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Pasvolsky O, Marcoux C, Dai J, Milton DR, Tanner MR, Syed N, Bashir Q, Srour S, Saini N, Lin P, Ramdial J, Nieto Y, Tang G, Aljawai Y, Lee HC, Gaballa MR, Patel KK, Kebriaei P, Thomas SK, Orlowski RZ, Shpall EJ, Champlin RE, Qazilbash MH. Trends in Outcomes After Upfront Autologous Transplant for Multiple Myeloma Over Three Decades. Transplant Cell Ther 2024:S2666-6367(24)00438-X. [PMID: 38852784 DOI: 10.1016/j.jtct.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/28/2024] [Accepted: 06/01/2024] [Indexed: 06/11/2024]
Abstract
Upfront autologous stem cell transplantation (auto-SCT) remains standard of care for eligible patients with newly diagnosed multiple myeloma (NDMM), although recently its role has been questioned. The aim of the study was to evaluate trends in patient characteristics, treatment, and outcomes of NDMM who underwent upfront auto-SCT over three decades. We conducted a single-center retrospective analysis of patients with NDMM who underwent upfront auto-SCT at MD Anderson Cancer Center between 1988 to 2021. Primary end points were progression-free survival (PFS) and overall survival (OS). Patients were grouped by the year of auto-SCT: 1988-2000 (n = 249), 2001-2005 (n = 373), 2006-2010 (n = 568), 2011-2015 (n = 815) and 2016-2021 (n = 1036). High-risk cytogenetic abnormalities were defined as del (17p), t (4;14), t (14;16), and 1q21 gain or amplification by fluorescence in situ hybridization. We included 3041 MM patients in the analysis. Median age at auto-SCT increased from 52 years (1988-2000) to 62 years (2016-2021), as did the incidence of high-risk cytogenetics from 15% to 40% (P < .001). Comorbidity burden, as measured by a Hematopoietic Cell Transplantation-Specific Comorbidity Index (HCT-CI) of >3, increased from 17% (1988-2000) to 28% (2016-2021) (P < .001). Induction regimens evolved from predominantly chemotherapy to immunomodulatory drug (IMiD) and proteasome inhibitor (PI) based regimens, with 74% of patients receiving IMiD-PI triplets in 2016-2021 (39% bortezomib, lenalidomide and dexamethasone (VRD) and 35% carfilzomib, lenalidomide and dexamethasone [KRD]). Response rates prior to auto-SCT steadily increased, with 4% and 10% achieving a ≥CR and ≥VGPR compared to 19% and 65% between 1988-2000 and 2016-2021, respectively. Day 100 response rates post auto-SCT improved from 24% and 49% achieving ≥CR and ≥VGPR between 1988-2000 to 41% and 81% between 2016-2021, respectively. Median PFS improved from 22.3 months between 1988-2000 to 58.6 months between 2016-2021 (HR 0.42, P < .001). Among patients with high-risk cytogenetics, median PFS increased from 13.7 months to 36.8 months (HR 0.32, P < .001). Patients aged ≥65 years also had an improvement in median PFS from 33.6 months between 2001 and 2005 to 52.8 months between 2016-2021 (HR 0.56, P = .001). Median OS improved from 55.1 months between 1988-2000 to not reached (HR 0.41, P < .001). Patients with high-risk cytogenetics had an improvement in median OS from 32.9 months to 66.5 months between 2016-2021 (HR 0.39, P < .001). Day 100 non-relapse mortality from 2001 onwards was ≤1%. Age-adjust rates of second primary malignancies were similar in patients transplanted in different time periods. Despite increasing patient age and comorbidity burden, this large real-world study demonstrated significant improvements in the depth of response and survival outcomes in patients with NDMM undergoing upfront auto-SCT over the past three decades, including those with high-risk disease.
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Affiliation(s)
- Oren Pasvolsky
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Curtis Marcoux
- Division of Hematology, Dalhousie University, Halifax, Canada
| | - Jianliang Dai
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Denái R Milton
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mark R Tanner
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Naureen Syed
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Qaiser Bashir
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Samer Srour
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Neeraj Saini
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Paul Lin
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeremy Ramdial
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yago Nieto
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Guilin Tang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yosra Aljawai
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hans C Lee
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mahmoud R Gaballa
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Krina K Patel
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Partow Kebriaei
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sheeba K Thomas
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Robert Z Orlowski
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Elizabeth J Shpall
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Richard E Champlin
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Muzaffar H Qazilbash
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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Liu M, Zhang JY. Reduction rate of monoclonal protein as a useful prognostic factor in standard-risk group of newly diagnosed multiple myeloma. World J Clin Cases 2023; 11:5643-5652. [PMID: 37727707 PMCID: PMC10506002 DOI: 10.12998/wjcc.v11.i24.5643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 07/02/2023] [Accepted: 08/01/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Multiple myeloma (MM) is a common hematologic malignancy that originates from a malignant clone of plasma cells. Solitary plasmacytoma, history of diabetes, and platelet count are considered as prognostic factors for MM. But some patients are still associated with much worse outcomes without any prognostic predictors. This study aimed to observe the reduction rate of monoclonal protein (M protein) after the first and fourth chemotherapy cycles, which is considered as a new prognostic factor for progression-free survival (PFS) in standard-risk group of newly diagnosed MM patients. AIM To investigate the reduction rate of M protein after first and fourth cycle chemotherapy as a useful prognostic factor. METHODS A total of 316 patients diagnosed with MM for the first time between 2010 and 2019 at the Lishui Municipal Central Hospital were included. All patients were diagnosed according to the National Comprehensive Cancer Network (NCCN) 2020.V1 diagnostic criteria. The risk assessment was performed by the Mayo Stratification for Macroglobulinemia and Risk-Adapted Therapy guidelines. After diagnosis, 164 patients were evaluated and underwent treatment with four to eight courses of continuous induction chemotherapy. The patients with no response after induction treatment were administered additional therapy following the NCCN 2020.V1 criteria. The following baseline data from the patients were collected: Gender, age at diagnosis, Durie-Salmon stage, glutamic-pyruvic transaminase, glutamic-oxaloacetic transaminase, catabolite activator protein, albumin/globulin ratio, lactate dehydrogenase, translocation (t)(6;14), t(11;14), maintenance regimen, total cholesterol (TC), triglyceride, and phosphorous. All baseline data and the reduction rate of M protein after each chemotherapy cycle from the first to fourth were assessed by univariate analysis. The factors influencing the overall survival and PFS were then assessed by multivariate analysis. We found the first cycle (C1) reduction rate and the fourth cycle (C4) reduction rate as predictors of PFS. Then, PFS was compared between patients with a C1 reduction rate of M protein of ≥ 25% vs < 25% and ≥ 50% vs < 50%, and between patients with a C4 reduction rate of ≥ 25% vs < 25%, ≥ 50% vs < 50%, and ≥ 75% vs < 75%. RESULTS Multivariate analysis revealed age [hazard ratio (HR): 1.059, 95% confidence interval (95%CI): 1.033-1.085, P ≤ 0.001], International Staging System stage (HR: 2.136, 95%CI: 1.500-3.041, P ≤ 0.001), autotransplantion (HR: 0.201, 95%CI: 0.069-0.583, P = 0.019), TC (HR: 0.689, 95%CI: 0.533-0.891, P = 0.019), C1 reduction rate (HR: 0474, 95%CI: 0.293-0.767, P = 0.019), and C4 reduction rate (HR: 0.254, 95%CI: 0.139-0.463, P = 0.019) as predictors of PFS. The Kaplan-Meier survival analysis and the log-rank tests revealed that a higher reduction rate of M protein after first cycle (≥ 50%) and fourth cycle (≥ 75%) chemotherapy was associated with a longer PFS than the lower one. CONCLUSION Higher reduction rates of M protein after the first and fourth chemotherapy cycles can act as advantageous prognostic factors for PFS in standard-risk group of MM patients during initial diagnosis.
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Affiliation(s)
- Min Liu
- Department of Hematology, Lishui Municipal Central Hospital, Lishui 323000, Zhejiang Province, China
| | - Jun-Yu Zhang
- Department of Hematology, Lishui Municipal Central Hospital, Lishui 323000, Zhejiang Province, China
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Shi X, Wei Y, Yao X, Du B, Wu X, Kong X, Du X. In vivo antitumor efficacy of 17-AAG loaded PMMA in a human multiple myeloma xenograft mouse model. Clin Exp Med 2023; 23:45-54. [PMID: 34989932 DOI: 10.1007/s10238-021-00786-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 12/13/2021] [Indexed: 11/26/2022]
Abstract
Multiple myeloma (MM) is a monoclonal malignancy characterized by abnormal proliferation of plasma cells. The disease clinically manifests as anemia, hypercalcemia, renal insufficiencies, and osteolytic damage. Osteolytic damage goes with severe bone pain, spinal instability, and pathological fracture, symptoms that are collectively referred to as multiple myeloma bone disease (MMBD). Polymethylmethacrylate (PMMA) bone cement is widely used for bone repair after MMBD surgery, owing to its excellent biomechanical properties and fast curing. To date, however, efficacy of drug-loading PMMA in inhibition of tumor growth and angiogenesis remains unknown. Here, we report that 17-AAG-loaded PMMA bone cement inhibits MM growth in vivo and suppresses tumor diffusion to peripheral tissues. In addition, 17-AAG-loaded PMMA promotes MM apoptosis by downregulating Bax and active Caspase-3.
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Affiliation(s)
- Xiangjun Shi
- Department of Hematology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100022, China
| | - Yanzhe Wei
- Department of Orthopedics, Shenzhen University General Hospital, Shenzhen, 518055, China
- Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100022, China
| | - Xingchen Yao
- Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100022, China
| | - Boran Du
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, 100026, China
| | - Xiaoguang Wu
- Department of Anatomy, Chengde Medical University, Hebei, 067000, China
| | - Xiangyu Kong
- Department of Anatomy, Chengde Medical University, Hebei, 067000, China
| | - Xinru Du
- Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100022, China.
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4
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Sikibi M. Use Data Mining Cleansing to Prepare Data for Strategic Decisions. ARTIF INTELL 2022. [DOI: 10.5772/intechopen.99144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pre-processing data on the dataset is often neglected, but it is an important step in the data mining process. Analyzing data that has not been carefully screened for such challenges can produce misleading results. Thus, the representation and quality of data are first and foremost before running an analysis. In this paper, the sources of data collection to remove errors are identified and presented. The data mining cleaning and its methods are discussed. Data preparation has become a ubiquitous function of production organizations – for record-keeping and strategical making in supporting various data analysis tasks critical to the organizational mission. Despite the importance of data collection, data quality remains a pervasive and thorny challenge in almost any production organization. The presence of incorrect or inconsistent data can significantly distort the results of analyses, often negating the potential benefits of strategical making driven approaches. This tool has removed and eliminated errors, duplications, and inconsistent records on the datasets.
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Patel D, Mangano A, Moccia D, Esperti S, Udani K, Henderson J, Balanchivadze N. Acute Plasma Cell Leukemia Presenting as Primary Hyperammonemic Encephalopathy. J Med Cases 2021; 11:320-323. [PMID: 34434338 PMCID: PMC8383598 DOI: 10.14740/jmc3559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 08/08/2020] [Indexed: 11/11/2022] Open
Abstract
Primary plasma cell leukemia (PPCL) is a rare form of multiple myeloma (MM) and is a rare aggressive disease with a median overall survival of 6 - 11 months. We present a case of acute hyperammonemic encephalopathy as the initial presentation of PPCL in a 78-year-old woman to highlight an atypical presentation of this disorder.
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Affiliation(s)
- Dveet Patel
- Department of Internal Medicine, Grand Strand Health, Myrtle Beach, SC, USA.,Affiliated Hospital of Grand Strand Medical Center, Myrtle Beach, SC, USA
| | - Andrew Mangano
- Affiliated Hospital of Grand Strand Medical Center, Myrtle Beach, SC, USA
| | - David Moccia
- Affiliated Hospital of Grand Strand Medical Center, Myrtle Beach, SC, USA
| | - Shawn Esperti
- Affiliated Hospital of Grand Strand Medical Center, Myrtle Beach, SC, USA
| | - Kunjan Udani
- Affiliated Hospital of Grand Strand Medical Center, Myrtle Beach, SC, USA
| | - Jordan Henderson
- Affiliated Hospital of Grand Strand Medical Center, Myrtle Beach, SC, USA
| | - Nino Balanchivadze
- Department of Hematology/Oncology, Henry Ford Health System, Detroit, MI, USA
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6
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Li C, Xia J, Franqui-Machin R, Chen F, He Y, Ashby TC, Teng F, Xu H, Liu D, Gai D, Johnson SK, van Rhee F, Janz S, Shaughnessy JD, Tricot G, Frech I, Zhan F. TRIP13 modulates protein deubiquitination and accelerates tumor development and progression of B cell malignancies. J Clin Invest 2021; 131:e146893. [PMID: 34061780 DOI: 10.1172/jci146893] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 05/25/2021] [Indexed: 12/22/2022] Open
Abstract
Multiple myeloma (MM), a terminally differentiated B cell malignancy, remains difficult to cure. Understanding the molecular mechanisms underlying the progression of MM may identify therapeutic targets and lead to a fundamental shift in treatment of the disease. Deubiquitination, like ubiquitination, is a highly regulated process, implicated in almost every cellular process. Multiple deubiquitinating enzymes (DUBs) have been identified, but their regulation is poorly defined. Here, we determined that TRIP13 increases cellular deubiquitination. Overexpression of TRIP13 in mice and cultured cells resulted in excess cellular deubiquitination by enhancing the association of the DUB USP7 with its substrates. We show that TRIP13 is an oncogenic protein because it accelerates B cell tumor development in transgenic mice. TRIP13-induced resistance to proteasome inhibition can be overcome by a USP7 inhibitor in vitro and in vivo. These findings suggest that TRIP13 expression plays a critical role in B cell lymphoma and MM by regulating deubiquitination of critical oncogenic (NEK2) and tumor suppressor (PTEN, p53) proteins. High TRIP13 identifies a high-risk patient group amenable to adjuvant anti-USP7 therapy.
