151
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Szalat R, Avet-Loiseau H, Munshi NC. Gene Expression Profiles in Myeloma: Ready for the Real World? Clin Cancer Res 2016; 22:5434-5442. [PMID: 28151711 PMCID: PMC5546147 DOI: 10.1158/1078-0432.ccr-16-0867] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 09/19/2016] [Accepted: 09/20/2016] [Indexed: 12/16/2022]
Abstract
Multiple myeloma is a plasma cell malignancy characterized by molecular and clinical heterogeneity. The outcome of the disease has been dramatically improved with the advent of new drugs in the past few years. However, even in this context of increasing therapeutic options, important challenges remain, such as accurately evaluating patients' prognosis and predicting sensitivity to specific treatments and drug combinations. Transcriptomic studies have largely contributed to help decipher multiple myeloma complexity, characterizing multiple myeloma subgroups distinguished by different outcomes. Microarrays and, more recently, RNA sequencing allow evaluation of expression of coding and noncoding genes, alternate splicing events, mutations, and novel transcriptome modifiers, providing new information regarding myeloma biology, prognostication, and therapy. In this review, we discuss the role and impact of gene expression profiling studies in myeloma. Clin Cancer Res; 22(22); 5434-42. ©2016 AACR SEE ALL ARTICLES IN THIS CCR FOCUS SECTION, "MULTIPLE MYELOMA MULTIPLYING THERAPIES".
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Affiliation(s)
- Raphael Szalat
- Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Herve Avet-Loiseau
- Centre de Recherche en Cancerologie de Toulouse, Institut National de la Sante et de la Recherche Medicale, Toulouse, France.
| | - Nikhil C Munshi
- Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.
- Boston Veterans Administration Healthcare System, Boston, Massachusetts
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152
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Jiménez C, Jara-Acevedo M, Corchete LA, Castillo D, Ordóñez GR, Sarasquete ME, Puig N, Martínez-López J, Prieto-Conde MI, García-Álvarez M, Chillón MC, Balanzategui A, Alcoceba M, Oriol A, Rosiñol L, Palomera L, Teruel AI, Lahuerta JJ, Bladé J, Mateos MV, Orfão A, San Miguel JF, González M, Gutiérrez NC, García-Sanz R. A Next-Generation Sequencing Strategy for Evaluating the Most Common Genetic Abnormalities in Multiple Myeloma. J Mol Diagn 2016; 19:99-106. [PMID: 27863261 DOI: 10.1016/j.jmoldx.2016.08.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 08/04/2016] [Accepted: 08/12/2016] [Indexed: 12/16/2022] Open
Abstract
Identification and characterization of genetic alterations are essential for diagnosis of multiple myeloma and may guide therapeutic decisions. Currently, genomic analysis of myeloma to cover the diverse range of alterations with prognostic impact requires fluorescence in situ hybridization (FISH), single nucleotide polymorphism arrays, and sequencing techniques, which are costly and labor intensive and require large numbers of plasma cells. To overcome these limitations, we designed a targeted-capture next-generation sequencing approach for one-step identification of IGH translocations, V(D)J clonal rearrangements, the IgH isotype, and somatic mutations to rapidly identify risk groups and specific targetable molecular lesions. Forty-eight newly diagnosed myeloma patients were tested with the panel, which included IGH and six genes that are recurrently mutated in myeloma: NRAS, KRAS, HRAS, TP53, MYC, and BRAF. We identified 14 of 17 IGH translocations previously detected by FISH and three confirmed translocations not detected by FISH, with the additional advantage of breakpoint identification, which can be used as a target for evaluating minimal residual disease. IgH subclass and V(D)J rearrangements were identified in 77% and 65% of patients, respectively. Mutation analysis revealed the presence of missense protein-coding alterations in at least one of the evaluating genes in 16 of 48 patients (33%). This method may represent a time- and cost-effective diagnostic method for the molecular characterization of multiple myeloma.
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Affiliation(s)
- Cristina Jiménez
- Hematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), Salamanca, Spain
| | - María Jara-Acevedo
- DNA Sequencing Service, University of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), Salamanca, Spain
| | - Luis A Corchete
- Hematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), Salamanca, Spain
| | | | | | - María E Sarasquete
- Hematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), Salamanca, Spain
| | - Noemí Puig
- Hematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), Salamanca, Spain
| | - Joaquín Martínez-López
- Hematology Department, 12 de Octubre Hospital, Unit of Cancer Research Innovation Spain (CRIS), Spanish National Cancer Research Center (CNIO), University of Madrid, Madrid, Spain
| | - María I Prieto-Conde
- Hematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), Salamanca, Spain
| | - María García-Álvarez
- Hematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), Salamanca, Spain
| | - María C Chillón
- Hematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), Salamanca, Spain
| | - Ana Balanzategui
- Hematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), Salamanca, Spain
| | - Miguel Alcoceba
- Hematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), Salamanca, Spain
| | - Albert Oriol
- Catalan Institute of Oncology, Josep Carreras Institute, Germans Trias i Pujol Hospital, Barcelona, Spain
| | - Laura Rosiñol
- Research Biomedical Institute August Pi i Sunyer, Clinical Hospital of Barcelona, Barcelona, Spain
| | | | | | - Juan J Lahuerta
- Hematology Department, 12 de Octubre Hospital, Unit of Cancer Research Innovation Spain (CRIS), Spanish National Cancer Research Center (CNIO), University of Madrid, Madrid, Spain
| | - Joan Bladé
- Research Biomedical Institute August Pi i Sunyer, Clinical Hospital of Barcelona, Barcelona, Spain
| | - María V Mateos
- Hematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), Salamanca, Spain
| | - Alberto Orfão
- DNA Sequencing Service, University of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), Salamanca, Spain
| | - Jesús F San Miguel
- Center for Applied Medical Research, University of Navarra Hospital, Institute of Health Research of Navarra (IDISNA), Pamplona, Spain
| | - Marcos González
- Hematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), Salamanca, Spain.
| | - Norma C Gutiérrez
- Hematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), Salamanca, Spain
| | - Ramón García-Sanz
- Hematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), Salamanca, Spain
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153
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Johnsen HE, Bøgsted M, Schmitz A, Bødker JS, El-Galaly TC, Johansen P, Valent P, Zojer N, Van Valckenborgh E, Vanderkerken K, van Duin M, Sonneveld P, Perez-Andres M, Orfao A, Dybkær K. The myeloma stem cell concept, revisited: from phenomenology to operational terms. Haematologica 2016; 101:1451-1459. [PMID: 27903712 DOI: 10.3324/haematol.2015.138826] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 08/30/2016] [Indexed: 11/09/2022] Open
Abstract
The concept of the myeloma stem cell may have important therapeutic implications, yet its demonstration has been hampered by a lack of consistency in terms and definitions. Here, we summarize the current documentation and propose single-cell in vitro studies for future translational studies. By the classical approach, a CD19-/CD45low/-/CD38high/CD138+ malignant plasma cell, but not the CD19+/CD38low/- memory B cell compartment, is enriched for tumorigenic cells that initiate myeloma in xenografted immunodeficient mice, supporting that myeloma stem cells are present in the malignant PC compartment. Using a new approach, analysis of c-DNA libraries from CD19+/CD27+/CD38- single cells has identified clonotypic memory B cell, suggested to be the cell of origin. This is consistent with multiple myeloma being a multistep hierarchical process before or during clinical presentation. We anticipate that further characterization will require single cell geno- and phenotyping combined with clonogenic assays. To implement such technologies, we propose a revision of the concept of a myeloma stem cell by including operational in vitro assays to describe the cellular components of origin, initiation, maintenance, and evolution of multiple myeloma. These terms are in accordance with recent (2012) consensus statements on the definitions, assays, and nomenclature of cancer stem cells, which is technically precise without completely abolishing established terminology. We expect that this operational model will be useful for future reporting of parameters used to identify and characterize the multiple myeloma stem cells. We strongly recommend that these parameters include validated standard technologies, reproducible assays, and, most importantly, supervised prospective sampling of selected biomaterial which reflects clinical stages, disease spectrum, and therapeutic outcome. This framework is key to the characterization of the cellular architecture of multiple myeloma and its use in precision medicine.
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Affiliation(s)
- Hans Erik Johnsen
- Department of Haematology Aalborg University Hospital, Denmark .,Clinical Cancer Research Center, Aalborg University Hospital, Denmark.,The Department of Clinical Medicine, Aalborg University, Denmark
| | - Martin Bøgsted
- Department of Haematology Aalborg University Hospital, Denmark.,Clinical Cancer Research Center, Aalborg University Hospital, Denmark.,The Department of Clinical Medicine, Aalborg University, Denmark
| | | | | | - Tarec Christoffer El-Galaly
- Department of Haematology Aalborg University Hospital, Denmark.,Clinical Cancer Research Center, Aalborg University Hospital, Denmark.,The Department of Clinical Medicine, Aalborg University, Denmark
| | - Preben Johansen
- Department of Hematopathology, Aalborg University Hospital, Denmark
| | - Peter Valent
- The Department of Internal Medicine I, Division of Hematology Medical University of Vienna, Austria
| | - Niklas Zojer
- Wilhelminen Cancer Research Institute and Ludwig Boltzmann Cluster Oncology, First Department of Medicine, Center for Oncology and Hematology, Vienna, Austria
| | - Els Van Valckenborgh
- Department of Hematology and Immunology-Myeloma Center, Vrije University Brussels, Belgium
| | - Karin Vanderkerken
- Department of Hematology and Immunology-Myeloma Center, Vrije University Brussels, Belgium
| | - Mark van Duin
- Department of Hematology, Erasmus Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - Pieter Sonneveld
- Department of Hematology, Erasmus Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - Martin Perez-Andres
- Department of Medicine and Cytometry Service (NUCLEUS), Cancer Research Center (IBMCC, USAL-CSIC), Institute for Biomedical Research of Salamanca (IBSAL), University of Salamanca (USAL), Spain
| | - Alberto Orfao
- Department of Medicine and Cytometry Service (NUCLEUS), Cancer Research Center (IBMCC, USAL-CSIC), Institute for Biomedical Research of Salamanca (IBSAL), University of Salamanca (USAL), Spain
| | - Karen Dybkær
- Department of Haematology Aalborg University Hospital, Denmark.,Clinical Cancer Research Center, Aalborg University Hospital, Denmark.,The Department of Clinical Medicine, Aalborg University, Denmark
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154
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Muchtar E, Magen H, Gertz MA. High-risk multiple myeloma: a multifaceted entity, multiple therapeutic challenges. Leuk Lymphoma 2016; 58:1283-1296. [PMID: 27734720 DOI: 10.1080/10428194.2016.1233540] [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: 12/22/2022]
Abstract
The term high-risk multiple myeloma is aimed to identify a heterogeneous group of patients who are more likely to progress and die early of their disease. Therefore, recognition of these patients is crucial. With the increase in the number of treatment options, the outcome for high-risk patients has probably improved, although the true extent of this improvement remains unknown, due to both the heterogeneous components of high-risk disease and its under-representation in clinical trials. In this article, we review the definitions of high-risk disease, emphasizing the fact that no single definition can represent the entire high-risk population. In the second part, we review the treatment options available for the management of high-risk myeloma as well as our general approach for high-risk disease. In light of the poor prognosis associated with high-risk myeloma, even in the current era, new approaches for the management of this subset of patients are needed.
