201
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Gounari E, Tsavdaridou V, Koletsa T, Nikolaidou A, Kaiafa G, Papaioannou M, Kostopoulos I, Skoura L. Utility of hematology analyzer and flow cytometry in timely and correct detection of circulating plasma cells: Report of three cases. CYTOMETRY PART B-CLINICAL CYTOMETRY 2015; 90:531-537. [PMID: 26663635 DOI: 10.1002/cyto.b.21350] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 11/21/2015] [Accepted: 12/04/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Circulating neoplastic plasma cells (PCs) are a common feature between classical plasma cell myeloma (PCM) and its aggressive variant, plasma cell leukemia (PCL), with their early suspicion and detection being of clinical importance for prognostic and diagnostic purposes. METHODS Morphological and flow cytometric enumeration and characterization of peripheral blood (PB) neoplastic PCs were performed in 3 PCM patients after complete blood count (CBC) evaluation. RESULTS Early suspicion of circulating PCs by initial CBC scatter plots and monocytosis led to morphological enumeration of PCs, with low level of concordance between morphologists. Flow cytometric PB analysis permitted accurate quantification and characterization of circulating clonal PCs. CONCLUSIONS CBC findings can prompt early suspicion of circulating PCs in PCM patients leading to early and accurate flow cytometric analysis of clonal PCs in addition to morphological PB evaluation. The suggested combined approach proved to be most important in the PCL case with discordant morphological evaluations and marginal PC numbers according to current criteria. © 2016 International Clinical Cytometry Society.
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Affiliation(s)
- Evdoxia Gounari
- Immunology Department, Microbiology Laboratory, AHEPA University Hospital, Thessaloniki, Greece
| | - Vasiliki Tsavdaridou
- Immunology Department, Microbiology Laboratory, AHEPA University Hospital, Thessaloniki, Greece
| | - Triantafyllia Koletsa
- Pathology Department, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Androula Nikolaidou
- Haematology Department, Microbiology Laboratory, AHEPA University Hospital, Thessaloniki, Greece
| | - Georgia Kaiafa
- Haematology Department, First Propedeutic Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Papaioannou
- Haematology Department, First Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Kostopoulos
- Pathology Department, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Lemonia Skoura
- Immunology Department, Microbiology Laboratory, AHEPA University Hospital, Thessaloniki, Greece
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202
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Hsu P, Lin TW, Gau JP, Yu YB, Hsiao LT, Tzeng CH, Chen PM, Chiou TJ, Liu JH, Liu YC, Liu CJ. Risk of Early Mortality in Patients With Newly Diagnosed Multiple Myeloma. Medicine (Baltimore) 2015; 94:e2305. [PMID: 26683968 PMCID: PMC5058940 DOI: 10.1097/md.0000000000002305] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The overall survival of patients with multiple myeloma (MM) has been improved greatly over the last 2 decades with the broader use of novel drugs and autologous tandem transplantation. However, more than one tenth of myeloma patients still die shortly after diagnosis. We therefore aim to investigate the risk factors of early mortality (death within 60 days after diagnosis) in patients with MM. We included in this study 451 consecutive patients with MM, newly diagnosed at an Asian tertiary medical center between January 1, 2002 and April 30, 2015. A total of 57 subjects who experienced early mortality were identified. Risk factors for early mortality in myeloma patients were collected and analyzed. Early mortality occurred in 57 (12.6%) of the myeloma patients. In the multivariate analysis, being male (adjusted OR 2.93, 95% CI 1.17-7.31), serum albumin < 3.5 g/dL (adjusted OR 2.71, 95% CI 1.09-6.74), primary plasma cell leukemia (adjusted OR 17.61, 95% CI 1.01-306.05), serum albumin (adjusted OR 2.70, 95% CI 1.15-6.38), corrected serum calcium ≥ 12 mg/dL (adjusted OR 2.94, 95% CI 1.21-7.14), and LDH ≥ 250 U/L (adjusted OR 3.07, 95% CI 1.50-6.27) were identified as independent risk factors of early mortality. Pneumonia with other infections contributed most to early mortality (n = 36, 65%), followed by renal failure and cardiac failure. The early mortality rate is high (12.6%) in patients with MM. Patients who are male and those with primary plasma cell leukemia, low serum albumin, high-corrected serum calcium, or LDH are at risk of early mortality. Nearly two thirds of the myeloma patients who experienced early mortality in our study (37 of 57, 65%) died of infection. Once a high-risk group is identified, much effort is required to target new approaches for prevention, early detection, and treatment of infections.
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Affiliation(s)
- Pei Hsu
- From the Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital (PH, J-PG, Y-BY, L-TH, C-HT, P-MC, J-HL, Y-CL, C-JL), School of Medicine, National Yang-Ming University (T-WL, J-PG, Y-BY, L-TH, C-HT, P-MC, T-JC, J-HL, Y-CL, C-JL), Department of Medical Education, Taipei Veterans General Hospital (T-WL), Institute of Public Health, National Yang-Ming University (C-JL); and Division of Transfusion Medicine, Taipei Veterans General Hospital, Taipei, Taiwan (T-JC); Department of Medicine of Yang-Ming Branch, Taipei City Hospital, Taipei, Taiwan (Y-CL)
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203
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Marshall R, Vaughan J, David R, Schapkaitz E, Carmona S, Wiggill T. Primary plasma cell leukaemia in a 22-year-old woman: A case
report. Afr J Lab Med 2015; 4:289. [PMID: 38440312 PMCID: PMC10911651 DOI: 10.4102/ajlm.v4i1.289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 08/18/2015] [Indexed: 03/06/2024] Open
Abstract
Introduction Primary plasma cell leukaemia is a rare and highly aggressive disease that is commonly diagnosed a decade earlier than multiple myeloma, at a median age of 55 years. However, it has also been described in younger patients, as documented in this case report. It often presents with hepatosplenomegaly and lymphadenopathy, whilst the presence of bony lesions are less-commonly seen when compared to multiple myeloma. Case presentation This report describes the case of a young woman who presented with symptoms of anaemia and a history of menorrhagia. On further careful examination, she was found to have additional signs and symptoms and was later diagnosed with primary plasma cell leukaemia. Management and outcome On admission, the patient received supportive care measures, including blood products. At diagnosis, a specific chemotherapy regimen was commenced; however, this failed to induce remission. The decision to continue with supportive care only was made and the patient died seven months later. Discussion This case study is presented because of its rarity, the young age of the patient at presentation and the unusual clinical and laboratory findings. Persistent anaemia unresponsive to standard treatment should raise the index of suspicion and further investigations directed to exclude malignancies should be considered.
