMM 2016; 8:112-121. [PMID: 30108696 DOI: 10.1039/c6md00410e] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 11/17/2016] [Indexed: 01/08/2023]
Abstract
Multiple myeloma (MM) remains an incurable malignancy despite the development of novel therapeutics. This is believed to be due to a subset of rare chemotherapy-resistant cancer stem cells (CSCs). Differentiation therapy represents one strategy aimed at reducing the stemness of CSCs. The anticancer effect of withaferin A (WFA) was studied in MM-CSCs and RPMI 8226 MM tumoral plasma cells (RPMIs). WFA exhibited growth inhibitory effects in both MM-CSCs and RPMIs, with IC50 values of 649 and 224 nM, respectively. WFA also induced a G2 cell cycle arrest, as well as cell death and apoptosis. Although, WFA did not exhibit a direct anti-migratory effect, a remarkable morphological change was observed in MM-CSCs in response to WFA treatment. Using qPCR gene expression analyses, WFA caused a reduction in stemness markers, and a promotion of differentiation markers in MM-CSCs. These results warrant further investigation of WFA in relevant MM animal models.
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Affiliation(s)
- Mark E Issa
- School of Pharmaceutical Sciences , University of Geneva , University of Lausanne , Rue Michel Servet 1 , CH-1211 Geneva 4 , Switzerland . ; ; Tel: +41 22 379 3386
| | - Muriel Cuendet
- School of Pharmaceutical Sciences , University of Geneva , University of Lausanne , Rue Michel Servet 1 , CH-1211 Geneva 4 , Switzerland . ; ; Tel: +41 22 379 3386
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106
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Starr MR, Henkin S, Greenlund LS. 77-Year-Old Man With a Painful Left Knee, Anemia, and Renal Insufficiency. Mayo Clin Proc 2016; 91:e149-e153. [PMID: 27519907 DOI: 10.1016/j.mayocp.2016.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 03/26/2016] [Accepted: 04/01/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Matthew R Starr
- Resident in Internal Medicine, Mayo School of Graduate Medical Education, Rochester, MN
| | - Stanislav Henkin
- Resident in Internal Medicine, Mayo School of Graduate Medical Education, Rochester, MN
| | - Laura S Greenlund
- Advisor to residents and Consultant in Primary Care Internal Medicine, Rochester, MN
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107
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Fregnani ER, Leite AA, Parahyba CJ, Nesrallah ACA, Ramos-Perez FMDM, Perez DEDC. Mandibular destructive radiolucent lesion: The first sign of multiple myeloma. J Clin Exp Dent 2016; 8:e465-e468. [PMID: 27703618 PMCID: PMC5045697 DOI: 10.4317/jced.52832] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 02/10/2016] [Indexed: 12/22/2022] Open
Abstract
The occurrence of a mandibular lesion as the first sign of multiple myeloma (MM) is uncommon. This report describes a case of MM diagnosed because of a mandibular lesion. A 62-year-old woman presented a destructive radiolucent lesion in the right mandibular ramus. The lesion caused rupture of the anterior cortical bone and extended from the retromolar area to the coronoid process. An incisional biopsy was performed. Histopathological examination revealed numerous pleomorphic plasma cells, some with binucleated nuclei. The tumor cells showed kappa light-chain restriction. Bone marrow biopsy showed findings of massive infiltration of neoplastic plasma cells, besides lesions in the vertebrae. The diagnosis of MM was established. The patient underwent autologous hematopoietic stem-cell transplantation. Currently, the patient is under regular follow up after 40 months of initial treatment. In conclusion, MM should be considered in the differential diagnosis of destructive mandibular lesions.
Key words:Mandible, multiple myeloma, radiolucent lesion.
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Affiliation(s)
| | - Amanda-Almeida Leite
- Department of Clinical and Preventive Dentistry, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | | | | | | | - Danyel-Elias-da Cruz Perez
- Department of Clinical and Preventive Dentistry, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
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108
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Dowling M, Kelly M, Meenaghan T. Multiple myeloma: managing a complex blood cancer. ACTA ACUST UNITED AC 2016; 25:S18-28. [DOI: 10.12968/bjon.2016.25.s18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Maura Dowling
- School of Nursing and Midwifery, National University of Ireland, Galway, Ireland
| | - Mary Kelly
- Advanced Nurse Practitioner (Haematology), Midlands Regional Hospitals, County Offaly, Ireland
| | - Teresa Meenaghan
- Advanced Nurse Practitioner (Haematology) Galway University Hospital, Galway, Ireland
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109
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Leng Y, Qiu L, Hou J, Zhao Y, Zhang X, Yang S, Xi H, Huang Z, Pan L, Chen W. Phase II open-label study of recombinant circularly permuted TRAIL as a single-agent treatment for relapsed or refractory multiple myeloma. CHINESE JOURNAL OF CANCER 2016; 35:86. [PMID: 27608772 PMCID: PMC5016961 DOI: 10.1186/s40880-016-0140-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 07/28/2016] [Indexed: 02/05/2023]
Abstract
Background Despite the recent development of new therapies, multiple myeloma (MM) remains an incurable disease. Thus, new, effective treatments are urgently needed, particularly for relapsed or refractory MM (RRMM). In an earlier phase I study, a novel form of recombinant human Apo2L/tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) that is currently in clinical development for the treatment of hematologic malignancies, i.e., circularly permuted TRAIL (CPT), was well tolerated at a dose of 2.5 mg/kg per day and showed promising preliminary activity in patients with RRMM. This phase II, open-label, multicenter study further investigated the efficacy and safety of 2.5-mg/kg per day CPT as single-agent therapy for patients with RRMM. Methods Patients with RRMM were treated once daily with CPT (2.5 mg/kg, intravenously) for 14 consecutive days for each 21-day cycle. Clinical response and toxicity were assessed after each treatment cycle. Results Twenty-seven patients received CPT. Using the European Group for Blood and Marrow Transplantation criteria, we calculated the overall response rate of 33.3% with 1 near-complete response (nCR) and 8 partial responses (PRs). The clinical benefit rate (48.1%) included 1 nCR, 8 PRs, and 4 minimal responses. The most common treatment-related adverse events (TRAEs) were fever, aspartate aminotransferase elevation, alanine aminotransferase elevation, leucopenia, rash, neutropenia, and thrombocytopenia. We graded toxicity using the Common Toxicity Criteria for Adverse Events, version 3.0, and determined that 37.0% of patients had at least 1 grade 3–4 TRAE. Conclusions CPT as a single agent can elicit a response in patients with RRMM and is well tolerated. Further clinical investigation is warranted. Trial Registration ChiCTR-ONC-12002065 http://www.chictr.org/cn
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Affiliation(s)
- Yun Leng
- Department of Hematology, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, P. R. China
| | - Lugui Qiu
- Department of Lymphoma Center, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Tianjin, 300020, P. R. China
| | - Jian Hou
- Department of Hematology, Shanghai Changzheng Hospital, The Second Military Medical University, Shanghai, 200003, P. R. China
| | - Yaozhong Zhao
- Department of Lymphoma Center, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Tianjin, 300020, P. R. China
| | - Xuejun Zhang
- Department of Hematology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, P. R. China
| | - Shifang Yang
- Beijing Sunbio Biotech Co., Ltd., Beijing, 100176, P. R. China
| | - Hao Xi
- Department of Hematology, Shanghai Changzheng Hospital, The Second Military Medical University, Shanghai, 200003, P. R. China
| | - Zhongxia Huang
- Department of Hematology, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, P. R. China
| | - Ling Pan
- Department of Hematology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, P. R. China
| | - Wenming Chen
- Department of Hematology, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, P. R. China.
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110
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Combined expression of miR-34a and Smac mediated by oncolytic vaccinia virus synergistically promote anti-tumor effects in Multiple Myeloma. Sci Rep 2016; 6:32174. [PMID: 27552933 PMCID: PMC5001249 DOI: 10.1038/srep32174] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 08/03/2016] [Indexed: 02/07/2023] Open
Abstract
Despite great progress made in the treatment of multiple myeloma (MM), it is still incurable. Promising phase II clinical results have been reported recently for oncolytic vaccinia virus (OVV) clinic therapeutics. One reason for this has focused on the critical therapeutic importance of the immune response raised by these viruses. However, few studies have performed their applications as an optimal delivery system for therapeutic gene, especially miRNA in MM. In this study, we constructed two novel OVVs (TK deletion) that express anti-tumor genes, miR-34a and Smac, respectively, in MM cell lines and xenograft model. The results demonstrated that the novel OVV can effectively infect MM cell lines, and forcefully enhance the exogenous gene (miR-34a or Smac) expression. Furthermore, utilization of VV-miR-34a combined with VV-Smac synergistically inhibited tumor growth and induced apoptosis in vitro and in vivo. The underlying mechanism is proposed that blocking of Bcl-2 by VV-miR-34a increases the release of cytochrome c from mitochondria and then synergistically amplifies the antitumor effects of Smac-induced cell apoptosis. Our study is the first to utilize OVV as the vector for miR-34a or Smac expression to treat MM, and lays the groundwork for future clinical therapy for MM.
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111
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Nath CE, Trotman J, Tiley C, Presgrave P, Joshua D, Kerridge I, Kwan YL, Gurney H, McLachlan AJ, Earl JW, Nivison‐Smith I, Zeng L, Shaw PJ. High melphalan exposure is associated with improved overall survival in myeloma patients receiving high dose melphalan and autologous transplantation. Br J Clin Pharmacol 2016; 82:149-59. [PMID: 26879446 PMCID: PMC4917807 DOI: 10.1111/bcp.12906] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 02/01/2016] [Accepted: 02/09/2016] [Indexed: 11/28/2022] Open
Abstract
AIM High dose melphalan (HDM) and autologous stem cell transplantation (ASCT) retains a central role in the treatment of myeloma. The aim of this study was to determine whether HDM exposure (area under the concentration vs. time curve, AUC), is significantly associated with transplant outcomes. METHODS Melphalan concentrations were measured in six to 11 plasma samples collected after HDM (median 192 mg m(-) (2) ) to determine melphalan AUC for a total of 114 patients. Binary logistic regression was used to assess whether melphalan AUC was associated with severe (≥ grade 3) oral mucositis. Multivariate Cox regression was used to assess whether melphalan AUC was significantly associated with time to progression, progression-free survival and overall survival (OS). RESULTS Melphalan AUC ranged from 4.9 to 24.6 mg l(-1) h, median 12.84 mg l(-1) h. Melphalan AUC above the median was a risk factor for severe mucositis (HR 1.21, 95% CI 1.06, 1.38, P = 0.004) but was also associated with significantly improved overall survival (OS) (HR 0.40, 95% CI 0.20, 0.81, P = 0.001), with an estimated median survival of 8.50 years vs. 5.38 years for high vs. low AUC groups. Multivariate analysis did not identify melphalan AUC as being significantly associated with time to progression or progression-free survival. CONCLUSIONS This large scale pharmacodynamic analysis of HDM demonstrates that high melphalan exposure is associated with improved survival, with an acceptable increase in transplant toxicity. These results suggest studies targeting a higher AUC are warranted in patients undergoing HDM and ASCT for myeloma.