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Affiliation(s)
- Can Li
- Myeloma Center, Winthrop P. Rockefeller Institute, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.,Department of Hematology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jiliang Xia
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | | | - Fangping Chen
- Department of Hematology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yanjuan He
- Department of Hematology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Timothy Cody Ashby
- Myeloma Center, Winthrop P. Rockefeller Institute, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Feixiang Teng
- Myeloma Center, Winthrop P. Rockefeller Institute, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Hongwei Xu
- Myeloma Center, Winthrop P. Rockefeller Institute, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Dingxiao Liu
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Dongzheng Gai
- Myeloma Center, Winthrop P. Rockefeller Institute, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.,Department of Hematology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Sarah K Johnson
- Myeloma Center, Winthrop P. Rockefeller Institute, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Frits van Rhee
- Myeloma Center, Winthrop P. Rockefeller Institute, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Siegfried Janz
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - John D Shaughnessy
- Myeloma Center, Winthrop P. Rockefeller Institute, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Guido Tricot
- Myeloma Center, Winthrop P. Rockefeller Institute, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Ivana Frech
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Fenghuang Zhan
- Myeloma Center, Winthrop P. Rockefeller Institute, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Alsouqi A, Khan M, Dhakal B, Du L, Harrell S, Hari P, Cornell RF. KD-PACE Salvage Therapy for Aggressive Relapsed Refractory Multiple Myeloma, Plasma Cell Leukemia and Extramedullary Myeloma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2021; 21:526-535. [PMID: 33985931 DOI: 10.1016/j.clml.2021.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/23/2021] [Accepted: 03/30/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Patients with advanced/aggressive multiple myeloma have limited treatment options to achieve rapid disease control. In eligible patients, bortezomib, dexamethasone, thalidomide, cisplatin, doxorubicin, cyclophosphamide, and etoposide is often used. However, many patients are refractory to or have toxicities from bortezomib and there is a need for bridging therapy. We have used a modified regimen incorporating the second-generation proteasome inhibitor carfilzomib (carfilzomib, dexamethasone, thalidomide, cisplatin, doxorubicin, cyclophosphamide and etoposide [KD-PACE]) instead of bortezomib for relapsed/refractory multiple myeloma. PATIENTS AND METHODS This 2-center retrospective study included consecutive patients receiving KD-PACE for relapsed or refractory multiple myeloma, plasma cell leukemia, or extramedullary myeloma. The primary outcome was the feasibility of KD-PACE as a bridging therapy to a more definitive treatment option. RESULTS Fifty-two patients were included. The median age was 57 years, and 67% were male. Thirty-one patients were bridged with KD-PACE to autologous hematopoietic stem cell transplant (29%), allogenic hematopoietic stem cell transplant (27%), or a clinical trial (12%). Patients bridged to autologous hematopoietic stem cell transplant, allogenic hematopoietic stem cell transplant, or a clinical trial had a superior progression-free survival (8.3 months vs 2.3 months in the nonbridged group; P < .001) and overall survival (median, 16.7 months vs 4.3 months in the nonbridged group; P < .001). No unexpected toxicities occurred from the treatment regimen. CONCLUSION KD-PACE is a promising treatment option for select patients with advanced/aggressive forms of myeloma requiring rapid disease control before a more definitive salvage therapy such as auto/allotransplantation or a clinical trial.
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Affiliation(s)
- Aseel Alsouqi
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Muhammad Khan
- Department of Medicine, Division of Hematology and Oncology Medical College of Wisconsin, Milwaukee, WI, USA
| | - Binod Dhakal
- Department of Medicine, Division of Hematology and Oncology Medical College of Wisconsin, Milwaukee, WI, USA
| | - Liping Du
- Department of Biostatistics, Vanderbilt Center for Quantitative Sciences, Nashville, TN, USA
| | - Shelton Harrell
- Department of Medicine, Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Parameswaran Hari
- Department of Medicine, Division of Hematology and Oncology Medical College of Wisconsin, Milwaukee, WI, USA
| | - Robert F Cornell
- Department of Medicine, Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
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Padala SA, Barsouk A, Barsouk A, Rawla P, Vakiti A, Kolhe R, Kota V, Ajebo GH. Epidemiology, Staging, and Management of Multiple Myeloma. Med Sci (Basel) 2021; 9:medsci9010003. [PMID: 33498356 PMCID: PMC7838784 DOI: 10.3390/medsci9010003] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 01/13/2021] [Accepted: 01/15/2021] [Indexed: 12/24/2022] Open
Abstract
Multiple myeloma (MM) is a plasma cell disorder that is on the rise throughout the world, especially in the US, Australia, and Western Europe. In the US, MM accounts for almost 2% of cancer diagnoses and over 2% of cancer deaths (more than double the global proportion). Incidence has risen by 126% globally and over 40% in the US since 1990, while global mortality has risen by 94% and US mortality has fallen by 18%. The 5 year survival in the US has more than doubled over the past decades with the introduction of new targeted therapies and transplant techniques. Risk factors for MM include age (average age of diagnosis is 69), race (African Americans are over double as likely to be diagnosed), sex (men are at a 1.5× risk), and family history. Diagnosis includes serum or urine electrophoresis and free light-chain assay but requires bone marrow biopsy. It is distinguished from smoldering myeloma and monoclonal gammopathy of undetermined significance by a high (>3 g/dL) level of M-protein (monoclonal light chains) and the presence of CRAB (Hypercalcemia, Renal failure, Anemia, Bone pain) symptoms, which include hypercalcemia, renal failure, anemia, and bone pain, suggesting an end-organ damage. International staging system staging involves beta 2 microglobulin and albumin levels, while the revised system considers prognostic factors such as lactate dehydrogenase levels and chromosomal abnormalities. Front-line management includes induction regimen, maintenance therapy and hematopoietic cell transplantation for eligible patients and bisphosphonates or bone-stimulating agents for the prevention of skeletal events. Treatment for relapsed disease includes newly approved monoclonal antibodies like the CD38-targeting daratumumab, proteasome inhibitors, immunomodulating agents, and investigational therapies such as B cell maturation antigen Chimeric antigen receptor T cells.
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Affiliation(s)
- Sandeep Anand Padala
- Department of Medicine, Division of Nephrology, Hypertension and Transplant, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
- Correspondence: or ; Tel.: +516-673-6675; Fax: +706-721-7136
| | - Adam Barsouk
- Sidney Kimmel Cancer Center, Jefferson University, Philadelphia, PA 19107, USA;
| | - Alexander Barsouk
- Hematology-Oncology, Allegheny Health Network, Pittsburgh, PA 15212, USA;
| | - Prashanth Rawla
- Department of Internal Medicine, Sovah Health, Martinsville, VA 24112, USA;
| | - Anusha Vakiti
- Department of Medicine, Hematology-Oncology, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA; (A.V.); (V.K.); (G.H.A.)
| | - Ravindra Kolhe
- Department of Medicine, Pathology, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA;
| | - Vamsi Kota
- Department of Medicine, Hematology-Oncology, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA; (A.V.); (V.K.); (G.H.A.)
| | - Germame Hailegiorgis Ajebo
- Department of Medicine, Hematology-Oncology, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA; (A.V.); (V.K.); (G.H.A.)
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9
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Zhang L, Wang Q, Wu X, Zhao A, Feng J, Zhang H, Cao X, Li S, Cai H, Sun Z, Duan M, Zhu T, Zhang W, Jin Z, Zhou D, Xue H, Li J. Baseline bone marrow ADC value of diffusion-weighted MRI: a potential independent predictor for progression and death in patients with newly diagnosed multiple myeloma. Eur Radiol 2020; 31:1843-1852. [PMID: 32965573 DOI: 10.1007/s00330-020-07295-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/07/2020] [Accepted: 09/15/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To illuminate the prognostic value of ADC (apparent diffusion coefficient), an important quantitative parameter of diffusion-weighted MRI, for multiple myeloma (MM). METHODS A prospective single-center study which enrolled 114 consecutive newly diagnosed MM patients with baseline whole-body diffusion-weighted MRI (WB DW-MRI) results was conducted. Baseline clinical and MRI parameters were analyzed with univariate and multivariate approaches to identify independent risk factors for progression-free survival (PFS) and overall survival (OS). RESULTS Five different DW-MRI patterns were seen, and the mean ADC value of the representative background bone marrow was 0.4662 ± 0.1939 × 10-3 mm2/s. After a mean follow-up of 50.2 months (range, 15.7-75.8 months), twenty-four patients died and seven were lost to follow-up. The mean ADC value of the representative background bone marrow was showed to be an independent risk factor for both PFS (HR 4.664; 95% confidence interval (CI) 1.138-19.121; p = 0.032) and OS (HR 14.130; 95% CI 1.544-129.299; p = 0.019). Normal/salt-and-pepper pattern on DW-MRI was associated with PFS using univariate analysis (p = 0.035) but lost the significance with multivariate Cox regression. CONCLUSIONS Mean ADC value of the representative background bone marrow predicts both PFS and OS which suggests the role of baseline DW-MRI for risk stratification in newly diagnosed MM patients. KEY POINTS • Whole-body diffusion-weighted MRI (WB DW-MRI) might be helpful to improve the current risk stratification systems for newly diagnosed multiple myeloma (MM). • Morphological parameters as MRI pattern and focal lesion-associated parameters have been reported to be related to survival. However, important functional parameters such as apparent diffusion coefficient (ADC) values were not incorporated into the current risk stratification model. • This study is one of the first endeavors to delineate the correlation of baseline ADC values and survival in MM patients. It is revealed that the mean ADC value of the representative background bone marrow (L3-S1 and iliac bone) was an independent risk factor for both PFS and OS.
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Affiliation(s)
- Lu Zhang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Qin Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Xia Wu
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Ailin Zhao
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Jun Feng
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Haibo Zhang
- Department of Radiology, China-Japan Friendship Hospital, Yinghua East Road 2#, Heping Street, Chaoyang District, Beijing, 100029, China
| | - Xinxin Cao
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Shuo Li
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Huacong Cai
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Zhaoyong Sun
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Minghui Duan
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Tienan Zhu
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Wei Zhang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Zhengyu Jin
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Daobin Zhou
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Huadan Xue
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
| | - Jian Li
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
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10
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Chu B, Bao L, Wang Y, Lu M, Shi L, Gao S, Fang L, Xiang Q, Liu X. CD27 antigen negative expression indicates poor prognosis in newly diagnosed multiple myeloma. Clin Immunol 2020; 213:108363. [PMID: 32120013 DOI: 10.1016/j.clim.2020.108363] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 12/19/2019] [Accepted: 02/17/2020] [Indexed: 12/20/2022]
Abstract
To investigate the role of CD27 in multiple myeloma(MM), bone marrow samples from 165 newly diagnosed MM were analysed by flow cytometry. CD27- group (n = 93) had higher level of plasma cell proportion (37.00% vs 22.50%, p < .05), β2-MG (5.42 vs 3.20 mg/L, p < .05), calcium (2.45 vs 2.28 mmol/L, p < .05),higher percentage of ISS stage III (49.46% vs 22.22%, p < .05) and patients with ≥2 high-risk cytogenetics (24.73% vs 15.28%, p < .05) than CD27+ group (n = 72). After 4 cycles of chemotherapy, the overall response rate in CD27- group were lower than CD27+ group (56.67% vs 73.02%,p < .05). After a median follow-up of 18 months, progression-free survival was significantly shorter in CD27- group than in CD27+ group (22 vs 40 months, p < .05), so was overall survival (median OS not reached, p < .05). Gene sequencing showed more adverse mutations in CD27- group than CD27+ group.