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Affiliation(s)
- Robyn Marshall
- Department of Molecular Medicine and Haematology,
University of the Witwatersrand, Johannesburg, South Africa
- National Health Laboratory Service, Johannesburg, South
Africa
| | - Jenifer Vaughan
- Department of Molecular Medicine and Haematology,
University of the Witwatersrand, Johannesburg, South Africa
- National Health Laboratory Service, Johannesburg, South
Africa
| | - Ria David
- Department of Molecular Medicine and Haematology,
University of the Witwatersrand, Johannesburg, South Africa
- Division of Medical Oncology, Department of Internal
Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Elise Schapkaitz
- Department of Molecular Medicine and Haematology,
University of the Witwatersrand, Johannesburg, South Africa
- National Health Laboratory Service, Johannesburg, South
Africa
| | - Sergio Carmona
- Department of Molecular Medicine and Haematology,
University of the Witwatersrand, Johannesburg, South Africa
- National Health Laboratory Service, Johannesburg, South
Africa
| | - Tracey Wiggill
- Department of Molecular Medicine and Haematology,
University of the Witwatersrand, Johannesburg, South Africa
- National Health Laboratory Service, Johannesburg, South
Africa
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204
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Iriuchishima H, Ozaki S, Konishi J, Matsumoto M, Murayama K, Nakamura F, Yamamoto G, Handa H, Saitoh T, Nagura E, Shimizu K, Nojima Y, Murakami H. Primary Plasma Cell Leukemia in the Era of Novel Agents: A Multicenter Study of the Japanese Society of Myeloma. Acta Haematol 2015; 135:113-21. [PMID: 26505781 DOI: 10.1159/000439424] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 08/16/2015] [Indexed: 11/19/2022]
Abstract
We investigated the treatment and outcome of Japanese patients with primary plasma cell leukemia (pPCL) in the era of novel agents and analyzed the risk factors affecting survival. Among 3,318 patients with symptomatic multiple myeloma (MM), 38 patients were diagnosed with pPCL. The median overall survival (OS) of the pPCL patients was 2.85 years, which was significantly extended compared with that in previous reports. The proportion of patients treated with novel agents was 61%. The OS of the patients treated with novel agents was significantly extended compared with that of patients treated without novel agents according to the generalized Wilcoxon test (2.85 vs. 1.16 years, p = 0.049). This statistical finding suggests that treatment with novel agents could have prevented early death in the patients with pPCL. Age was the only statistically significant prognostic factor associated with an inferior OS (hazard ratio 4.57). Five patients received maintenance therapy with novel agents, and their OS tended to be longer than that of the other patients without maintenance (4.45 vs. 2.85 years). Unlike MM, OS for pPCL has not been improved significantly over the last decade, especially in elderly patients. Therefore, it is important to establish the treatment strategy, particularly after induction treatment.
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Affiliation(s)
- Hirono Iriuchishima
- Department of Medicine and Clinical Science, Gunma University Graduate School of Medicine, Maebashi, Japan
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205
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Musto P. Novel Agents for the Treatment of Primary Plasma-Cell Leukemia: Lights and Shadows. Acta Haematol 2015; 135:110-2. [PMID: 26506015 DOI: 10.1159/000441345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 09/24/2015] [Indexed: 11/19/2022]
Affiliation(s)
- Pellegrino Musto
- IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero in Vulture, Italy
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206
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Colombo M, Galletti S, Garavelli S, Platonova N, Paoli A, Basile A, Taiana E, Neri A, Chiaramonte R. Notch signaling deregulation in multiple myeloma: A rational molecular target. Oncotarget 2015; 6:26826-40. [PMID: 26308486 PMCID: PMC4694956 DOI: 10.18632/oncotarget.5025] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 08/03/2015] [Indexed: 12/16/2022] Open
Abstract
Despite recent therapeutic advances, multiple myeloma (MM) is still an incurable neoplasia due to intrinsic or acquired resistance to therapy. Myeloma cell localization in the bone marrow milieu allows direct interactions between tumor cells and non-tumor bone marrow cells which promote neoplastic cell growth, survival, bone disease, acquisition of drug resistance and consequent relapse. Twenty percent of MM patients are at high-risk of treatment failure as defined by tumor markers or presentation as plasma cell leukemia. Cumulative evidences indicate a key role of Notch signaling in multiple myeloma onset and progression. Unlike other Notch-related malignancies, where the majority of patients carry gain-of-function mutations in Notch pathway members, in MM cell Notch signaling is aberrantly activated due to an increased expression of Notch receptors and ligands; notably, this also results in the activation of Notch signaling in surrounding stromal cells which contributes to myeloma cell proliferation, survival and migration, as well as to bone disease and intrinsic and acquired pharmacological resistance. Here we review the last findings on the mechanisms and the effects of Notch signaling dysregulation in MM and provide a rationale for a therapeutic strategy aiming at inhibiting Notch signaling, along with a complete overview on the currently available Notch-directed approaches.
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Affiliation(s)
- Michela Colombo
- Department of Health Sciences, Università degli Studi di Milano, 20142 Milano, Italy
| | - Serena Galletti
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano; Hematology, Fondazione Cà Granda IRCCS Policlinico, 20122 Milano, Italy
| | - Silvia Garavelli
- Department of Health Sciences, Università degli Studi di Milano, 20142 Milano, Italy
| | - Natalia Platonova
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano; Hematology, Fondazione Cà Granda IRCCS Policlinico, 20122 Milano, Italy
| | - Alessandro Paoli
- Department of Health Sciences, Università degli Studi di Milano, 20142 Milano, Italy
| | - Andrea Basile
- Department of Health Sciences, Università degli Studi di Milano, 20142 Milano, Italy
| | - Elisa Taiana
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano; Hematology, Fondazione Cà Granda IRCCS Policlinico, 20122 Milano, Italy
| | - Antonino Neri
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano; Hematology, Fondazione Cà Granda IRCCS Policlinico, 20122 Milano, Italy
| | - Raffaella Chiaramonte
- Department of Health Sciences, Università degli Studi di Milano, 20142 Milano, Italy
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207
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Wong KY, Chim CS. DNA methylation of tumor suppressor protein-coding and non-coding genes in multiple myeloma. Epigenomics 2015; 7:985-1001. [DOI: 10.2217/epi.15.57] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Multiple myeloma is an incurable hematological malignancy arising from immortalized plasma cells in the bone marrow. DNA methylation refers to the catalytic addition of a methyl group to the cytosine ring of a CpG dinucleotide. Methylation of a promoter-associated CpG island, a cluster of CpG dinucleotides, may lead to silencing of the associated gene. In carcinogenesis, methylation of protein-coding or non-coding tumor suppressor genes/miRNAs is associated with transcriptional silencing, loss of tumor suppressor function and prognostic significance. This review first introduces pathogenesis of myeloma and DNA methylation in cancer. Then, it summarizes methylation of protein-coding tumor suppressor genes, especially, the latest genome-wide methylation studies in myeloma, followed by the latest findings of methylation of non-coding tumor suppressor miRNAs in myeloma.