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Affiliation(s)
- Eli Muchtar
- a Division of Hematology , Mayo Clinic , Rochester , MN , USA
| | - Hila Magen
- b Institute of Hematology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center , Petah-Tikva , Israel
| | - Morie A Gertz
- a Division of Hematology , Mayo Clinic , Rochester , MN , USA
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155
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MGUS to myeloma: a mysterious gammopathy of underexplored significance. Blood 2016; 128:2599-2606. [PMID: 27737890 DOI: 10.1182/blood-2016-09-692954] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 10/04/2016] [Indexed: 12/13/2022] Open
Abstract
All cases of multiple myeloma (MM) are preceded by precursor states termed monoclonal gammopathy of undetermined significance (MGUS) or smoldering myeloma (SMM). Genetic analyses of MGUS cells have provided evidence that it is a genetically advanced lesion, wherein tumor cells carry many of the genetic changes found in MM cells. Intraclonal heterogeneity is also established early during the MGUS phase. Although the genetic features of MGUS or SMM cells at baseline may predict disease risk, transition to MM involves altered growth of preexisting clones. Recent advances in mouse modeling of MGUS suggest that the clinical dormancy of the clone may be regulated in part by growth controls extrinsic to the tumor cells. Interactions of MGUS cells with immune cells, bone cells, and others in the bone marrow niche may be key regulators of malignant transformation. These interactions involve a bidirectional crosstalk leading to both growth-supporting and inhibitory signals. Because MGUS is already a genetically complex lesion, application of new tools for earlier detection should allow delineation of earlier stages, which we term as pre-MGUS Analyses of populations at increased risk of MGUS also suggest the possible existence of a polyclonal phase preceding the development of MGUS. Monoclonal gammopathy in several patients may have potential clinical significance in spite of low risk of malignancy. Understanding the entire spectrum of these disorders may have broader implications beyond prevention of clinical malignancy.
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156
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Das R, Strowig T, Verma R, Koduru S, Hafemann A, Hopf S, Kocoglu MH, Borsotti C, Zhang L, Branagan A, Eynon E, Manz MG, Flavell RA, Dhodapkar MV. Microenvironment-dependent growth of preneoplastic and malignant plasma cells in humanized mice. Nat Med 2016; 22:1351-1357. [PMID: 27723723 PMCID: PMC5101153 DOI: 10.1038/nm.4202] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 09/13/2016] [Indexed: 02/07/2023]
Abstract
Most human cancers including myeloma are preceded by a precursor state.
There is an unmet need for in vivo models to study the
interaction of human preneoplastic cells in the bone marrow microenvironment
with non-malignant cells. Here, we genetically humanized mice to permit the
growth of primary human pre-neoplastic and malignant plasma cells together with
non-malignant cells in vivo. Growth was
largely restricted to the bone marrow, mirroring the pattern in patients.
Xenografts captured the genomic complexity of parental tumors and revealed
additional somatic changes. Moreover, xenografts from patients with
preneoplastic gammopathy showed progressive growth, suggesting that the clinical
stability of these lesions may in part be due to growth controls extrinsic to
tumor cells. These data demonstrate a new approach to investigate the entire
spectrum of human plasma cell neoplasia and illustrate the utility of humanized
models for understanding the functional diversity of human tumors.
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Affiliation(s)
- Rituparna Das
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Till Strowig
- Department of Immunobiology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Rakesh Verma
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Srinivas Koduru
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Anja Hafemann
- Department of Immunobiology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Stephanie Hopf
- Department of Immunobiology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Mehmet H Kocoglu
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Chiara Borsotti
- Division of Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Lin Zhang
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Andrew Branagan
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Elizabeth Eynon
- Department of Immunobiology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Markus G Manz
- Division of Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Richard A Flavell
- Department of Immunobiology, Yale University School of Medicine, New Haven, Connecticut, USA.,Howard Hughes Medical Institute, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Madhav V Dhodapkar
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.,Department of Immunobiology, Yale University School of Medicine, New Haven, Connecticut, USA.,Yale Cancer Center, Yale University School of Medicine, New Haven, Connecticut, USA
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157
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Abstract
Prevention is an essential component of cancer eradication. Next-generation sequencing of cancer genomes and epigenomes has defined large numbers of driver mutations and molecular subgroups, leading to therapeutic advances. By comparison, there is a relative paucity of such knowledge in premalignant neoplasia, which inherently limits the potential to develop precision prevention strategies. Studies on the interplay between germ-line and somatic events have elucidated genetic processes underlying premalignant progression and preventive targets. Emerging data hint at the immune system's ability to intercept premalignancy and prevent cancer. Genetically engineered mouse models have identified mechanisms by which genetic drivers and other somatic alterations recruit inflammatory cells and induce changes in normal cells to create and interact with the premalignant tumor microenvironment to promote oncogenesis and immune evasion. These studies are currently limited to only a few lesion types and patients. In this Perspective, we advocate a large-scale collaborative effort to systematically map the biology of premalignancy and the surrounding cellular response. By bringing together scientists from diverse disciplines (e.g., biochemistry, omics, and computational biology; microbiology, immunology, and medical genetics; engineering, imaging, and synthetic chemistry; and implementation science), we can drive a concerted effort focused on cancer vaccines to reprogram the immune response to prevent, detect, and reject premalignancy. Lynch syndrome, clonal hematopoiesis, and cervical intraepithelial neoplasia which also serve as models for inherited syndromes, blood, and viral premalignancies, are ideal scenarios in which to launch this initiative.
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158
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Manier S, Salem KZ, Park J, Landau DA, Getz G, Ghobrial IM. Genomic complexity of multiple myeloma and its clinical implications. Nat Rev Clin Oncol 2016; 14:100-113. [DOI: 10.1038/nrclinonc.2016.122] [Citation(s) in RCA: 293] [Impact Index Per Article: 36.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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159
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Clonal selection and double-hit events involving tumor suppressor genes underlie relapse in myeloma. Blood 2016; 128:1735-44. [PMID: 27516441 DOI: 10.1182/blood-2016-06-723007] [Citation(s) in RCA: 155] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 08/02/2016] [Indexed: 02/06/2023] Open
Abstract
To elucidate the mechanisms underlying relapse from chemotherapy in multiple myeloma, we performed a longitudinal study of 33 patients entered into Total Therapy protocols investigating them using gene expression profiling, high-resolution copy number arrays, and whole-exome sequencing. The study illustrates the mechanistic importance of acquired mutations in known myeloma driver genes and the critical nature of biallelic inactivation events affecting tumor suppressor genes, especially TP53, the end result being resistance to apoptosis and increased proliferation rates, which drive relapse by Darwinian-type clonal evolution. The number of copy number aberration changes and biallelic inactivation of tumor suppressor genes was increased in GEP70 high risk, consistent with genomic instability being a key feature of high risk. In conclusion, the study highlights the impact of acquired genetic events, which enhance the evolutionary fitness level of myeloma-propagating cells to survive multiagent chemotherapy and to result in relapse.
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160
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Cell autonomous and microenvironmental regulation of tumor progression in precursor states of multiple myeloma. Curr Opin Hematol 2016; 23:426-33. [DOI: 10.1097/moh.0000000000000259] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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161
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Keppler S, Weiβbach S, Langer C, Knop S, Pischimarov J, Kull M, Stühmer T, Steinbrunn T, Bargou R, Einsele H, Rosenwald A, Leich E. Rare SNPs in receptor tyrosine kinases are negative outcome predictors in multiple myeloma. Oncotarget 2016; 7:38762-38774. [PMID: 27246973 PMCID: PMC5122427 DOI: 10.18632/oncotarget.9607] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 05/04/2016] [Indexed: 12/25/2022] Open
Abstract
Multiple myeloma (MM) is a plasma cell disorder that is characterized by a great genetic heterogeneity. Recent next generation sequencing studies revealed an accumulation of tumor-associated mutations in receptor tyrosine kinases (RTKs) which may also contribute to the activation of survival pathways in MM. To investigate the clinical role of RTK-mutations in MM, we deep-sequenced the coding DNA-sequence of EGFR, EPHA2, ERBB3, IGF1R, NTRK1 and NTRK2 which were previously found to be mutated in MM, in 75 uniformly treated MM patients of the "Deutsche Studiengruppe Multiples Myelom". Subsequently, we correlated the detected mutations with common cytogenetic alterations and clinical parameters. We identified 11 novel non-synonymous SNVs or rare patient-specific SNPs, not listed in the SNP databases 1000 genomes and dbSNP, in 10 primary MM cases. The mutations predominantly affected the tyrosine-kinase and ligand-binding domains and no correlation with cytogenetic parameters was found. Interestingly, however, patients with RTK-mutations, specifically those with rare patient-specific SNPs, showed a significantly lower overall, event-free and progression-free survival. This indicates that RTK SNVs and rare patient-specific RTK SNPs are of prognostic relevance and suggests that MM patients with RTK-mutations could potentially profit from treatment with RTK-inhibitors.
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Affiliation(s)
- Sarah Keppler
- Institute of Pathology, University of Würzburg, Würzburg, Germany
- Comprehensive Cancer Center Mainfranken (CCC MF), University Hospital Würzburg, Würzburg, Germany
| | - Susann Weiβbach
- Institute of Pathology, University of Würzburg, Würzburg, Germany
- Comprehensive Cancer Center Mainfranken (CCC MF), University Hospital Würzburg, Würzburg, Germany
| | - Christian Langer
- Department of Internal Medicine III, University Hospital Ulm, Ulm, Germany
| | - Stefan Knop
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Jordan Pischimarov
- Institute of Pathology, University of Würzburg, Würzburg, Germany
- Comprehensive Cancer Center Mainfranken (CCC MF), University Hospital Würzburg, Würzburg, Germany
| | - Miriam Kull
- Department of Internal Medicine III, University Hospital Ulm, Ulm, Germany
| | - Thorsten Stühmer
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Torsten Steinbrunn
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Ralf Bargou
- Comprehensive Cancer Center Mainfranken (CCC MF), University Hospital Würzburg, Würzburg, Germany
| | - Hermann Einsele
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Andreas Rosenwald
- Institute of Pathology, University of Würzburg, Würzburg, Germany
- Comprehensive Cancer Center Mainfranken (CCC MF), University Hospital Würzburg, Würzburg, Germany
| | - Ellen Leich
- Institute of Pathology, University of Würzburg, Würzburg, Germany
- Comprehensive Cancer Center Mainfranken (CCC MF), University Hospital Würzburg, Würzburg, Germany
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162
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Vatolin S, Phillips JG, Jha BK, Govindgari S, Hu J, Grabowski D, Parker Y, Lindner DJ, Zhong F, Distelhorst CW, Smith MR, Cotta C, Xu Y, Chilakala S, Kuang RR, Tall S, Reu FJ. Novel Protein Disulfide Isomerase Inhibitor with Anticancer Activity in Multiple Myeloma. Cancer Res 2016; 76:3340-50. [PMID: 27197150 DOI: 10.1158/0008-5472.can-15-3099] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 03/11/2016] [Indexed: 11/16/2022]
Abstract
Multiple myeloma cells secrete more disulfide bond-rich proteins than any other mammalian cell. Thus, inhibition of protein disulfide isomerases (PDI) required for protein folding in the endoplasmic reticulum (ER) should increase ER stress beyond repair in this incurable cancer. Here, we report the mechanistically unbiased discovery of a novel PDI-inhibiting compound with antimyeloma activity. We screened a 30,355 small-molecule library using a multilayered multiple myeloma cell-based cytotoxicity assay that modeled disease niche, normal liver, kidney, and bone marrow. CCF642, a bone marrow-sparing compound, exhibited a submicromolar IC50 in 10 of 10 multiple myeloma cell lines. An active biotinylated analog of CCF642 defined binding to the PDI isoenzymes A1, A3, and A4 in MM cells. In vitro, CCF642 inhibited PDI reductase activity about 100-fold more potently than the structurally distinct established inhibitors PACMA 31 and LOC14. Computational modeling suggested a novel covalent binding mode in active-site CGHCK motifs. Remarkably, without any further chemistry optimization, CCF642 displayed potent efficacy in an aggressive syngeneic mouse model of multiple myeloma and prolonged the lifespan of C57BL/KaLwRij mice engrafted with 5TGM1-luc myeloma, an effect comparable to the first-line multiple myeloma therapeutic bortezomib. Consistent with PDI inhibition, CCF642 caused acute ER stress in multiple myeloma cells accompanied by apoptosis-inducing calcium release. Overall, our results provide an illustration of the utility of simple in vivo simulations as part of a drug discovery effort, along with a sound preclinical rationale to develop a new small-molecule therapeutic to treat multiple myeloma. Cancer Res; 76(11); 3340-50. ©2016 AACR.