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Affiliation(s)
- Bin Chu
- Department of hematology, Beijing Jishuitan Hospital, Beijing, China
| | - Li Bao
- Department of hematology, Beijing Jishuitan Hospital, Beijing, China.
| | - Yutong Wang
- Department of hematology, Beijing Jishuitan Hospital, Beijing, China
| | - Minqiu Lu
- Department of hematology, Beijing Jishuitan Hospital, Beijing, China
| | - Lei Shi
- Department of hematology, Beijing Jishuitan Hospital, Beijing, China
| | - Shan Gao
- Department of hematology, Beijing Jishuitan Hospital, Beijing, China
| | - Lijuan Fang
- Department of hematology, Beijing Jishuitan Hospital, Beijing, China
| | - Qiuqing Xiang
- Department of hematology, Beijing Jishuitan Hospital, Beijing, China
| | - Xi Liu
- Department of hematology, Beijing Jishuitan Hospital, Beijing, China
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11
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Boodman C, Libman M, Ndao M, Yansouni CP. Case Report: Trypanosoma brucei Gambiense Human African Trypanosomiasis as the Cause of Fever in an Inpatient with Multiple Myeloma and HIV-1 Coinfection. Am J Trop Med Hyg 2020; 101:123-125. [PMID: 31074413 DOI: 10.4269/ajtmh.18-0889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We report the case of a 64-year-old woman found to have urban-acquired Trypanosoma brucei (T.b.) gambiense human African trypanosomiasis (HAT) as the cause of sustained fever starting 9 months after returning to Canada from Democratic Republic of the Congo, in the context of concomitant multiple myeloma and HIV-1 coinfection. Approaches for the management of both clinical stages of T.b. gambiense HAT are well defined for endemic settings using current diagnostics and treatments. However, few data inform the diagnosis and management of patients with bone marrow suppression from active malignancy, recent anticancer therapy, or HIV coinfection. We discuss the implications of immunosuppression for diagnosis and management of T.b. gambiense HAT.
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Affiliation(s)
- Carl Boodman
- J.D. MacLean Centre for Tropical Diseases, Montreal, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Michael Libman
- Division of Infectious Diseases, Department of Medical Microbiology, McGill University Health Centre, Montreal, Canada.,J.D. MacLean Centre for Tropical Diseases, Montreal, Canada
| | - Momar Ndao
- National Reference Centre for Parasitology, Montreal, Canada.,J.D. MacLean Centre for Tropical Diseases, Montreal, Canada
| | - Cedric P Yansouni
- Division of Infectious Diseases, Department of Medical Microbiology, McGill University Health Centre, Montreal, Canada.,J.D. MacLean Centre for Tropical Diseases, Montreal, Canada
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12
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Topp MS, Duell J, Zugmaier G, Attal M, Moreau P, Langer C, Krönke J, Facon T, Salnikov AV, Lesley R, Beutner K, Kalabus J, Rasmussen E, Riemann K, Minella AC, Munzert G, Einsele H. Anti-B-Cell Maturation Antigen BiTE Molecule AMG 420 Induces Responses in Multiple Myeloma. J Clin Oncol 2020; 38:775-783. [PMID: 31895611 DOI: 10.1200/jco.19.02657] [Citation(s) in RCA: 209] [Impact Index Per Article: 52.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
PURPOSE The anti-B-cell maturation antigen BiTE molecule AMG 420 was assessed in patients with relapsed/refractory multiple myeloma. PATIENTS AND METHODS In this first-in-human study, up to 10 cycles of AMG 420 were given (4-week infusions/6-week cycles). Patients had progression after ≥ 2 lines of prior therapy and no extramedullary disease. Minimal residual disease (MRD) response was defined as < 1 tumor cell/104 bone marrow cells by flow cytometry. RESULTS Forty-two patients received AMG 420 at 0.2-800 μg/d. Median age was 65 years, and median disease duration was 5.2 years. Median exposure was 1 cycle (range, 1-10 cycles) and 7 cycles (range, 1-10 cycles) for responders. Patients discontinued for disease progression (n = 25), adverse events (AEs; n = 7), death (n = 4), completion of 10 cycles (n = 3), and consent withdrawal (n = 1). Two patients remain on treatment. There were 2 nontreatment-related deaths from AEs, influenza/aspergillosis and adenovirus-related hepatitis. Serious AEs (n = 20; 48%) included infections (n = 14) and polyneuropathy (n = 2); treatment-related serious AEs included 2 grade 3 polyneuropathies and 1 grade 3 edema. There were no grade ≥ 3 CNS toxicities or anti-AMG 420 antibodies. In this study, 800 μg/d was considered to not be tolerable because of 1 instance each of grade 3 cytokine release syndrome and grade 3 polyneuropathy, both of which resolved. The overall response rate was 31% (n = 13 of 42). At the maximum tolerated dose (MTD) of 400 μg/d, the response rate was 70% (n = 7 of 10). Of these, five patients experienced MRD-negative complete responses, and 1 had a partial response, and 1 had a very good partial response; all 7 patients responded during the first cycle, and some responses lasted > 1 year. CONCLUSION In this study of AMG 420 in patients with relapsed/refractory multiple myeloma, the response rate was 70%, including 50% MRD-negative complete responses, at 400 μg/d, the MTD for this study.
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Affiliation(s)
- Max S Topp
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Johannes Duell
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | | | | | - Philippe Moreau
- Hematology Department, University Hospital Center of Nantes, Nantes, France
| | | | | | - Thierry Facon
- Regional University Hospital of Lille, Lille, France
| | | | | | | | | | | | | | | | | | - Hermann Einsele
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
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13
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Terrada O, Cherradi B, Raihani A, Bouattane O. A novel medical diagnosis support system for predicting patients with atherosclerosis diseases. INFORMATICS IN MEDICINE UNLOCKED 2020. [DOI: 10.1016/j.imu.2020.100483] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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14
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Zhu F, Jiang D, Zhang M, Zhao B. 2,4-Dihydroxy-3'-methoxy-4'-ethoxychalcone suppresses cell proliferation and induces apoptosis of multiple myeloma via the PI3K/akt/mTOR signaling pathway. PHARMACEUTICAL BIOLOGY 2019; 57:641-648. [PMID: 31564190 PMCID: PMC6781472 DOI: 10.1080/13880209.2019.1662814] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 08/26/2019] [Accepted: 08/28/2019] [Indexed: 06/10/2023]
Abstract
Context: Caragana pruinosa Kom. (Fabaceae), a commonly used folk medicine, has been found to possess antitumor effects. However, the antiproliferative effect of 2,4-dihydroxy-3'-methoxy-4'-ethoxychalcone (DMEC) derived from C. pruinosa against multiple myeloma (MM) has never been investigated. Objective: This study systematically evaluates the antiproliferative effect of DMEC against MM cells. Materials and methods: The antiproliferative effect of DMEC (1, 2, 4, 8, 16, 32, and 64 μM) on MM cells lines, including RPMI8226, MM.1S, and U266, was examined using Cell counting kit-8 (CCK-8) assay after 24 h incubation. The proapoptotic effect of DMEC (20 μM) was determined using fluorescent microscope and flow cytometer, and its possible underlying mechanisms were further studied by using western blotting analysis. Results: The half maximal inhibitory concentrations (IC50) of DMEC on RPMI8226, MM.1S, and U266 cells were calculated as 25.97, 18.36, and 15.02 μM, respectively. The inhibitory effect of DMEC on MM cells was related to mitochondria-mediated apoptosis via upregulation of the cleaved-caspase-3 (C-3), cleaved-caspase-9 (C-9), Bad, and cytochrome C (Cyto C), but downregulation of the Bcl-2 and poly ADP-ribose polymerase (PARP). Furthermore, DMEC (5, 10, and 20 μM) reduced the expression of phosphatidylinositol-3-kinase (PI3K), phosphorylated (p)-protein kinase B (Akt), and p-mammalian target of rapamycin (p-mTOR), which were further evidenced by pretreatment with IGF-1, a PI3K activator. Conclusion: Collectively, our results indicate that the DMEC could be treated as a new candidate for treatment of multiple myeloma in the future. Also, an in vivo study is warranted in the future.
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Affiliation(s)
- FengChen Zhu
- Department of Orthopaedics, The Yongchuan Affiliated Hospital, Chongqing Medical University, Chongqing, P.R. China
| | - DianMing Jiang
- Department of Orthopaedics, Third Affiliated Hospital, Chongqing Medical University, Chongqing, P.R. China
| | - MingHua Zhang
- Department of Orthopaedics, The Yongchuan Affiliated Hospital, Chongqing Medical University, Chongqing, P.R. China
| | - Bo Zhao
- Department of Orthopaedics, The Yongchuan Affiliated Hospital, Chongqing Medical University, Chongqing, P.R. China
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15
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Mendoza H, Tormey CA, Siddon AJ. Use of B-Cell Gene Rearrangement Studies to Establish Clonality in Non-producer Non-secretory Multiple Myeloma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 20:e18-e21. [PMID: 31711890 DOI: 10.1016/j.clml.2019.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 10/15/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Hadrian Mendoza
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT
| | - Christopher A Tormey
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT; Pathology and Laboratory Medicine Service, VA Connecticut Healthcare System, West Haven, CT
| | - Alexa J Siddon
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT; Department of Pathology, Yale School of Medicine, New Haven, CT; Pathology and Laboratory Medicine Service, VA Connecticut Healthcare System, West Haven, CT.
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16
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Riva E, Bove V, Villano F, Mori M, Córdoba C, Noria A, Petruskevicius P, Cardeza A, Díaz L. From guidelines to real world: results from the National Multiple Myeloma Registry in Uruguay on 222 newly diagnosed multiple myeloma patients from 2012 to 2015. Curr Med Res Opin 2019; 35:1197-1203. [PMID: 30621522 DOI: 10.1080/03007995.2019.1568091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Introduction: In the last decade, substantial improvements in the understanding of the biology of multiple myeloma and the development of novel therapeutic options have led to increased response rates, progression free survival and overall survival. In underdeveloped countries, it is a huge challenge to adapt for this evolution, both in diagnostic and therapeutic aspects. Methods: We conducted a retrospective, national analysis of all patients with newly diagnosed multiple myeloma in a recent period. Diagnostic and prognostic evaluation is carried out according to international recommendations in the majority of patients. Results: The clinical presentation at diagnosis is similar to those reported internationally, although with higher rates of anemia and severe renal failure. Most patients were diagnosed in advanced Durie-Salmon stage (80%), with high ISS score (48% ISS 3). Treatment, both in candidates and non-candidates for transplantation, is conditioned by a limited supply of possibilities, scarce availability of new drugs and absence of clinical trials. This determines lower results in response depth and survival. At 32 months, overall survival was 61.8%, with a statistical difference in favor of younger patients, standard-risk MM and those treated with novel drugs. No patient received antibacterial or antifungal prophylaxis while the majority received adequate antiviral prophylaxis. Infections were the main cause of death (29.7%), overcoming the disease itself. Conclusions: This analysis allows us to raise awareness about strengths and weaknesses in our management of MM patients. There is a need to promote earlier detection, improve supportive care and reduce infection mortality. Greater availability of evidence-based recommended treatment options is required. Access to clinical trials is warranted if care is to be improved.
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Affiliation(s)
- E Riva
- a Cátedra de Hematología , Hospital de Clínicas , Montevideo , Uruguay
- b Servicio de Hematología , Asociación Española Primera de Socorros Mutuos , Montevideo , Uruguay
- c Servicio de Hematología , Médica Uruguaya , Montevideo , Uruguay
- d Servicio de Hematología , Hospital Británico , Montevideo , Uruguay
| | - V Bove
- a Cátedra de Hematología , Hospital de Clínicas , Montevideo , Uruguay
- e Servicio de Hematología , Servicio Médico Integral , Montevideo , Uruguay
| | - F Villano
- a Cátedra de Hematología , Hospital de Clínicas , Montevideo , Uruguay
- f Servicio de Hematología , CASMU , Montevideo , Uruguay
| | - M Mori
- g Servicio de Hematología , Hospital Maciel , Montevideo , Uruguay
| | - C Córdoba
- h Servicio de Hematología , Asociación Médica de Salto , Salto , Uruguay
| | - A Noria
- i Departamento de Métodos Cuantitativos , Facultad de Medicina , Montevideo , Uruguay
| | - P Petruskevicius
- j Comisión Honoraria de Lucha Contra el Cáncer , Montevideo , Uruguay
| | - A Cardeza
- b Servicio de Hematología , Asociación Española Primera de Socorros Mutuos , Montevideo , Uruguay
| | - L Díaz
- a Cátedra de Hematología , Hospital de Clínicas , Montevideo , Uruguay
- e Servicio de Hematología , Servicio Médico Integral , Montevideo , Uruguay
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17
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Ye CY, Zheng CP, Ying WW, Weng SS. Up-regulation of microRNA-497 inhibits the proliferation, migration and invasion but increases the apoptosis of multiple myeloma cells through the MAPK/ERK signaling pathway by targeting Raf-1. Cell Cycle 2018; 17:2666-2683. [PMID: 30382763 PMCID: PMC6343711 DOI: 10.1080/15384101.2018.1542895] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Multiple myeloma (MM) is a cancer that occurs in plasma cells, which fall under the category of white blood cells that are in charge of antibody production. According to previous studies, microRNA-497 (miR-497) functions as a tumor suppressor in several types of cancer, including gastric cancer and colorectal cancer. Therefore, the present study aims to investigate the effects of miR-497 on cellular function of human MM cells through the mitogen-activated protein kinase/extracellular signal-regulated kinase (MAPK/ERK) signaling pathway by targeting Raf-1. The differentially expressed genes and miRs in MM, and the relationship between the miR and gene were verified. It was found that Raf-1 was a target gene of miR-497. The data obtained from MM tissues showed increased Raf-1 level and decreased miR-497 level. MM cells were treated with mimic, inhibitor and siRNA in order to evaluate the role of miR-497, Raf-1 and MAPK/ERK in MM. The expression pattern of miR-497, Raf-1, ERK1/2, survivin, B-cell lymphoma-2 (Bcl-2) and BCL2-Associated X (Bax) as well as the extent of ERK1/2 phosphorylation were determined. Retored miR-497 and si-Raf-1 resulted in increases in the Bax expression and cell apoptosis and decreases in the expressions of Raf-1, MEK-2, survivin, Bcl-2, along with the extent of ERK1/2 phosphorylation. In addition, the biological function evaluations of MM cells revealed that miR-497 mimic or si-Raf-1 led to suppression in cell proliferation, invasion and migration. In conclusion, our results have demonstrated that miR-497 targets Raf-1 in order to inhibit the progression of MM by blocking the MAPK/ERK signaling pathway.