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Affiliation(s)
- Kwan Yeung Wong
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Chor Sang Chim
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam, Hong Kong
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208
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Molecular Classification and Pharmacogenetics of Primary Plasma Cell Leukemia: An Initial Approach toward Precision Medicine. Int J Mol Sci 2015; 16:17514-34. [PMID: 26263974 PMCID: PMC4581206 DOI: 10.3390/ijms160817514] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Revised: 07/21/2015] [Accepted: 07/22/2015] [Indexed: 12/20/2022] Open
Abstract
Primary plasma cell leukemia (pPCL) is a rare and aggressive variant of multiple myeloma (MM) which may represent a valid model for high-risk MM. This disease is associated with a very poor prognosis, and unfortunately, it has not significantly improved during the last three decades. New high-throughput technologies have allowed a better understanding of the molecular basis of this disease and moved toward risk stratification, providing insights for targeted therapy studies. This knowledge, added to the pharmacogenetic profile of new and old agents in the analysis of efficacy and safety, could contribute to help clinical decisions move toward a precision medicine and a better clinical outcome for these patients. In this review, we describe the available literature concerning the genomic characterization and pharmacogenetics of plasma cell leukemia (PCL).
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209
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Agarwal A, Klair J, Patolia S, Meena NK. Intrapleural cisplatin for management of malignant pleural effusion in a patient with plasma cell leucaemia. BMJ Case Rep 2015; 2015:bcr-2015-210044. [PMID: 26123465 DOI: 10.1136/bcr-2015-210044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Plasma cell leucaemia (PCL) is a rare aggressive form of multiple myeloma. It occasionally involves the pleura, causing malignant pleural effusion (MPE). MPE presents a management dilemma for physicians, given the different treatment options available with varying efficacy and side effects. We report a case of a 64-year-old man with MPE due to PCL, successfully managed with intrapleural cisplatin and a tunnelled pleural catheter. We believe this to be the first report of management of PCL-associated MPE with intrapleural cisplatin.
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Affiliation(s)
| | - Jagpal Klair
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Setu Patolia
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Nikhil K Meena
- Department of Pulmonary and Critical Care Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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210
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Localized Relapse of Primary Plasma Cell Leukaemia in the Central Nervous System. Case Rep Hematol 2015; 2015:273565. [PMID: 26064713 PMCID: PMC4441999 DOI: 10.1155/2015/273565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 04/17/2015] [Indexed: 12/14/2022] Open
Abstract
Primary plasma cell leukaemia (pPCL) is a rare and aggressive form of plasma cell malignancies with a very poor prognosis. Compared to other plasma cell malignancies the tendency to extramedullary spread is increased; however central nervous system (CNS) involvement is rare and only reported in few cases. We report the case of a 61-year-old man who was diagnosed with pPCL and achieved a complete remission after autologous stem cell transplantation but had a relapse in the CNS without systemic disease.
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211
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Plasma cell leukemia: Clinicopathologic, immunophenotypic and cytogenetic characteristics of 4 cases. Hematol Oncol Stem Cell Ther 2015; 8:71-7. [PMID: 25929729 DOI: 10.1016/j.hemonc.2015.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 03/28/2015] [Accepted: 04/04/2015] [Indexed: 12/19/2022] Open
Abstract
Plasma cell leukemia (PCL) is a rare hematologic malignancy with very poor outcome. It is defined by the presence of >2 × 10(9)/L plasma cells or >20% plasmacytosis of the differential white cell count in the peripheral blood. Primary PCL is first diagnosed in the leukemic phase, while secondary PCL corresponds to the leukemic transformation of a previously diagnosed multiple myeloma (MM). The incidence of PCL ranges between 2-4% of patients with MM and 0.9% of patients with acute leukemia. In this case series, we describe the clinicopathologic, immunophenotypic, and cytogenetic findings of four patients diagnosed with PCL within a ten-year period (2002-2012) at King Faisal Specialist Hospital and Research Centre (General Organization), Riyadh, Saudi Arabia.
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212
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Plasma cell morphology in multiple myeloma and related disorders. Morphologie 2015; 99:38-62. [PMID: 25899140 DOI: 10.1016/j.morpho.2015.02.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 02/23/2015] [Indexed: 12/28/2022]
Abstract
Normal and reactive plasma cells (PC) are easy to ascertain on human bone marrow films, due to their small mature-appearing nucleus and large cytoplasm, the latter usually deep blue after Giemsa staining. Cytoplasm is filled with long strands of rough endoplasmic reticulum and one large Golgi apparatus (paranuclear hof), demonstrating that PC are dedicated mainly to protein synthesis and excretion (immunoglobulin). Deregulation of the genome may induce clonal expansion of one PC that will lead to immunoglobulin overproduction and eventually to one among the so-called PC neoplasms. In multiple myeloma (MM), the number of PC is over 10% in most patients studied. Changes in the morphology of myeloma PC may be inconspicuous as compared to normal PC (30-50% patients). In other instances PC show one or several morphological changes. One is related to low amount of cytoplasm, defining lymphoplasmacytoid myeloma (10-15% patients). In other cases (40-50% patients), named immature myeloma cases, nuclear-cytoplasmic asynchrony is observed: presence of one nucleolus, finely dispersed chromatin and/or irregular nuclear contour contrast with a still large and blue (mature) cytoplasm. A peculiar morphological change, corresponding to the presence of very immature PC named plasmablasts, is observed in 10-15% cases. Several prognostic morphological classifications have been published, as mature myeloma is related to favorable outcome and immature myeloma, peculiarly plasmablastic myeloma, is related to dismal prognosis. However, such classifications are no longer included in current prognostic schemes. Changes related to the nucleus are very rare in monoclonal gammopathy of unknown significance (MGUS). In contrast, anomalies related to the cytoplasm of PC, including color (flaming cells), round inclusions (Mott cells, Russell bodies), Auer rod-like or crystalline inclusions, are reported in myeloma cases as well as in MGUS and at times in reactive disorders. They do not correspond to malignant changes of PC but are related to abnormal synthesis, trafficking, or excretion of the immunoglobulin that is stored in excess within the cytoplasm. Occurrence of crystalline inclusions within PC may be the first anomaly leading to the diagnosis of adult Fanconi syndrome. After a historical perspective, the authors report on the various morphological aspects of PC that may occur in multiple myeloma and related disorders, and discuss about their clinical and pathophysiological significance. Today, morphological identification and accurate determination of % PC within bone marrow remain ancillary criteria for the diagnosis of MM and help for the diagnosis of rare renal disorders.