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Affiliation(s)
- Sergei Vatolin
- Department of Translational Hematology & Oncology Research, Cleveland Clinic, Cleveland, Ohio
| | - James G Phillips
- Department of Translational Hematology & Oncology Research, Cleveland Clinic, Cleveland, Ohio
| | - Babal K Jha
- Department of Translational Hematology & Oncology Research, Cleveland Clinic, Cleveland, Ohio
| | | | - Jennifer Hu
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Dale Grabowski
- Department of Translational Hematology & Oncology Research, Cleveland Clinic, Cleveland, Ohio
| | - Yvonne Parker
- Department of Translational Hematology & Oncology Research, Cleveland Clinic, Cleveland, Ohio
| | - Daniel J Lindner
- Department of Translational Hematology & Oncology Research, Cleveland Clinic, Cleveland, Ohio. Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Fei Zhong
- Division of Hematology & Oncology, University Hospitals of Cleveland, Cleveland, Ohio
| | - Clark W Distelhorst
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio. Division of Hematology & Oncology, University Hospitals of Cleveland, Cleveland, Ohio
| | - Mitchell R Smith
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio. Department of Hematology & Medical Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Claudiu Cotta
- Department of Clinical Pathology, Cleveland Clinic, Cleveland, Ohio
| | - Yan Xu
- Department of Chemistry, Cleveland State University, Cleveland, Ohio
| | - Sujatha Chilakala
- Department of Chemistry, Cleveland State University, Cleveland, Ohio
| | | | | | - Frederic J Reu
- Department of Translational Hematology & Oncology Research, Cleveland Clinic, Cleveland, Ohio. Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio. Department of Hematology & Medical Oncology, Cleveland Clinic, Cleveland, Ohio.
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163
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Cifola I, Lionetti M, Pinatel E, Todoerti K, Mangano E, Pietrelli A, Fabris S, Mosca L, Simeon V, Petrucci MT, Morabito F, Offidani M, Di Raimondo F, Falcone A, Caravita T, Battaglia C, De Bellis G, Palumbo A, Musto P, Neri A. Whole-exome sequencing of primary plasma cell leukemia discloses heterogeneous mutational patterns. Oncotarget 2016; 6:17543-58. [PMID: 26046463 PMCID: PMC4627327 DOI: 10.18632/oncotarget.4028] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 05/11/2015] [Indexed: 02/04/2023] Open
Abstract
Primary plasma cell leukemia (pPCL) is a rare and aggressive form of plasma cell dyscrasia and may represent a valid model for high-risk multiple myeloma (MM). To provide novel information concerning the mutational profile of this disease, we performed the whole-exome sequencing of a prospective series of 12 pPCL cases included in a Phase II multicenter clinical trial and previously characterized at clinical and molecular levels. We identified 1, 928 coding somatic non-silent variants on 1, 643 genes, with a mean of 166 variants per sample, and only few variants and genes recurrent in two or more samples. An excess of C > T transitions and the presence of two main mutational signatures (related to APOBEC over-activity and aging) occurring in different translocation groups were observed. We identified 14 candidate cancer driver genes, mainly involved in cell-matrix adhesion, cell cycle, genome stability, RNA metabolism and protein folding. Furthermore, integration of mutation data with copy number alteration profiles evidenced biallelically disrupted genes with potential tumor suppressor functions. Globally, cadherin/Wnt signaling, extracellular matrix and cell cycle checkpoint resulted the most affected functional pathways. Sequencing results were finally combined with gene expression data to better elucidate the biological relevance of mutated genes. This study represents the first whole-exome sequencing screen of pPCL and evidenced a remarkable genetic heterogeneity of mutational patterns. This may provide a contribution to the comprehension of the pathogenetic mechanisms associated with this aggressive form of PC dyscrasia and potentially with high-risk MM.
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Affiliation(s)
- Ingrid Cifola
- Institute for Biomedical Technologies, National Research Council, Milan, Italy
| | - Marta Lionetti
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Hematology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Eva Pinatel
- Institute for Biomedical Technologies, National Research Council, Milan, Italy
| | - Katia Todoerti
- Laboratory of Pre-Clinical and Translational Research, IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero in Vulture (PZ), Italy
| | - Eleonora Mangano
- Institute for Biomedical Technologies, National Research Council, Milan, Italy
| | | | - Sonia Fabris
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Hematology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Laura Mosca
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Hematology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Vittorio Simeon
- Laboratory of Pre-Clinical and Translational Research, IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero in Vulture (PZ), Italy
| | - Maria Teresa Petrucci
- Hematology, Department of Cellular Biotechnologies and Hematology, La Sapienza University, Rome, Italy
| | | | - Massimo Offidani
- Hematologic Clinic, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - Francesco Di Raimondo
- Department of Biomedical Sciences, Division of Hematology, Ospedale Ferrarotto, University of Catania, Catania, Italy
| | - Antonietta Falcone
- Hematology Unit, IRCCS "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Italy
| | - Tommaso Caravita
- Department of Hematology, Ospedale S. Eugenio, Tor Vergata University, Rome, Italy
| | - Cristina Battaglia
- Institute for Biomedical Technologies, National Research Council, Milan, Italy.,Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | - Gianluca De Bellis
- Institute for Biomedical Technologies, National Research Council, Milan, Italy
| | - Antonio Palumbo
- Division of Hematology, University of Torino, A.O.U. San Giovanni Battista, Torino, Italy
| | - Pellegrino Musto
- Scientific Direction, IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero in Vulture (PZ), Italy
| | - Antonino Neri
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Hematology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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164
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Pellegrino M, Sciambi A, Yates JL, Mast JD, Silver C, Eastburn DJ. RNA-Seq following PCR-based sorting reveals rare cell transcriptional signatures. BMC Genomics 2016; 17:361. [PMID: 27189161 PMCID: PMC4869385 DOI: 10.1186/s12864-016-2694-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 05/04/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Rare cell subtypes can profoundly impact the course of human health and disease, yet their presence within a sample is often missed with bulk molecular analysis. Single-cell analysis tools such as FACS, FISH-FC and single-cell barcode-based sequencing can investigate cellular heterogeneity; however, they have significant limitations that impede their ability to identify and transcriptionally characterize many rare cell subpopulations. RESULTS PCR-activated cell sorting (PACS) is a novel cytometry method that uses single-cell TaqMan PCR reactions performed in microfluidic droplets to identify and isolate cell subtypes with high-throughput. Here, we extend this method and demonstrate that PACS enables high-dimensional molecular profiling on TaqMan-targeted cells. Using a random priming RNA-Seq strategy, we obtained high-fidelity transcriptome measurements following PACS sorting of prostate cancer cells from a heterogeneous population. The sequencing data revealed prostate cancer gene expression profiles that were obscured in the unsorted populations. Single-cell expression analysis with PACS was subsequently used to confirm a number of the differentially expressed genes identified with RNA sequencing. CONCLUSIONS PACS requires minimal sample processing, uses readily available TaqMan assays and can isolate cell subtypes with high sensitivity. We have now validated a method for performing next-generation sequencing on mRNA obtained from PACS isolated cells. This capability makes PACS well suited for transcriptional profiling of rare cells from complex populations to obtain maximal biological insight into cell states and behaviors.
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Affiliation(s)
| | - Adam Sciambi
- Mission Bio, Inc., 953 Indiana St., San Francisco, California, 94107, USA
| | - Jamie L Yates
- Mission Bio, Inc., 953 Indiana St., San Francisco, California, 94107, USA
| | - Joshua D Mast
- Mission Bio, Inc., 953 Indiana St., San Francisco, California, 94107, USA
| | - Charles Silver
- Mission Bio, Inc., 953 Indiana St., San Francisco, California, 94107, USA
| | - Dennis J Eastburn
- Mission Bio, Inc., 953 Indiana St., San Francisco, California, 94107, USA.
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165
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van de Donk NWCJ, Mutis T, Poddighe PJ, Lokhorst HM, Zweegman S. Diagnosis, risk stratification and management of monoclonal gammopathy of undetermined significance and smoldering multiple myeloma. Int J Lab Hematol 2016; 38 Suppl 1:110-22. [DOI: 10.1111/ijlh.12504] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2016] [Indexed: 11/28/2022]
Affiliation(s)
| | - T. Mutis
- Department of Hematology; VU University Medical Center; Amsterdam The Netherlands
| | - P. J. Poddighe
- Department of Clinical Genetics; VU University Medical Center; Amsterdam The Netherlands
| | - H. M. Lokhorst
- Department of Hematology; VU University Medical Center; Amsterdam The Netherlands
| | - S. Zweegman
- Department of Hematology; VU University Medical Center; Amsterdam The Netherlands
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166
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Martello M, Remondini D, Borsi E, Santacroce B, Procacci M, Pezzi A, Dico FA, Martinelli G, Zamagni E, Tacchetti P, Pantani L, Testoni N, Marzocchi G, Rocchi S, Zannetti BA, Mancuso K, Cavo M, Terragna C. Opposite activation of the Hedgehog pathway in CD138+ plasma cells and CD138-CD19+ B cells identifies two subgroups of patients with multiple myeloma and different prognosis. Leukemia 2016; 30:1869-76. [PMID: 27074969 DOI: 10.1038/leu.2016.77] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 03/02/2016] [Accepted: 03/14/2016] [Indexed: 12/14/2022]
Abstract
Hyperactivation of the Hedgehog (Hh) pathway, which controls refueling of multiple myeloma (MM) clones, might be critical to disease recurrence. Although several studies suggest the Hh pathway is activated in CD138- immature cells, differentiated CD138+ plasma cells might also be able to self-renew by producing themselves the Hh ligands. We studied the gene expression profiles of 126 newly diagnosed MM patients analyzed in both the CD138+ plasma cell fraction and CD138-CD19+ B-cell compartment. Results demonstrated that an Hh-gene signature was able to cluster patients in two subgroups characterized by the opposite Hh pathway expression in mature plasma cells and their precursors. Strikingly, patients characterized by Hh hyperactivation in plasma cells, but not in their B cells, displayed high genomic instability and an unfavorable outcome in terms of shorter progression-free survival (hazard ratio: 1.92; 95% confidence interval: 1.19-3.07) and overall survival (hazard ratio: 2.61; 95% confidence interval: 1.26-5.38). These results suggest that the mechanisms triggered by the Hh pathway ultimately led to identify a more indolent vs a more aggressive biological and clinical subtype of MM. Therefore, patient stratification according to their molecular background might help the fine-tuning of future clinical and therapeutic studies.