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Affiliation(s)
- Christa E. Nath
- The Children's Hospital at WestmeadHawkesbury RdWestmead2145
| | - Judith Trotman
- Concord HospitalHospital RoadConcordNSW2139
- University of SydneySydneyNSW2006
| | - Campbell Tiley
- Gosford HospitalHolden StGosfordNSW2250
- University of Newcastle, University DrCallaghanNSW2308
| | - Peter Presgrave
- Wollongong HospitalLoftus StWollongongNSW2500
- University of WollongongNorthfields AveWollongongNSW2522
| | - Douglas Joshua
- University of SydneySydneyNSW2006
- Royal Prince Alfred HospitalMissenden RdCamperdownNSW2050
| | - Ian Kerridge
- University of SydneySydneyNSW2006
- Westmead HospitalHawkesbury RdWestmeadNSW2145
| | | | - Howard Gurney
- University of SydneySydneyNSW2006
- Westmead HospitalHawkesbury RdWestmeadNSW2145
| | - Andrew J. McLachlan
- Concord HospitalHospital RoadConcordNSW2139
- University of SydneySydneyNSW2006
| | - John W. Earl
- The Children's Hospital at WestmeadHawkesbury RdWestmead2145
- University of SydneySydneyNSW2006
| | - Ian Nivison‐Smith
- Australasian Bone Marrow Transplant Recipient Registry370 Victoria StreetDarlinghurstNSW2010Australia
| | - Lihua Zeng
- The Children's Hospital at WestmeadHawkesbury RdWestmead2145
| | - Peter J. Shaw
- The Children's Hospital at WestmeadHawkesbury RdWestmead2145
- University of SydneySydneyNSW2006
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Rajkumar SV. Multiple myeloma: 2016 update on diagnosis, risk-stratification, and management. Am J Hematol 2016; 91:719-34. [PMID: 27291302 PMCID: PMC5291298 DOI: 10.1002/ajh.24402] [Citation(s) in RCA: 312] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 04/25/2016] [Indexed: 02/07/2023]
Abstract
Multiple myeloma accounts for approximately 10% of hematologic malignancies.The diagnosis requires ≥10% clonal bone marrow plasma cells or a biopsy proven plasmacytoma plus evidence of one or more multiple myeloma defining events (MDE): CRAB (hypercalcemia, renal failure, anemia, or lytic bone lesions) features felt related to the plasma cell disorder, bone marrow clonal plasmacytosis ≥60%, serum involved/uninvolved free light chain (FLC) ratio ≥100 (provided involved FLC is ≥100 mg/L), or >1 focal lesion on magnetic resonance imaging. Patients with del(17p), t(14;16), and t(14;20) have high-risk multiple myeloma. Patients with t(4;14) translocation and gain(1q) have intermediate-risk. All others are considered standard-risk. Initial treatment consists of bortezomib, lenalidomide, dexamethasone (VRD). In high-risk patients, carfilzomib, lenalidomide, dexamethasone (KRD) is an alternative to VRD. In eligible patients, initial therapy is given for approximately 3-4 months followed by autologous stem cell transplantation (ASCT). Standard risk patients can opt for delayed ASCT at first relapse. Patients not candidates for transplant are treated with Rd until progression, or alternatively, a triplet regimen such as VRD for approximately 12-18 months. After ASCT, lenalidomide maintenance is considered for standard risk patients especially in those who are not in very good partial response or better, while maintenance with a bortezomib-based regimen is needed for patients with intermediate or high-risk disease. Patients with indolent relapse can be treated with 2-drug or 3-drug combinations. Patients with more aggressive relapse require a triplet regimen or a combination of multiple active agents. Am. J. Hematol. 91:720-734, 2016. © 2016 Wiley Periodicals, Inc.
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Szabo AG, Gang AO, Pedersen MØ, Poulsen TS, Klausen TW, Nørgaard P. Overexpression of c-myc is associated with adverse clinical features and worse overall survival in multiple myeloma. Leuk Lymphoma 2016; 57:2526-34. [PMID: 27243588 DOI: 10.1080/10428194.2016.1187275] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The role of c-myc in multiple myeloma (MM) is controversial. We conducted a retrospective study of 117 patients with MM diagnosed between 2004 and 2010 at Herlev Hospital. Immunohistochemistry (IHC) and fluorescent in situ hybridization (FISH) were performed on tissue microarrays (TMAs) made from diagnostic bone marrow aspirates. Clinical data were obtained from the Danish Multiple Myeloma Database (DMMD). Overexpression of c-myc was found in 40% of patients. MYC translocation was found in 10% of patients. Overexpression of c-myc was not associated with MYC translocation. Overexpression of c-myc was associated with hypercalcemia (p = 0.02) and extramedullary myeloma (p < 0.01). Overexpression of c-myc was associated with shorter overall survival (OS) by multivariable analysis of the entire patient cohort [HR 1.92 (1.06-3.45), p = 0.03] and univariable analysis of high-dose-therapy (HDT)-ineligible patients [HR 2.01 (1.05-3.86), p = 0.04]. Further studies of c-myc overexpression in larger cohorts of patients with MM are warranted.
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Affiliation(s)
- Agoston Gyula Szabo
- a Department of Pathology , Copenhagen University Hospital Herlev , Herlev , Denmark
| | - Anne Ortved Gang
- b Department of Hematology , Copenhagen University Hospital Herlev , Herlev , Denmark
| | - Mette Ølgod Pedersen
- a Department of Pathology , Copenhagen University Hospital Herlev , Herlev , Denmark
| | - Tim Svenstrup Poulsen
- a Department of Pathology , Copenhagen University Hospital Herlev , Herlev , Denmark
| | | | - Peter Nørgaard
- a Department of Pathology , Copenhagen University Hospital Herlev , Herlev , Denmark
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Sultan S, Irfan SM, Parveen S, Taufiq U. International Scoring System in Symptomatic Multiple Myeloma: Experience from a Tertiary Care Center. Asian Pac J Cancer Prev 2016; 17:2031-3. [PMID: 27221891 DOI: 10.7314/apjcp.2016.17.4.2031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Symptomatic multiple myeloma (MM) is an acquired B-cell malignant proliferation of anti- body secreting plasma cells, characterized by end organ damage due to monoclonal immunoglobulin secretion. The aim of this study wa to determine the stage stratification according to an international scoring system in adult Pakistani MM patients at presentation. MATERIALS AND METHODS This single centre retrospective study extendedfrom January 2012 to December 2015. Data were retrieved from the departmental maintained records. RESULTS A total of 39 patients were diagnosed at our center with MM during the period of the study, 25 males and 14 females. Age ranged between 36 and 81 with a mean of 54.5±14.8 and a median of 57 years. Common presenting complaints included fatigue (80.9%), backache (79.3%) and bone pain (66.2%). Overall, 9 patients were in ISS stage I (23%), 12 were in stage II (30.7%) and 18 were in stage III (46.1%). Out of the total, 29 (74.3%) had kappa immunoglobulin andthe remaining 10 (25.6%) had lambda type myelomas. IgG myeloma was commonest, seen in 26 (66.6%) followed by IgA in 11 (28.2%) with non secretory myeloma in one (2.5%) and light chain disease also in one patient (2.5%). CONCLUSIONS MM in Pakistani patients is seen in a relatively young population with male predominance. Primarily patients are symptomatic and risk stratification revealed a predominance of advanced stage III disease in our setting.
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Affiliation(s)
- Sadia Sultan
- Department of Hematology and Blood bank, Liaquat National Hospital and Medical College, Karachi, Pakistan, E-mail :
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Sultan S, Irfan SM, Parveen S, Ali H, Basharat M. Multiple Myeloma: a Retrospective Analysis of 61 Patients from a Tertiary Care Center. Asian Pac J Cancer Prev 2016; 17:1833-5. [PMID: 27221861 DOI: 10.7314/apjcp.2016.17.4.1833] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multiple myeloma (MM) is an acquired clonal B-cell malignancy which primarily affects elderly individuals with an annual incidence of approximately 1% of all malignancies. Our aim is to study demographic and clinicopathological features of adult Pakistani MM patients at presentation. MATERIALS AND METHODS This single centre retrospective study extended from January 2010 to December 2014. Data were retrieved from the patients' maintained records on predetermined performa. RESULTS Overall, 61 patients were diagnosed at our institution with MM during the study period. There were 43 males and 18 females. Age ranged between 34 and 81 years with a mean of 56.1±12.8 and a median of 57 years. The male to female ratio was ~2:1. Common presenting complaints included fatigue (81.9%), backache (80.3%) and bone pain (67.2%). Physical findings revealed pallor (44.2%) as a presenting clinical feature. The mean hemoglobin value was 8.9±1.7g/dl with a mean MCV of 85.3±11.0 fl. Severe anemia with hemoglobin <8.5 gm/dl was seen in 40.9%. The mean total leukocyte count was 8.9±8.2x109/l, the ANC was 5.0±3.1x109/l and the mean platelet count was 188.4±150.6x109/l. CONCLUSIONS MM in Pakistani patients is seen in a relatively young population with male preponderance. The majority of patients present with symptomatic anemia and backache to seek medical attention. However, clinico-pathological features appear comparable to the published literature.
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Affiliation(s)
- Sadia Sultan
- 1Department of Hematology and Blood Bank, Liaquat National Hospital and Medical College, Pakistan, Karachi E-mail :
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Takeda T, Tsubaki M, Kino T, Kawamura A, Isoyama S, Itoh T, Imano M, Tanabe G, Muraoka O, Matsuda H, Satou T, Nishida S. Mangiferin enhances the sensitivity of human multiple myeloma cells to anticancer drugs through suppression of the nuclear factor κB pathway. Int J Oncol 2016; 48:2704-12. [PMID: 27035859 DOI: 10.3892/ijo.2016.3470] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 03/15/2016] [Indexed: 11/05/2022] Open
Abstract
Multiple myeloma (MM) is still an incurable hematological malignancy with a 5-year survival rate of ~35%, despite the use of various treatment options. The nuclear factor κB (NF-κB) pathway plays a crucial role in the pathogenesis of MM. Thus, inhibition of the NF-κB pathway is a potential target for the treatment of MM. In a previous study, we showed that mangiferin suppressed the nuclear translocation of NF-κB. However, the treatment of MM involves a combination of two or three drugs. In this study, we examined the effect of the combination of mangiferin and conventional anticancer drugs in an MM cell line. We showed that the combination of mangiferin and an anticancer drug decreased the viability of MM cell lines in comparison with each drug used separately. The decrease in the combination of mangiferin and an anticancer drug induced cell viability was attributed to increase the expression of p53 and Noxa and decreases the expression of XIAP, survivin, and Bcl-xL proteins via inhibition of NF-κB pathway. In addition, the combination treatment caused the induction of apoptosis, activation of caspase-3 and the accumulation of the cells in the sub-G1 phase of the cell cycle. Our findings suggest that the combination of mangiferin and an anticancer drug could be used as a new regime for the treatment of MM.
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Affiliation(s)
- Tomoya Takeda
- Division of Pharmacotherapy, Kinki University School of Pharmacy, Kowakae, Higashi-Osaka, Japan
| | - Masanobu Tsubaki
- Division of Pharmacotherapy, Kinki University School of Pharmacy, Kowakae, Higashi-Osaka, Japan
| | - Toshiki Kino
- Division of Pharmacotherapy, Kinki University School of Pharmacy, Kowakae, Higashi-Osaka, Japan
| | - Ayako Kawamura
- Division of Pharmacotherapy, Kinki University School of Pharmacy, Kowakae, Higashi-Osaka, Japan
| | - Shota Isoyama
- Division of Pharmacotherapy, Kinki University School of Pharmacy, Kowakae, Higashi-Osaka, Japan
| | - Tatsuki Itoh
- Department of Food Science and Nutrition, Kinki University School of Agriculture, Nara, Japan
| | - Motohiro Imano
- Department of Surgery, Kinki University School of Medicine, Osakasayama, Osaka, Japan
| | - Genzoh Tanabe
- Laboratory of Pharmaceutical Organic Chemistry, Kinki University School of Pharmacy, Kowakae, Higashi-Osaka, Japan
| | - Osamu Muraoka
- Laboratory of Pharmaceutical Organic Chemistry, Kinki University School of Pharmacy, Kowakae, Higashi-Osaka, Japan
| | - Hideaki Matsuda
- Department of Natural Drugs Resources, Kinki University School of Pharmacy, Kowakae, Higashi-Osaka, Japan
| | - Takao Satou
- Department of Pathology, Kinki University School of Medicine, Osakasayama, Osaka, Japan
| | - Shozo Nishida
- Division of Pharmacotherapy, Kinki University School of Pharmacy, Kowakae, Higashi-Osaka, Japan
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Sonneveld P, Broijl A. Treatment of relapsed and refractory multiple myeloma. Haematologica 2016; 101:396-406. [PMID: 27033237 PMCID: PMC5004403 DOI: 10.3324/haematol.2015.129189] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 01/13/2016] [Indexed: 12/22/2022] Open
Abstract
The approach to the patient with relapsed or relapsed/refractory multiple myeloma (RRMM) requires a careful evaluation of the results of previous treatments, the toxicities associated with them and an assessment of prognostic factors. Since the majority of patients will have received prior therapy with drug combinations including a proteasome inhibitor and/or an immunomodulatory drug (IMiD), it is the physician's task to choose the right moment for the start of therapy and define with the patient which goals need to be achieved. The choice of regimen is usually based on prior responsiveness, drugs already received, prior adverse effects, the condition of the patient and expected effectiveness and tolerability. Many double and triple drug combinations are available. In addition, promising new drugs like pomalidomide, carfilzomib and monoclonal antibodies are, or will be, available shortly, while other options can be tried in clinical studies. Finally, supportive care and palliative options need to be considered in some patients. It is becoming increasingly more important to consider the therapeutic options for the whole duration of the disease rather than take a step by step approach, and to develop a systematic approach for each individual patient.