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213
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Jelinek T, Kryukov F, Rihova L, Hajek R. Plasma cell leukemia: from biology to treatment. Eur J Haematol 2015; 95:16-26. [DOI: 10.1111/ejh.12533] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2014] [Indexed: 12/15/2022]
Affiliation(s)
- Tomas Jelinek
- University Hospital Ostrava; Department of Haematooncology; Ostrava Czech Republic
| | - Fedor Kryukov
- University of Ostrava; Faculty of Medicine; Ostrava Czech Republic
| | - Lucie Rihova
- University Hospital Brno; Department of Clinical Haematology; Brno Czech Republic
| | - Roman Hajek
- University Hospital Ostrava; Department of Haematooncology; Ostrava Czech Republic
- University of Ostrava; Faculty of Medicine; Ostrava Czech Republic
- University Hospital Brno; Department of Clinical Haematology; Brno Czech Republic
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214
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Vyhlídalová I, Uherková L, Pleschnerová M, Špička I, Březinová J, Michalová K, Čermáková K, Polanská V, Jedelský PL, Hamšíková E, Kuželová K, Stöckbauer P. Characterization of a new human plasma cell leukemia cell line UHKT-944. Eur J Haematol 2015; 95:352-60. [PMID: 25600340 DOI: 10.1111/ejh.12505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE A new interleukin-6 (IL-6)-dependent plasma cell leukemia cell line UHKT-944 was established from bone marrow cells derived from a 55-yr-old man with plasma cell leukemia. RESULTS The cell line possesses phenotypic characteristics of plasma cells including the production of a monoclonal immunoglobulin IgA1-kappa. VH3-9 region of IgVH genes was rearranged and somatically hypermutated. The UHKT-944 cells were found to be negative for most of tested B-cell, T-cell, and myeloid markers. According to cytogenetic analysis, the cells were classified as near tetraploid with several numerical and structural abnormalities including the t(14;20) involving IgH locus. CONCLUSION The established permanent plasma cell leukemia cell line is a suitable model for the study of cellular and molecular mechanisms of pathogenesis of this rare malignant disease.
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Affiliation(s)
- Ilona Vyhlídalová
- Department of Cellular Biochemistry, Institute of Hematology and Blood Transfusion (IHBT), Prague, Czech Republic.,Department of Biochemistry, Faculty of Science, Charles University, Prague, Czech Republic
| | - Lenka Uherková
- Department of Cellular Biochemistry, Institute of Hematology and Blood Transfusion (IHBT), Prague, Czech Republic
| | - Markéta Pleschnerová
- Department of Immunology, Faculty of Science, Charles University, Prague, Czech Republic
| | - Ivan Špička
- 1st Department of Internal Medicine, Division of Hematology, General Faculty Hospital, Charles University, Prague, Czech Republic
| | - Jana Březinová
- Department of Cytogenetics, IHBT, Prague, Czech Republic
| | - Kyra Michalová
- Department of Cytogenetics, IHBT, Prague, Czech Republic
| | - Kamila Čermáková
- Leukemia PCR Diagnostics Laboratory, IHBT, Prague, Czech Republic
| | | | - Petr L Jedelský
- Faculty of Science, Charles University, Prague, Czech Republic.,Faculty of Arts, Charles University, Prague, Czech Republic
| | - Eva Hamšíková
- Department of Experimental Virology, IHBT, Prague, Czech Republic
| | - Kateřina Kuželová
- Department of Cellular Biochemistry, Institute of Hematology and Blood Transfusion (IHBT), Prague, Czech Republic
| | - Petr Stöckbauer
- Department of Cellular Biochemistry, Institute of Hematology and Blood Transfusion (IHBT), Prague, Czech Republic
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215
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Landsburg DJ, Vogl DT, Plastaras JP, Stadtmauer EA. Melphalan/Total Body Irradiation–Conditioned Myeloablative Allogeneic Hematopoietic Cell Transplantation for Patients With Primary Plasma Cell Leukemia. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2014; 14:e225-8. [DOI: 10.1016/j.clml.2014.07.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 07/16/2014] [Accepted: 07/29/2014] [Indexed: 10/24/2022]
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216
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Kalff A, Khong T, Wall M, Gorniak M, Mithraprabhu S, Campbell LJ, Spencer A. A rare case of IGH/MYC and IGH/BCL2 double hit primary plasma cell leukemia. Haematologica 2014; 100:e60-2. [PMID: 25381133 DOI: 10.3324/haematol.2014.111385] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Anna Kalff
- Alfred Hospital, Myeloma Research Group, Australian Centre for Blood Diseases, Monash University, Melbourne
| | - Tiffany Khong
- Alfred Hospital, Myeloma Research Group, Australian Centre for Blood Diseases, Monash University, Melbourne
| | - Meaghan Wall
- Victorian Cancer Cytogenetics Service, St Vincent's Hospital, Melbourne Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Malgorzata Gorniak
- Department of Laboratory Haematology, Alfred Hospital, Melbourne, Australia
| | - Sridurga Mithraprabhu
- Alfred Hospital, Myeloma Research Group, Australian Centre for Blood Diseases, Monash University, Melbourne
| | - Lynda J Campbell
- Victorian Cancer Cytogenetics Service, St Vincent's Hospital, Melbourne Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Andrew Spencer
- Alfred Hospital, Myeloma Research Group, Australian Centre for Blood Diseases, Monash University, Melbourne
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217
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218
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Rajeswari G, Paul TR, Uppin MS, Uppin SG, Rao DR, Raju D DSB, Sadashindu G. Plasma cell leukemia: A case series from South India with emphasis on rarer variants. Indian J Med Paediatr Oncol 2014; 35:211-4. [PMID: 25336792 PMCID: PMC4202617 DOI: 10.4103/0971-5851.142037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Plasma cell leukemia (PCL) is a rare and aggressive variant of plasma cell dyscrasia. They occur de novo (primary) or as a late manifestation of multiple myeloma (secondary). Patients present with anemia, thrombocytopenia, renal failure, organomegaly and extramedullary manifestations. We are presenting this series as it is the second largest series from India (16) with 4 young cases (under 40 years of age), more number of female patients and two having ‘hairy cell’ morphology. It is recommended that techniques like immunophenotyping and protein electrophoresis be performed, whenever the morphology is not characteristic of plasma cells.