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Affiliation(s)
- Cheng-Yu Ye
- a Department of Hematologic Oncology , Wenzhou Central Hospital, Dingli Clinical Medical School of Wenzhou Medical University , Wenzhou , P.R. China
| | - Cui-Ping Zheng
- a Department of Hematologic Oncology , Wenzhou Central Hospital, Dingli Clinical Medical School of Wenzhou Medical University , Wenzhou , P.R. China
| | - Wei-Wei Ying
- b Wenzhou Medical University , Wenzhou , P.R. China
| | - Shan-Shan Weng
- a Department of Hematologic Oncology , Wenzhou Central Hospital, Dingli Clinical Medical School of Wenzhou Medical University , Wenzhou , P.R. China
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18
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Clark CA, Mosse CA, Chen H, Byrne M, Chinratanalab W, Engelhardt BG, Goodman SA, Harrell SL, Kassim AA, Savani BN, Sengsayadeth S, Jagasia M, Cornell RF. Prospective trial of minimal residual disease assessment by multiparametric flow cytometry for multiple myeloma in the era of bortezomib-based chemotherapy. Bone Marrow Transplant 2018; 53:1589-1592. [PMID: 29915217 DOI: 10.1038/s41409-018-0241-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/06/2018] [Accepted: 05/11/2018] [Indexed: 12/31/2022]
Affiliation(s)
- C Amos Clark
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Claudio A Mosse
- Department of Hematopathology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Heidi Chen
- Division of Biostatistics and Quantitative Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michael Byrne
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Wichai Chinratanalab
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Brian G Engelhardt
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Stacey A Goodman
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Shelton L Harrell
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Adetola A Kassim
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Bipin N Savani
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Salyka Sengsayadeth
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Madan Jagasia
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - R Frank Cornell
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
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19
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Lenalidomide vs bortezomib maintenance choice post-autologous hematopoietic cell transplantation for multiple myeloma. Bone Marrow Transplant 2018; 53:701-707. [PMID: 29703965 DOI: 10.1038/s41409-018-0177-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 02/18/2018] [Accepted: 03/23/2018] [Indexed: 12/22/2022]
Abstract
Maintenance therapy post-autologous hematopoietic cell transplantation (AHCT) with either lenalidomide or bortezomib for multiple myeloma (MM) have separately been shown to improve progression-free survival (PFS), but have never been directly compared. We performed a retrospective study to investigate progression-free and overall survival outcomes and toxicities of lenalidomide maintenance therapy compared with bortezomib maintenance in MM patients post-AHCT. This study included 156 patients who received post-AHCT lenalidomide or bortezomib maintenance therapy for MM. The primary outcome was PFS. Ninety-two patients received lenalidomide maintenance and 64 received bortezomib maintenance post-AHCT. By multivariable analysis, maintenance therapy choice and cytogenetics risk did not impact PFS or OS. Staging by International Staging System and pre-maintenance disease response were the greatest predictors for PFS. Treatment-related toxicities were as anticipated with 5.4% of patients receiving maintenance lenalidomide experiencing secondary primary malignancies (SPMs) compared with 3% for bortezomib. These findings suggest there were no differences in PFS or OS between lenalidomide and bortezomib maintenance therapy options for post-transplantation MM patients. These data should be validated in a larger, prospective cohort to determine if maintenance choice should be guided by side effect profile and patient anticipated tolerance rather than by disease biology alone.
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20
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Chakravarthy SN, Ramanathan S, Menon S, Valappil V, Durairaj M, Arokia J. Cinderella in Serum Protein Electrophoresis. Indian J Clin Biochem 2018; 33:113-116. [PMID: 29371780 DOI: 10.1007/s12291-017-0643-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 02/15/2017] [Indexed: 11/29/2022]
Abstract
Paraproteinemia is characterised by clonal proliferation of plasma cells. A common laboratory finding in paraproteinemia being a monoclonal peak in serum protein electrophoresis (M band). But there are factors which produce a peak similar to M spike in serum protein electrophoresis and these factors are known as pseudoparaproteins. This case report discusses a rare cause of pseudo M spike in a known case of autoimmune hemolytic anaemia due to administration of drug-Rituximab, a monoclonal antibody by itself.
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Affiliation(s)
| | - Satish Ramanathan
- Department of Laboratory Medicine, MIOT Hospitals, No. 4/112, Mount Poonamallee Road, Manapakkam, Chennai, Tamil Nadu 600089 India
| | - Smitha Menon
- Department of Laboratory Medicine, MIOT Hospitals, No. 4/112, Mount Poonamallee Road, Manapakkam, Chennai, Tamil Nadu 600089 India
| | - Vijayakumar Valappil
- Department of Laboratory Medicine, MIOT Hospitals, No. 4/112, Mount Poonamallee Road, Manapakkam, Chennai, Tamil Nadu 600089 India
| | - Mathivanan Durairaj
- Department of Laboratory Medicine, MIOT Hospitals, No. 4/112, Mount Poonamallee Road, Manapakkam, Chennai, Tamil Nadu 600089 India
| | - Jayarani Arokia
- Department of Laboratory Medicine, MIOT Hospitals, No. 4/112, Mount Poonamallee Road, Manapakkam, Chennai, Tamil Nadu 600089 India
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21
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Ely S, Forsberg P, Ouansafi I, Rossi A, Modin A, Pearse R, Pekle K, Perry A, Coleman M, Jayabalan D, Di Liberto M, Chen-Kiang S, Niesvizky R, Mark TM. Cellular Proliferation by Multiplex Immunohistochemistry Identifies High-Risk Multiple Myeloma in Newly Diagnosed, Treatment-Naive Patients. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2017; 17:825-833. [DOI: 10.1016/j.clml.2017.09.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 08/07/2017] [Accepted: 09/11/2017] [Indexed: 10/18/2022]
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22
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Bahuaud M, Bodilis H, Malphettes M, Maugard Landre A, Matondo C, Bouscary D, Batteux F, Launay O, Fermand JP. Immunogenicity and persistence of the 13-valent Pneumococcal Conjugate Vaccine (PCV13) in patients with untreated Smoldering Multiple Myeloma (SMM): A pilot study. Heliyon 2017; 3:e00441. [PMID: 29159320 PMCID: PMC5681344 DOI: 10.1016/j.heliyon.2017.e00441] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 09/27/2017] [Accepted: 10/26/2017] [Indexed: 11/24/2022] Open
Abstract
Smoldering multiple myeloma (SMM) is an asymptomatic clonal plasma cell disorder that frequently progress to multiple myeloma (MM), a disease at high risk of pneumococcal infections. Moreover, if the polysaccharide vaccine is poorly immunogenic in MM, the 13-valent conjugated vaccine has never been tested in clonal plasma cell disorders. We evaluated its immunogenicity for 7 serotypes in 20 patients ≥ 50 years of age with smoldering multiple myeloma (SMM) pre and post routine-vaccination with PCV13. Concentrations of IgG specific for 7 serotypes were measured at baseline, 1, 6, and 12 months after vaccination by standardized ELISA and an Opsonophagocytic Assay (OPA). The primary endpoint was the proportion of patients responding to at least 5 of the 7 serotypes by ELISA at one month. At 1 month post vaccination, 12 patients (60%) were responders by ELISA, among whom 8 were also responders by OPA. At 6 months, 6 (30% of total) of the 12 responders had persistent immunity, and only 2 (10% of total) at 12 months. These results suggested a partial response in this population and a rapid decrease in antibody levels in the first months of vaccination. Although one injection of the 13-valent pneumococcal conjugate vaccine is immunogenic in some patients with SMM, the response is transient. Repeated injections are likely to be needed for effective and sustained protection.
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Affiliation(s)
- Mathilde Bahuaud
- Plateforme d'Immunomonotoring Vaccinal, Laboratoire d'Immunologie, Groupe hospitalier Cochin-Broca-Hôtel Dieu, AP-HP, Paris, France
| | - Hélène Bodilis
- Centre d'Investigation Clinique Cochin-Pasteur (CIC1417), Groupe hospitalier Cochin-Broca-Hôtel Dieu, AP-HP, Paris, France
| | - Marion Malphettes
- Service d'Immuno-Hématologie clinique, Groupe hospitalier Saint-Louis-Lariboisière-Fernand Widal, APHP, Paris, France
| | - Anaïs Maugard Landre
- Centre d'Investigation Clinique Cochin-Pasteur (CIC1417), Groupe hospitalier Cochin-Broca-Hôtel Dieu, AP-HP, Paris, France
| | - Caroline Matondo
- Plateforme d'Immunomonotoring Vaccinal, Laboratoire d'Immunologie, Groupe hospitalier Cochin-Broca-Hôtel Dieu, AP-HP, Paris, France
| | - Didier Bouscary
- Service d'Hématologie clinique, Groupe hospitalier Cochin-Broca-Hôtel Dieu, AP-HP, Paris, France
| | - Frédéric Batteux
- Plateforme d'Immunomonotoring Vaccinal, Laboratoire d'Immunologie, Groupe hospitalier Cochin-Broca-Hôtel Dieu, AP-HP, Paris, France
| | - Odile Launay
- Centre d'Investigation Clinique Cochin-Pasteur (CIC1417), Groupe hospitalier Cochin-Broca-Hôtel Dieu, AP-HP, Paris, France
| | - Jean-Paul Fermand
- Service d'Immuno-Hématologie clinique, Groupe hospitalier Saint-Louis-Lariboisière-Fernand Widal, APHP, Paris, France
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Lee KJ, Lee KH, Yoon KA, Sohn JY, Lee E, Lee H, Eom HS, Kong SY. Chromothripsis in Treatment Resistance in Multiple Myeloma. Genomics Inform 2017; 15:87-97. [PMID: 29020724 PMCID: PMC5637343 DOI: 10.5808/gi.2017.15.3.87] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 08/17/2017] [Accepted: 08/29/2017] [Indexed: 12/24/2022] Open
Abstract
Multiple myeloma (MM) is a malignant disease caused by an abnormal proliferation of plasma cells, of which the prognostic factors include chromosomal abnormality, β-2 microglobulin, and albumin. Recently, the term chromothripsis has emerged, which is the massive but highly localized chromosomal rearrangement in response to a one-step catastrophic event. Many studies have shown an association of chromothripsis with the prognosis in several cancers; however, few studies have investigated it in MM. Here, we studied the association between chromothripsis-like patterns and treatment resistance or prognosis. First, we analyzed nine MM cell lines (U266, MM.1S, RPMI8226, KMS-11, KMS-12-BM, KMS-12-PE, KMS-28-BM, KMS-28-PE, and NCI-H929) and bone marrow samples of four patients who were diagnosed with MM by next-generation sequencing-based copy number variation analysis. The frequency of the chromothripsis-like pattern was observed in seven cell lines. We analyzed the treatment-induced chromothripsis-like patterns in KMS-12-BM and KMS-12-PE cells. As a result, breakpoints and chromothripsis-like patterns were increased after drug treatment in the relatively resistant KMS-12-BM. We further analyzed the patients’ results according to the therapeutic response, which was divided into sensitive and resistant, as suggested by the International Myeloma Working Group. The chromothripsis-like pattern was more frequently observed in the resistant group. In the sensitive group, the frequency of the chromothripsis-like pattern decreased after treatment, whereas the resistant group showed increased chromothripsis-like patterns after the treatment. These results suggest that the chromothripsis-like pattern is associated with treatment response in MM.