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Affiliation(s)
- Pieter Sonneveld
- Erasmus MC Cancer Institute, Department of Hematology, Rm Na824, Rotterdam, the Netherlands
| | - Annemiek Broijl
- Erasmus MC Cancer Institute, Department of Hematology, Rm Na824, Rotterdam, the Netherlands
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Takeda T, Tsubaki M, Kino T, Yamagishi M, Iida M, Itoh T, Imano M, Tanabe G, Muraoka O, Satou T, Nishida S. Mangiferin induces apoptosis in multiple myeloma cell lines by suppressing the activation of nuclear factor kappa B-inducing kinase. Chem Biol Interact 2016; 251:26-33. [PMID: 26996543 DOI: 10.1016/j.cbi.2016.03.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 02/18/2016] [Accepted: 03/15/2016] [Indexed: 12/17/2022]
Abstract
Mangiferin is a naturally occurring glucosyl xanthone, which induces apoptosis in various cancer cells. However, the molecular mechanism underlying mangiferin-induced apoptosis has not been clarified thus far. Therefore, we examined the molecular mechanism underlying mangiferin-induced apoptosis in multiple myeloma (MM) cell lines. We found that mangiferin decreased the viability of MM cell lines in a concentration-dependent manner. We also observed an increased number of apoptotic cells, caspase-3 activation, and a decrease in the mitochondrial membrane potential. In addition, mangiferin inhibited the nuclear translocation of nuclear factor kappa B (NF-κB) and expression of phosphorylated inhibitor kappa B (IκB) and increased the expression of IκB protein, whereas no changes were observed in the phosphorylation levels of extracellular signal-regulated kinase 1/2 (ERK1/2), c-Jun N-terminal protein kinase 1/2 (JNK1/2), and mammalian target of rapamycin (mTOR). The molecular mechanism responsible for mangiferin-induced inhibition of nuclear translocation of NF-κB was a decrease in the expression of phosphorylated NF-κB-inducing kinase (NIK). Moreover, mangiferin decreased the expression of X-linked inhibitor of apoptosis protein (XIAP), survivin, and Bcl-xL proteins. Knockdown of NIK expression showed results similar to those observed with mangiferin treatment. Our results suggest that mangiferin induces apoptosis through the inhibition of nuclear translocation of NF-κB by suppressing NIK activation in MM cell lines. Our results provide a new insight into the molecular mechanism of mangiferin-induced apoptosis. Importantly, since the number of reported NIK inhibitors is limited, mangiferin, which targets NIK, may be a potential anticancer agent for the treatment of MM.
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Affiliation(s)
- Tomoya Takeda
- Division of Pharmacotherapy, Kinki University School of Pharmacy, Kowakae, Higashi-Osaka, Japan
| | - Masanobu Tsubaki
- Division of Pharmacotherapy, Kinki University School of Pharmacy, Kowakae, Higashi-Osaka, Japan
| | - Toshiki Kino
- Division of Pharmacotherapy, Kinki University School of Pharmacy, Kowakae, Higashi-Osaka, Japan
| | - Misa Yamagishi
- Division of Pharmacotherapy, Kinki University School of Pharmacy, Kowakae, Higashi-Osaka, Japan
| | - Megumi Iida
- Division of Pharmacotherapy, Kinki University School of Pharmacy, Kowakae, Higashi-Osaka, Japan
| | - Tatsuki Itoh
- Department of Food Science and Nutrition, Kinki University School of Agriculture, Nara, Nara, Japan
| | - Motohiro Imano
- Department of Surgery, Kinki University School of Medicine, Osakasayama, Osaka, Japan
| | - Genzoh Tanabe
- Laboratory of Pharmaceutical Organic Chemistry, School of Pharmacy, Kinki University, Kowakae, Higashi-Osaka, Japan
| | - Osamu Muraoka
- Laboratory of Pharmaceutical Organic Chemistry, School of Pharmacy, Kinki University, Kowakae, Higashi-Osaka, Japan
| | - Takao Satou
- Department of Pathology, Kinki University School of Medicine, Osakasayama, Osaka, Japan
| | - Shozo Nishida
- Division of Pharmacotherapy, Kinki University School of Pharmacy, Kowakae, Higashi-Osaka, Japan.
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Wang L, Zhang S, Ou J, Bai H. [Cytotoxity of pomalidomide combined CAR-T cell for multiple myeloma cell RPMI8226 and U266]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2016; 36:497-500. [PMID: 26134016 PMCID: PMC7343067 DOI: 10.3760/cma.j.issn.0253-2727.2015.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
目的 观察CD138-CAR-T细胞对人多发性骨髓瘤(MM)细胞株RPMI8226和U266细胞的杀伤作用,探讨泊马度胺对CD138-CAR-T细胞及其杀伤作用的影响。 方法 采用CFSE/7-AAD双标法检测CD138-CAR-T细胞及其联合泊马度胺对RPMI8226、U266细胞的杀伤活性。ELISA法检测CD138-CAR-T细胞分泌IFN-γ的变化。 结果 CD138-CAR-T细胞作用18 h后,对RPMI8226、U266细胞的杀伤活性分别为(55.2±3.9)%、(85.1±2.4)%,对照组分别为(7.0±1.5)%、(12.5±2.1)%,差异均有统计学意义(P值均<0.01);与CD138-CAR-T细胞组比较,CD138-CAR-T细胞联合泊马度胺(2.5 µg/ml)作用18 h后,对RPMI8226、U266细胞的杀伤活性差异无统计学意义(P值均>0.05)。与CD138-CAR-T细胞组比较,CD138-CAR-T细胞和MM细胞共培养组IFN-γ分泌水平显著增高;与共培养组比较,加入泊马度胺后能显著促进IFN-γ的释放,差异均有统计学意义(P值均<0.01)。 结论 CD138-CAR-T细胞对MM细胞及耐药细胞株均有明显的杀伤作用;其与MM细胞共培养能促进后者IFN-γ的分泌;泊马度胺能促进CD138-CAR-T细胞分泌IFN-γ。
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Affiliation(s)
- Lei Wang
- Department of Hematology, Center of Hematologic Diseases of Chinese PLA; Lanzhou Military Area General Hospital, Lanzhou 730050, China
| | - Shuting Zhang
- Department of Hematology, Center of Hematologic Diseases of Chinese PLA; Lanzhou Military Area General Hospital, Lanzhou 730050, China
| | - Jianfeng Ou
- Department of Hematology, Center of Hematologic Diseases of Chinese PLA; Lanzhou Military Area General Hospital, Lanzhou 730050, China
| | - Hai Bai
- Department of Hematology, Center of Hematologic Diseases of Chinese PLA; Lanzhou Military Area General Hospital, Lanzhou 730050, China
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[A retrospective analysis of autologous peripheral blood hematopoietic stem cell mobilizations and collections in 149 multiple myeloma patients]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2016; 36:367-71. [PMID: 26031520 PMCID: PMC7342593 DOI: 10.3760/cma.j.issn.0253-2727.2015.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To analyze the results and influential factors of mobilization and harvesting of autologous peripheral blood stem cell in patients with multiple myeloma (MM). METHODS Retrospective analysis of peripheral blood stem cell collection data [CD34⁺ cells collected, successful mobilization rate (CD34⁺ cells≥2×10⁶/kg body weight), good mobilization rate (CD34⁺ cells≥5×10⁶/kg body weight)] of 149 multiple myeloma patients who were treated with cyclophosphamide (CTX) or E-CHOP (etoposide+ CTX+epirubicin+vindesine+prednisone) chemotherapy combined with G-CSF mobilization from January 1998 to March 2014. The relevance between gender, age, subtype, DS staging, ISS staging, treatment before mobilization, disease status at mobilization, regiment of mobilizationand the collection results was analyzed. RESULTS A total of 177 stem cell mobilizations were performed in 149 MM patients, the median CD34⁺ cells harvested were 3.20 (0.13-22.34)×10⁶/kg body weight (BW), successful mobilization rate and good mobilization rate were 74.5% and 27.5%, respectively. The single logistic regression analysis showed that gender, age (>60 ys vs ≤60 ys), subtype, DS staging (III vs II+I), ISS staging (III vs II+I) and regiment of mobilization (E-CHOP+G-CSF vs ID-CTX+G-CSF) were not correlated with the cell collection or successful mobilization rate (P>0.05). However, successful collection rate of single harvest in old patients (age>60 ys) was lower (P<0.05), andthe good mobilization rate in patients at ISS stage III was lower (P<0.05). The collection results of patients with fewer cycles of treatment (treatment before mobilization ≤6 cycles) and optimal disease status (disease status at mobilization ≥partial remission) were much better. Analysis of logistic factors revealed that treatment efficacy before mobilization affected success rate of collection (P=0.006). Risk of collection failure in patients who received more than 6 cycles of treatment before mobilization was high (OR 3.57, 95% CI 1.45-8.78). CONCLUSION Gender, age, subtype, DS staging, ISS staging and mobilization regimen did not influence MM patients peripheral blood stem cell collection; but old patients may need twice mobilizations to collect sufficiently. Few cycles of treatment and stable disease status before mobilization is favorable to the mobilization and collection of peripheral blood stem cells.
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122
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Rajkumar SV. Myeloma today: Disease definitions and treatment advances. Am J Hematol 2016; 91:90-100. [PMID: 26565896 PMCID: PMC4715763 DOI: 10.1002/ajh.24236] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 11/06/2015] [Indexed: 12/12/2022]
Abstract
There have been major advances in the diagnosis, staging, risk-stratification, and management of multiple myeloma (MM). In addition to established CRAB (hypercalcemia, renal failure, anemia, and lytic bone lesions) features, new diagnostic criteria include three new biomarkers to diagnose the disease: bone marrow clonal plasmacytosis ≥60%, serum involved/uninvolved free light chain ratio ≥100, and >1 focal lesion on magnetic resonance imaging. MM can be classified into several subtypes based on baseline cytogenetics, and prognosis varies according to underlying cytogenetic abnormalities. A Revised International Staging System has been developed which combines markers of tumor burden (albumin, beta-2 microglobulin) with markers of aggressive disease biology (high-risk cytogenetics and elevated serum lactate dehydrogenase). Although the approach to therapy remains largely the same, the treatment options at every stage of the disease have changed. Carfilzomib, pomalidomide, panobinostat, daratumumab, elotuzumab, and ixazomib have been approved for the treatment of the disease. These drugs combined with older agents such as cyclophosphamide, dexamethasone, thalidomide, bortezomib, and lenalidomide dramatically increase the repertoire of regimens available for the treatment of MM. This review provides a concise overview of recent advances in MM, including updates to diagnostic criteria, staging, risk-stratification, and management.
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Glavey SV, Manier S, Sacco A, Salem K, Kawano Y, Bouyssou J, Ghobrial IM, Roccaro AM. Epigenetics in Multiple Myeloma. Cancer Treat Res 2016; 169:35-49. [PMID: 27696257 DOI: 10.1007/978-3-319-40320-5_4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Multiple myeloma is characterized by clonal proliferation of plasma cells within the bone marrow resulting in anemia, lytic bone lesions, hypercalcemia, and renal impairment. Despite advanced in our understanding of this complex disease in recent years, it is still considered an incurable malignancy. This is, in part, due to the highly heterogenous genomic and phenotypic nature of the disease, which is to date incompletely understood. It is clear that a deeper level of knowledge of the biological events underlying the development of these diseases is needed to identify new targets and generate effective novel therapies. MicroRNAs (miRNAs), which are single strand, 20-nucleotide, noncoding RNA's, are key regulators of gene expression and have been reported to exert transcriptional control in multiple myeloma. miRNAs are now recognized to play a role in many key areas such as cellular proliferation, differentiation, apoptosis and stress response. Substantial advances have been made in recent years in terms of our understanding of the biological role of miRNAs in a diverse range of hematological and solid malignancues, In multiple myeloma these advances have yielded new information of prognostic and diagnostic relevance which have helped to shed light on epigenetic regulation in this disease.
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Affiliation(s)
- Siobhan V Glavey
- Harvard Medical School, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Salomon Manier
- Harvard Medical School, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Antonio Sacco
- Harvard Medical School, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Karma Salem
- Harvard Medical School, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Yawara Kawano
- Harvard Medical School, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Juliette Bouyssou
- Harvard Medical School, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Irene M Ghobrial
- Harvard Medical School, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Aldo M Roccaro
- Harvard Medical School, Dana-Farber Cancer Institute, Boston, MA, USA. .,Department of Hematology, CREA Laboratory, ASST-Spedali Civili di Brescia, Brescia, BS, Italy.