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Affiliation(s)
- G Rajeswari
- Department of Pathology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana, India
| | - T Roshni Paul
- Department of Pathology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana, India
| | - Megha S Uppin
- Department of Pathology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana, India
| | - Shantveer G Uppin
- Department of Pathology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana, India
| | - D Raghunadha Rao
- Department of Medical Oncology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana, India
| | - D Sree Bhushan Raju D
- Department of Nephrology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana, India
| | - G Sadashindu
- Department of Medical Oncology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana, India
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219
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Majhi U, Murhekar K, Sundersingh S, Rajalekshmi KR. Primary plasma cell leukaemia with unusual presentations: a case series. Indian J Hematol Blood Transfus 2014; 30:390-3. [PMID: 25332628 DOI: 10.1007/s12288-014-0430-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 06/24/2014] [Indexed: 12/22/2022] Open
Abstract
We present here three cases of plasma cell dyscrasias; first case presenting as primary plasma cell leukemia showing unusual morphology and aberrant expression of myeloid markers; the second case presenting as plasma cell leukaemia with atypical plasma cells in peripheral blood and the third case presenting as myelomatous pleural effusion after treatment for myeloma.
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Affiliation(s)
- Urmila Majhi
- Department of Oncopathology, Cancer Institute (WIA), 38, Sardar Patel road, Chennai, 600036 India
| | - Kanchan Murhekar
- Department of Oncopathology, Cancer Institute (WIA), 38, Sardar Patel road, Chennai, 600036 India
| | - Shirley Sundersingh
- Department of Oncopathology, Cancer Institute (WIA), 38, Sardar Patel road, Chennai, 600036 India
| | - K R Rajalekshmi
- Department of Oncopathology, Cancer Institute (WIA), 38, Sardar Patel road, Chennai, 600036 India
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220
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Fernández de Larrea C, Delforge M, Davies F, Bladé J. Response evaluation and monitoring of multiple myeloma. Expert Rev Hematol 2014; 7:33-42. [PMID: 24483347 DOI: 10.1586/17474086.2014.876899] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Monitoring multiple myeloma (MM) is essential during the evaluation of response to each therapy line, after transplantation and at the time of relapse or progression in all patients. An initial complete workup, including appropriate protein studies in serum and urine is mandatory. The use of uniform criteria is particularly important in the context of clinical trials. Complete remission (CR) definition, the goal for the majority of patients, is now in constant evolution, with immunophenotypic and molecular minimal residual disease measurement in bone marrow as well as imaging techniques. Identification of relapse/progression with traditional and novel techniques for eventual prompt intervention with rescue treatment is a current issue of debate.
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Affiliation(s)
- Carlos Fernández de Larrea
- Department of Hematology, Amyloidosis and Myeloma Unit, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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221
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An G, Qin X, Acharya C, Xu Y, Deng S, Shi L, Zang M, Sui W, Yi S, Li Z, Hao M, Feng X, Jin F, Zou D, Qi J, Zhao Y, Tai YT, Wang J, Qiu L. Multiple myeloma patients with low proportion of circulating plasma cells had similar survival with primary plasma cell leukemia patients. Ann Hematol 2014; 94:257-64. [DOI: 10.1007/s00277-014-2211-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 09/03/2014] [Indexed: 10/24/2022]
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222
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Glitza IC, Lu G, Shah R, Bashir Q, Shah N, Champlin RE, Shah J, Orlowski RZ, Qazilbash MH. Chromosome 8q24.1/c-MYC abnormality: a marker for high-risk myeloma. Leuk Lymphoma 2014; 56:602-7. [PMID: 24844357 DOI: 10.3109/10428194.2014.924116] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The proto-oncogene c-MYC is rearranged in about 15% of patients with multiple myeloma (MM). We identified 23 patients with MM and c-MYC. Primary objectives were to describe the clinical characteristics, response to therapy, progression-free survival and overall survival (OS). Twelve out of twenty-three patients presented with or progressed to either plasma cell leukemia (PCL) and/or extramedullary disease (EMD). Induction therapy consisted of an immunomodulatory, proteasome inhibitor-based or conventional chemotherapy regimen. Fifteen patients achieved a partial response and three achieved a very good partial response. Sixteen patients received an autologous and one patient an allogeneic hematopoietic stem cell transplant. Median OS from diagnosis was 20.2 months. Patients with PCL or EMD had significantly shorter OS (15.5 vs. 40.4 months, p = 0.0005). This is the first report describing the clinical characteristics of patients with MM and c-MYC. These abnormalities are associated with an aggressive form of MM, high incidence of PCL/EMD and short OS.
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Affiliation(s)
- Isabella C Glitza
- Hematology/Oncology Fellowship, Division of Cancer Medicine, The University of Texas M. D. Anderson Cancer Center , Houston, TX , USA
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223
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Jimenez-Zepeda VH, Reece DE, Trudel S, Chen C, Tiedemann R, Kukreti V. Lenalidomide (Revlimid), bortezomib (Velcade) and dexamethasone for the treatment of secondary plasma cell leukemia. Leuk Lymphoma 2014; 56:232-5. [DOI: 10.3109/10428194.2014.893304] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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224
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Trends in survival of patients with primary plasma cell leukemia: a population-based analysis. Blood 2014; 124:907-12. [PMID: 24957143 DOI: 10.1182/blood-2014-03-565051] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Primary plasma cell leukemia (pPCL) is a rare malignancy with an aggressive course and poor outcome. There has been significant improvement in the survival of multiple myeloma patients over the past decade as a result of incorporating autologous stem cell transplantation (ASCT) and novel agents into treatment regimens. However, it is unknown whether these therapies have had a similar impact on the survival of patients with pPCL. We conducted an analysis of the Surveillance, Epidemiology, and End Results database to evaluate the trends in survival of 445 patients with pPCL between 1973 and 2009. The widespread availability of ASCT and use of novel agents in the upfront setting of multiple myeloma and pPCL began after 1995 and 2006, respectively. The median overall survival based on periods of diagnosis were 5, 6, 4, and 12 months for those diagnosed during 1973-1995, 1996-2000, 2001-2005, and 2006-2009, respectively (P = .001). Thus, the current study confirms the recent survival improvement in pPCL within a large US population that may be associated with the use of better therapeutic strategies.