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Affiliation(s)
- M Martello
- Institute of Haematology 'L. & A. Seràgnoli', Department of Experimental Diagnostic and Specialty Medicine (DIMES), Bologna University School of Medicine, Bologna, Italy
| | - D Remondini
- Department of Physics and Astronomy (DIFA), University of Bologna, Bologna, Italy
| | - E Borsi
- Institute of Haematology 'L. & A. Seràgnoli', Department of Experimental Diagnostic and Specialty Medicine (DIMES), Bologna University School of Medicine, Bologna, Italy
| | - B Santacroce
- Institute of Haematology 'L. & A. Seràgnoli', Department of Experimental Diagnostic and Specialty Medicine (DIMES), Bologna University School of Medicine, Bologna, Italy
| | - M Procacci
- Institute of Haematology 'L. & A. Seràgnoli', Department of Experimental Diagnostic and Specialty Medicine (DIMES), Bologna University School of Medicine, Bologna, Italy
| | - A Pezzi
- Institute of Haematology 'L. & A. Seràgnoli', Department of Experimental Diagnostic and Specialty Medicine (DIMES), Bologna University School of Medicine, Bologna, Italy
| | - F A Dico
- Institute of Haematology 'L. & A. Seràgnoli', Department of Experimental Diagnostic and Specialty Medicine (DIMES), Bologna University School of Medicine, Bologna, Italy
| | - G Martinelli
- Institute of Haematology 'L. & A. Seràgnoli', Department of Experimental Diagnostic and Specialty Medicine (DIMES), Bologna University School of Medicine, Bologna, Italy
| | - E Zamagni
- Institute of Haematology 'L. & A. Seràgnoli', Department of Experimental Diagnostic and Specialty Medicine (DIMES), Bologna University School of Medicine, Bologna, Italy
| | - P Tacchetti
- Institute of Haematology 'L. & A. Seràgnoli', Department of Experimental Diagnostic and Specialty Medicine (DIMES), Bologna University School of Medicine, Bologna, Italy
| | - L Pantani
- Institute of Haematology 'L. & A. Seràgnoli', Department of Experimental Diagnostic and Specialty Medicine (DIMES), Bologna University School of Medicine, Bologna, Italy
| | - N Testoni
- Institute of Haematology 'L. & A. Seràgnoli', Department of Experimental Diagnostic and Specialty Medicine (DIMES), Bologna University School of Medicine, Bologna, Italy
| | - G Marzocchi
- Institute of Haematology 'L. & A. Seràgnoli', Department of Experimental Diagnostic and Specialty Medicine (DIMES), Bologna University School of Medicine, Bologna, Italy
| | - S Rocchi
- Institute of Haematology 'L. & A. Seràgnoli', Department of Experimental Diagnostic and Specialty Medicine (DIMES), Bologna University School of Medicine, Bologna, Italy
| | - B A Zannetti
- Institute of Haematology 'L. & A. Seràgnoli', Department of Experimental Diagnostic and Specialty Medicine (DIMES), Bologna University School of Medicine, Bologna, Italy
| | - K Mancuso
- Institute of Haematology 'L. & A. Seràgnoli', Department of Experimental Diagnostic and Specialty Medicine (DIMES), Bologna University School of Medicine, Bologna, Italy
| | - M Cavo
- Institute of Haematology 'L. & A. Seràgnoli', Department of Experimental Diagnostic and Specialty Medicine (DIMES), Bologna University School of Medicine, Bologna, Italy
| | - C Terragna
- Institute of Haematology 'L. & A. Seràgnoli', Department of Experimental Diagnostic and Specialty Medicine (DIMES), Bologna University School of Medicine, Bologna, Italy
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167
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D’Agostino M, Palumbo A. Moving Toward a Tailored Therapy in Multiple Myeloma. J Oncol Pract 2016; 12:293-4. [DOI: 10.1200/jop.2016.011627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Mattia D’Agostino
- University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Antonio Palumbo
- University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
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168
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Korde N, Roschewski M, Zingone A, Kwok M, Manasanch EE, Bhutani M, Tageja N, Kazandjian D, Mailankody S, Wu P, Morrison C, Costello R, Zhang Y, Burton D, Mulquin M, Zuchlinski D, Lamping L, Carpenter A, Wall Y, Carter G, Cunningham SC, Gounden V, Sissung TM, Peer C, Maric I, Calvo KR, Braylan R, Yuan C, Stetler-Stevenson M, Arthur DC, Kong KA, Weng L, Faham M, Lindenberg L, Kurdziel K, Choyke P, Steinberg SM, Figg W, Landgren O. Treatment With Carfilzomib-Lenalidomide-Dexamethasone With Lenalidomide Extension in Patients With Smoldering or Newly Diagnosed Multiple Myeloma. JAMA Oncol 2016; 1:746-54. [PMID: 26181891 DOI: 10.1001/jamaoncol.2015.2010] [Citation(s) in RCA: 248] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Carfilzomib-lenalidomide-dexamethasone therapy yields deep responses in patients with newly diagnosed multiple myeloma (NDMM). It is important to gain an understanding of this combination's tolerability and impact on minimal residual disease (MRD) negativity because this end point has been associated with improved survival. OBJECTIVE To assess the safety and efficacy of carfilzomib-lenalidomide-dexamethasone therapy in NDMM and high-risk smoldering multiple myeloma (SMM). DESIGN, SETTING, AND PARTICIPANTS Clinical and correlative pilot study at the National Institutes of Health Clinical Center. Patients with NDMM or high-risk SMM were enrolled between July 11, 2011, and October 9, 2013. Median follow-up was 17.3 (NDMM) and 15.9 months (SMM). INTERVENTIONS Eight 28-day cycles were composed of carfilzomib 20/36 mg/m2 on days 1, 2, 8, 9, 15, and 16; lenalidomide 25 mg on days 1 through 21; and dexamethasone 20/10 mg (cycles 1-4/5-8) on days 1, 2, 8, 9, 15, 16, 22, and 23. Patients who achieved at least stable disease subsequently received 24 cycles of lenalidomide extended dosing. MAIN OUTCOMES AND MEASURES Primary end points were neuropathy of grade 3 or greater (NDMM) and at least very good partial response rates (SMM). Minimal residual disease was also assessed. RESULTS Of 45 patients with NDMM, none had neuropathy of grade 3 or greater. Of 12 patients with high-risk SMM, the most common of any-grade adverse events were lymphopenia (12 [100%]) and gastrointestinal disorders (11 [92%]). All patients with SMM achieved at least a very good partial response during the study period. Among the 28 patients with NDMM and the 12 with SMM achieving at least a near-complete response, MRD negativity was found in 28 of 28 (100% [95% CI, 88%-100%]), 11 of 12 (92% [95% CI, 62%-100%]) (multiparametric flow cytometry), 14 of 21 (67% [95% CI, 43%-85%]), and 9 of 12 (75% [95% CI, 43%-94%]) (next-generation sequencing), respectively. In patients with NDMM, 12-month progression-free survival for MRD-negative vs MRD-positive status by flow cytometry and next-generation sequencing was 100% vs 79% (95% CI, 47%-94%; P < .001) and 100% vs 95% (95% CI, 75%-99%; P = .02), respectively. CONCLUSIONS AND RELEVANCE Carfilzomib-lenalidomide-dexamethasone therapy is tolerable and demonstrates high rates of MRD negativity in NDMM, translating into longer progression-free survival in patients achieving MRD negativity. Carfilzomib-lenalidomide-dexamethasone therapy also demonstrates efficacy in high-risk SMM.
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Affiliation(s)
- Neha Korde
- Multiple Myeloma Section, Lymphoid Malignancies Branch, National Cancer Institute, National Institutes of Health, New York, New York2Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mark Roschewski
- Multiple Myeloma Section, Lymphoid Malignancies Branch, National Cancer Institute, National Institutes of Health, New York, New York
| | - Adriana Zingone
- Multiple Myeloma Section, Lymphoid Malignancies Branch, National Cancer Institute, National Institutes of Health, New York, New York
| | - Mary Kwok
- Multiple Myeloma Section, Lymphoid Malignancies Branch, National Cancer Institute, National Institutes of Health, New York, New York
| | - Elisabet E Manasanch
- Multiple Myeloma Section, Lymphoid Malignancies Branch, National Cancer Institute, National Institutes of Health, New York, New York3Department of Lymphoma and Myeloma, University of Texas MD Anderson Cancer Center, Houston
| | - Manisha Bhutani
- Multiple Myeloma Section, Lymphoid Malignancies Branch, National Cancer Institute, National Institutes of Health, New York, New York4Medical Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland5Department of Hemato
| | - Nishant Tageja
- Multiple Myeloma Section, Lymphoid Malignancies Branch, National Cancer Institute, National Institutes of Health, New York, New York4Medical Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Dickran Kazandjian
- Multiple Myeloma Section, Lymphoid Malignancies Branch, National Cancer Institute, National Institutes of Health, New York, New York
| | - Sham Mailankody
- Multiple Myeloma Section, Lymphoid Malignancies Branch, National Cancer Institute, National Institutes of Health, New York, New York4Medical Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Peter Wu
- Multiple Myeloma Section, Lymphoid Malignancies Branch, National Cancer Institute, National Institutes of Health, New York, New York
| | - Candis Morrison
- Multiple Myeloma Section, Lymphoid Malignancies Branch, National Cancer Institute, National Institutes of Health, New York, New York
| | - Rene Costello
- Multiple Myeloma Section, Lymphoid Malignancies Branch, National Cancer Institute, National Institutes of Health, New York, New York
| | - Yong Zhang
- Multiple Myeloma Section, Lymphoid Malignancies Branch, National Cancer Institute, National Institutes of Health, New York, New York
| | - Debra Burton
- Multiple Myeloma Section, Lymphoid Malignancies Branch, National Cancer Institute, National Institutes of Health, New York, New York
| | - Marcia Mulquin
- Multiple Myeloma Section, Lymphoid Malignancies Branch, National Cancer Institute, National Institutes of Health, New York, New York
| | - Diamond Zuchlinski
- Multiple Myeloma Section, Lymphoid Malignancies Branch, National Cancer Institute, National Institutes of Health, New York, New York
| | - Liz Lamping
- Multiple Myeloma Section, Lymphoid Malignancies Branch, National Cancer Institute, National Institutes of Health, New York, New York
| | - Ashley Carpenter
- Multiple Myeloma Section, Lymphoid Malignancies Branch, National Cancer Institute, National Institutes of Health, New York, New York
| | - Yvonne Wall
- Multiple Myeloma Section, Lymphoid Malignancies Branch, National Cancer Institute, National Institutes of Health, New York, New York
| | - George Carter
- Multiple Myeloma Section, Lymphoid Malignancies Branch, National Cancer Institute, National Institutes of Health, New York, New York
| | - Schuyler C Cunningham
- Multiple Myeloma Section, Lymphoid Malignancies Branch, National Cancer Institute, National Institutes of Health, New York, New York
| | - Verena Gounden
- Hematology Service, Department of Laboratory Medicine, Center for Cancer Research, National Institutes of Health, Bethesda, Maryland
| | - Tristan M Sissung
- Department of Pharmacokinetics, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Cody Peer
- Department of Pharmacokinetics, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Irina Maric
- Hematology Service, Department of Laboratory Medicine, Center for Cancer Research, National Institutes of Health, Bethesda, Maryland
| | - Katherine R Calvo
- Hematology Service, Department of Laboratory Medicine, Center for Cancer Research, National Institutes of Health, Bethesda, Maryland
| | - Raul Braylan
- Hematology Service, Department of Laboratory Medicine, Center for Cancer Research, National Institutes of Health, Bethesda, Maryland
| | - Constance Yuan
- Lab of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Maryalice Stetler-Stevenson
- Lab of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Diane C Arthur
- Lab of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Li Weng
- Sequenta Inc, San Francisco, California
| | | | - Liza Lindenberg
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Karen Kurdziel
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Peter Choyke
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Seth M Steinberg
- Biostatistics and Data Management Section, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - William Figg
- Department of Pharmacokinetics, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Ola Landgren
- Multiple Myeloma Section, Lymphoid Malignancies Branch, National Cancer Institute, National Institutes of Health, New York, New York2Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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169
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Preclinical animal models of multiple myeloma. BONEKEY REPORTS 2016; 5:772. [PMID: 26909147 DOI: 10.1038/bonekey.2015.142] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 11/30/2015] [Indexed: 01/19/2023]
Abstract
Multiple myeloma is an incurable plasma-cell malignancy characterized by osteolytic bone disease and immunosuppression. Murine models of multiple myeloma and myeloma bone disease are critical tools for an improved understanding of the pathogenesis of the disease and the development of novel therapeutic strategies. This review will cover commonly used immunocompetent and xenograft models of myeloma, describing the advantages and disadvantages of each model system. In addition, this review provides detailed protocols for establishing systemic and local models of myeloma using both murine and human myeloma cell lines.