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Affiliation(s)
- Kyoung Joo Lee
- Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy, Goyang 10408, Korea
| | - Ki Hong Lee
- Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy, Goyang 10408, Korea
| | - Kyong-Ah Yoon
- College of Veterinary Medicine, Konkuk University, Seoul 05029, Korea
| | - Ji Yeon Sohn
- Department of Laboratory Medicine, Center for Diagnostic Oncology, Research Institute and Hospital, National Cancer Center, Goyang 10408, Korea
| | - Eunyoung Lee
- Center for Hematologic Malignancy, National Cancer Center, Goyang 10408, Korea
| | - Hyewon Lee
- Center for Hematologic Malignancy, National Cancer Center, Goyang 10408, Korea.,Precision Medicine Branch, Division of Precision Medicine, National Cancer Center, Goyang 10408, Korea
| | - Hyeon-Seok Eom
- Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy, Goyang 10408, Korea.,Center for Hematologic Malignancy, National Cancer Center, Goyang 10408, Korea
| | - Sun-Young Kong
- Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy, Goyang 10408, Korea.,Department of Laboratory Medicine, Center for Diagnostic Oncology, Research Institute and Hospital, National Cancer Center, Goyang 10408, Korea.,Center for Hematologic Malignancy, National Cancer Center, Goyang 10408, Korea.,Translational Research Branch, Division of Translational Science, National Cancer Center, Goyang 10408, Korea
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Outcomes from Autologous Hematopoietic Cell Transplantation versus Chemotherapy Alone for the Management of Light Chain Amyloidosis. Biol Blood Marrow Transplant 2017; 23:1473-1477. [DOI: 10.1016/j.bbmt.2017.05.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 05/17/2017] [Indexed: 11/21/2022]
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26
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Podar K, Pecherstorfer M. Current and developing synthetic pharmacotherapy for treating relapsed/refractory multiple myeloma. Expert Opin Pharmacother 2017; 18:1061-1079. [PMID: 28604120 DOI: 10.1080/14656566.2017.1340942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The introduction of novel agents has significantly improved multiple myeloma (MM) patient outcome during the last two decades. MM received the most drug approvals for any one malignancy during this time period, both in the United States as well as in Europe. Areas covered: Proteasome inhibitors, immunomodulatory drugs, and monoclonal antibodies are prototype drug classes, which target both specific MM cell functions, as well as the tumor supportive bone marrow microenvironment, and represent current cornerstones of MM therapy. Importantly, the unprecedented extent and frequency of durable responses, in relapsed/refractory multiple myeloma (RRMM), in particular, is predominantly based on the combinatorial use of these agents with conventional chemotherapeutics or representatives of other drug classes. This article will summarize past landmark discoveries in MM that led to the dramatic progress of today's clinical practice. Moreover, developing strategies will be discussed that are likely to yet improve patient outcome even further. Expert opinion: Despite significant therapeutic advancements, MM remains an incurable disease. With several novel agents in the preclinical and early clinical pipeline, among those novel CD38 and BCMA mAbs, immune checkpoint inhibitors, as well as ricolinostat, selinexor, venetoclax, CAR-T cells, and vaccines, further advances in MM patient outcome are expected in the near future.
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Affiliation(s)
- Klaus Podar
- a Department of Internal Medicine , Karl Landsteiner University of Health Sciences, University Hospital , Krems , Austria
| | - Martin Pecherstorfer
- a Department of Internal Medicine , Karl Landsteiner University of Health Sciences, University Hospital , Krems , Austria
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Barta SK, Jain R, Mazumder A, Carter J, Almanzar L, Browne R, Shahnaz S, Elkind R, Kaminetzky D, Battini R, Derman O, Kornblum N, Verma A, Braunschweig I. Pharmacokinetics-directed Intravenous Busulfan Combined With High-dose Melphalan and Bortezomib as a Conditioning Regimen for Patients With Multiple Myeloma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2017; 17:650-657. [PMID: 28684379 DOI: 10.1016/j.clml.2017.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 05/24/2017] [Accepted: 06/08/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) has a well-established role in the treatment of patients with multiple myeloma. Melphalan 200 mg/m2 (Mel200) is the most commonly used preparative regimen. Several studies have provided evidence for potential synergism and safety when combining bortezomib (Btz) or busulfan (Bu) with melphalan (Mel). PATIENTS AND METHODS We conducted a prospective phase II study to investigate the safety and efficacy of conditioning with pharmacokinetics (PK)-directed intravenous (IV) Bu with Btz and Mel. Bu dosing was adjusted to target a total area under the curve (AUC) of 20,000 μM × min. Patients received Btz (1 mg/m2 × 4 doses) and Mel (140 mg/m2). RESULTS A total of 19 subjects were enrolled. Their median age was 55 years, and the median follow-up period was 23.7 months. PK testing resulted in 86% of patients achieving an estimated total AUC of 20,000 ± 2500 μM × min. The overall response rate (ORR) at day +100 after ASCT was 100% in the evaluable patients, with 11% of patients achieving a complete response. The 2-year progression-free survival rate was 57.9% (95% confidence interval [CI], 38%-89%), and the 2-year overall survival rate was 88.5% (95% CI, 76%-100%). The most common grade 3 and 4 toxicities were febrile neutropenia, dysphagia/odynophagia, and oral mucositis. No case of hepatic sinusoidal obstruction syndrome developed. One treatment-related mortality occurred before day +100. CONCLUSION A preparative regimen of PK-directed IV Bu with Btz and Mel led to an ORR of 100% with acceptable toxicity and should be considered for direct comparison with the Mel200 regimen in future trials.
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Affiliation(s)
- Stefan K Barta
- Fox Chase Cancer Center, Philadelphia, PA; Montefiore Medical Center, Albert Einstein Cancer Center, Bronx, NY.
| | - Rishi Jain
- Fox Chase Cancer Center, Philadelphia, PA; Montefiore Medical Center, Albert Einstein Cancer Center, Bronx, NY
| | - Amithaba Mazumder
- NYU Clinical Cancer Institute, New York, NY; Westchester Medical Center, New York Medical College, Valhalla, NY
| | - Jason Carter
- Montefiore Medical Center, Albert Einstein Cancer Center, Bronx, NY; Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Roy Browne
- Montefiore Medical Center, Albert Einstein Cancer Center, Bronx, NY
| | | | - Richard Elkind
- Montefiore Medical Center, Albert Einstein Cancer Center, Bronx, NY
| | | | | | - Olga Derman
- Montefiore Medical Center, Albert Einstein Cancer Center, Bronx, NY
| | - Noah Kornblum
- Montefiore Medical Center, Albert Einstein Cancer Center, Bronx, NY
| | - Amit Verma
- Montefiore Medical Center, Albert Einstein Cancer Center, Bronx, NY
| | - Ira Braunschweig
- Montefiore Medical Center, Albert Einstein Cancer Center, Bronx, NY
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Sui WW, Zou DH, An G, Yi SH, Deng SH, Huang WY, Wang TY, Li J, Liu H, Fu MW, Lyu R, Liu W, Xu Y, Li ZJ, Zhao YZ, Qiu LG. [Long-term follow-up of multiple myeloma after autologous hematopoietic stem cell transplantation: a single center results]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2017; 38:499-504. [PMID: 28655093 PMCID: PMC7342971 DOI: 10.3760/cma.j.issn.0253-2727.2017.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
目的 评价诱导治疗联合自体周血造血干细胞移植(ASCT)治疗、移植后巩固维持治疗的整体方案治疗多发性骨髓瘤(MM)患者的有效性和长期随访结果。 方法 回顾性分析2005年1月1日至2016年2月1日接受整体方案治疗的144例MM患者资料,总结其长期随访结果,分析移植前疗效、移植后缓解深度,以及早期移植、晚期移植、不同预后分期系统等因素对患者生存的影响。 结果 144例患者中获得部分缓解(PR)以上治疗反应率为89.4%[完全缓解(CR)率64.1%]。中位随访47(6~121)个月,患者中位总体生存(OS)和无进展生存(PFS)时间分别为120.9和56.9个月;早期和晚期移植组患者的中位OS分别为120.9和50.1个月,中位PFS时间分别为60.2和16.7个月(P值均<0.001)。127例可进行修订的国际分期系统(R-ISS)分期患者中,Ⅰ期(43例)、Ⅱ期(64例)、Ⅲ期(20例)患者的中位OS时间分别为120.9、88.4、35.6个月,组间差异有统计学意义(P=0.000)。对早期和晚期移植组患者进行亚组生存分析,R-ISS Ⅲ期患者中位OS时间差异有统计学意义(35.6个月对15.8个月,P=0.031);两组患者各期中位PFS时间差异均有统计学意义(Ⅰ期:72.1个月对18.9个月;Ⅱ期:53.4个月对16.7个月;Ⅲ期:28.5对5.9个月,P值分别为0.000、0.012、0.001)。多因素分析结果显示R-ISS Ⅲ期是影响患者OS的危险因素(HR=8.486,95%CI 2.549~28.255,P=0.003),移植后未获得CR是影响患者PFS的危险因素(HR=2.412,95%CI 1.364~4.266,P=0.002)。 结论 以新药为基础的化疗联合ASCT的整体治疗方案对适合移植的MM患者是有效的,可进一步提高缓解率和缓解深度,延长患者的PFS和OS时间。早期较晚期移植可明显延长患者的OS和PFS时间。R-ISS分期和移植前疗效是影响患者生存的预后因素。
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Affiliation(s)
- W W Sui
- State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Disease Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
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Nathwani N, Wildes TM. Study design for vulnerable older adults with multiple myeloma. J Geriatr Oncol 2017; 8:162-164. [PMID: 28412160 DOI: 10.1016/j.jgo.2017.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Nitya Nathwani
- Judy and Bernard Briskin Center for Multiple Myeloma Research, Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, 1500 E. Duarte Road, Duarte, CA 91010, United States.
| | - Tanya M Wildes
- Division of Medical Oncology, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8056, St Louis, MO 63110, United States
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Shen X, Ye Y, Qi J, Shi W, Wu X, Ni H, Cong H, Ju S. Identification of a novel microRNA, miR-4449, as a potential blood based marker in multiple myeloma. Clin Chem Lab Med 2017; 55:748-754. [PMID: 27155004 DOI: 10.1515/cclm-2015-1108] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 04/04/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND miRNAs act in diverse biological processes including development, cell growth, apoptosis, and hematopoiesis, suggesting their role in cancer. METHODS We examined the miRNAs perturbed in CD138+ primary multiple myeloma (MM) cells, using microarray analysis and real-time quantitative PCR (RT-qPCR). Serum miR-4449 expression levels were detected from 71 primary MM patients and 46 healthy controls by RT-qPCR. RESULTS Our analysis revealed up-regulation of 54 and down-regulation of 28 miRNAs in MM subjects compared to healthy controls. miR-4449 has not been reported in MM. It was found that the relative expression of bone marrow miR-4449 in MM patients (2.14±1.42) was higher than that in healthy controls (0.815±0.165) (U=8, p=0.0093). The relative expression of serum miR-4449 in MM patients (2.11±2.10) was significantly higher than that in healthy controls (0.357±0.235) (U=374, p<0.0001) and was significantly correlated with β2M, λ light and κ light chain concentration (r=0.480, p=0.0003; r=0.560, p<0.0001; r=0.560, p<0.0001), but not correlated with the lactate dehydrogenase (LDH) concentration (r=0.247, p=0.0611). The area under the curve (AUC) of the receiver-operating characteristics (ROC) curve of serum miR-4449 was 0.885 (95% CI, 0.826-0.945), which is higher than for other markers. Combining miR-4449, λ light chain, and β2M together, the sensitivity was highest compared with λ light chain or β2M alone, or combined. CONCLUSIONS The expression levels of serum miR-4449 in MM patients were significantly higher than in healthy controls, suggesting that it may prove to be useful in the auxiliary diagnosis of MM.