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Matsumoto T, Jimi S, Migita K, Takamatsu Y, Hara S. Inhibition of glucose transporter 1 induces apoptosis and sensitizes multiple myeloma cells to conventional chemotherapeutic agents. Leuk Res 2015; 41:103-10. [PMID: 26790725 DOI: 10.1016/j.leukres.2015.12.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 12/16/2015] [Accepted: 12/18/2015] [Indexed: 12/13/2022]
Abstract
Despite the recent development of anti-myeloma drugs, the prognosis of high-risk multiple myeloma remains poor. Therefore, new effective treatment strategies for this disease are needed. It has been reported that high intensity of 18-fluorodeoxyglucose positron emission tomography is high-risk factor in myeloma, suggesting that glucose uptake can be therapeutic target in high-risk myeloma. In this study, we addressed the utility of glucose transporter 1 (GLUT1) as a therapeutic target for myeloma with increased glucose uptake. We found myeloma cell lines with elevated glucose uptake activity via GLUT1 up-regulation. STF-31, a selective GLUT1 inhibitor, completely suppressed the glucose uptake activity and induced apoptosis in GLUT1 expressing myeloma cells. On the other hand, this agent little shows the cytotoxicity in normal peripheral blood mononuclear cells. Moreover, STF-31 synergistically enhanced the cell death induced by melphalan, doxorubicin, and bortezomib. GLUT1 may be promising therapeutic target in myeloma with elevated glucose uptake.
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Affiliation(s)
- Taichi Matsumoto
- Department of Drug Informatics, Faculty of Pharmaceutical Sciences, Fukuoka University, Fukuoka, Japan.
| | - Shiro Jimi
- Central Laboratory for Pathology and Morphology, Department of Medicine, Fukuoka University, Fukuoka, Japan
| | - Keisuke Migita
- Department of Drug Informatics, Faculty of Pharmaceutical Sciences, Fukuoka University, Fukuoka, Japan
| | - Yasushi Takamatsu
- Division of Medical Oncology, Hematology and Infectious Diseases, Department of Medicine, Fukuoka University, Fukuoka, Japan
| | - Shuuji Hara
- Department of Drug Informatics, Faculty of Pharmaceutical Sciences, Fukuoka University, Fukuoka, Japan
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The Applicability of the International Staging System in Chinese Patients with Multiple Myeloma Receiving Bortezomib or Thalidomide-Based Regimens as Induction Therapy: A Multicenter Analysis. BIOMED RESEARCH INTERNATIONAL 2015; 2015:856704. [PMID: 26640799 PMCID: PMC4658402 DOI: 10.1155/2015/856704] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 09/13/2015] [Indexed: 11/18/2022]
Abstract
The International Staging System (ISS) is the most important prognostic system for multiple myeloma (MM). It was identified in the era of conventional agents. The outcome of MM has significantly changed by novel agents. Thus the applicability of ISS system in the era of novel agents in Chinese patients needs to be demonstrated. We retrospectively analyzed the clinical outcomes and prognostic significance of ISS system in 1016 patients with newly diagnosed multiple myeloma in Chinese patients between 2008 and 2012, who received bortezomib- or thalidomide-based regimens as first-line therapy. The median overall survival (OS) of patients for ISS stages I/II/III was not reached/55.4 months/41.7 months (p < 0.001), and the median progression-free survival (PFS) was 30/29.5/25 months (p = 0.072), respectively. Statistically significant difference in survival was confirmed among three ISS stages in thalidomide-based group, but not between ISS stages I and II in bortezomib-based group. These findings suggest that ISS system can predict the survival in the era of novel agents in Chinese MM patients, and bortezomib may have the potential to partially overcome adverse effect of risk factors on survival, especially in higher stage of ISS system.
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Wang Y, Yang F, Shen Y, Zhang W, Wang J, Chang VT, Andersson BS, Qazilbash MH, Champlin RE, Berenson JR, Guan X, Wang ML. Maintenance Therapy With Immunomodulatory Drugs in Multiple Myeloma: A Meta-Analysis and Systematic Review. J Natl Cancer Inst 2015; 108:djv342. [PMID: 26582244 DOI: 10.1093/jnci/djv342] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 10/15/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Immunomodulatory drugs (IMiDs) and proteasome inhibitors have dramatically changed management of multiple myeloma (MM). While MM remains incurable, consolidation and maintenance therapy aimed at improving duration of response can potentially improve survival outcomes. A majority of randomized controlled trials (RCTs) have demonstrated benefit of IMiD-based maintenance therapy in delaying disease progression; however, whether this therapy can lead to improved survival remains controversial. METHODS PubMed and abstract databases of major hematology and/or oncology meetings were searched for RCTs that studied maintenance therapy with IMiDs in MM. A meta-analysis was conducted to systematically evaluate the impact of IMiD-based maintenance therapy on survival outcomes and serious adverse events associated with the therapy. All statistical tests were two-sided. RESULTS Eighteen phase 3 RCTs enrolling 7730 patients were included. IMiD-based maintenance therapy statistically significantly prolonged progression-free survival (PFS; hazard ratio (HR) = 0.62, 95% confidence interval (CI) = 0.57 to 0.67, P < .001) but failed to improve overall survival (OS; HR = 0.93, 95% CI = 0.85 to 1.01, P = .082). Stratified analyses demonstrated that both thalidomide and lenalidomide provided PFS but not OS benefit in transplantation as well as nontransplantation settings. IMiD-based maintenance therapy in MM led to a higher risk of grade 3-4 thromboembolism (risk ratio = 2.52, 95% CI = 1.41 to 4.52, P = .002). Thalidomide maintenance therapy increased the risk of peripheral neuropathy; lenalidomide maintenance therapy increased the risks of myelosuppression and second primary hematological malignancies. CONCLUSIONS Thalidomide- or lenalidomide-based maintenance therapy improves PFS but not OS in MM and increases risks of grade 3-4 adverse events, including thromboembolism, peripheral neuropathy, neutropenia, and infection.
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Affiliation(s)
- Yucai Wang
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ (YW, VTC); Department of Medical Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China (FY, YS, WZ, XG); Department of Medicine, University of Chicago, Chicago, IL (JW); Section of Hematology/Oncology, VA New Jersey Health Care System, East Orange, NJ (VTC); Department of Stem Cell Transplantation and Cellular Therapy (BSA, MHQ, REC) and Department of Lymphoma/Myeloma (MLW), The University of Texas MD Anderson Cancer Center, Houston, TX; Institute for Myeloma & Bone Cancer Research, West Hollywood, CA (JRB)
| | - Fang Yang
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ (YW, VTC); Department of Medical Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China (FY, YS, WZ, XG); Department of Medicine, University of Chicago, Chicago, IL (JW); Section of Hematology/Oncology, VA New Jersey Health Care System, East Orange, NJ (VTC); Department of Stem Cell Transplantation and Cellular Therapy (BSA, MHQ, REC) and Department of Lymphoma/Myeloma (MLW), The University of Texas MD Anderson Cancer Center, Houston, TX; Institute for Myeloma & Bone Cancer Research, West Hollywood, CA (JRB)
| | - Yan Shen
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ (YW, VTC); Department of Medical Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China (FY, YS, WZ, XG); Department of Medicine, University of Chicago, Chicago, IL (JW); Section of Hematology/Oncology, VA New Jersey Health Care System, East Orange, NJ (VTC); Department of Stem Cell Transplantation and Cellular Therapy (BSA, MHQ, REC) and Department of Lymphoma/Myeloma (MLW), The University of Texas MD Anderson Cancer Center, Houston, TX; Institute for Myeloma & Bone Cancer Research, West Hollywood, CA (JRB)
| | - Wenwen Zhang
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ (YW, VTC); Department of Medical Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China (FY, YS, WZ, XG); Department of Medicine, University of Chicago, Chicago, IL (JW); Section of Hematology/Oncology, VA New Jersey Health Care System, East Orange, NJ (VTC); Department of Stem Cell Transplantation and Cellular Therapy (BSA, MHQ, REC) and Department of Lymphoma/Myeloma (MLW), The University of Texas MD Anderson Cancer Center, Houston, TX; Institute for Myeloma & Bone Cancer Research, West Hollywood, CA (JRB)
| | - Jacqueline Wang
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ (YW, VTC); Department of Medical Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China (FY, YS, WZ, XG); Department of Medicine, University of Chicago, Chicago, IL (JW); Section of Hematology/Oncology, VA New Jersey Health Care System, East Orange, NJ (VTC); Department of Stem Cell Transplantation and Cellular Therapy (BSA, MHQ, REC) and Department of Lymphoma/Myeloma (MLW), The University of Texas MD Anderson Cancer Center, Houston, TX; Institute for Myeloma & Bone Cancer Research, West Hollywood, CA (JRB)
| | - Victor T Chang
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ (YW, VTC); Department of Medical Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China (FY, YS, WZ, XG); Department of Medicine, University of Chicago, Chicago, IL (JW); Section of Hematology/Oncology, VA New Jersey Health Care System, East Orange, NJ (VTC); Department of Stem Cell Transplantation and Cellular Therapy (BSA, MHQ, REC) and Department of Lymphoma/Myeloma (MLW), The University of Texas MD Anderson Cancer Center, Houston, TX; Institute for Myeloma & Bone Cancer Research, West Hollywood, CA (JRB)
| | - Borje S Andersson
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ (YW, VTC); Department of Medical Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China (FY, YS, WZ, XG); Department of Medicine, University of Chicago, Chicago, IL (JW); Section of Hematology/Oncology, VA New Jersey Health Care System, East Orange, NJ (VTC); Department of Stem Cell Transplantation and Cellular Therapy (BSA, MHQ, REC) and Department of Lymphoma/Myeloma (MLW), The University of Texas MD Anderson Cancer Center, Houston, TX; Institute for Myeloma & Bone Cancer Research, West Hollywood, CA (JRB)
| | - Muzaffar H Qazilbash
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ (YW, VTC); Department of Medical Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China (FY, YS, WZ, XG); Department of Medicine, University of Chicago, Chicago, IL (JW); Section of Hematology/Oncology, VA New Jersey Health Care System, East Orange, NJ (VTC); Department of Stem Cell Transplantation and Cellular Therapy (BSA, MHQ, REC) and Department of Lymphoma/Myeloma (MLW), The University of Texas MD Anderson Cancer Center, Houston, TX; Institute for Myeloma & Bone Cancer Research, West Hollywood, CA (JRB)
| | - Richard E Champlin
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ (YW, VTC); Department of Medical Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China (FY, YS, WZ, XG); Department of Medicine, University of Chicago, Chicago, IL (JW); Section of Hematology/Oncology, VA New Jersey Health Care System, East Orange, NJ (VTC); Department of Stem Cell Transplantation and Cellular Therapy (BSA, MHQ, REC) and Department of Lymphoma/Myeloma (MLW), The University of Texas MD Anderson Cancer Center, Houston, TX; Institute for Myeloma & Bone Cancer Research, West Hollywood, CA (JRB)
| | - James R Berenson
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ (YW, VTC); Department of Medical Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China (FY, YS, WZ, XG); Department of Medicine, University of Chicago, Chicago, IL (JW); Section of Hematology/Oncology, VA New Jersey Health Care System, East Orange, NJ (VTC); Department of Stem Cell Transplantation and Cellular Therapy (BSA, MHQ, REC) and Department of Lymphoma/Myeloma (MLW), The University of Texas MD Anderson Cancer Center, Houston, TX; Institute for Myeloma & Bone Cancer Research, West Hollywood, CA (JRB)
| | - Xiaoxiang Guan
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ (YW, VTC); Department of Medical Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China (FY, YS, WZ, XG); Department of Medicine, University of Chicago, Chicago, IL (JW); Section of Hematology/Oncology, VA New Jersey Health Care System, East Orange, NJ (VTC); Department of Stem Cell Transplantation and Cellular Therapy (BSA, MHQ, REC) and Department of Lymphoma/Myeloma (MLW), The University of Texas MD Anderson Cancer Center, Houston, TX; Institute for Myeloma & Bone Cancer Research, West Hollywood, CA (JRB).
| | - Michael L Wang
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ (YW, VTC); Department of Medical Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China (FY, YS, WZ, XG); Department of Medicine, University of Chicago, Chicago, IL (JW); Section of Hematology/Oncology, VA New Jersey Health Care System, East Orange, NJ (VTC); Department of Stem Cell Transplantation and Cellular Therapy (BSA, MHQ, REC) and Department of Lymphoma/Myeloma (MLW), The University of Texas MD Anderson Cancer Center, Houston, TX; Institute for Myeloma & Bone Cancer Research, West Hollywood, CA (JRB).