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170
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Katodritou E, Papadaki S, Konstantinidou P, Terpos E. Is it possible to cure myeloma without allogeneic transplantation? Transfus Apher Sci 2016; 54:63-70. [PMID: 26850930 DOI: 10.1016/j.transci.2016.01.015] [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: 01/01/2023]
Abstract
During the last decades, a better understanding of the biology of multiple myeloma (MM) has led to the application of novel treatment strategies for MM patients. The new anti-myeloma regimens produce higher incidence of durable and of better quality responses and they improve overall survival, challenging the dogma of incurable disease, outside the context of allogeneic transplantation. This review presents all these strategies that aim to cure MM, including continuous treatment i.e. induction, consolidation and maintenance, treatment of asymptomatic MM and monitoring minimal residual disease using modern techniques, such as multi-parameter flow cytometry, molecular assays and advanced imaging.
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Affiliation(s)
- Eirini Katodritou
- Department of Hematology, Theagenion Cancer Hospital, Thessaloniki, Greece; Greek Myeloma Study Group, Athens, Greece
| | - Sofia Papadaki
- Department of Hematology, Theagenion Cancer Hospital, Thessaloniki, Greece
| | | | - Evangelos Terpos
- Greek Myeloma Study Group, Athens, Greece; Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
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171
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Abstract
Unprecedented advances in multiple myeloma (MM) therapy during the last 15 years are predominantly based on our increasing understanding of the pathophysiologic role of the bone marrow (BM) microenvironment. Indeed, new treatment paradigms, which incorporate thalidomide, immunomodulatory drugs (IMiDs), and proteasome inhibitors, target the tumor cell as well as its BM microenvironment. Ongoing translational research aims to understand in more detail how disordered BM-niche functions contribute to MM pathogenesis and to identify additional derived targeting agents. One of the most exciting advances in the field of MM treatment is the emergence of immune therapies including elotuzumab, daratumumab, the immune checkpoint inhibitors, Bispecific T-cell engagers (BiTes), and Chimeric antigen receptor (CAR)-T cells. This chapter will review our knowledge on the pathophysiology of the BM microenvironment and discuss derived novel agents that hold promise to further improve outcome in MM.
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Affiliation(s)
- Michele Moschetta
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Yawara Kawano
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Klaus Podar
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), University of Heidelberg, Heidelberg, Germany.
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172
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Abstract
Multiple myeloma (MM) is a genetically complex disease. The past few years have seen an evolution in cancer research with the emergence of next-generation sequencing (NGS), enabling high throughput sequencing of tumors-including whole exome, whole genome, RNA, and single-cell sequencing as well as genome-wide association study (GWAS). A few inherited variants have been described, counting for some cases of familial disease. Hierarchically, primary events in MM can be divided into hyperdiploid (HDR) and nonhyperdiploid subtypes. HRD tumors are characterized by trisomy of chromosomes 3, 5, 7, 9, 11, 15, 19, and/or 21. Non-HRD tumors harbor IGH translocations, mainly t(4;14), t(6;14), t(11;14), t(14;16), and t(14;20). Secondary events participate to the tumor progression and consist in secondary translocation involving MYC, copy number variations (CNV) and somatic mutations (such as mutations in KRAS, NRAS, BRAF, P53). Moreover, the dissection of clonal heterogeneity helps to understand the evolution of the disease. The following review provides a comprehensive review of the genomic landscape in MM.
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Affiliation(s)
- Salomon Manier
- Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
- Department of Hematology, Lille Hospital University, Lille, France
| | - Karma Salem
- Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - Siobhan V Glavey
- Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - Aldo M Roccaro
- Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
- Department of Hematology, CREA Laboratory, ASST-Spedali Civili di Brescia, Brescia, BS, Italy
| | - Irene M Ghobrial
- Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA.
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Mitra AK, Mukherjee UK, Harding T, Jang JS, Stessman H, Li Y, Abyzov A, Jen J, Kumar S, Rajkumar V, Van Ness B. Single-cell analysis of targeted transcriptome predicts drug sensitivity of single cells within human myeloma tumors. Leukemia 2015; 30:1094-102. [DOI: 10.1038/leu.2015.361] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 11/30/2015] [Accepted: 12/15/2015] [Indexed: 12/14/2022]
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Immune status of high-risk smoldering multiple myeloma patients and its therapeutic modulation under LenDex: a longitudinal analysis. Blood 2015; 127:1151-62. [PMID: 26668134 DOI: 10.1182/blood-2015-10-662320] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 12/03/2015] [Indexed: 12/13/2022] Open
Abstract
There is significant interest in immunotherapy for the treatment of high-risk smoldering multiple myeloma (SMM), but no available data on the immune status of this particular disease stage. Such information is important to understand the interplay between immunosurveillance and disease transformation, but also to define whether patients with high-risk SMM might benefit from immunotherapy. Here, we have characterized T lymphocytes (including CD4, CD8, T-cell receptor γδ, and regulatory T cells), natural killer (NK) cells, and dendritic cells from 31 high-risk SMM patients included in the treatment arm of the QUIREDEX trial, and with longitudinal peripheral blood samples at baseline and after 3 and 9 cycles of lenalidomide plus low-dose dexamethasone (LenDex). High-risk SMM patients showed at baseline decreased expression of activation-(CD25/CD28/CD54), type 1 T helper-(CD195/interferon-γ/tumor necrosis factor-α/interleukin-2), and proliferation-related markers (CD119/CD120b) as compared with age-matched healthy individuals. However, LenDex was able to restore the normal expression levels for those markers and induced a marked shift in T-lymphocyte and NK-cell phenotype. Accordingly, high-risk SMM patients treated with LenDex showed higher numbers of functionally active T lymphocytes. Together, our results indicate that high-risk SMM patients have an impaired immune system that could be reactivated by the immunomodulatory effects of lenalidomide, even when combined with low-dose dexamethasone, and support the value of therapeutic immunomodulation to delay the progression to multiple myeloma. The QUIREDEX trial was registered to www.clinicaltrials.gov as #NCT00480363.
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Abstract
Multiple myeloma is a plasma cell malignancy in which significant advances have been observed during the last 15 years. Our understanding of the disease has been advanced through its molecular characterization. We have also seen improvements in patient care with the development of 2 new classes of active agents, proteasome inhibitors and immunomodulatory drugs (IMiDs), resulting in a significant improvement in overall survival of myeloma patients such that it can now be debated as to whether some subsets of myeloma patients can be cured. However, the advances in our understanding of myeloma biology occurred in parallel with advances in treatment as opposed to being directly informed by the research. Moreover, the molecular characterization of malignant plasma cells would not have predicted the effectiveness of these novel therapies.We hypothesize that proteasome inhibitors and IMiDs are highly active because malignant plasma cells are constrained by many of the characteristics of their normal counterparts and these novel therapies target both normal plasma cell biology and the cancer biology of myeloma. Thus, a better understanding of normal plasma cell biology will likely yield as many actionable targets as mapping the genomic landscape of this disease.
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176
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Karadimitris A, Chaidos A, Caputo V, Goudevenou K, Ponnusamy K, Xiao X. Myeloma Propagating Cells, Drug Resistance and Relapse. Stem Cells 2015; 33:3205-11. [DOI: 10.1002/stem.2199] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 07/16/2015] [Indexed: 01/05/2023]
Affiliation(s)
- Anastasios Karadimitris
- Centre for Haematology, Department of Medicine; Imperial College London; London United Kingdom
- Department of Haematology; Hammersmith Hospital, Imperial College Healthcare NHS Trust; London United Kingdom
| | - Aristeidis Chaidos
- Centre for Haematology, Department of Medicine; Imperial College London; London United Kingdom
- Department of Haematology; Hammersmith Hospital, Imperial College Healthcare NHS Trust; London United Kingdom
| | - Valentina Caputo
- Centre for Haematology, Department of Medicine; Imperial College London; London United Kingdom
| | - Katerina Goudevenou
- Centre for Haematology, Department of Medicine; Imperial College London; London United Kingdom
| | - Kanagaraju Ponnusamy
- Centre for Haematology, Department of Medicine; Imperial College London; London United Kingdom
| | - Xiaolin Xiao
- Centre for Haematology, Department of Medicine; Imperial College London; London United Kingdom
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Apostoli AJ, Ailles L. Clonal evolution and tumor-initiating cells: New dimensions in cancer patient treatment. Crit Rev Clin Lab Sci 2015; 53:40-51. [PMID: 26397062 DOI: 10.3109/10408363.2015.1083944] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Human cancer is not a uniform disease but a plethora of disparate tumor types and subtypes. The differences that exist between individual tumors (intertumoral heterogeneity) present a significant roadblock to the eradication of cancer. It has also become increasingly clear that variations across individual tumors (intratumoral heterogeneity) have important implications to cancer progression and treatment efficacy. Therefore, in order to improve patient care and develop novel chemotherapeutics, the evolving tumor landscape needs to be further explored. Next-generation sequencing (NGS) technologies are revolutionizing the cancer research arena by providing state-of-the-art, high-speed methods of genome sequencing at single-nucleotide resolution, thus enabling an unprecedented detection of tumor-specific genetic abnormalities. These anomalies can be quantified to reveal specific frequencies of DNA alterations that correspond to distinct clonal populations within a given tumor. As such, NGS approaches have also been utilized to explore the heterogeneous landscape of patient tumors as well as to match metastatic and/or recurrent growths and patient-derived engrafts. By sequencing in this manner--through time so to speak--cancer researchers can track shifting clonal populations, make important inferences about tumor evolution and potentially identify tumor subclones that could be viably targeted. This exciting new territory has important implications for the competing clonal evolution and cancer stem cell models of tumor heterogeneity, and also offers a new dimension for cancer treatment and profound hope for patients in the coming years.
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Affiliation(s)
- Anthony J Apostoli
- a Princess Margaret Cancer Centre, University Health Network , Toronto , Ontario , Canada and
| | - Laurie Ailles
- a Princess Margaret Cancer Centre, University Health Network , Toronto , Ontario , Canada and.,b Department of Medical Biophysics , University of Toronto , Toronto , Ontario , Canada
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178
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Abstract
PURPOSE OF REVIEW This review summarizes the recent progress in defining the patterns of genetic evolution giving rise to relapse in follicular lymphoma and multiple myeloma, and discusses their implications with respect to 'personalized medicine'. RECENT FINDINGS High-throughput sequencing studies have uncovered a large degree of clonal heterogeneity within tumors, and found that subclones have a variable contribution to relapse. Recent studies aimed at defining patterns of clonal evolution have revealed that serial tumors in some malignancies share their ancestry in a less evolved common progenitor cell (CPC) that bears only a subset of the mutations that are present in the fully evolved tumors that present clinically. This pattern of 'divergent evolution' means that the majority of 'actionable mutations' in tumor specimens are absent within the progenitors that give rise to relapse. SUMMARY Follicular lymphoma and multiple myeloma are clinically, biologically and genetically distinct mature B-cell malignancies. However, recent studies have found them to share important similarities in their patterns of genetic evolution. Tumor cells that constitute subclonal populations within these tumors, or between consecutive tumors, share their origins within a genetically less evolved common progenitor cell. This pattern of evolution indicates that current therapies are unable to eradicate these less evolved populations that are at the root of relapse. This suggests that in order to obtain the best results with modern 'targeted therapies' that are directed towards 'actionable mutations', these mutations should be considered within the context of the evolutionary stage at which mutations are acquired, not simply on a presence or absence basis.