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Affiliation(s)
- Xianjuan Shen
- Surgical Comprehensive Laboratory, Affiliated Hospital of Nantong University, Nantong, P.R
| | - Yan Ye
- Laboratory Medicine Center, Affiliated Hospital of Nantong University, Nantong, P.R
| | - Jing Qi
- Surgical Comprehensive Laboratory, Affiliated Hospital of Nantong University, Nantong, P.R
| | - Wei Shi
- Surgical Comprehensive Laboratory, Affiliated Hospital of Nantong University, Nantong, P.R
| | - Xinhua Wu
- Surgical Comprehensive Laboratory, Affiliated Hospital of Nantong University, Nantong, P.R
| | - Hongbing Ni
- Laboratory Medicine Center, Affiliated Hospital of Nantong University, Nantong, P.R
| | - Hui Cong
- Laboratory Medicine Center, Affiliated Hospital of Nantong University, Nantong, P.R
| | - Shaoqing Ju
- Laboratory Medicine Center, Affiliated Hospital of Nantong University, #20 Xisi Road, Nantong 226001, JS, P.R
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Wang C, He Z, Shi Y, Zhang L, Chen Y, Chen Z, Yu L. Low-dose lenalidomide and dexamethasone combination treatment in elderly patients with relapsed and refractory multiple myeloma. HEMATOLOGY (AMSTERDAM, NETHERLANDS) 2017; 22:88-92. [PMID: 27665836 DOI: 10.1080/10245332.2016.1234186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study investigated the efficacy and safety of low-dose lenalidomide combined with dexamethasone in elderly patients with relapsed and refractory multiple myeloma (MM). METHODS Thirty-two elderly patients with refractory and recurrent MM (median age: 64 years) were treated with low-dose lenalidomide (LD-R) combined with dexamethasone (D). LD-R (10 mg/d) was administered orally for 21 days and D (40 mg/d) was administered twice a day on days 1-4, 9-12, and 17-20. The treatment lasted 2-8 28-day cycles. RESULTS After two cycles, the complete, very good partial, and partial remission rates were 12.5% (4/32), 25.0% (8/32), and 34.4% (11/32), respectively. The overall response rate was 71.9% (23/32). After a 24-month follow-up, 23 patients responded to therapy, three were in complete remission, four were stable, and 16 exhibited disease progression. In addition, median time-to-progression was 13 months. Observed side effects were hypodynamia, gastrointestinal reaction, peripheral neuritis, and mild hypocytosis. CONCLUSION Low-dose lenalidomide in combination with dexamethasone is an effective and safe treatment for relapsed and refractory MM in elderly patients.
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Affiliation(s)
- Chunling Wang
- a Department of Hematology, Huai'an First People's Hospital , Nanjing Medical University , Huai'an 223300 , Jiangsu , China
| | - Zhengmei He
- a Department of Hematology, Huai'an First People's Hospital , Nanjing Medical University , Huai'an 223300 , Jiangsu , China
| | - Yuye Shi
- a Department of Hematology, Huai'an First People's Hospital , Nanjing Medical University , Huai'an 223300 , Jiangsu , China
| | - Lijuan Zhang
- a Department of Hematology, Huai'an First People's Hospital , Nanjing Medical University , Huai'an 223300 , Jiangsu , China
| | - Yue Chen
- a Department of Hematology, Huai'an First People's Hospital , Nanjing Medical University , Huai'an 223300 , Jiangsu , China
| | - Zhi Chen
- a Department of Hematology, Huai'an First People's Hospital , Nanjing Medical University , Huai'an 223300 , Jiangsu , China
| | - Liang Yu
- a Department of Hematology, Huai'an First People's Hospital , Nanjing Medical University , Huai'an 223300 , Jiangsu , China
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Sathitruangsak C, Righolt CH, Klewes L, Tung Chang D, Kotb R, Mai S. Distinct and shared three-dimensional chromosome organization patterns in lymphocytes, monoclonal gammopathy of undetermined significance and multiple myeloma. Int J Cancer 2017; 140:400-410. [PMID: 27711972 PMCID: PMC5132008 DOI: 10.1002/ijc.30461] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 07/11/2016] [Accepted: 09/29/2016] [Indexed: 12/24/2022]
Abstract
The consistent appearance of specific chromosomal translocations in multiple myeloma has suggested that the positioning of chromosomes in the interphase nucleus might play a role in the occurrence of particular chromosomal rearrangements associated with malignant transformation. Using fluorescence in situ hybridization, we have determined the positions of selected chromosome pairs (18 and 19, 9 and 22, 4 and 14, 14 and 16, 11 and 14) in interphase nuclei of myeloma cells compared to normal lymphocytes of treatment-naïve patients. All chromosome pairs were arranged in a nonrandom pattern. Chromosomes commonly involved in myeloma-associated translocations (4 and 14, 14 and 16, 11 and 14) were found in close spatial proximity, and this is correlated with the occurrence of overlapping chromosome territories. The spatial distribution of chromosomes may increase the possibility of chromosomal translocations in multiple myeloma.
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Affiliation(s)
- Chirawadee Sathitruangsak
- Department of Cell BiologyUniversity of Manitoba, Research Institute of Hematology and Oncology, CancerCare ManitobaWinnipegManitobaCanada
- Division of Medical OncologyDepartment of Internal MedicinePrince of Songkla UniversitySongkhlaThailand
| | - Christiaan H. Righolt
- Department of Cell BiologyUniversity of Manitoba, Research Institute of Hematology and Oncology, CancerCare ManitobaWinnipegManitobaCanada
| | - Ludger Klewes
- Department of Cell BiologyUniversity of Manitoba, Research Institute of Hematology and Oncology, CancerCare ManitobaWinnipegManitobaCanada
- Department of Cell BiologyCancerCare Manitoba, Genomic Centre for Cancer Research and Diagnosis (GCCRD)WinnipegManitobaCanada
| | - Doris Tung Chang
- Department of Cell BiologyUniversity of Manitoba, Research Institute of Hematology and Oncology, CancerCare ManitobaWinnipegManitobaCanada
| | - Rami Kotb
- Department of HaematologyCancerCare ManitobaWinnipegManitobaCanada
| | - Sabine Mai
- Department of Cell BiologyUniversity of Manitoba, Research Institute of Hematology and Oncology, CancerCare ManitobaWinnipegManitobaCanada
- Department of Cell BiologyCancerCare Manitoba, Genomic Centre for Cancer Research and Diagnosis (GCCRD)WinnipegManitobaCanada
- Department of Physiology and PathophysiologyUniversity of ManitobaWinnipegManitobaCanada
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Abstract
Multiple myeloma is a heterogeneous disease. Its chromosomal abnormalities have been extensively studied with a view to accurate prognostication and personalized therapy. Here, we describe the techniques commonly employed for elucidating chromosomal aberrations, prognostic impact of recurrent chromosomal abnormalities, and recently updated risk stratification systems.
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Affiliation(s)
- Nelson Chun Ngai Chan
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, Hong Kong.
| | - Natalie Pui Ha Chan
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, Hong Kong
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Bock F, Lu G, Srour SA, Gaballa S, Lin HY, Baladandayuthapani V, Honhar M, Stich M, Shah ND, Bashir Q, Patel K, Popat U, Hosing C, Korbling M, Delgado R, Rondon G, Shah JJ, Thomas SK, Manasanch EE, Isermann B, Orlowski RZ, Champlin RE, Qazilbash MH. Outcome of Patients with Multiple Myeloma and CKS1B Gene Amplification after Autologous Hematopoietic Stem Cell Transplantation. Biol Blood Marrow Transplant 2016; 22:2159-2164. [PMID: 27638366 PMCID: PMC5911156 DOI: 10.1016/j.bbmt.2016.09.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 09/06/2016] [Indexed: 12/22/2022]
Abstract
The gain/amplification of the CKS1B gene on chromosome 1q21 region is associated with a poor outcome in patients with multiple myeloma (MM). However, there are limited data on the outcome of patients with CKS1B amplification after a single high-dose chemotherapy and autologous hematopoietic stem cell transplantation (auto-HCT). We retrospectively evaluated the outcome of patients with CKS1B amplification who received an auto-HCT between June 2012 and July 2014 at our institution. We identified 58 patients with MM and CKS1B gene amplification detected by fluorescent in situ hybridization (FISH). We compared their outcomes with a propensity score-matched control group of 58 patients without CKS1B amplification who were treated at approximately the same time. The primary objective was to compare the progression-free (PFS) and overall survival (OS) between the CKS1B and the control groups. Stratified log-rank test with the matched pairs as strata and double robust estimation under the Cox model were used to assess the effect of CKS1B gene amplification on PFS or OS in the matched cohort. Patients in the CKS1B and control groups were well matched for age, gender, disease status, year of auto-HCT, response to pretransplantation therapy, and baseline hemoglobin level. In both groups, 57% patients were in first remission and 43% had relapsed disease at auto-HCT. Twenty-seven (47%) patients with CKS1B amplification had concurrent monosomy 13 or 13q deletion; 6 (10%) by conventional cytogenetics only, 16 (28%) by FISH only, and 5 (9%) by both. Median follow-up after auto-HCT was 25.4 months. The median PFS of the CKS1B and the control groups were 15.0 months and 33.0 months (P = .002), respectively. The median OS have not been reached yet. The 2-year OS rates in the CKS1B and the control groups were 62% and 91% (P = .02), respectively. In conclusion, Patients with CKS1B amplification are more likely to have additional high-risk cytogenetic abnormalities and a shorter PFS and OS after an auto-HCT.
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Affiliation(s)
- Fabian Bock
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, Texas; Institute of Clinical Chemistry and Pathobiochemistry, Otto-von-Guericke-University, Magdeburg, Germany
| | - Gary Lu
- Department of Hematopathology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Samer A Srour
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sameh Gaballa
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Heather Y Lin
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Medhavi Honhar
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Maximilian Stich
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nina Das Shah
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Qaiser Bashir
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Krina Patel
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Uday Popat
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Chitra Hosing
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Martin Korbling
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ruby Delgado
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gabriela Rondon
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jatin J Shah
- Department of Hematopathology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sheeba K Thomas
- Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Elisabet E Manasanch
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Berend Isermann
- Institute of Clinical Chemistry and Pathobiochemistry, Otto-von-Guericke-University, Magdeburg, Germany
| | - Robert Z Orlowski
- Department of Hematopathology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Richard E Champlin
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Muzaffar H Qazilbash
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, Texas.
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Boudreault JS, Touzeau C, Moreau P. The role of SLAMF7 in multiple myeloma: impact on therapy. Expert Rev Clin Immunol 2016; 13:67-75. [PMID: 27376202 DOI: 10.1080/1744666x.2016.1209112] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Multiple myeloma (MM), a mature B-cell neoplasm, is the second most common hematologic malignancy worldwide. Despite significant improvements in outcome with new therapies, the majority of responding patients will eventually develop resistance to treatment. Furthermore, patients swith disease refractory to both proteasome inhibitors and immunomodulatory drugs (IMiDs) have a poor prognosis. Areas covered: Several new therapeutic approaches are emerging and immunotherapeutic strategies present an important advance for the treatment of patients with relapsed or refractory MM. Among the monoclonal antibodies under development in MM, those targeting SLAMF7 and CD38 have shown the most consistent benefit in trials to date. In this review, we will specifically focus on elotuzumab (anti-SLAMF7 antibody), and provide a summary of the mechanism of action, the clinical results and the safety profile of this new drug. Expert commentary: Although elotuzumab has no single agent activity in MM, randomized trials in relapsed/refractory MM have demonstrated significantly improved progression-free survival when the agent is added to bortezomib-dexamethasone or lenalidomide-dexamethasone. Furthermore, this agent with its novel mechanism of action can be combined with standard therapies without a significant increase in toxicity. Elotuzumab is a highly effective therapy and future data are necessary to identify the best place for this therapy in the setting of MM.
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Affiliation(s)
| | - Cyrille Touzeau
- a Hematology Department , University Hospital Hôtel-Dieu , Nantes , France
| | - Philippe Moreau
- a Hematology Department , University Hospital Hôtel-Dieu , Nantes , France
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36
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Tan Y, Xu S, Li X, Chen J. The effects of allogeneic stem cell transplantation with matched sibling donor versus autologous stem cell transplantation for newly diagnosed multiple myeloma. Hippokratia 2016. [DOI: 10.1002/14651858.cd010484.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ya Tan
- Southwest Hospital, Third Military Medical University; Center for Hematology; 38 Gao Tanyan Street Chongqing China 400038
| | - ShuangNian Xu
- Southwest Hospital, Third Military Medical University; Center for Hematology; 38 Gao Tanyan Street Chongqing China 400038
| | - Xi Li
- Southwest Hospital, Third Military Medical University; Center for Hematology; 38 Gao Tanyan Street Chongqing China 400038
| | - JiePing Chen
- Southwest Hospital, Third Military Medical University; Center for Hematology; 38 Gao Tanyan Street Chongqing China 400038
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37
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Dunn TJ, Dinner S, Price E, Coutré SE, Gotlib J, Hao Y, Berube C, Medeiros BC, Liedtke M. A phase 1, open-label, dose-escalation study of pralatrexate in combination with bortezomib in patients with relapsed/refractory multiple myeloma. Br J Haematol 2016; 173:253-9. [PMID: 27040320 DOI: 10.1111/bjh.13946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 11/24/2015] [Indexed: 11/30/2022]
Abstract
Pralatrexate inhibits folic acid metabolism, and preclinical studies have shown that it is cytotoxic to multiple myeloma cells. This phase 1 study investigated the safety and efficacy of pralatrexate in combination with bortezomib in adults with relapsed or refractory multiple myeloma. A standard 3 + 3 design was used. Patients received intravenous pralatrexate at doses ranging from 10 to 30 mg/m(2) and intravenous bortezomib at a dose of 1·3 mg/m(2) on days 1, 8 and 15 of each 4-week cycle. Eleven patients were enrolled and completed a median of two cycles. The maximum tolerated dose was 20 mg/m(2) . Two patients experienced dose-limiting toxicity of mucositis. The most frequent non-haematological toxicities were fatigue (55%) and mucositis (45%). There were three serious adverse events in three patients: rash, sepsis and hypotension. One patient (9%) had a very good partial response, 1 (9%) had a partial response, 1 (9%) had minimal response and two (18%) had progressive disease. The median duration of response was 4 months, the median time to next treatment was 3·4 months and the median time to progression was 4 months. Pralatrexate, in combination with bortezomib, was generally safe and demonstrated modest activity in relapsed or refractory multiple myeloma. Clinicaltrials.gov identifier: NCT01114282.