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225
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Sorigue M, Juncà J, Gassiot S, Millá F, Mate JL, Navarro JT. A case of CD138−/CD19+/CD4+ IgD plasma cell leukemia. CYTOMETRY PART B-CLINICAL CYTOMETRY 2014; 88:69-73. [DOI: 10.1002/cyto.b.21173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 03/12/2014] [Accepted: 03/14/2014] [Indexed: 12/18/2022]
Affiliation(s)
- Marc Sorigue
- IJC, Hospital Germans Trias i Pujol, Hematology Laboratory and Pathology Service; Badalona Spain
| | - Jordi Juncà
- IJC, Hospital Germans Trias i Pujol, Hematology Laboratory and Pathology Service; Badalona Spain
| | - Susanna Gassiot
- IJC, Hospital Germans Trias i Pujol, Hematology Laboratory and Pathology Service; Badalona Spain
| | - Fuensanta Millá
- IJC, Hospital Germans Trias i Pujol, Hematology Laboratory and Pathology Service; Badalona Spain
| | - José-Luis Mate
- IJC, Hospital Germans Trias i Pujol, Hematology Laboratory and Pathology Service; Badalona Spain
| | - Josep Tomàs Navarro
- IJC, Hospital Germans Trias i Pujol, Hematology Laboratory and Pathology Service; Badalona Spain
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226
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Kikuchi J, Koyama D, Mukai HY, Furukawa Y. Suitable drug combination with bortezomib for multiple myeloma under stroma-free conditions and in contact with fibronectin or bone marrow stromal cells. Int J Hematol 2014; 99:726-36. [DOI: 10.1007/s12185-014-1573-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 03/17/2014] [Accepted: 03/17/2014] [Indexed: 12/12/2022]
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227
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Gonsalves WI, Rajkumar SV, Gupta V, Morice WG, Timm MM, Singh PP, Dispenzieri A, Buadi FK, Lacy MQ, Kapoor P, Gertz MA, Kumar SK. Quantification of clonal circulating plasma cells in newly diagnosed multiple myeloma: implications for redefining high-risk myeloma. Leukemia 2014; 28:2060-5. [PMID: 24618735 DOI: 10.1038/leu.2014.98] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 02/21/2014] [Indexed: 12/22/2022]
Abstract
The presence of clonal circulating plasma cells (cPCs) is a marker of high-risk disease in all stages of monoclonal gammopathies. However, the prognostic utility of quantitating cPCs using multiparametric flow cytometry in multiple myeloma (MM) patients with current treatments is unknown. There were 157 consecutive patients with newly diagnosed MM seen at the Mayo Clinic, Rochester from 2009 to 2011 that had their peripheral blood evaluated for cPCs by multiparameter flow cytometry. Survival analysis was performed by the Kaplan-Meier method and differences assessed using the log-rank test. Using a receiver operating characteristics (ROC) analysis, ⩾400 cPCs were considered as the optimal cutoff for defining high-risk disease. The presence of ⩾400 cPCs was associated with higher plasma cell (PC) proliferation and adverse cytogenetics. The median time-to-next-treatment and overall survival (OS) in patients with ⩾400 cPCs (N=37, 24%) was 14 months and 32 months compared with 26 months and not reached for the rest (P<0.001). In a multivariable model, the presence of ⩾400 cPCs and older age adversely affected OS. Flow cytometry to quantify cPCs is a valuable test for risk stratifying newly diagnosed MM patients in the era of novel agents. Future studies are needed to determine its role in developing a risk-adapted treatment approach.
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Affiliation(s)
- W I Gonsalves
- 1] Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA [2] Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - S V Rajkumar
- 1] Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA [2] Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - V Gupta
- 1] Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA [2] Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - W G Morice
- 1] Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA [2] Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - M M Timm
- 1] Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA [2] Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - P P Singh
- 1] Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA [2] Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - A Dispenzieri
- 1] Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA [2] Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - F K Buadi
- 1] Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA [2] Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - M Q Lacy
- 1] Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA [2] Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - P Kapoor
- 1] Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA [2] Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - M A Gertz
- 1] Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA [2] Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - S K Kumar
- 1] Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA [2] Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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228
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Katodritou E, Terpos E, Kelaidi C, Kotsopoulou M, Delimpasi S, Kyrtsonis MC, Symeonidis A, Giannakoulas N, Stefanoudaki A, Christoulas D, Chatziaggelidou C, Gastari V, Spyridis N, Verrou E, Konstantinidou P, Zervas K, Dimopoulos MA. Treatment with bortezomib-based regimens improves overall response and predicts for survival in patients with primary or secondary plasma cell leukemia: Analysis of the Greek myeloma study group. Am J Hematol 2014; 89:145-50. [PMID: 24123068 DOI: 10.1002/ajh.23600] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 09/26/2013] [Indexed: 11/12/2022]
Abstract
Plasma cell leukemia (PCL) is a rare and aggressive plasma cell disorder, with poor outcome. Bortezomib-based regimens (BBR) are highly effective in myeloma, but there is limited information about their efficacy and safety in PCL. Thus, we retrospectively collected data from 42 consecutive PCL patients (25 with primary PCL-pPCL and 17 with secondary PCL-sPCL) to explore the role of BBR in this entity. BBR were administered in 29 of 42 patients, while 6 of 25 patients with pPCL underwent autologous transplantation. Objective response (≥partial response) was significantly higher in patients treated with BBR versus conventional therapies (69% vs. 30.8%, P = 0.04); 27.5% of patients treated with BBR achieved at least very good partial response (vgPR). The highest ORR was observed in pPCL patients treated with BBR (88.9%; ≥vgPR: 33.3%). In BBR-group, grade 3 of 4 hematological, neurological and renal toxicity and neutropenic infections were observed in 41.4%, 7%, 3.4%, and 31%, respectively. With a median follow-up of 51 months, median overall survival (OS) for patients treated with BBR versus conventional therapies was 13 versus 2 months (P < 0.007). Median OS of patients with pPCL and sPCL treated with BBR was 18 and 7 months, respectively (P < 0.001). In the multivariate analysis normal PLTs, treatment with BBR and high quality response were the only powerful predictors for survival. Our study carrying the longest reported median follow-up, demonstrated that treatment of PCL with BBR induces high response rates and prolongs survival over conventional therapies, regardless of additional autologous transplantation rescue or established high risk features, with manageable toxicity.