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179
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Brioli A, Melchor L, Walker BA, Davies FE, Morgan GJ. Biology and treatment of myeloma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2015; 14 Suppl:S65-70. [PMID: 25486959 DOI: 10.1016/j.clml.2014.06.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 04/13/2014] [Accepted: 06/04/2014] [Indexed: 11/16/2022]
Abstract
In recent years significant progress has been made in the understanding of multiple myeloma (MM) biology and its treatment. Current strategies for the treatment of MM involve the concept of sequential blocks of therapy given as an induction followed by consolidation and maintenance. In an age characterized by emerging and more powerful laboratory techniques, it is of primary importance to understand the biology of MM and how this biology can guide the development of new treatment strategies. This review focuses on the genetic basis of myeloma, including the most common genetic abnormalities and pathways affected and the effects that these have on MM treatment strategies. MM biology is discussed also in the light of more recent theory of intraclonal heterogeneity.
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Affiliation(s)
- Annamaria Brioli
- Centre for Myeloma Research, Division of Molecular Pathology, Institute of Cancer Research, London, United Kingdom; Istituto di Ematologia Seràgnoli, Università degli Studi di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Lorenzo Melchor
- Centre for Myeloma Research, Division of Molecular Pathology, Institute of Cancer Research, London, United Kingdom
| | - Brian A Walker
- Centre for Myeloma Research, Division of Molecular Pathology, Institute of Cancer Research, London, United Kingdom
| | - Faith E Davies
- Centre for Myeloma Research, Division of Molecular Pathology, Institute of Cancer Research, London, United Kingdom
| | - Gareth J Morgan
- Centre for Myeloma Research, Division of Molecular Pathology, Institute of Cancer Research, London, United Kingdom.
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180
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Monoclonal antibodies in the treatment of multiple myeloma: current status and future perspectives. Leukemia 2015; 30:526-35. [PMID: 26265184 PMCID: PMC4777772 DOI: 10.1038/leu.2015.223] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 07/21/2015] [Accepted: 07/22/2015] [Indexed: 02/06/2023]
Abstract
The treatment landscape for patients with multiple myeloma (MM) is constantly evolving. Over the past decade, the introduction of novel agents such as proteasome inhibitors and immunomodulatory drugs has led to notable changes in therapeutic strategy, and improvements in survival, yet MM remains incurable in the vast majority of cases. More recently, a targeted approach to MM treatment has emerged, using monoclonal antibodies (mAbs) to target antigens expressed on the surface of MM cells. MAbs tested to date kill MM cells via the host's immune system and/or by promoting apoptosis, and appear to have generally improved tolerability compared with currently available treatments. Due to their distinct mode of action, mAbs are promising both for patients who have exhausted current regimens, and as part of first-line treatments in newly diagnosed patients. This review examines the recent developments in mAb-based therapy for MM, primarily focused on those agents in ongoing clinical testing.
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181
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Heuck CJ, Jethava Y, Khan R, van Rhee F, Zangari M, Chavan S, Robbins K, Miller SE, Matin A, Mohan M, Ali SM, Stephens PJ, Ross JS, Miller VA, Davies F, Barlogie B, Morgan G. Inhibiting MEK in MAPK pathway-activated myeloma. Leukemia 2015; 30:976-80. [PMID: 26228812 PMCID: PMC4832073 DOI: 10.1038/leu.2015.208] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- C J Heuck
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Y Jethava
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - R Khan
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - F van Rhee
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - M Zangari
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - S Chavan
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - K Robbins
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - S E Miller
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - A Matin
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - M Mohan
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - S M Ali
- Foundation Medicine, Inc., Cambridge, MA, USA
| | | | - J S Ross
- Foundation Medicine, Inc., Cambridge, MA, USA.,Department of Pathology, Albany Medical College, Albany, NY, USA
| | - V A Miller
- Foundation Medicine, Inc., Cambridge, MA, USA
| | - F Davies
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - B Barlogie
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - G Morgan
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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182
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Cowan G, Weston-Bell NJ, Bryant D, Seckinger A, Hose D, Zojer N, Sahota SS. Massive parallel IGHV gene sequencing reveals a germinal center pathway in origins of human multiple myeloma. Oncotarget 2015; 6:13229-40. [PMID: 25929340 PMCID: PMC4537010 DOI: 10.18632/oncotarget.3644] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 03/24/2015] [Indexed: 12/14/2022] Open
Abstract
Human multiple myeloma (MM) is characterized by accumulation of malignant terminally differentiated plasma cells (PCs) in the bone marrow (BM), raising the question when during maturation neoplastic transformation begins. Immunoglobulin IGHV genes carry imprints of clonal tumor history, delineating somatic hypermutation (SHM) events that generally occur in the germinal center (GC). Here, we examine MM-derived IGHV genes using massive parallel deep sequencing, comparing them with profiles in normal BM PCs. In 4/4 presentation IgG MM, monoclonal tumor-derived IGHV sequences revealed significant evidence for intraclonal variation (ICV) in mutation patterns. IGHV sequences of 2/2 normal PC IgG populations revealed dominant oligoclonal expansions, each expansion also displaying mutational ICV. Clonal expansions in MM and in normal BM PCs reveal common IGHV features. In such MM, the data fit a model of tumor origins in which neoplastic transformation is initiated in a GC B-cell committed to terminal differentiation but still targeted by on-going SHM. Strikingly, the data parallel IGHV clonal sequences in some monoclonal gammopathy of undetermined significance (MGUS) known to display on-going SHM imprints. Since MGUS generally precedes MM, these data suggest origins of MGUS and MM with IGHV gene mutational ICV from the same GC B-cell, arising via a distinctive pathway.
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Affiliation(s)
- Graeme Cowan
- Institute of Immunology and Infection Research, Centre for Immunity, Infection and Evolution, University of Edinburgh, UK
| | - Nicola J. Weston-Bell
- Tumour Immunogenetics Group, Cancer Sciences Academic Unit, Faculty of Medicine, University of Southampton, UK
| | - Dean Bryant
- Tumour Immunogenetics Group, Cancer Sciences Academic Unit, Faculty of Medicine, University of Southampton, UK
| | - Anja Seckinger
- Medizinische Klinik V, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Dirk Hose
- Medizinische Klinik V, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Niklas Zojer
- Center for Oncology and Hematology, 1st Department of Medicine, Wilhelminenspital, Vienna, Austria
| | - Surinder S. Sahota
- Tumour Immunogenetics Group, Cancer Sciences Academic Unit, Faculty of Medicine, University of Southampton, UK
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183
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Szalat R, Munshi NC. Genomic heterogeneity in multiple myeloma. Curr Opin Genet Dev 2015; 30:56-65. [PMID: 25982873 DOI: 10.1016/j.gde.2015.03.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 03/17/2015] [Accepted: 03/19/2015] [Indexed: 10/23/2022]
Abstract
Multiple myeloma (MM) is an incurable malignancy in majority of patients characterized by clonal proliferation of plasma cells. To date, treatment is established based on general conditions and age of patients. However, MM is a heterogeneous disease, featured by various subtypes and different outcomes. Thus, the understanding of MM biology is currently a major challenge to eventually cure the disease. During the last decade, karyotype studies and gene expression profiling have identified robust prognostic markers as well as a widespread genomic landscape. More recently, studies of epigenetic, transcriptional modifications and next generation sequencing have allowed characterization of critical genes and pathways, clonal heterogeneity and mutational profiles involved in myelomagenesis. Altogether, these findings constitute important tools to develop new targeted and personalized therapies in MM.
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Affiliation(s)
- Raphaël Szalat
- Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States
| | - Nikhil C Munshi
- Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States; VA Boston Healthcare System, Boston, MA, United States.
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184
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Furukawa Y, Kikuchi J. Molecular pathogenesis of multiple myeloma. Int J Clin Oncol 2015; 20:413-22. [DOI: 10.1007/s10147-015-0837-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 04/21/2015] [Indexed: 12/31/2022]
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185
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Kuroda J, Kobayashi T, Taniwaki M. Prognostic indicators of lenalidomide for multiple myeloma: consensus and controversy. Expert Rev Anticancer Ther 2015; 15:787-804. [PMID: 25947283 DOI: 10.1586/14737140.2015.1044249] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The long-term outcome of multiple myeloma (MM) has been greatly improved through new agents, one being lenalidomide (LEN). Based upon the findings of in vitro experiments, its mode of action against MM occurs through a combination of direct tumoricidal effects on myeloma cells, modulatory effects on tumor immunity and tumor microenvironment-regulatory effects. However, it has not been clearly defined whether the clinical response and long-term outcome of MM with LEN treatment truly reflect the mechanisms of action of LEN proposed by in vitro studies. To ascertain what is known and what remains to be elucidated with LEN, we review the current literature on the mode of action of LEN in association with myeloma pathophysiology, and discuss the prognostic indicators in the treatment of MM with LEN.
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Affiliation(s)
- Junya Kuroda
- Department of Medicine, Division of Hematology and Oncology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-Ku, Kyoto, 602-8566, Japan
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186
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Jensen JL, Rakhmilevich A, Heninger E, Broman AT, Hope C, Phan F, Miyamoto S, Maroulakou I, Callander N, Hematti P, Chesi M, Bergsagel PL, Sondel P, Asimakopoulos F. Tumoricidal Effects of Macrophage-Activating Immunotherapy in a Murine Model of Relapsed/Refractory Multiple Myeloma. Cancer Immunol Res 2015; 3:881-90. [PMID: 25941352 DOI: 10.1158/2326-6066.cir-15-0025-t] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 04/22/2015] [Indexed: 12/23/2022]
Abstract
Myeloma remains a virtually incurable malignancy. The inevitable evolution of multidrug-resistant clones and widespread clonal heterogeneity limit the potential of traditional and novel therapies to eliminate minimal residual disease (MRD), a reliable harbinger of relapse. Here, we show potent anti-myeloma activity of macrophage-activating immunotherapy (αCD40+CpG) that resulted in prolongation of progression-free survival (PFS) and overall survival (OS) in an immunocompetent, preclinically validated, transplant-based model of multidrug-resistant, relapsed/refractory myeloma (t-Vκ*MYC). αCD40+CpG was effective in vivo in the absence of cytolytic natural killer, T, or B cells and resulted in expansion of M1-polarized (cytolytic/tumoricidal) macrophages in the bone marrow. Moreover, we show that concurrent loss/inhibition of Tpl2 kinase (Cot, Map3k8), a MAP3K that is recruited to activated CD40 complex and regulates macrophage activation/cytokine production, potentiated direct, ex vivo anti-myeloma tumoricidal activity of αCD40+CpG-activated macrophages, promoted production of antitumor cytokine IL12 in vitro and in vivo, and synergized with αCD40+CpG to further prolong PFS and OS in vivo. Our results support the combination of αCD40-based macrophage activation and TPL2 inhibition for myeloma immunotherapy. We propose that αCD40-mediated activation of innate antitumor immunity may be a promising approach to control/eradicate MRD following cytoreduction with traditional or novel anti-myeloma therapies.