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Rajan AM, Rajkumar SV. Interpretation of cytogenetic results in multiple myeloma for clinical practice. Blood Cancer J 2015; 5:e365. [PMID: 26517360 PMCID: PMC4635200 DOI: 10.1038/bcj.2015.92] [Citation(s) in RCA: 149] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 09/18/2015] [Indexed: 12/16/2022] Open
Abstract
The interpretation of cytogenetic abnormalities in multiple myeloma (MM) is often a challenging task. MM is characterized by several cytogenetic abnormalities that occur at various time points in the disease course. The interpretation of cytogenetic results in MM is complicated by the number and complexity of the abnormalities, the methods used to detect them and the disease stage at which they are detected. Specific cytogenetic abnormalities affect clinical presentation, progression of smoldering multiple myeloma (SMM) to MM, prognosis of MM and management strategies. The goal of this paper is to provide a review of how MM is classified into specific subtypes based on primary cytogenetic abnormalities and to provide a concise overview of how to interpret cytogenetic abnormalities based on the disease stage to aid clinical practice and patient management.
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Affiliation(s)
- A M Rajan
- Aureus University School of Medicine, Oranjestad, Aruba
| | - S V Rajkumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
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Abstract
Introduction It is understood that cancer is a clonal disease initiated by a single cell, and that metastasis, which is the spread of cancer from the primary site, is also initiated by a single cell. The seemingly natural capability of cancer to adapt dynamically in a Darwinian manner is a primary reason for therapeutic failures. Survival advantages may be induced by cancer therapies and also occur as a result of inherent cell and microenvironmental factors. The selected "more fit" clones outmatch their competition and then become dominant in the tumor via propagation of progeny. This clonal expansion leads to relapse, therapeutic resistance and eventually death. The goal of this study is to develop and demonstrate a more detailed clonality approach by utilizing integrative genomics. Methods Patient tumor samples were profiled by Whole Exome Sequencing (WES) and RNA-seq on an Illumina HiSeq 2500 and methylation profiling was performed on the Illumina Infinium 450K array. STAR and the Haplotype Caller were used for RNA-seq processing. Custom approaches were used for the integration of the multi-omic datasets. Results Reported are major enhancements to CloneViz, which now provides capabilities enabling a formal tumor multi-dimensional clonality analysis by integrating: i) DNA mutations, ii) RNA expressed mutations, and iii) DNA methylation data. RNA and DNA methylation integration were not previously possible, by CloneViz (previous version) or any other clonality method to date. This new approach, named iCloneViz (integrated CloneViz) employs visualization and quantitative methods, revealing an integrative genomic mutational dissection and traceability (DNA, RNA, epigenetics) thru the different layers of molecular structures. Conclusion The iCloneViz approach can be used for analysis of clonal evolution and mutational dynamics of multi-omic data sets. Revealing tumor clonal complexity in an integrative and quantitative manner facilitates improved mutational characterization, understanding, and therapeutic assignments.
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Panero J, Stella F, Schutz N, Fantl DB, Slavutsky I. Differential Expression of Non-Shelterin Genes Associated with High Telomerase Levels and Telomere Shortening in Plasma Cell Disorders. PLoS One 2015; 10:e0137972. [PMID: 26366868 PMCID: PMC4569359 DOI: 10.1371/journal.pone.0137972] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 08/24/2015] [Indexed: 12/25/2022] Open
Abstract
Telomerase, shelterin proteins and various interacting factors, named non-shelterin proteins, are involved in the regulation of telomere length (TL). Altered expression of any of these telomere-associated genes can lead to telomere dysfunction, causing genomic instability and disease development. In this study, we investigated the expression profile of a set of non-shelterin genes involved in essential processes such as replication (RPA1), DNA damage repair pathways (MRE11-RAD50-NBS1) and stabilization of telomerase complex (DKC1), in 35 patients with monoclonal gammopathy of undetermined significance (MGUS) and 40 cases with multiple myeloma (MM). Results were correlated with hTERT expression, TL and clinical parameters. Overall, a significant increase in DKC1, RAD50, MRE11, NBS1 and RPA1 expression along with an upregulation of hTERT in MM compared with MGUS was observed (p≤0.032). Interestingly, in both entities high mRNA levels of non-shelterin genes were associated with short TLs and increased hTERT expression. Significant differences were observed for DKC1 in MM (p ≤0.026), suggesting an important role for this gene in the maintenance of short telomeres by telomerase in myeloma plasma cells. With regard to clinical associations, we observed a significant increase in DKC1, RAD50, MRE11 and RPA1 expression in MM cases with high bone marrow infiltration (p≤0.03) and a tendency towards cases with advanced ISS stage, providing the first evidence of non-shelterin genes associated to risk factors in MM. Taken together, our findings bring new insights into the intricate mechanisms by which telomere-associated proteins collaborate in the maintenance of plasma cells immortalization and suggest a role for the upregulation of these genes in the progression of the disease.
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Affiliation(s)
- Julieta Panero
- Laboratorio de Genética de Neoplasias Linfoides, Instituto de Medicina Experimental, CONICET-Academia Nacional de Medicina, Buenos Aires, Argentina
- * E-mail:
| | - Flavia Stella
- Laboratorio de Genética de Neoplasias Linfoides, Instituto de Medicina Experimental, CONICET-Academia Nacional de Medicina, Buenos Aires, Argentina
| | - Natalia Schutz
- Departamento de Clínica Médica, Sección Hematología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Dorotea Beatriz Fantl
- Departamento de Clínica Médica, Sección Hematología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Irma Slavutsky
- Laboratorio de Genética de Neoplasias Linfoides, Instituto de Medicina Experimental, CONICET-Academia Nacional de Medicina, Buenos Aires, Argentina
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Sgherza N, Iacobazzi A, Cramarossa A, DE Tullio G, Guarini A. A voluminous mass as an initial clinical symptom of multiple myeloma: A case report. Exp Ther Med 2015; 10:1689-1691. [PMID: 26640537 DOI: 10.3892/etm.2015.2720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 05/21/2015] [Indexed: 11/06/2022] Open
Abstract
Extramedullary multiple myeloma (EMM) is a type of multiple myeloma (MM) that is defined by the presence of extraskeletal (soft tissue or visceral) clonal plasma cell infiltrates, which may be present at the time of initial diagnosis or at the time of relapse. Although extramedullary lesions may be present with other clinical features at the time of diagnosis, the onset of a solid formation as a first clinical symptom of MM is unusual. The present study reports the case of a 77-year-old male who was admitted to the Hematology Unit of the National Cancer Research Center, Istituto Tumori 'Giovanni Paolo II' (Bari, Italy) with a mass protruding from the right side of his lower back. Serum immunofixation revealed positivity for monoclonal protein (M-protein) and Bence Jones proteinuria was positive. In addition, a computed tomography scan of the abdomen, which was confirmed by magnetic resonance imaging, revealed a voluminous solid formation resembling a sarcoma. M-protein is known to be present in numerous diseases encountered in clinical practice, including hematological or other diseases; thus, a Tru-Cut biopsy of the lesion was performed, which revealed an infiltration of plasma cells. In addition, a bone marrow biopsy revealed the presence of 70% plasma cells, and a diagnosis of primary EMM was established. In conclusion, EMM should be included in the differential diagnosis of a mass, particularly in patients where M-protein is detected in the blood and/or urine.
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Affiliation(s)
- Nicola Sgherza
- Hematology Unit, National Cancer Research Center, Istituto Tumori 'Giovanni Paolo II', Bari 70124, Italy
| | - Angela Iacobazzi
- Hematology Unit, National Cancer Research Center, Istituto Tumori 'Giovanni Paolo II', Bari 70124, Italy
| | - Angelantonio Cramarossa
- Radiology Unit, National Cancer Research Center, Istituto Tumori 'Giovanni Paolo II', Bari 70124, Italy
| | - Giacoma DE Tullio
- Hematology Unit, National Cancer Research Center, Istituto Tumori 'Giovanni Paolo II', Bari 70124, Italy
| | - Attilio Guarini
- Hematology Unit, National Cancer Research Center, Istituto Tumori 'Giovanni Paolo II', Bari 70124, Italy
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Larsen JT, Kumar S. Evolving Paradigms in the Management of Multiple Myeloma: Novel Agents and Targeted Therapies. ACTA ACUST UNITED AC 2015; 3:47-68. [PMID: 27182478 PMCID: PMC4837942 DOI: 10.1007/s40487-015-0009-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Indexed: 12/22/2022]
Abstract
Multiple myeloma (MM) is a clonal plasma cell disorder defined by bone marrow infiltration and osteolytic bone lesions and is the second most common hematologic malignancy after non-Hodgkin lymphoma. The landscape of MM treatment was transformed at the dawn of the twenty-first century by the introduction of novel agents including proteasome inhibitors (bortezomib) and immunomodulatory drugs (thalidomide, lenalidomide), which have prolonged the survival of MM patients. The recently revised International Myeloma Working Group diagnostic criteria for MM added validated biomarkers (clonal bone marrow plasma cell ≥60%, involved:uninvolved serum free light chain ratio ≥100, or >1 focal lesion on magnetic resonance imaging) to identify near inevitable progression to symptomatic MM requiring therapy. In addition, the definition of myeloma-defining CRAB features (hypercalcemia, renal failure, anemia, and bone lesions) has been refined based on advances in imaging and laboratory techniques since the 2003 IMWG consensus. Despite expanded treatment options, MM remains an incurable disease. Drug resistance and clonal evolution remain problematic, and novel therapeutic agents are needed. New approaches to myeloma treatment include anti-CD38 antibodies, next generation proteasome inhibitors, epigenetic modulation with histone deacetylase inhibitors, and targeting the tumor microenvironment. In this article, the diagnosis, staging, and prognostic stratification of newly diagnosed MM will be reviewed. Clinical data pertaining to the emerging targeted agents will be discussed, and a suggested framework for integration of these new therapeutic options will be provided.
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Affiliation(s)
- Jeremy T Larsen
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN USA
| | - Shaji Kumar
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN USA
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Panchabhai S, Kelemen K, Ahmann G, Sebastian S, Mantei J, Fonseca R. Tumor-associated macrophages and extracellular matrix metalloproteinase inducer in prognosis of multiple myeloma. Leukemia 2015. [PMID: 26202926 DOI: 10.1038/leu.2015.191] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- S Panchabhai
- Division of Hematology/Oncology, Mayo Clinic, Scottsdale, AZ, USA
| | - K Kelemen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ, USA
| | - G Ahmann
- Division of Hematology/Oncology, Mayo Clinic, Scottsdale, AZ, USA
| | - S Sebastian
- Division of Hematology/Oncology, Mayo Clinic, Scottsdale, AZ, USA
| | - J Mantei
- Division of Hematology/Oncology, Mayo Clinic, Scottsdale, AZ, USA
| | - R Fonseca
- Division of Hematology/Oncology, Mayo Clinic, Scottsdale, AZ, USA
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Chhabra S, Jain S, Wallace C, Hong F, Liu B. High expression of endoplasmic reticulum chaperone grp94 is a novel molecular hallmark of malignant plasma cells in multiple myeloma. J Hematol Oncol 2015; 8:77. [PMID: 26108343 PMCID: PMC4483199 DOI: 10.1186/s13045-015-0177-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Accepted: 06/17/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Multiple myeloma (MM) is a hematologic malignancy that is characterized by the proliferation of abnormal bone marrow plasma cells (BMPC) and overproduction of immunoglobulin or light chains with evidence of end-organ damage such as bone damage, anemia, hypercalcemia, and renal dysfunction. The pathogenesis of MM is closely linked to dysregulated unfolded protein response (UPR) in the endoplasmic reticulum (ER). Constitutive activation of UPR in mice, as demonstrated by transgenic expression of a master UPR transcription factor XBP1s (a UPR-specific splice variant of X-box binding protein 1), causes myeloma. grp94 (gp96) is a key downstream chaperone in the ER that mediates the UPR as a part of the protein quality control mechanism in the secretory pathway. Our recent study has shown that the persistence of plasma cells as well as the development of myeloma in XBP1s-transgenic mice is critically dependent on grp94. However, the role of grp94 in the initiation and progression of human MM is still unknown. METHODS The expression level of grp94 in BMPCs was measured by flow cytometry, real-time RT-PCR, and Western blot analysis. We compared the expression levels of grp94 in BMPCs in a spectrum of patients including MM, monoclonal gammopathy of undetermined significance (MGUS), smoldering MM (SMM), as well as non-plasma cell disorders (NPC). RESULTS We found that grp94 was highly expressed in malignant plasma cells in patients with MM, but not in BMPCs in patients with MGUS/SMM and NPC. The expression level of grp94 correlated significantly with CD138 expression level. We also found that the grp94 expression level in BMPCs from International Staging System (ISS) stage III MM patients is higher than those in ISS stage I/II MM patients. CONCLUSIONS grp94 is highly expressed in BMPCs in MM, which correlates with the advanced stage of this disease. Our data demonstrated that grp94 is a novel diagnostic and prognostic biomarker. It also positioned grp94 as a promising therapeutic target for MM.