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Affiliation(s)
- Eirini Katodritou
- Hematology Department; Theagenion Cancer Hospital; Thessaloniki Greece
| | - Evangelos Terpos
- Department of Clinical Therapeutics; National and Kapodistrian University of Athens, School of Medicine; Athens Greece
| | - Charikleia Kelaidi
- Hematology Department; General Hospital “G. Papanikolaou,”; Thessaloniki Greece
| | - Maria Kotsopoulou
- Hematology Department; General Anticancer Hospital “Metaxa,”; Athens Greece
| | - Sossana Delimpasi
- Hematology Department; General Hospital of Athens “Evangelismos,”; Athens Greece
| | - Marie-Christine Kyrtsonis
- First Department of Propedeutic/Internal Medicine; National and Kapodistrian University of Athens, School of Medicine; Athens Greece
| | | | - Nikos Giannakoulas
- Hematology Department; University of Thessalia; School of Medicine; Larissa Greece
| | | | | | | | - Vassiliki Gastari
- Hematology Department; Theagenion Cancer Hospital; Thessaloniki Greece
| | - Nikos Spyridis
- Hematology Department; Theagenion Cancer Hospital; Thessaloniki Greece
| | - Evgenia Verrou
- Hematology Department; Theagenion Cancer Hospital; Thessaloniki Greece
| | | | - Kostas Zervas
- Hematology Department; Theagenion Cancer Hospital; Thessaloniki Greece
| | - Meletios A. Dimopoulos
- Department of Clinical Therapeutics; National and Kapodistrian University of Athens, School of Medicine; Athens Greece
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229
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230
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Detailed characterization of multiple myeloma circulating tumor cells shows unique phenotypic, cytogenetic, functional, and circadian distribution profile. Blood 2013; 122:3591-8. [PMID: 24072855 DOI: 10.1182/blood-2013-06-510453] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Circulating myeloma tumor cells (CTCs) as defined by the presence of peripheral blood (PB) clonal plasma cells (PCs) are a powerful prognostic marker in multiple myeloma (MM). However, the biological features of CTCs and their pathophysiological role in MM remains unexplored. Here, we investigate the phenotypic, cytogenetic, and functional characteristics as well as the circadian distribution of CTCs vs paired bone marrow (BM) clonal PCs from MM patients. Our results show that CTCs typically represent a unique subpopulation of all BM clonal PCs, characterized by downregulation (P < .05) of integrins (CD11a/CD11c/CD29/CD49d/CD49e), adhesion (CD33/CD56/CD117/CD138), and activation molecules (CD28/CD38/CD81). Fluorescence in situ hybridization analysis of fluorescence-activated cell sorter-sorted CTCs also unraveled different cytogenetic profiles vs paired BM clonal PCs. Moreover, CTCs were mostly quiescent and associated with higher clonogenic potential when cocultured with BM stromal cells. Most interestingly, CTCs showed a circadian distribution which fluctuates in a similar pattern to that of CD34(+) cells, and opposite to stromal cell-derived factor 1 plasma levels and corresponding surface expression of CXC chemokine receptor 4 on clonal PCs, suggesting that in MM, CTCs may egress to PB to colonize/metastasize other sites in the BM during the patients' resting period.
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231
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Musto P, Simeon V, Martorelli MC, Petrucci MT, Cascavilla N, Di Raimondo F, Caravita T, Morabito F, Offidani M, Olivieri A, Benevolo G, Mina R, Guariglia R, D'Arena G, Mansueto G, Filardi N, Nobile F, Levi A, Falcone A, Cavalli M, Pietrantuono G, Villani O, Bringhen S, Omedè P, Lerose R, Agnelli L, Todoerti K, Neri A, Boccadoro M, Palumbo A. Lenalidomide and low-dose dexamethasone for newly diagnosed primary plasma cell leukemia. Leukemia 2013; 28:222-5. [PMID: 23958922 DOI: 10.1038/leu.2013.241] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- P Musto
- Scientific Direction, Centro di Riferimento Oncologico della Basilicata, Istituto di Ricovero e Cura a Carattere Scientifico, Rionero in Vulture (Pz), Italy
| | - V Simeon
- Laboratory of Pre-clinical and Translational Research, Centro di Riferimento Oncologico della Basilicata, Istituto di Ricovero e Cura a Carattere Scientifico, Rionero in Vulture (Pz), Italy
| | - M C Martorelli
- Unit of Hematology and Hemopoietic Stem Cell Transplantation, Centro di Riferimento Oncologico della Basilicata, Istituto di Ricovero e Cura a Carattere Scientifico, Rionero in Vulture (Pz), Italy
| | - M T Petrucci
- Department of Cellular Biotechnologies and Hematology, La Sapienza University, Rome, Italy
| | - N Cascavilla
- Division of Hematology and Stem Cell Transplantation, Casa Sollievo della Sofferenza, Istituto di Ricovero e Cura a Carattere Scientifico, San Giovanni Rotondo, Italy
| | - F Di Raimondo
- Division of Hematology, Department of Biomedical Sciences, Azienda Ospedaliera Ferrarotto, University of Catania, Catania, Italy
| | - T Caravita
- Department of Hematology, Azienda Ospedaliera S. Eugenio, Tor Vergata University, Rome, Italy
| | - F Morabito
- Hematology Unit, Azienda Ospedaliera Annunziata, Cosenza, Italy
| | - M Offidani
- Hematology Clinic, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - A Olivieri
- Hematology and Medicine Clinic, Marche Polytechnic University, Ancona, Italy
| | - G Benevolo
- Hematology 2, Azienda Ospedaliera Città della Salute e della Scienza, Turin, Italy
| | - R Mina
- Division of Hematology, University of Turin, Azienda Ospedaliera S. Giovanni Battista, Turin, Italy
| | - R Guariglia
- Unit of Hematology and Hemopoietic Stem Cell Transplantation, Centro di Riferimento Oncologico della Basilicata, Istituto di Ricovero e Cura a Carattere Scientifico, Rionero in Vulture (Pz), Italy
| | - G D'Arena
- Unit of Hematology and Hemopoietic Stem Cell Transplantation, Centro di Riferimento Oncologico della Basilicata, Istituto di Ricovero e Cura a Carattere Scientifico, Rionero in Vulture (Pz), Italy
| | - G Mansueto
- Unit of Hematology and Hemopoietic Stem Cell Transplantation, Centro di Riferimento Oncologico della Basilicata, Istituto di Ricovero e Cura a Carattere Scientifico, Rionero in Vulture (Pz), Italy