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Affiliation(s)
- Jeffrey Lee Jensen
- Department of Medicine, Division of Hematology/Oncology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin. University of Wisconsin Carbone Cancer Center, Madison, Wisconsin
| | - Alexander Rakhmilevich
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin. Department of Human Oncology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Erika Heninger
- Department of Medicine, Division of Hematology/Oncology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin. University of Wisconsin Carbone Cancer Center, Madison, Wisconsin
| | - Aimee Teo Broman
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, Wisconsin
| | - Chelsea Hope
- Department of Medicine, Division of Hematology/Oncology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin. University of Wisconsin Carbone Cancer Center, Madison, Wisconsin
| | - Funita Phan
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin. Department of Oncology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Shigeki Miyamoto
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin. Department of Oncology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Ioanna Maroulakou
- Department of Molecular Biology and Genetics, Democritus University of Thrace, Alexandroupolis, Greece
| | - Natalie Callander
- Department of Medicine, Division of Hematology/Oncology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin. University of Wisconsin Carbone Cancer Center, Madison, Wisconsin
| | - Peiman Hematti
- Department of Medicine, Division of Hematology/Oncology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin. University of Wisconsin Carbone Cancer Center, Madison, Wisconsin
| | | | | | - Paul Sondel
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin. Department of Human Oncology, University of Wisconsin-Madison, Madison, Wisconsin. Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Fotis Asimakopoulos
- Department of Medicine, Division of Hematology/Oncology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin. University of Wisconsin Carbone Cancer Center, Madison, Wisconsin.
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187
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Danhof S, Schreder M, Strifler S, Einsele H, Knop S. Long-term disease control by pomalidomide-/dexamethasone-based therapy in a patient with advanced multiple myeloma: a case report and review of the literature. Case Rep Oncol 2015; 8:189-95. [PMID: 25969681 PMCID: PMC4427147 DOI: 10.1159/000381983] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Therapy for multiple myeloma (MM) has substantially improved in the era of immunomodulatory drugs and bortezomib. However, the prognosis of patients with progressive disease despite treatment with these ‘novel agents’ remains poor. Recently, pomalidomide was approved in this setting, but a median progression-free survival of <4 months still leaves room for improvement. Pomalidomide-based combination therapies are currently under investigation, but data on long-term treatment are lacking. Case Report We present the case of a 68-year-old woman with refractory MM who received pomalidomide in combination with various drugs including anthracyclines, alkylators and proteasome inhibitors. Initially, major hematological toxicities and infectious complications including a hepatitis B virus reactivation were encountered. With careful dose adjustments and selection of combination partners, pomalidomide treatment was maintained for over 4 years and led to a sustained partial remission. In particular, the well-tolerated regimen of bortezomib, cyclophosphamide and dexamethasone together with pomalidomide was administered for >30 cycles. Conclusion This case illustrates the value of an individualized approach to myeloma care given an increasing availability of ‘novel agents’. Tailored treatment using these drugs as a backbone is essential to achieve long-lasting responses and minimize side effects.
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Affiliation(s)
- Sophia Danhof
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Wuerzburg University Medical Center, Wuerzburg, Germany
| | - Martin Schreder
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Wuerzburg University Medical Center, Wuerzburg, Germany
| | - Susanne Strifler
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Wuerzburg University Medical Center, Wuerzburg, Germany
| | - Hermann Einsele
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Wuerzburg University Medical Center, Wuerzburg, Germany
| | - Stefan Knop
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Wuerzburg University Medical Center, Wuerzburg, Germany
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188
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Abstract
INTRODUCTION Smoldering multiple myeloma (SMM) is a heterogeneous clinical entity that defines patients in the spectrum of disease progression from monoclonal gammopathy of undetermined significance to multiple myeloma (MM). Current standard of care is observation until end organ damage occurs. In spite of this, the scientific community has begun to question whether the strategy of watchful waiting should be replaced with earlier therapeutic intervention with the ultimate goal of preventing clonal heterogeneity and end organ damage. AREAS COVERED In this review, we challenge the concept of observation as the best option of therapy in SMM. We present current data on diagnosis, prognostic factors of disease progression and studies that have been conducted to date to determine whether earlier therapeutic interventions will lead to an improvement in overall survival of patients with MM. EXPERT OPINION If the recommendations of treatment of SMM were to change, the scientific body of evidence would have to overcome four major hurdles: to demonstrate that early intervention leads to prolonged survival and delay in development of end organ damage, that it does not have long-term toxicities, that it is implemented in patients with a high-likelihood of developing myeloma and that it does not lead to the outgrowth of more resistant clones. Only well-designed clinical trials will determine whether cure can be achieved with earlier interventions.
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189
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The cellular origin and malignant transformation of Waldenström macroglobulinemia. Blood 2015; 125:2370-80. [DOI: 10.1182/blood-2014-09-602565] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 01/27/2015] [Indexed: 01/14/2023] Open
Abstract
Key Points
Benign (ie, IgM MGUS and smoldering WM) clonal B cells already harbor the phenotypic and molecular signatures of the malignant WM clone. Multistep transformation from benign (ie, IgM MGUS and smoldering WM) to malignant WM may require specific copy number abnormalities.
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190
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Pathogenesis beyond the cancer clone(s) in multiple myeloma. Blood 2015; 125:3049-58. [PMID: 25838343 DOI: 10.1182/blood-2014-11-568881] [Citation(s) in RCA: 200] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 03/09/2015] [Indexed: 02/06/2023] Open
Abstract
Over the past 4 decades, basic research has provided crucial information regarding the cellular and molecular biology of cancer. In particular, the relevance of cancer microenvironment (including both cellular and noncellular elements) and the concept of clonal evolution and heterogeneity have emerged as important in cancer pathogenesis, immunologic escape, and resistance to therapy. Multiple myeloma (MM), a cancer of terminally differentiated plasma cells, is emblematic of the impact of cancer microenvironment and the role of clonal evolution. Although genetic and epigenetic aberrations occur in MM and evolve over time under the pressure of exogenous stimuli, they are also largely present in premalignant plasma cell dyscrasia such as monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM), suggesting that genetic mutations alone are necessary, but not sufficient, for myeloma transformation. The role of bone marrow microenvironment in mediating survival, proliferation, and resistance to therapy in myeloma is well established; and although an appealing speculation, its role in fostering the evolution of MGUS or SMM into MM is yet to be proven. In this review, we discuss MM pathogenesis with a particular emphasis on the role of bone marrow microenvironment.
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191
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Longitudinal analysis of 25 sequential sample-pairs using a custom multiple myeloma mutation sequencing panel (M(3)P). Ann Hematol 2015; 94:1205-11. [PMID: 25743686 DOI: 10.1007/s00277-015-2344-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 02/22/2015] [Indexed: 01/31/2023]
Abstract
Recent advances in genomic sequencing technologies now allow results from deep next-generation sequencing to be obtained within clinically meaningful timeframes, making this an attractive approach to better guide personalized treatment strategies. No multiple myeloma-specific gene panel has been established so far; we therefore designed a 47-gene-targeting gene panel, containing 39 genes known to be mutated in ≥3 % of multiple myeloma cases and eight genes in pathways therapeutically targeted in multiple myeloma (MM). We performed targeted sequencing on tumor/germline DNA of 25 MM patients in which we also had a sequential sample post treatment. Mutation analysis revealed KRAS as the most commonly mutated gene (36 % in each time point), followed by NRAS (20 and 16 %), TP53 (16 and 16 %), DIS3 (16 and 16 %), FAM46C (12 and 16 %), and SP140 (12 and 12 %). We successfully tracked clonal evolution and identified mutation acquisition and/or loss in FAM46C, FAT1, KRAS, NRAS, SPEN, PRDM1, NEB, and TP53 as well as two mutations in XBP1, a gene associated with bortezomib resistance. Thus, we present the first longitudinal analysis of a MM-specific targeted sequencing gene panel that can be used for individual tumor characterization and for tracking clonal evolution over time.
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192
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Pawlyn C, Kaiser MF, Davies FE, Morgan GJ. Current and potential epigenetic targets in multiple myeloma. Epigenomics 2015; 6:215-28. [PMID: 24811790 DOI: 10.2217/epi.14.12] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Despite recent advances in therapy, subgroups of multiple myeloma continue to have a poor prognosis. Numerous epigenetic changes have been described and occur as both etiologic and secondary events, making myeloma a good disease in which to understand the role of epigenetic therapies. Here, we describe a number of current and potential epigenetic targets in myeloma.
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Affiliation(s)
- Charlotte Pawlyn
- Centre for Myeloma Research, Institute of Cancer Research, 15 Cotswold Rd, Sutton, SM2 5NG, UK
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193
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Weißbach S, Langer C, Puppe B, Nedeva T, Bach E, Kull M, Bargou R, Einsele H, Rosenwald A, Knop S, Leich E. The molecular spectrum and clinical impact of DIS3 mutations in multiple myeloma. Br J Haematol 2014; 169:57-70. [PMID: 25521164 DOI: 10.1111/bjh.13256] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 11/04/2014] [Indexed: 01/09/2023]
Abstract
Multiple myeloma (MM) is a plasma cell neoplasm that presents with a major biological and clinical heterogeneity. We here investigated the spectrum of clonal and subclonal mutations of DIS3, an active part of the exosome complex, that may play a role in the development or progression of MM. The whole coding sequence of DIS3 was subjected to deep sequencing in 81 uniformly-treated MM patients and 12 MM cell lines and the overall occurrence of DIS3 mutations as well as the presence of DIS3 mutations in minor and major subclones were correlated with cytogenetic alterations and clinical parameters. Our study identified DIS3 mutations in 9/81 patients that were associated with 13q14 deletions and IGH translocations on the cytogenetic level. Specifically, we detected seven novel somatic DIS3 single nucleotide variants (SNVs) and defined three hot spot mutations within the RNB domain. Lastly, we found a trend towards a shorter median overall survival for patients with DIS3 mutations, and patients carrying DIS3 mutations in minor subclones of their tumours showed a significantly worse response to therapy compared to patients with DIS3 mutations in the major subclone.
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Affiliation(s)
- Susann Weißbach
- Institute of Pathology, University of Würzburg, Comprehensive Cancer Center Mainfranken (CCC MF), Würzburg, Germany
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194
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Ghobrial IM, Landgren O. How I treat smoldering multiple myeloma. Blood 2014; 124:3380-8. [PMID: 25298034 PMCID: PMC4246036 DOI: 10.1182/blood-2014-08-551549] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 09/23/2014] [Indexed: 11/20/2022] Open
Abstract
Smoldering myeloma is a heterogeneous clinical entity where a subset of patients has an indolent course of disease that mimics monoclonal gammopathy of undermined significance, whereas others have a more aggressive course that has been described as "early myeloma." It is defined as either serum M-protein ≥ 3 g/L or ≥ 10% monoclonal plasma cells in the bone marrow. There are currently no molecular factors to differentiate risks of progression for these patients. Current recommendations of therapy continue to be patient observation or patient enrollment in clinical trials. However, new definitions of active multiple myeloma recently agreed upon by the International Myeloma Working Group may alter the timing of therapy. On the basis of emerging data of therapy in these patients, it seems reasonable to believe that future recommendations for therapy of patients with smoldering myeloma will become an increasingly important topic. In this article, we review the current knowledge of this disease and risk factors associated with progression. We also examine biological insights and alterations that occur in the tumor clone and the surrounding bone marrow niche. Finally, we review clinical trials that have been performed in these patients and provide recommendations for follow-up of patients with this unique disease entity.