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Affiliation(s)
- Saurabh Chhabra
- Hollings Cancer Center, 86 Jonathan Lucas Street, Charleston, SC, 29425, USA. .,Division of Hematology and Oncology, Department of Medicine, Medical University of South Carolina, Charleston, SC, 29425, USA.
| | - Sandeep Jain
- Hollings Cancer Center, 86 Jonathan Lucas Street, Charleston, SC, 29425, USA. .,Division of Hematology and Oncology, Department of Medicine, Medical University of South Carolina, Charleston, SC, 29425, USA.
| | - Caroline Wallace
- Hollings Cancer Center, 86 Jonathan Lucas Street, Charleston, SC, 29425, USA. .,Department of Microbiology and Immunology, Medical University of South Carolina, 86 Jonathan Lucas Street, Charleston, SC, 29425, USA.
| | - Feng Hong
- Hollings Cancer Center, 86 Jonathan Lucas Street, Charleston, SC, 29425, USA. .,Department of Microbiology and Immunology, Medical University of South Carolina, 86 Jonathan Lucas Street, Charleston, SC, 29425, USA.
| | - Bei Liu
- Hollings Cancer Center, 86 Jonathan Lucas Street, Charleston, SC, 29425, USA. .,Department of Microbiology and Immunology, Medical University of South Carolina, 86 Jonathan Lucas Street, Charleston, SC, 29425, USA.
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Linet MS, Yin SN, Gilbert ES, Dores GM, Hayes RB, Vermeulen R, Tian HY, Lan Q, Portengen L, Ji BT, Li GL, Rothman N. A retrospective cohort study of cause-specific mortality and incidence of hematopoietic malignancies in Chinese benzene-exposed workers. Int J Cancer 2015; 137:2184-97. [PMID: 25944549 DOI: 10.1002/ijc.29591] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 02/19/2015] [Accepted: 02/23/2015] [Indexed: 12/31/2022]
Abstract
Benzene exposure has been causally linked with acute myeloid leukemia (AML), but inconsistently associated with other hematopoietic, lymphoproliferative and related disorders (HLD) or solid tumors in humans. Many neoplasms have been described in experimental animals exposed to benzene. We used Poisson regression to estimate adjusted relative risks (RR) and the likelihood ratio statistic to derive confidence intervals for cause-specific mortality and HLD incidence in 73,789 benzene-exposed compared with 34,504 unexposed workers in a retrospective cohort study in 12 cities in China. Follow-up and outcome assessment was based on factory, medical and other records. Benzene-exposed workers experienced increased risks for all-cause mortality (RR = 1.1, 95% CI = 1.1, 1.2) due to excesses of all neoplasms (RR = 1.3, 95% CI = 1.2, 1.4), respiratory diseases (RR = 1.7, 95% CI = 1.2, 2.3) and diseases of blood forming organs (RR = ∞, 95% CI = 3.4, ∞). Lung cancer mortality was significantly elevated (RR = 1.5, 95% CI = 1.2, 1.9) with similar RRs for males and females, based on three-fold more cases than in our previous follow-up. Significantly elevated incidence of all myeloid disorders reflected excesses of myelodysplastic syndrome/acute myeloid leukemia (RR = 2.7, 95% CI = 1.2, 6.6) and chronic myeloid leukemia (RR = 2.5, 95% CI = 0.8, 11), and increases of all lymphoid disorders included excesses of non-Hodgkin lymphoma (RR = 3.9, 95%CI = 1.5, 13) and all lymphoid leukemia (RR = 5.4, 95%CI = 1.0, 99). The 28-year follow-up of Chinese benzene-exposed workers demonstrated increased risks of a broad range of myeloid and lymphoid neoplasms, lung cancer, and respiratory diseases and suggested possible associations with other malignant and non-malignant disorders.
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Affiliation(s)
- Martha S Linet
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Rockville, MD
| | - Song-Nian Yin
- National Institute of Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ethel S Gilbert
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Rockville, MD
| | - Graça M Dores
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Rockville, MD
| | - Richard B Hayes
- Division of Epidemiology, Department of Population Health, New York University School of Medicine, New York, NY
| | - Roel Vermeulen
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Hao-Yuan Tian
- National Institute of Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Qing Lan
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Rockville, MD
| | - Lutzen Portengen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Bu-Tian Ji
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Rockville, MD
| | - Gui-Lan Li
- National Institute of Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Nathaniel Rothman
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Rockville, MD
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135
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Selective targeting of IRF4 by synthetic microRNA-125b-5p mimics induces anti-multiple myeloma activity in vitro and in vivo. Leukemia 2015; 29:2173-83. [PMID: 25987254 PMCID: PMC4635336 DOI: 10.1038/leu.2015.124] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 04/27/2015] [Accepted: 05/05/2015] [Indexed: 12/19/2022]
Abstract
Interferon regulatory factor 4 (IRF4) is an attractive therapeutic target in multiple myeloma (MM). We here report that expression of IRF4 mRNA inversely correlates with microRNA (miR)-125b in MM patients. Moreover, we provide evidence that miR-125b is downregulated in TC2/3 molecular MM subgroups and in established cell lines. Importantly, constitutive expression of miR-125b-5p by lentiviral vectors or transfection with synthetic mimics impaired growth and survival of MM cells and overcame the protective role of bone marrow stromal cells in vitro. Apoptotic and autophagy-associated cell death were triggered in MM cells on miR-125b-5p ectopic expression. Importantly, we found that the anti-MM activity of miR-125b-5p was mediated via direct downregulation of IRF4 and its downstream effector BLIMP-1. Moreover, inhibition of IRF4 translated into downregulation of c-Myc, caspase-10 and cFlip, relevant IRF4-downstream effectors. Finally, in vivo intra-tumor or systemic delivery of formulated miR-125b-5p mimics against human MM xenografts in severe combined immunodeficient/non-obese diabetic mice induced significant anti-tumor activity and prolonged survival. Taken together, our findings provide evidence that miR-125b, differently from other hematologic malignancies, has tumor-suppressor activity in MM. Furthermore, our data provide proof-of-concept that synthetic miR-125b-5p mimics are promising anti-MM agents to be validated in early clinical trials.
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136
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Zhang W, Gu Y, Sun Q, Siegel DS, Tolias P, Yang Z, Lee WY, Zilberberg J. Ex Vivo Maintenance of Primary Human Multiple Myeloma Cells through the Optimization of the Osteoblastic Niche. PLoS One 2015; 10:e0125995. [PMID: 25973790 PMCID: PMC4431864 DOI: 10.1371/journal.pone.0125995] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 03/27/2015] [Indexed: 11/18/2022] Open
Abstract
We previously reported a new approach for culturing difficult-to-preserve primary patient-derived multiple myeloma cells (MMC) using an osteoblast (OSB)-derived 3D tissue scaffold constructed in a perfused microfluidic environment and a culture medium supplemented with patient plasma. In the current study, we used this biomimetic model to show, for the first time, that the long-term survival of OSB is the most critical factor in maintaining the ex vivo viability and proliferative capacity of MMC. We found that the adhesion and retention of MMC to the tissue scaffold was meditated by osteoblastic N-cadherin, as one of potential mechanisms that regulate MMC-OSB interactions. However, in the presence of MMC and patient plasma, the viability and osteogenic activity of OSB became gradually compromised, and consequently MMC could not remain viable over 3 weeks. We demonstrated that the long-term survival of both OSB and MMC could be enhanced by: (1) optimizing perfusion flow rate and patient-derived plasma composition in the culture medium and (2) replenishing OSB during culture as a practical means of prolonging MMC's viability beyond several weeks. These findings were obtained using a high-throughput well plate-based perfusion device from the perspective of optimizing the ex vivo preservation of patient-derived MM biospecimens for downstream use in biological studies and chemosensitivity analyses.
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Affiliation(s)
- Wenting Zhang
- Department of Chemical Engineering and Materials Science, Stevens Institute of Technology, 1 Castle Point on Hudson, Hoboken, New Jersey, 07030, United States of America
| | - Yexin Gu
- Department of Chemical Engineering and Materials Science, Stevens Institute of Technology, 1 Castle Point on Hudson, Hoboken, New Jersey, 07030, United States of America
| | - Qiaoling Sun
- Department of Chemical Engineering and Materials Science, Stevens Institute of Technology, 1 Castle Point on Hudson, Hoboken, New Jersey, 07030, United States of America
| | - David S. Siegel
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey, 07601, United States of America
| | - Peter Tolias
- Department of Chemistry, Chemical Biology, and Biomedical Engineering, Stevens Institute of Technology, Hoboken, New Jersey, 07030, United States of America
- Center for Healthcare Innovation, Stevens Institute of Technology, Hoboken, New Jersey, 07030, United States of America
| | - Zheng Yang
- Research Department, Hackensack University Medical Center, Hackensack, New Jersey, 07601, United States of America
| | - Woo Y. Lee
- Department of Chemical Engineering and Materials Science, Stevens Institute of Technology, 1 Castle Point on Hudson, Hoboken, New Jersey, 07030, United States of America
| | - Jenny Zilberberg
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey, 07601, United States of America
- Research Department, Hackensack University Medical Center, Hackensack, New Jersey, 07601, United States of America
- * E-mail:
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137
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Decreased level of phosphatidylcholine (16:0/20:4) in multiple myeloma cells compared to plasma cells: a single-cell MALDI–IMS approach. Anal Bioanal Chem 2015; 407:5273-80. [DOI: 10.1007/s00216-015-8741-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Revised: 04/16/2015] [Accepted: 04/24/2015] [Indexed: 10/23/2022]
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138
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Johnston SJ, Carroll JS. Transcription factors and chromatin proteins as therapeutic targets in cancer. BIOCHIMICA ET BIOPHYSICA ACTA 2015; 1855:183-92. [PMID: 25721328 DOI: 10.1016/j.bbcan.2015.02.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 02/09/2015] [Accepted: 02/09/2015] [Indexed: 01/15/2023]
Abstract
Targeting the factors that regulate gene transcription is a compelling strategy in cancer therapeutics. Traditionally, these have been considered intractable targets, but recent work has revealed novel strategies for the regulation of transcription factor activity in cancer. This review will highlight some of the emerging concepts and provide examples where agents that target transcription factors are being exploited clinically for cancer therapies.
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Affiliation(s)
- Simon J Johnston
- Cancer Research UK Cambridge Institute, University of Cambridge, Robinson Way, Cambridge CB2 0RE, UK
| | - Jason S Carroll
- Cancer Research UK Cambridge Institute, University of Cambridge, Robinson Way, Cambridge CB2 0RE, UK.
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139
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Imaging myeloma and related monoclonal plasma cell disorders using MRI, low-dose whole-body CT and FDG PET/CT. Clin Transl Imaging 2015. [DOI: 10.1007/s40336-015-0119-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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140
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Phase I/II study of melphalan, prednisone and lenalidomide combination for patients with newly diagnosed multiple myeloma who are not candidates for stem cell transplantation. Blood Cancer J 2015; 5:e294. [PMID: 25794130 PMCID: PMC4382664 DOI: 10.1038/bcj.2015.23] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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141
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Yang G, Geng C, Chen W. Clinical characteristics of a group of patients with multiple myeloma who had two different λ light chains by immunofixation electrophoresis: A retrospective study from a single center. Exp Ther Med 2015; 9:1895-1900. [PMID: 26136911 DOI: 10.3892/etm.2015.2352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 02/13/2015] [Indexed: 11/05/2022] Open
Abstract
The objective of the present study was to conduct a retrospective analysis of the clinical characteristics of a group of patients with multiple myeloma (MM) who had two different immunoglobulin λ light chains as determined by immunofixation electrophoresis (IFE). A total of 26 patients with MM had two different λ light chains by IFE at diagnosis in hospital from January 2006 to June 2012. Data were collected from the medical records of these patients. The clinical characteristics, laboratory parameters, responses, risk factors and outcomes of this special group of patients were retrospectively analyzed. The patients with MM and two different λ light chains by IFE accounted for 5.4% (26/483) of all the patients with MM during the same period. There were 17 patients (65.4%) with renal dysfunction and 10 patients (38.5%) with extramedullary plasmacytoma (EMP) at diagnosis. Ten patients (38.5%) had abnormalities by fluorescence in situ hybridization (FISH) including t(4;14), t(14;16) and/or del17p. Of these patients, three (11.5%) achieved complete remission (CR), six (23.1%) very good partial remission (VGPR), six (23.1%) partial remission (PR) and the overall remission (OR) rate was 57.7% (15/26). The OR rate of the patients who received chemotherapy with bortezomib was superior to that of the patients who received chemotherapy without bortezomib (78.6% vs. 33.3%; P<0.05). The OR rate of the patients who received autologous stem cell transplantation (SCT) was superior to that of the patients who did not receive autologous SCT (77.8% vs. 47.1%; P<0.05). The median overall survival (OS) was 12.6 months (range, 2-38 months) in this study. The patients who received chemotherapy with bortezomib had a significantly longer median OS as compared with the patients who received chemotherapy without bortezomib (19 vs. 6 months; P=0.049). The patients who received autologous SCT also had significantly longer median OS as compared with the patients who did not receive autologous SCT (18 vs. 7 months; P=0.041). The median duration of remission (DOR) was 5 months (range, 0-28 months). The patients who received bortezomib or autologous SCT had significantly longer median DOR than those who did not (P=0.046 and P=0.012, respectively). The patients with abnormalities by FISH had similar OR rates, median OS and median DOR as compared with the patients without abnormalities by FISH and there was no statistically significant difference in OR rate, median OS and median DOR between the patients with EMP and those without. The MM patients with two different λ light chains by IFE may have specific characteristics, and are accompanied by a high incidence of renal dysfunction and EMP. They have a poor prognosis and require novel therapy including bortezomib and autologous SCT.