| | - N Filardi
- Unit of Hematology, San Carlo Hospital, Potenza, Italy
| | - F Nobile
- Division of Hematology, Azienda Ospedaliera Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - A Levi
- Department of Cellular Biotechnologies and Hematology, La Sapienza University, Rome, Italy
| | - A Falcone
- Division of Hematology and Stem Cell Transplantation, Casa Sollievo della Sofferenza, Istituto di Ricovero e Cura a Carattere Scientifico, San Giovanni Rotondo, Italy
| | - M Cavalli
- Division of Hematology, Department of Biomedical Sciences, Azienda Ospedaliera Ferrarotto, University of Catania, Catania, Italy
| | - G Pietrantuono
- Unit of Hematology and Hemopoietic Stem Cell Transplantation, Centro di Riferimento Oncologico della Basilicata, Istituto di Ricovero e Cura a Carattere Scientifico, Rionero in Vulture (Pz), Italy
| | - O Villani
- Unit of Hematology and Hemopoietic Stem Cell Transplantation, Centro di Riferimento Oncologico della Basilicata, Istituto di Ricovero e Cura a Carattere Scientifico, Rionero in Vulture (Pz), Italy
| | - S Bringhen
- Division of Hematology, University of Turin, Azienda Ospedaliera S. Giovanni Battista, Turin, Italy
| | - P Omedè
- Division of Hematology, University of Turin, Azienda Ospedaliera S. Giovanni Battista, Turin, Italy
| | - R Lerose
- Pharmacy Unit, Centro di Riferimento Oncologico della Basilicata, Istituto di Ricovero e Cura a Carattere Scientifico, Rionero in Vulture (Pz), Italy
| | - L Agnelli
- Department of Clinical Sciences and Community Health, University of Milan; Hematology 1, Fondazione Ca' Grande Ospedale Maggiore Policlinico, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - K Todoerti
- Laboratory of Pre-clinical and Translational Research, Centro di Riferimento Oncologico della Basilicata, Istituto di Ricovero e Cura a Carattere Scientifico, Rionero in Vulture (Pz), Italy
| | - A Neri
- Department of Clinical Sciences and Community Health, University of Milan; Hematology 1, Fondazione Ca' Grande Ospedale Maggiore Policlinico, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - M Boccadoro
- Division of Hematology, University of Turin, Azienda Ospedaliera S. Giovanni Battista, Turin, Italy
| | - A Palumbo
- Division of Hematology, University of Turin, Azienda Ospedaliera S. Giovanni Battista, Turin, Italy
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232
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Clinical manifestation of angioimmunoblastic T-cell lymphoma with exuberant plasmacytosis. Int J Hematol 2013; 98:366-74. [PMID: 23949915 DOI: 10.1007/s12185-013-1411-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2013] [Revised: 07/29/2013] [Accepted: 08/06/2013] [Indexed: 02/06/2023]
Abstract
Angioimmunoblastic T-cell lymphoma (AITL) is a rare subtype of non-Hodgkin lymphoma characterized by aggressive symptoms and various abnormal laboratory test results. One of the rare immunologic abnormalities in AITL is exuberant polyclonal plasmacytosis, but its clinical significance has not been evaluated. This report concerns three AITL cases with exuberant polyclonal plasmacytosis and investigates its clinical impact by comparison with 12 patients without plasmacytosis. Our study found that the performance status (PS) of the former was significantly worse and their serum immunoglobulin levels were significantly higher. All other parameters, including B symptoms, various prognostic scores, blood cell counts other than plasmacyte, and serum levels of lactate dehydrogenase, C-reactive protein and soluble interleukin-2 receptor, showed no significant differences. More importantly, although the diagnosis of AITL with plasmacytosis was not straightforward in our series, outcomes of treatment with conventional chemotherapy or immunosuppressive therapy with cyclosporine A were favorable. To conclude, AITL should be considered a candidate underlying disease of exuberant polyclonal plasmacytosis. Provided a correct diagnosis is made early and is followed by adequate treatment, the prognosis for AITL with plasmacytosis may not be worse than that for those without plasmacytosis despite the severe exhaustion at first presentation.
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Mangiacavalli S, Pochintesta L, Cocito F, Pompa A, Bernasconi P, Cazzola M, Corso A. Correlation between burden of 17P13.1 alteration and rapid escape to plasma cell leukaemia in multiple myeloma. Br J Haematol 2013; 162:555-8. [PMID: 23718846 DOI: 10.1111/bjh.12385] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Systemic joint laxity and mandibular range of movement. Cranio 1989; 10:70. [PMID: 32555163 PMCID: PMC7303180 DOI: 10.1038/s41408-020-0336-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 05/28/2020] [Accepted: 06/04/2020] [Indexed: 12/13/2022]
Abstract
Primary plasma cell leukemia (pPCL) is a rare and aggressive form of multiple myeloma (MM) that is characterized by the presence of ≥20% circulating plasma cells. Overall survival remains poor despite advances of anti-MM therapy. The disease biology as well as molecular mechanisms that distinguish pPCL from non-pPCL MM remain poorly understood and, given the rarity of the disease, are challenging to study. In an attempt to identify key biological mechanisms that result in the aggressive pPCL phenotype, we performed whole-exome sequencing and gene expression analysis in 23 and 41 patients with newly diagnosed pPCL, respectively. The results reveal an enrichment of complex structural changes and high-risk mutational patterns in pPCL that explain, at least in part, the aggressive nature of the disease. In particular, pPCL patients with traditional low-risk features such as translocation t(11;14) or hyperdiploidy accumulated adverse risk genetic events that could account for the poor outcome in this group. Furthermore, gene expression profiling showed upregulation of adverse risk modifiers in pPCL compared to non-pPCL MM, while adhesion molecules and extracellular matrix proteins became increasingly downregulated. In conclusion, this is one of the largest studies to dissect pPCL on a genomic and molecular level.
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