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Affiliation(s)
- Irene M Ghobrial
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; and
| | - Ola Landgren
- Memorial Sloan Kettering Cancer Center, New York, NY
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195
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Coexistent hyperdiploidy does not abrogate poor prognosis in myeloma with adverse cytogenetics and may precede IGH translocations. Blood 2014; 125:831-40. [PMID: 25428216 DOI: 10.1182/blood-2014-07-584268] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The acquisition of the cytogenetic abnormalities hyperdiploidy or translocations into the immunoglobulin gene loci are considered as initiating events in the pathogenesis of myeloma and were often assumed to be mutually exclusive. These lesions have clinical significance; hyperdiploidy or the presence of the t(11;14) translocation is associated with a favorable outcome, whereas t(4;14), t(14;16), and t(14;20) are unfavorable. Poor outcomes are magnified when lesions occur in association with other high-risk features, del17p and +1q. Some patients have coexistence of both good and poor prognostic lesions, and there has been no consensus on their risk status. To address this, we have investigated their clinical impact using cases in the Myeloma IX study (ISRCTN68454111) and shown that the coexistence of hyperdiploidy or t(11;14) does not abrogate the poor prognosis associated with adverse molecular lesions, including translocations. We have also used single-cell analysis to study cases with coexistent translocations and hyperdiploidy to determine how these lesions cosegregate within the clonal substructure, and we have demonstrated that hyperdiploidy may precede IGH translocation in a proportion of patients. These findings have important clinical and biological implications, as we conclude patients with coexistence of adverse lesions and hyperdiploidy should be considered high risk and treated accordingly.
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196
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Ahn IE, Mailankody S, Korde N, Landgren O. Dilemmas in treating smoldering multiple myeloma. J Clin Oncol 2014; 33:115-23. [PMID: 25422486 DOI: 10.1200/jco.2014.56.4351] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Novel therapies hold promise for high-risk smoldering multiple myeloma (SMM). Recent studies suggest that modern combination approaches can be options for high-risk SMM to obtain deep molecular responses with favorable toxicity profiles. Although pioneering treatment trials based on small numbers of patients suggest progression-free and overall survival benefits, application of the data to real-life practice remains to be validated. Therapeutic modulation of disease tempo, disease burden, clonal evolution, and tumor microenvironment in SMM remains to be understood and calls for reliable biomarkers reflective of disease biology. Here, we review studies that open a new management platform for SMM, address ongoing dilemmas in practice and under investigation, and highlight emerging scientific questions in the era of SMM treatment.
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Affiliation(s)
- Inhye E Ahn
- Inhye Ahn and Sham Mailankody, the National Cancer Institute, National Institutes of Health, Bethesda, MD; Neha Korde and Ola Landgren, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sham Mailankody
- Inhye Ahn and Sham Mailankody, the National Cancer Institute, National Institutes of Health, Bethesda, MD; Neha Korde and Ola Landgren, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Neha Korde
- Inhye Ahn and Sham Mailankody, the National Cancer Institute, National Institutes of Health, Bethesda, MD; Neha Korde and Ola Landgren, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ola Landgren
- Inhye Ahn and Sham Mailankody, the National Cancer Institute, National Institutes of Health, Bethesda, MD; Neha Korde and Ola Landgren, Memorial Sloan Kettering Cancer Center, New York, NY.
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197
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Bianchi G, Ghobrial IM. Biological and Clinical Implications of Clonal Heterogeneity and Clonal Evolution in Multiple Myeloma. CURRENT CANCER THERAPY REVIEWS 2014; 10:70-79. [PMID: 25705146 PMCID: PMC4334389 DOI: 10.2174/157339471002141124121404] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Clonal heterogeneity and clonal evolution have emerged as critical concepts in the field of oncology over the past four decades, largely thanks to the implementation of novel technologies such as comparative genomic hybridization, whole genome/exome sequencing and epigenetic analysis. Along with the identification of cancer stem cells in the majority of neoplasia, the recognition of intertumor and intratumor variability has provided a novel perspective to understand the mechanisms behind tumor evolution and its implication in terms of treatment failure and cancer relapse or recurrence. First hypothesized over two decades ago, clonal heterogeneity and clonal evolution have been confirmed in multiple myeloma (MM), an incurable cancer of plasma cells, almost universally preceded by a pre-malignant conditioned named monoclonal gammopathy of undetermined significance (MGUS). The genetic events and molecular mechanisms underlying such evolution have been difficult to dissect. Moreover, while a role for the bone marrow microenvironment in supporting MM cell survival, proliferation and drug-resistance has been well established, whether it is directly involved in driving evolution from MGUS to MM is at present unclear. We present in this review a historical excursus on the concepts of clonal heterogeneity and clonal evolution in MM with a special emphasis on their role in the progression from MGUS to MM; the contribution of the microenvironment; and the clinical implications in terms of resistance to treatment and disease relapse/recurrence.
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Affiliation(s)
- Giada Bianchi
- Dana-Farber Cancer Institute, Department of Medical Oncology, Harvard Medical School, 450 Brookline Avenue, Boston, MA 02215, USA
| | - Irene M Ghobrial
- Dana-Farber Cancer Institute, Department of Medical Oncology, Harvard Medical School, 450 Brookline Avenue, Boston, MA 02215, USA
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198
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Rashid NU, Sperling AS, Bolli N, Wedge DC, Van Loo P, Tai YT, Shammas MA, Fulciniti M, Samur MK, Richardson PG, Magrangeas F, Minvielle S, Futreal PA, Anderson KC, Avet-Loiseau H, Campbell PJ, Parmigiani G, Munshi NC. Differential and limited expression of mutant alleles in multiple myeloma. Blood 2014; 124:3110-7. [PMID: 25237203 PMCID: PMC4231420 DOI: 10.1182/blood-2014-04-569327] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 09/03/2014] [Indexed: 11/20/2022] Open
Abstract
Recent work has delineated mutational profiles in multiple myeloma and reported a median of 52 mutations per patient, as well as a set of commonly mutated genes across multiple patients. In this study, we have used deep sequencing of RNA from a subset of these patients to evaluate the proportion of expressed mutations. We find that the majority of previously identified mutations occur within genes with very low or no detectable expression. On average, 27% (range, 11% to 47%) of mutated alleles are found to be expressed, and among mutated genes that are expressed, there often is allele-specific expression where either the mutant or wild-type allele is suppressed. Even in the absence of an overall change in gene expression, the presence of differential allelic expression within malignant cells highlights the important contribution of RNA-sequencing in identifying clinically significant mutational changes relevant to our understanding of myeloma biology and also for therapeutic applications.
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Affiliation(s)
- Naim U Rashid
- Jerome Lipper Multiple Myeloma Center, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Department of Biostatistics, Dana-Farber Cancer Institute and Harvard School of Public Health, Boston, MA
| | - Adam S Sperling
- Jerome Lipper Multiple Myeloma Center, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Niccolo Bolli
- Department of Cancer Genetics and Genomics, Cancer Genome Project, Wellcome Trust Sanger Institute, Hinxton, United Kingdom; Department of Haematology, University of Cambridge, Cambridge Institute for Medical Research, Cambridge, United Kingdom
| | - David C Wedge
- Department of Cancer Genetics and Genomics, Cancer Genome Project, Wellcome Trust Sanger Institute, Hinxton, United Kingdom
| | - Peter Van Loo
- Department of Cancer Genetics and Genomics, Cancer Genome Project, Wellcome Trust Sanger Institute, Hinxton, United Kingdom; Department of Human Genetics, Vlaams Instituut voor Biotechnologie and University of Leuven, Leuven, Belgium
| | - Yu-Tzu Tai
- Jerome Lipper Multiple Myeloma Center, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Masood A Shammas
- Jerome Lipper Multiple Myeloma Center, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Department of Hematology/Oncology, Boston Veterans Administration Healthcare System, West Roxbury, MA
| | - Mariateresa Fulciniti
- Jerome Lipper Multiple Myeloma Center, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Mehmet K Samur
- Jerome Lipper Multiple Myeloma Center, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Department of Biostatistics, Dana-Farber Cancer Institute and Harvard School of Public Health, Boston, MA
| | - Paul G Richardson
- Jerome Lipper Multiple Myeloma Center, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Florence Magrangeas
- Hematology Department, Centre de Recherche en Cancérologie Nantes-Angers Unité Mixte de Recherche INSERM 892-Centre National de la Recherche Scientifique 6299 and Institut de Recherche Thérapeutique de l'Université de Nantes, Nantes, France
| | - Stephane Minvielle
- Hematology Department, Centre de Recherche en Cancérologie Nantes-Angers Unité Mixte de Recherche INSERM 892-Centre National de la Recherche Scientifique 6299 and Institut de Recherche Thérapeutique de l'Université de Nantes, Nantes, France
| | - P Andrew Futreal
- Department of Genomic Medicine, MD Anderson Cancer Center, Houston, TX
| | - Kenneth C Anderson
- Jerome Lipper Multiple Myeloma Center, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Herve Avet-Loiseau
- Unité de Génomique du Myélome, Centre Hospitalier Universitaire Rangueil, Toulouse, France; and Centre de Recherche en Cancérologie de Toulouse, INSERM U1037, Toulouse, France
| | - Peter J Campbell
- Department of Cancer Genetics and Genomics, Cancer Genome Project, Wellcome Trust Sanger Institute, Hinxton, United Kingdom; Department of Haematology, University of Cambridge, Cambridge Institute for Medical Research, Cambridge, United Kingdom
| | - Giovanni Parmigiani
- Department of Biostatistics, Dana-Farber Cancer Institute and Harvard School of Public Health, Boston, MA
| | - Nikhil C Munshi
- Jerome Lipper Multiple Myeloma Center, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Department of Hematology/Oncology, Boston Veterans Administration Healthcare System, West Roxbury, MA
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199
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Paíno T, Paiva B, Sayagués JM, Mota I, Carvalheiro T, Corchete LA, Aires-Mejía I, Pérez JJ, Sanchez ML, Barcena P, Ocio EM, San-Segundo L, Sarasquete ME, García-Sanz R, Vidriales MB, Oriol A, Hernández MT, Echeveste MA, Paiva A, Blade J, Lahuerta JJ, Orfao A, Mateos MV, Gutiérrez NC, San-Miguel JF. Phenotypic identification of subclones in multiple myeloma with different chemoresistant, cytogenetic and clonogenic potential. Leukemia 2014; 29:1186-94. [DOI: 10.1038/leu.2014.321] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 10/31/2014] [Accepted: 11/04/2014] [Indexed: 01/06/2023]
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200
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Bianchi G, Anderson KC. Understanding biology to tackle the disease: Multiple myeloma from bench to bedside, and back. CA Cancer J Clin 2014; 64:422-44. [PMID: 25266555 DOI: 10.3322/caac.21252] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 08/21/2014] [Accepted: 08/21/2014] [Indexed: 02/01/2023] Open
Abstract
Multiple myeloma (MM) is a cancer of antibody-producing plasma cells. The pathognomonic laboratory finding is a monoclonal immunoglobulin or free light chain in the serum and/or urine in association with bone marrow infiltration by malignant plasma cells. MM develops from a premalignant condition, monoclonal gammopathy of undetermined significance (MGUS), often via an intermediate stage termed smoldering multiple myeloma (SMM), which differs from active myeloma by the absence of disease-related end-organ damage. Unlike MGUS and SMM, active MM requires therapy. Over the past 6 decades, major advancements in the care of MM patients have occurred, in particular, the introduction of novel agents (ie, proteasome inhibitors, immunomodulatory agents) and the implementation of hematopoietic stem cell transplantation in suitable candidates. The effectiveness and good tolerability of novel agents allowed for their combined use in induction, consolidation, and maintenance therapy, resulting in deeper and more sustained clinical response and extended progression-free and overall survival. Previously a rapidly lethal cancer with few therapeutic options, MM is the hematologic cancer with the most novel US Food and Drug Administration-approved drugs in the past 15 years. These advances have resulted in more frequent long-term remissions, transforming MM into a chronic illness for many patients.
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Affiliation(s)
- Giada Bianchi
- Hematology Oncology Fellow, Jerome Lipper Multiple Myeloma Center and LeBow Institute for Myeloma Therapeutics, Department of Medical Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
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