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Affiliation(s)
- Guangzhong Yang
- Department of Hematology and Multiple Myeloma Research Center of Beijing, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, P.R. China
| | - Chuanying Geng
- Department of Hematology and Multiple Myeloma Research Center of Beijing, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, P.R. China
| | - Wenming Chen
- Department of Hematology and Multiple Myeloma Research Center of Beijing, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, P.R. China
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142
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Nishihori T, Baz R, Shain K, Kim J, Ochoa-Bayona JL, Yue B, Sullivan D, Dalton W, Alsina M. An open-label phase I/II study of cyclophosphamide, bortezomib, pegylated liposomal doxorubicin, and dexamethasone in newly diagnosed myeloma. Eur J Haematol 2015; 95:426-35. [PMID: 25600676 DOI: 10.1111/ejh.12509] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2014] [Indexed: 01/09/2023]
Abstract
We conducted a phase 1/2 trial evaluating the combination of cyclophosphamide, bortezomib, pegylated liposomal doxorubicin, and dexamethasone (CVDD) for newly diagnosed multiple myeloma (MM). The primary objective of the phase 1 was to evaluate the safety and tolerability of maximum planned dose (MPD) and the phase 2 was to assess the overall response rate. Patients received 6-8 cycles of CVDD at four dose levels. There were no dose-limiting toxicities. The MPD was cyclophosphamide 750 mg/m(2) IV on day 1, bortezomib 1.3 mg/m(2) IV on days 1, 4, 8, 11, pegylated liposomal doxorubicin 30 mg/m(2) IV on day 4, and dexamethasone 20 mg orally on the day of and after bortezomib (21-d cycle). Forty-nine patients were treated at the MPD of which 22% had high-risk myeloma. The most common grade ≥3 toxicities included myelosuppression, infection, and fatigue. Overall response and complete response rates were 91% and 26% in standard-risk, and 100% and 58% in high-risk cohort, respectively. After a median follow-up of 34 months, the median progression-free survival was 31.3 months. The 2-yr overall survival was 91.1% in the standard-risk and 88.9% in the high-risk cohort, respectively. CVDD regimen was well tolerated and was highly active in newly diagnosed MM.
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Affiliation(s)
- Taiga Nishihori
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.,Chemical Biology and Molecular Medicine Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Rachid Baz
- Chemical Biology and Molecular Medicine Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.,Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Kenneth Shain
- Chemical Biology and Molecular Medicine Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.,Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Jongphil Kim
- Chemical Biology and Molecular Medicine Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.,Biostatistics core, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Jose L Ochoa-Bayona
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.,Chemical Biology and Molecular Medicine Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Binglin Yue
- Biostatistics core, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Daniel Sullivan
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.,Chemical Biology and Molecular Medicine Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - William Dalton
- Chemical Biology and Molecular Medicine Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.,Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Melissa Alsina
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.,Chemical Biology and Molecular Medicine Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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143
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Chihara D, Ito H, Izutsu K, Hattori M, Nishino Y, Ioka A, Matsuda T, Ito Y. Advance and stagnation in the treatment of patients with lymphoma and myeloma: Analysis using population-based cancer registry data in Japan from 1993 to 2006. Int J Cancer 2015; 137:1217-23. [PMID: 25694231 DOI: 10.1002/ijc.29477] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 02/02/2015] [Indexed: 12/13/2022]
Abstract
There have been significant advances in the treatment of patients with lymphoma and myeloma. Although the improvements in survival outcome have been clearly addressed by clinical trials, these studies includes patients who are otherwise healthy and would be eligible for trials that the actual improvement in survival in the general patient population over time is yet to be elucidated. Therefore, we reviewed the cancer-registry data of patients with lymphoma and myeloma in Japan from 1993 to 2006 and estimated relative survival (adjusted for competing causes of death in same-age members of the general population) according to three periods of diagnosis (1993-1997, 1998-2002 and 2003-2006). We also estimated conditional 5-year relative survival (5-year survival rate of patients who have survived 5 years). A total of 26,141 patients were reviewed and analyzed. Relative survival improved in Hodgkin lymphoma (HL, N = 853, +20% improvement), diffuse large B-cell lymphoma (DLBCL, N = 4,919, +14% improvement) and follicular lymphoma (FL, N = 1,333, +13% improvement). In contrast, we found no significant improvement in survival since 1993 in peripheral T-cell lymphoma (PTCL, N = 667, +4% improvement), adult T-cell leukemia/lymphoma (ATLL, N = 2,166, -5% improvement) or multiple myeloma (MM, N = 4,914, -2% improvement). Conditional 5-year survival of HL, DLBCL, FL, PTCL, ATLL and MM was 88, 87, 79, 63, 53 and 45%, respectively. Relative survival of patients with HL, DLBCL and FL significantly improved from 1993 to 2006 in Japan; in contrast, no improvement was seen in other diseases, suggesting unmet need of novel treatment strategies.
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Affiliation(s)
- Dai Chihara
- Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan.,Department of Lymphoma and Myeloma, MD Anderson Cancer Center, Houston, TX
| | - Hidemi Ito
- Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - Koji Izutsu
- Department of Hematology, Toranomon Hospital, Tokyo, Japan
| | - Masakazu Hattori
- Department of Cancer Therapy Center, Fukui Prefectural Hospital, Fukui, Japan
| | - Yoshikazu Nishino
- Division of Cancer Epidemiology and Prevention, Miyagi Cancer Center Research Institute, Natori, Japan
| | - Akiko Ioka
- Center for Cancer Control and Statistics, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Tomohiro Matsuda
- Division of Surveillance, Center for Cancer Control and Information Services, National Cancer Center, Osaka, Japan
| | - Yuri Ito
- Center for Cancer Control and Statistics, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
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144
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Di Lullo G, Marcatti M, Heltai S, Brunetto E, Tresoldi C, Bondanza A, Bonini C, Ponzoni M, Tonon G, Ciceri F, Bordignon C, Protti MP. Th22 cells increase in poor prognosis multiple myeloma and promote tumor cell growth and survival. Oncoimmunology 2015; 4:e1005460. [PMID: 26155400 PMCID: PMC4485827 DOI: 10.1080/2162402x.2015.1005460] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 12/30/2014] [Accepted: 12/30/2014] [Indexed: 12/19/2022] Open
Abstract
There is increased production of plasmacytoid dendritic cells (pDCs) in the bone marrow (BM) of multiple myeloma (MM) patients and these favor Th22 cell differentiation. Here, we found that the frequency of interleukin (IL)-22+IL-17-IL-13+ T cells is significantly increased in peripheral blood (PB) and BM of stage III and relapsed/refractory MM patients compared with healthy donors and patients with asymptomatic or stage I/II disease. Th22 cells cloned from the BM of MM patients were CCR6+CXCR4+CCR4+CCR10- and produced IL-22 and IL-13 but not IL-17. Furthermore, polyfunctional Th22-Th2 and Th22-Th1 clones were identified based on the co-expression of additional chemokine receptors and cytokines (CRTh2 or CXCR3 and IL-5 or interferon gamma [IFNγ], respectively). A fraction of MM cell lines and primary tumors aberrantly expressed the IL-22RA1 and IL-22 induced STAT-3 phosphorylation, cell growth, and resistance to drug-induced cell death in MM cells. IL-13 treatment of normal BM mesenchymal stromal cells (MSCs) induced STAT-6 phosphorylation, adhesion molecule upregulation, and increased IL-6 production and significantly favored MM cell growth compared with untreated BM MSCs. Collectively, our data show that increased frequency of IL-22+IL-17-IL-13+ T cells correlates with poor prognosis in MM through IL-22 and IL-13 protumor activity and suggest that interference with IL-22 and IL-13 signaling pathways could be exploited for therapeutic intervention.
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Key Words
- Ab, antibody; BM, bone marrow; BMMCs, bone marrow mononuclear cells; DCs, dendritic cells; Dx, dexamethasone; ICS, intracellular cytokine staining; IFN, interferon; IL, interleukin; ISS, International Staging System; LCL, Epstein–Barr virus-transformed B lymphoblastoid cell line; Ln, lenalidomide; MGUS, monoclonal gammopathy of undetermined clinical significance; MM, multiple myeloma; MSC, mesenchymal stromal cell; PB, peripheral blood; PBMCs, peripheral blood mononuclear cells; pDCs, plasmacytoid dendritic cells; SMM, smoldering multiple myeloma; Th, T helper; TNF, tumor necrosis factor; Treg, regulatory T cells; WB, Western blot
- CD4+ T helper lymphocytes
- IL-22RA1
- Th22 cells
- bone marrow mesenchymal stromal cells
- bone marrow microenvironment
- interleukin-13
- interleukin-22
- multiple myeloma
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Affiliation(s)
- Giulia Di Lullo
- Tumor Immunology Unit; IRCCS San Raffaele Scientific Institute ; Milan, Italy ; Division of Immunology, Transplantation and Infectious Diseases; IRCCS San Raffaele Scientific Institute ; Milan, Italy
| | - Magda Marcatti
- Hematology and Bone Marrow Transplantation Unit; IRCCS San Raffaele Scientific Institute ; Milan, Italy
| | - Silvia Heltai
- Tumor Immunology Unit; IRCCS San Raffaele Scientific Institute ; Milan, Italy ; Division of Immunology, Transplantation and Infectious Diseases; IRCCS San Raffaele Scientific Institute ; Milan, Italy
| | - Emanuela Brunetto
- Tumor Immunology Unit; IRCCS San Raffaele Scientific Institute ; Milan, Italy ; Division of Immunology, Transplantation and Infectious Diseases; IRCCS San Raffaele Scientific Institute ; Milan, Italy
| | - Cristina Tresoldi
- Hematology and Bone Marrow Transplantation Unit; IRCCS San Raffaele Scientific Institute ; Milan, Italy
| | - Attilio Bondanza
- Division of Immunology, Transplantation and Infectious Diseases; IRCCS San Raffaele Scientific Institute ; Milan, Italy ; Leukenia Immunotherapy Group; IRCCS San Raffaele Scientific Institute ; Milan, Italy
| | - Chiara Bonini
- Division of Immunology, Transplantation and Infectious Diseases; IRCCS San Raffaele Scientific Institute ; Milan, Italy ; Experimental Hematology Unit; IRCCS San Raffaele Scientific Institute ; Milan, Italy
| | - Maurilio Ponzoni
- Pathology Unit; IRCCS San Raffaele Scientific Institute ; Milan, Italy ; Division of Molecular Oncology; IRCCS San Raffaele Scientific Institute ; Milan, Italy
| | - Giovanni Tonon
- Division of Molecular Oncology; IRCCS San Raffaele Scientific Institute ; Milan, Italy ; Functional Genomics of Cancer Unit; IRCCS San Raffaele Scientific Institute ; Milan, Italy
| | - Fabio Ciceri
- Hematology and Bone Marrow Transplantation Unit; IRCCS San Raffaele Scientific Institute ; Milan, Italy
| | - Claudio Bordignon
- MolMed SpA ; Milan, Italy ; Vita-Salute San Raffaele University ; Milan, Italy
| | - Maria Pia Protti
- Tumor Immunology Unit; IRCCS San Raffaele Scientific Institute ; Milan, Italy ; Division of Immunology, Transplantation and Infectious Diseases; IRCCS San Raffaele Scientific Institute ; Milan, Italy
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145
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Siveen KS, Mustafa N, Li F, Kannaiyan R, Ahn KS, Kumar AP, Chng WJ, Sethi G. Thymoquinone overcomes chemoresistance and enhances the anticancer effects of bortezomib through abrogation of NF-κB regulated gene products in multiple myeloma xenograft mouse model. Oncotarget 2015; 5:634-48. [PMID: 24504138 PMCID: PMC3996662 DOI: 10.18632/oncotarget.1596] [Citation(s) in RCA: 126] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Multiple myeloma (MM) is a B cell malignancy characterized by clonal proliferation of plasma cells in the bone marrow. With the advent of novel targeted agents, the median survival rate has increased to 5−7 years. However, majority of patients with myeloma suffer relapse or develop chemoresistance to existing therapeutic agents. Thus, there is a need to develop novel alternative therapies for the treatment of MM. Thus in the present study, we investigated whether thymoquinone (TQ), a bioactive constituent of black seed oil, could suppress the proliferation and induce chemosensitization in human myeloma cells and xenograft mouse model. Our results show that TQ inhibited the proliferation of MM cells irrespective of their sensitivity to doxorubicin, melphalan or bortezomib. Interestingly, TQ treatment also resulted in a significant inhibition in the proliferation of CD138+ cells isolated from MM patient samples in a concentration dependent manner. TQ also potentiated the apoptotic effects of bortezomib in various MM cell lines through the activation of caspase-3, resulting in the cleavage of PARP. TQ treatment also inhibited chemotaxis and invasion induced by CXCL12 in MM cells. Furthermore, in a xenograft mouse model, TQ potentiated the antitumor effects of bortezomib (p < 0.05, vehicle versus bortezomib + TQ; p < 0.05, bortezomib versus bortezomib + TQ), and this correlated with modulation of various markers for survival and angiogenesis, such as Ki-67, vascular endothelial growth factor (VEGF), Bcl-2 and p65 expression. Overall, our results demonstrate that TQ can enhance the anticancer activity of bortezomib in vitro and in vivo and may have a substantial potential in the treatment of MM.