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Affiliation(s)
- Tamara J Dunn
- Division of Hematology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Shira Dinner
- Division of Hematology/Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Elizabeth Price
- Division of Hematology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Steven E Coutré
- Division of Hematology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Jason Gotlib
- Division of Hematology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Ying Hao
- Division of Hematology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Caroline Berube
- Division of Hematology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Bruno C Medeiros
- Division of Hematology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Michaela Liedtke
- Division of Hematology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Gu C, Yang Y, Sompallae R, Xu H, Tompkins VS, Holman C, Hose D, Goldschmidt H, Tricot G, Zhan F, Janz S. FOXM1 is a therapeutic target for high-risk multiple myeloma. Leukemia 2016; 30:873-82. [PMID: 26648534 PMCID: PMC4826574 DOI: 10.1038/leu.2015.334] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 11/05/2015] [Accepted: 11/24/2015] [Indexed: 12/23/2022]
Abstract
The transcription factor forkhead box M1 (FOXM1) is a validated oncoprotein in solid cancers, but its role in malignant plasma cell tumors such as multiple myeloma (MM) is unknown. We analyzed publicly available MM data sets and found that overexpression of FOXM1 prognosticates inferior outcome in a subset (~15%) of newly diagnosed cases, particularly patients with high-risk disease based on global gene expression changes. Follow-up studies using human myeloma cell lines (HMCLs) as the principal experimental model system demonstrated that enforced expression of FOXM1 increased growth, survival and clonogenicity of myeloma cells, whereas knockdown of FOXM1 abolished these features. In agreement with that, constitutive upregulation of FOXM1 promoted HMCL xenografts in laboratory mice, whereas inducible knockdown of FOXM1 led to growth inhibition. Expression of cyclin-dependent kinase 6 (CDK6) and NIMA-related kinase 2 (NEK2) was coregulated with FOXM1 in both HMCLs and myeloma patient samples, suggesting interaction of these three genes in a genetic network that may lend itself to targeting with small-drug inhibitors for new approaches to myeloma therapy and prevention. These results establish FOXM1 as high-risk myeloma gene and provide support for the design and testing of FOXM1-targeted therapies specifically for the FOXM1(High) subset of myeloma.
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Affiliation(s)
- Chunyan Gu
- Basic Medical College, Nanjing University of Chinese Medicine, 210046 Nanjing, People’s Republic of China
- Department of Pathology, The University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, 52242 Iowa, USA
| | - Ye Yang
- Basic Medical College, Nanjing University of Chinese Medicine, 210046 Nanjing, People’s Republic of China
- Department of Internal Medicine, The University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, 52242 Iowa, USA
| | - Ramakrishna Sompallae
- Basic Medical College, Nanjing University of Chinese Medicine, 210046 Nanjing, People’s Republic of China
- Department of Bioinformatics Core Facility, The University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, 52242 Iowa, USA
| | - Hongwei Xu
- Department of Internal Medicine, The University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, 52242 Iowa, USA
| | - Van S. Tompkins
- Department of Pathology, The University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, 52242 Iowa, USA
| | - Carol Holman
- Department of Pathology, The University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, 52242 Iowa, USA
| | - Dirk Hose
- Medizinische Klinik V, Universitätsklinikum Heidelberg
- Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany
| | - Hartmut Goldschmidt
- Medizinische Klinik V, Universitätsklinikum Heidelberg
- Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany
| | - Guido Tricot
- Department of Internal Medicine, The University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, 52242 Iowa, USA
- Holden Comprehensive Cancer Center, The University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, 52242 Iowa, USA
| | - Fenghuang Zhan
- Department of Internal Medicine, The University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, 52242 Iowa, USA
- Holden Comprehensive Cancer Center, The University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, 52242 Iowa, USA
| | - Siegfried Janz
- Department of Pathology, The University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, 52242 Iowa, USA
- Holden Comprehensive Cancer Center, The University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, 52242 Iowa, USA
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Prakash G, Kaur A, Malhotra P, Khadwal A, Sharma P, Suri V, Varma N, Varma S. Current Role of Genetics in Hematologic Malignancies. Indian J Hematol Blood Transfus 2016; 32:18-31. [PMID: 26855503 PMCID: PMC4733682 DOI: 10.1007/s12288-015-0584-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 08/17/2015] [Indexed: 01/31/2023] Open
Abstract
Rapidly changing field of genetic technology and its application in the management of hematological malignancies has brought significant improvement in treatment and outcome of these disorders. Today, genetics plays pivotal role in diagnosis and prognostication of most hematologic neoplasms. The utilization of genetic tests in deciding specific treatment of various hematologic malignancies as well as for evaluation of depth of treatment response is rapidly advancing. Therefore, it is imperative for practitioners working in the field of hemato-oncology to have sufficient understanding of the basic concepts of genetics in order to comprehend upcoming molecular research in this area and to translate the same for patient care.
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Affiliation(s)
- Gaurav Prakash
- />Clinical Hematology and BMT Division, Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Anupriya Kaur
- />Medical Geneticist, Sarai Building, Government Medical College, Chandigarh, 160030 India
| | - Pankaj Malhotra
- />Clinical Hematology and BMT Division, Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Alka Khadwal
- />Clinical Hematology and BMT Division, Department of Internal Medicine, PGIMER, Chandigarh, India
| | | | - Vikas Suri
- />Clinical Hematology and BMT Division, Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Neelam Varma
- />Department of Hematology, PGIMER, Chandigarh, India
| | - Subhash Varma
- />Clinical Hematology and BMT Division, Department of Internal Medicine, PGIMER, Chandigarh, India
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40
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Canella A, Harshman SW, Radomska HS, Freitas MA, Pichiorri F. The potential diagnostic power of extracellular vesicle analysis for multiple myeloma. Expert Rev Mol Diagn 2016; 16:277-84. [PMID: 26671731 DOI: 10.1586/14737159.2016.1132627] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Multiple myeloma (MM) is a hematologic malignancy of plasma cells (PCs). In the United States, MM accounts for approximately 1% of all diagnoses and 2% of all cancer-related deaths. Although MM is a treatable disease, most patients eventually relapse, and despite the development of numerous treatment options it is still considered incurable. Mechanisms of communication between MM-PCs and bone marrow microenvironment, including cell-cell contacts and release of pro-survival factors, promote cancer cell survival and drug resistance. Recently, the importance of extracellular vesicles (EVs) as mechanisms of communication between MM cells and other cells in the microenvironment has been reported. In this review, the authors provide the update on the biology and clinical aspects of EVs in MM.
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Affiliation(s)
- Alessandro Canella
- a Comprehensive Cancer Center , The Ohio State University , Columbus , OH , USA
| | - Sean W Harshman
- a Comprehensive Cancer Center , The Ohio State University , Columbus , OH , USA.,b Department of Molecular Virology, Immunology and Medical Genetics , The Ohio State University , Columbus , OH , USA
| | - Hanna S Radomska
- a Comprehensive Cancer Center , The Ohio State University , Columbus , OH , USA
| | - Michael A Freitas
- a Comprehensive Cancer Center , The Ohio State University , Columbus , OH , USA.,b Department of Molecular Virology, Immunology and Medical Genetics , The Ohio State University , Columbus , OH , USA
| | - Flavia Pichiorri
- c Department of Internal Medicine, Division of Hematology , The Ohio State University , Columbus , OH , USA
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41
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Harshman SW, Canella A, Ciarlariello PD, Agarwal K, Branson OE, Rocci A, Cordero H, Phelps MA, Hade EM, Dubovsky JA, Palumbo A, Rosko A, Byrd JC, Hofmeister CC, Benson DM, Paulaitis ME, Freitas MA, Pichiorri F. Proteomic characterization of circulating extracellular vesicles identifies novel serum myeloma associated markers. J Proteomics 2016; 136:89-98. [PMID: 26775013 DOI: 10.1016/j.jprot.2015.12.016] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 11/14/2015] [Accepted: 12/15/2015] [Indexed: 12/21/2022]
Abstract
UNLABELLED Multiple myeloma (MM) is a hematological malignancy of clonal plasma cells in the bone marrow (BM). The microenvironment plays a key role in MM cell survival and drug resistance through release of soluble factors, expression of adhesion molecules and release of extracellular vesicles (EVs). The aim of this manuscript is to use proteomic profiling of EVs as a tool to identify circulating tumor associated markers in MM patients. First, we characterized the EV protein content obtained from different MM cell lines. Then, we established differences in protein abundance among EVs isolated from MM patient serum and BM and the serum of healthy donors. These data show that the Major Histocompatibility Complex Class I is highly enriched in EVs of MM cell lines and MM patient's serum. Next, we show that CD44 is highly expressed in the EVs isolated from the corticosteroid resistant MM cell line, MM.1R. Furthermore, CD44 was found to be differentially expressed in EVs isolated from newly diagnosed MM patients. Finally through ELISA analysis, we establish the potential of serum CD44 as a predictive biomarker of overall survival. These results support the analysis of EVs as an easily accessible source for MM biomarkers. BIOLOGICAL SIGNIFICANCE Extracellular vesicles are becoming a research focus due to their roles in cancer cell biology such as immune evasion, therapeutic resistance, proliferation and metastases. While numerous studies of vesicle characterization and biology have been conducted in many cancer models, the role of EV in MM remains relatively unstudied. Here we found that EVs isolated from MM cells are enriched in MHC-1 antigen presenting complex and its binding protein β2-MG, this observation is compatible with the enhanced proteasome activity of MM cells compared to other cancers and the ability of functional MHC-1 to bind and present peptides, generated from protein degradation by the proteasome. Additionally, our experiments show that CD44 is particularly enriched in the EV fraction of corticosteroid resistant MM.1R cells and is differentially expressed in the EV fraction of MM patients. This is of high significance due to the established role of CD44 in adhesion of MM cells to BMSC and induction of IL-6, the primary cytokine for MM cell survival, secretion by the BMSC. Furthermore, ELISA assays for CD44 content from the serum of 254 newly diagnosed MM patients enrolled in a Phase 3 randomized trial show highly variable CD44 levels and those patients with >280 ng/mL serum CD44 showing a reduced overall survival time. These results suggest the potential use of CD44 as a prognostic biomarker in MM.
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Affiliation(s)
- Sean W Harshman
- Department of Molecular Virology, Immunology and Medical Genetics, The Ohio State University, Columbus, OH, USA.,Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Alessandro Canella
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | | | - Kitty Agarwal
- The Ohio State Biochemistry Program, The Ohio State University, Columbus, OH, USA.,Nanoscale Science and Engineering Center, The Ohio State University, Columbus, OH, USA
| | - Owen E Branson
- The Ohio State Biochemistry Program, The Ohio State University, Columbus, OH, USA
| | - Alberto Rocci
- Department of Haematology, Manchester Royal Infirmary hospital, Oxford Road, Manchester, UK
| | - Hector Cordero
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Mitch A Phelps
- Division of Pharmaceutics, College of Pharmacy, The Ohio State University, Columbus, OH, USA
| | - Erinn M Hade
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA
| | - Jason A Dubovsky
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Antonio Palumbo
- Myeloma Unit, Division of Hematology, University of Turin, Azienda Ospedaliera Citta'della Salute e della Scienza di Torino, 10126 Torino, Italy
| | - Ashley Rosko
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - John C Byrd
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Craig C Hofmeister
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Don M Benson
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Michael E Paulaitis
- Nanoscale Science and Engineering Center, The Ohio State University, Columbus, OH, USA.,Department of Chemical and Biomolecular Engineering, The Ohio State University, Columbus, OH, USA
| | - Michael A Freitas
- Department of Molecular Virology, Immunology and Medical Genetics, The Ohio State University, Columbus, OH, USA.,Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Flavia Pichiorri
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH, USA
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Shen X, Guo Y, Qi J, Shi W, Wu X, Ni H, Ju S. Study on the Association Between miRNA-202 Expression and Drug Sensitivity in Multiple Myeloma Cells. Pathol Oncol Res 2015; 22:531-9. [DOI: 10.1007/s12253-015-0035-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 12/15/2015] [Indexed: 11/24/2022]
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43
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Hemminger J, Kandarpa M, Tsai A, Nadasdy T. Proliferative Glomerulonephritis With Monoclonal IgG1κ Deposits in a Hepatitis C Virus-Positive Patient. Am J Kidney Dis 2015; 67:703-8. [PMID: 26612277 DOI: 10.1053/j.ajkd.2015.08.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Accepted: 10/08/2015] [Indexed: 02/07/2023]
Abstract
Hepatitis C virus infection is associated with several glomerular diseases, most commonly cryoglobulinemic glomerulonephritis, which is typically secondary to type II mixed cryoglobulinemia. We present a patient with hepatitis C virus infection and cryoglobulinemic glomerulonephritis secondary to type I (monoclonal) cryoglobulinemia that is likely related to a concurrent hepatitis C virus infection-associated lymphoproliferative disorder. We list the differential diagnosis of cryoglobulinemic glomerulonephritis. Additionally, the case draws attention to the possibility that, rarely, even clinically undetectable "occult" B-cell lymphoproliferative disorders may result in significant kidney disease.