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146
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Cancer and bone: A complex complex. Arch Biochem Biophys 2014; 561:159-66. [DOI: 10.1016/j.abb.2014.07.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 07/03/2014] [Accepted: 07/08/2014] [Indexed: 12/13/2022]
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147
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Rajkumar SV, Dimopoulos MA, Palumbo A, Blade J, Merlini G, Mateos MV, Kumar S, Hillengass J, Kastritis E, Richardson P, Landgren O, Paiva B, Dispenzieri A, Weiss B, LeLeu X, Zweegman S, Lonial S, Rosinol L, Zamagni E, Jagannath S, Sezer O, Kristinsson SY, Caers J, Usmani SZ, Lahuerta JJ, Johnsen HE, Beksac M, Cavo M, Goldschmidt H, Terpos E, Kyle RA, Anderson KC, Durie BGM, Miguel JFS. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol 2014; 15:e538-48. [PMID: 25439696 DOI: 10.1016/s1470-2045(14)70442-5] [Citation(s) in RCA: 2875] [Impact Index Per Article: 287.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This International Myeloma Working Group consensus updates the disease definition of multiple myeloma to include validated biomarkers in addition to existing requirements of attributable CRAB features (hypercalcaemia, renal failure, anaemia, and bone lesions). These changes are based on the identification of biomarkers associated with near inevitable development of CRAB features in patients who would otherwise be regarded as having smouldering multiple myeloma. A delay in application of the label of multiple myeloma and postponement of therapy could be detrimental to these patients. In addition to this change, we clarify and update the underlying laboratory and radiographic variables that fulfil the criteria for the presence of myeloma-defining CRAB features, and the histological and monoclonal protein requirements for the disease diagnosis. Finally, we provide specific metrics that new biomarkers should meet for inclusion in the disease definition. The International Myeloma Working Group recommends the implementation of these criteria in routine practice and in future clinical trials, and recommends that future studies analyse any differences in outcome that might occur as a result of the new disease definition.
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Affiliation(s)
| | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, University of Athens, School of Medicine, Athens, Greece
| | - Antonio Palumbo
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | | | - Giampaolo Merlini
- Amyloidosis Center, University Hospital Policlinico San Matteo, Pavia, Italy
| | | | - Shaji Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Jens Hillengass
- Department of Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, University of Athens, School of Medicine, Athens, Greece
| | | | - Ola Landgren
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bruno Paiva
- Clinica Universidad de Navarra, Centro de Investigacion Medica Aplicada (CIMA), Pamplona, Spain
| | | | - Brendan Weiss
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Sonja Zweegman
- Department of Hematology, VU University Medical Center, Amsterdam, Netherlands
| | - Sagar Lonial
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | | | - Elena Zamagni
- Seràgnoli Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
| | | | | | | | - Jo Caers
- Department of Hematology, CHU de Liege, Liege, Belgium
| | - Saad Z Usmani
- Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC, USA
| | - Juan José Lahuerta
- Servicio de Hematología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Hans Erik Johnsen
- Department of Haematology, Aalborg University Hospital, Aalborg, Denmark
| | - Meral Beksac
- Ankara University School of Medicine, Ankara, Turkey
| | - Michele Cavo
- Seràgnoli Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
| | - Hartmut Goldschmidt
- Department of Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany
| | - Evangelos Terpos
- Department of Clinical Therapeutics, University of Athens, School of Medicine, Athens, Greece
| | - Robert A Kyle
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Brian G M Durie
- Cedars-Sinai Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Jesus F San Miguel
- Clinica Universidad de Navarra, Centro de Investigacion Medica Aplicada (CIMA), Pamplona, Spain
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148
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Peterson EA, Chavan SS, Bauer MA, Heuck CJ, Johann DJ. Revealing the inherent heterogeneity of human malignancies by variant consensus strategies coupled with cancer clonal analysis. BMC Bioinformatics 2014; 15 Suppl 11:S9. [PMID: 25350589 PMCID: PMC4251058 DOI: 10.1186/1471-2105-15-s11-s9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Tumors are heterogeneous in composition. They are composed of cancer cells proper, along with stromal elements that collectively form a microenvironment, all of which are necessary to nurture the malignant process. In addition, many of the stromal cells are modified to support the unique needs of the malignant state. Tumors are composed of a variety of clones or subpopulations of cancer cells, which may differ in karyotype, growth rate, expression of cell surface markers, sensitivity to therapeutics, etc. New tools and methods to provide an improved understanding of tumor clonal architecture are needed to guide therapy.
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149
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Tornatore L, Sandomenico A, Raimondo D, Low C, Rocci A, Tralau-Stewart C, Capece D, D'Andrea D, Bua M, Boyle E, van Duin M, Zoppoli P, Jaxa-Chamiec A, Thotakura AK, Dyson J, Walker BA, Leonardi A, Chambery A, Driessen C, Sonneveld P, Morgan G, Palumbo A, Tramontano A, Rahemtulla A, Ruvo M, Franzoso G. Cancer-selective targeting of the NF-κB survival pathway with GADD45β/MKK7 inhibitors. Cancer Cell 2014; 26:495-508. [PMID: 25314077 PMCID: PMC4197335 DOI: 10.1016/j.ccr.2014.07.027] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 05/26/2014] [Accepted: 07/29/2014] [Indexed: 11/07/2022]
Abstract
Constitutive NF-κB signaling promotes survival in multiple myeloma (MM) and other cancers; however, current NF-κB-targeting strategies lack cancer cell specificity. Here, we identify the interaction between the NF-κB-regulated antiapoptotic factor GADD45β and the JNK kinase MKK7 as a therapeutic target in MM. Using a drug-discovery strategy, we developed DTP3, a D-tripeptide, which disrupts the GADD45β/MKK7 complex, kills MM cells effectively, and, importantly, lacks toxicity to normal cells. DTP3 has similar anticancer potency to the clinical standard, bortezomib, but more than 100-fold higher cancer cell specificity in vitro. Notably, DTP3 ablates myeloma xenografts in mice with no apparent side effects at the effective doses. Hence, cancer-selective targeting of the NF-κB pathway is possible and, at least for myeloma patients, promises a profound benefit.
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Affiliation(s)
- Laura Tornatore
- Department of Medicine, Centre for Cell Signalling and Inflammation, Imperial College London, London W12 0NN, UK
| | - Annamaria Sandomenico
- Institute of Biostructures and Bioimages, National Research Council and CIRPeB, 80134 Naples, Italy
| | | | - Caroline Low
- Drug Discovery Centre, Imperial College London, London W6 8RP, UK
| | - Alberto Rocci
- Division of Hematology, University of Torino, AOU San Giovanni Battista, 10126 Turin, Italy
| | | | - Daria Capece
- Department of Medicine, Centre for Cell Signalling and Inflammation, Imperial College London, London W12 0NN, UK
| | - Daniel D'Andrea
- Department of Physics, "Sapienza" University, 00185 Rome, Italy
| | - Marco Bua
- Department of Medicine, Centre for Haematology, Imperial College London, London W12 0NN, UK
| | - Eileen Boyle
- Section of Haemato-Oncology, The Institute of Cancer Research, London SM2 5NG, UK
| | - Mark van Duin
- Department of Hematology, Erasmus University Medical Center, 3000 CA Rotterdam, the Netherlands
| | - Pietro Zoppoli
- Institute for Cancer Genetics, Columbia University Medical Center, New York, NY 10032, USA
| | | | - Anil K Thotakura
- Department of Medicine, Centre for Cell Signalling and Inflammation, Imperial College London, London W12 0NN, UK
| | - Julian Dyson
- Department of Medicine, Section of Molecular Immunology, Imperial College London, London W12 0NN, UK
| | - Brian A Walker
- Section of Haemato-Oncology, The Institute of Cancer Research, London SM2 5NG, UK
| | - Antonio Leonardi
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples "Federico II," 80131 Naples, Italy
| | - Angela Chambery
- Department of Environmental, Biological, and Pharmaceutical Sciences and Technologies, Second University of Naples, 81100 Caserta, Italy; IRCCS Multimedica, 20138 Milan, Italy
| | - Christoph Driessen
- Department of Oncology/Hematology, Kantonsspital St. Gallen, 9007 St. Gallen, Switzerland
| | - Pieter Sonneveld
- Department of Hematology, Erasmus University Medical Center, 3000 CA Rotterdam, the Netherlands
| | - Gareth Morgan
- Section of Haemato-Oncology, The Institute of Cancer Research, London SM2 5NG, UK
| | - Antonio Palumbo
- Division of Hematology, University of Torino, AOU San Giovanni Battista, 10126 Turin, Italy
| | - Anna Tramontano
- Department of Physics, "Sapienza" University, 00185 Rome, Italy; Istituto Pasteur Fondazione Cenci Bolognetti, "Sapienza" University, 00185 Rome, Italy
| | - Amin Rahemtulla
- Department of Medicine, Centre for Haematology, Imperial College London, London W12 0NN, UK
| | - Menotti Ruvo
- Institute of Biostructures and Bioimages, National Research Council and CIRPeB, 80134 Naples, Italy.
| | - Guido Franzoso
- Department of Medicine, Centre for Cell Signalling and Inflammation, Imperial College London, London W12 0NN, UK.
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150
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Rajkumar SV. Multiple myeloma: 2014 Update on diagnosis, risk-stratification, and management. Am J Hematol 2014; 89:999-1009. [PMID: 25223428 DOI: 10.1002/ajh.23810] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 07/16/2014] [Indexed: 12/21/2022]
Abstract
DISEASE OVERVIEW Multiple myeloma accounts for approximately 10% of hematologic malignancies. DIAGNOSIS The diagnosis requires 10% or more clonal plasma cells on bone marrow examination or a biopsy proven plasmacytoma plus evidence of associated end-organ damage. If end-organ damage is not present, the presence of 60% or more clonal plasma cells in the marrow is also considered as myeloma. RISK STRATIFICATION In the absence of concurrent trisomies, patients with 17p deletion, t(14;16), and t(14;20) are considered to have high-risk myeloma. Patients with t(4;14) translocation are considered intermediate-risk. All others are considered as standard-risk. Risk-adapted initial therapy: Standard-risk patients can be treated with lenalidomide plus low-dose dexamethasone (Rd), or a bortezomib-containing triplet such as bortezomib, cyclophosphamide, dexamethasone (VCD). Intermediate-risk and high-risk patients require a bortezomib-based triplet regimen. In eligible patients, initial therapy is given for approximately 4 months followed by autologous stem cell transplantation (ASCT). Standard risk patients can opt for delayed ASCT if stem cells can be cryopreserved. In patients who are not candidates for transplant, initial therapy is given for approximately 12 to 18 months. Maintenance therapy: After initial therapy, lenalidomide maintenance is considered for standard risk patients who are not in very good partial response or better, while maintenance with a bortezomib-based regimen should be considered in patients with intermediate or high risk myeloma. Management of refractory disease: Patients with indolent relapse can be treated first with 2-drug or 3-drug combinations. Patients with more aggressive relapse often require therapy with a combination of multiple active agents.
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