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Affiliation(s)
| | | | | | - Tibor Nadasdy
- Department of Pathology, The Ohio State University, Columbus, OH.
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44
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Rajan AM, Rajkumar SV. Interpretation of cytogenetic results in multiple myeloma for clinical practice. Blood Cancer J 2015; 5:e365. [PMID: 26517360 PMCID: PMC4635200 DOI: 10.1038/bcj.2015.92] [Citation(s) in RCA: 149] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 09/18/2015] [Indexed: 12/16/2022] Open
Abstract
The interpretation of cytogenetic abnormalities in multiple myeloma (MM) is often a challenging task. MM is characterized by several cytogenetic abnormalities that occur at various time points in the disease course. The interpretation of cytogenetic results in MM is complicated by the number and complexity of the abnormalities, the methods used to detect them and the disease stage at which they are detected. Specific cytogenetic abnormalities affect clinical presentation, progression of smoldering multiple myeloma (SMM) to MM, prognosis of MM and management strategies. The goal of this paper is to provide a review of how MM is classified into specific subtypes based on primary cytogenetic abnormalities and to provide a concise overview of how to interpret cytogenetic abnormalities based on the disease stage to aid clinical practice and patient management.
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Affiliation(s)
- A M Rajan
- Aureus University School of Medicine, Oranjestad, Aruba
| | - S V Rajkumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
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45
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Wang L, Du F, Zhang HM, Zhang WJ, Wang HX. Changes in circulating endothelial progenitor cells predict responses of multiple myeloma patients to treatment with bortezomib and dexamethasone. ACTA ACUST UNITED AC 2015; 48:736-42. [PMID: 26108099 PMCID: PMC4541694 DOI: 10.1590/1414-431x20154558] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 03/20/2015] [Indexed: 01/21/2023]
Abstract
Four cycles of chemotherapy are required to assess responses of multiple myeloma (MM)
patients. We investigated whether circulating endothelial progenitor cells (cEPCs)
could be a biomarker for predicting patient response in the first cycle of
chemotherapy with bortezomib and dexamethasone, so patients might avoid ineffective
and costly treatments and reduce exposure to unwanted side effects. We measured cEPCs
and stromal cell-derived factor-1α (SDF-1α) in 46 MM patients in the first cycle of
treatment with bortezomib and dexamethasone, and investigated clinical relevance
based on patient response after four 21-day cycles. The mononuclear cell fraction was
analyzed for cEPC by FACS analysis, and SDF-1α was analyzed by ELISA. The study
population was divided into 3 groups according to the response to chemotherapy: good
responders (n=16), common responders (n=12), and non-responders (n=18). There were no
significant differences among these groups at baseline day 1 (P>0.05). cEPC levels
decreased slightly at day 21 (8.2±3.3 cEPCs/μL) vs day 1 (8.4±2.9
cEPCs/μL) in good responders (P>0.05). In contrast, cEPC levels increased
significantly in the other two groups (P<0.05). SDF-1α changes were closely
related to changes in cEPCs. These findings indicate that change in cEPCs at day 21
in the first cycle might be considered a noninvasive biomarker for predicting a later
response, and extent of change could help decide whether to continue this costly
chemotherapy. cEPCs and the SDF-1α/CXCR4 axis are potential therapeutic targets for
improved response and outcomes in MM patients.
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Affiliation(s)
- L Wang
- Tongji Medical College, The Central Hospital of Wuhan, Department of Hematology, Huazhong University of Science and Technology, Wuhan, China
| | - F Du
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - H M Zhang
- Tongji Medical College, The Central Hospital of Wuhan, Department of Hematology, Huazhong University of Science and Technology, Wuhan, China
| | - W J Zhang
- Tongji Medical College, The Central Hospital of Wuhan, Department of Hematology, Huazhong University of Science and Technology, Wuhan, China
| | - H X Wang
- Tongji Medical College, The Central Hospital of Wuhan, Department of Hematology, Huazhong University of Science and Technology, Wuhan, China
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Single-molecule analysis reveals widespread structural variation in multiple myeloma. Proc Natl Acad Sci U S A 2015; 112:7689-94. [PMID: 26056298 DOI: 10.1073/pnas.1418577112] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Multiple myeloma (MM), a malignancy of plasma cells, is characterized by widespread genomic heterogeneity and, consequently, differences in disease progression and drug response. Although recent large-scale sequencing studies have greatly improved our understanding of MM genomes, our knowledge about genomic structural variation in MM is attenuated due to the limitations of commonly used sequencing approaches. In this study, we present the application of optical mapping, a single-molecule, whole-genome analysis system, to discover new structural variants in a primary MM genome. Through our analysis, we have identified and characterized widespread structural variation in this tumor genome. Additionally, we describe our efforts toward comprehensive characterization of genome structure and variation by integrating our findings from optical mapping with those from DNA sequencing-based genomic analysis. Finally, by studying this MM genome at two time points during tumor progression, we have demonstrated an increase in mutational burden with tumor progression at all length scales of variation.
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Abstract
Multiple myeloma is a malignant disease characterised by proliferation of clonal plasma cells in the bone marrow and typically accompanied by the secretion of monoclonal immunoglobulins that are detectable in the serum or urine. Increased understanding of the microenvironmental interactions between malignant plasma cells and the bone marrow niche, and their role in disease progression and acquisition of therapy resistance, has helped the development of novel therapeutic drugs for use in combination with cytostatic therapy. Together with autologous stem cell transplantation and advances in supportive care, the use of novel drugs such as proteasome inhibitors and immunomodulatory drugs has increased response rates and survival substantially in the past several years. Present clinical research focuses on the balance between treatment efficacy and quality of life, the optimum sequencing of treatment options, the question of long-term remission and potential cure by multimodal treatment, the pre-emptive treatment of high-risk smouldering myeloma, and the role of maintenance. Upcoming results of ongoing clinical trials, together with a pipeline of promising new treatments, raise the hope for continuous improvements in the prognosis of patients with myeloma in the future.
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Affiliation(s)
- Christoph Röllig
- Medizinische Klinik und Poliklinik I, Universitätsklinikum, Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
| | - Stefan Knop
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Martin Bornhäuser
- Medizinische Klinik und Poliklinik I, Universitätsklinikum, Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Han SS, Tompkins VS, Son DJ, Han S, Yun H, Kamberos NL, Dehoedt CL, Gu C, Holman C, Tricot G, Zhan F, Janz S. CDKN1A and FANCD2 are potential oncotargets in Burkitt lymphoma and multiple myeloma. Exp Hematol Oncol 2015; 4:9. [PMID: 25838973 PMCID: PMC4383050 DOI: 10.1186/s40164-015-0005-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 03/10/2015] [Indexed: 02/06/2023] Open
Abstract
Background Comparative genetic and biological studies on malignant tumor counterparts in human beings and laboratory mice may be powerful gene discovery tools for blood cancers, including neoplasms of mature B-lymphocytes and plasma cells such as Burkitt lymphoma (BL) and multiple myeloma (MM). Methods We used EMSA to detect constitutive NF-κB/STAT3 activity in BL- and MM-like neoplasms that spontaneously developed in single-transgenic IL6 (interleukin-6) or MYC (c-Myc) mice, or in double-transgenic IL6MYC mice. qPCR measurements and analysis of clinical BL and MM datasets were employed to validate candidate NF-κB/STAT3 target genes. Results qPCR demonstrated that IL6- and/or MYC-dependent neoplasms in mice invariably contain elevated mRNA levels of the NF-κB target genes, Cdkn1a and Fancd2. Clinical studies on human CDKN1A, which encodes the cell cycle inhibitor and tumor suppressor p21, revealed that high p21 message predicts poor therapy response and survival in BL patients. Similarly, up-regulation of FANCD2, which encodes a key member of the Fanconi anemia and breast cancer pathway of DNA repair, was associated with poor outcome of patients with MM, particularly those with high-risk disease. Conclusions Our findings suggest that CDKN1A and FANCD2 are potential oncotargets in BL and MM, respectively. Additionally, the IL-6- and/or MYC-driven mouse models of human BL and MM used in this study may lend themselves to the biological validation of CDKN1A and FANCD2 as molecular targets for new approaches to cancer therapy and prevention. Electronic supplementary material The online version of this article (doi:10.1186/s40164-015-0005-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Seong-Su Han
- Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA USA
| | - Van S Tompkins
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA USA
| | - Dong-Ju Son
- School of Applied Biosciences, Kyungpook National University, Daegu, 702-701 South Korea
| | - Sangwoo Han
- Department of Health and Human Physiology, University of Iowa Carver College of Medicine, Iowa City, IA USA
| | - Hwakyung Yun
- Department of Biological Sciences, Hanseo University, Choognam, South Korea
| | - Natalie L Kamberos
- Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA USA
| | - Casey L Dehoedt
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA USA
| | - Chunyan Gu
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA USA
| | - Carol Holman
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA USA
| | - Guido Tricot
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA USA
| | - Fenghuang Zhan
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA USA
| | - Siegfried Janz
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA USA
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Barbee MS, Nooka A, Kaufman JL, Kim S, Chen Z, Heffner LT, Lonial S, Harvey RD. Predictors of survival outcomes in phase 1 relapsed or refractory multiple myeloma patients. Cancer 2015; 121:853-62. [DOI: 10.1002/cncr.29136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 09/29/2014] [Accepted: 10/08/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Meagan S. Barbee
- Department of Pharmacy; Memorial Sloan Kettering Cancer Center; New York New York
| | - Ajay Nooka
- Department of Hematology and Medical Oncology; Winship Cancer Institute; Emory University; Atlanta Georgia
| | - Jonathan L. Kaufman
- Department of Hematology and Medical Oncology; Winship Cancer Institute; Emory University; Atlanta Georgia
| | - Sungjin Kim
- Biostatistics Shared Core Resource; Winship Cancer Institute; Emory University; Atlanta Georgia
| | - Zhengjia Chen
- Biostatistics Shared Core Resource; Winship Cancer Institute; Emory University; Atlanta Georgia
- Department of Biostatistics and Bioinformatics; Rollins School of Public Health; Emory University; Atlanta Georgia
| | - Leonard T. Heffner
- Department of Hematology and Medical Oncology; Winship Cancer Institute; Emory University; Atlanta Georgia
| | - Sagar Lonial
- Department of Hematology and Medical Oncology; Winship Cancer Institute; Emory University; Atlanta Georgia
| | - R. Donald Harvey
- Department of Hematology and Medical Oncology; Winship Cancer Institute; Emory University; Atlanta Georgia
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50
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Yağcı M, Karakaya F, Suyanı E, Haznedar R. Serum free light chain response after 2 courses of induction chemotherapy predicts prognosis in myeloma patients. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2014; 15:98-102. [PMID: 25441109 DOI: 10.1016/j.clml.2014.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 08/18/2014] [Accepted: 08/25/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND The aim of this study was to investigate the prognostic effect of serum free light chain (sFLC) response after 2 cycles of first-line chemotherapy (CT) in multiple myeloma (MM) patients. MATERIALS AND METHODS The data of 78 newly diagnosed MM patients who had sFLC levels at diagnosis and after 2 cycles of first-line CT were included in the study. The prognostic effect of sFLCs were evaluated with normalization of sFLC κ/λ ratio after 2 cycles of CT and involved/uninvolved (i/u) sFLCs. RESULTS At the end of follow-up the probability of overall survival (OS) was 95.7% versus 68.5% in patients with and without normalized sFLC κ/λ ratio, respectively (P = .072). The probability of OS with i/u sFLC assessment was 97.4% versus 55.8% with regard to i/u sFLC ≤ 10 and > 10, respectively (P = .001). In univariate and multivariate analysis including sFLC ratio, age, sex, and International Staging System, i/u sFLC ratio > 10 after 2 cycles of CT was identified as an independent risk factor for OS (P = .015; hazard ratio [HR], 13.2; 95% confidence interval [CI], 1.668-104.65 vs. P = .011; HR, 15.17; 95% CI, 1.85-123.89). CONCLUSION Early response assessment in terms of sFLC after 2 courses of induction CT seems to have a prognostic effect in MM patients. The methodology and timing of the evaluation based on sFLCs needs to be validated in prospective studies.
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Affiliation(s)
- Münci Yağcı
- Gazi University, Faculty of Medicine, Department of Hematology, Ankara, Turkey.
| | - Fatih Karakaya
- Gazi University, Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Elif Suyanı
- Gazi University, Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Rauf Haznedar
- Gazi University, Faculty of Medicine, Department of Hematology, Ankara, Turkey
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