1
|
Liu Z, Shen H, Han M, Zhao X, Liu H, Ding K, Song J, Fu R. Immune profiles to predict bortezomib-based treatment response for multiple myeloma patients. Int Immunopharmacol 2024; 130:111640. [PMID: 38377849 DOI: 10.1016/j.intimp.2024.111640] [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: 11/10/2023] [Revised: 01/30/2024] [Accepted: 01/30/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND To evaluate the distribution of bone marrow immune cell subsets and their correlation with treatment efficacy in patients with multiple myeloma (MM). METHODS We analyzed the bone marrow lymphocyte subsets of 186 newly diagnosed MM patients at diagnosis and their correlation with clinical characteristics. In our study, eight-color flow cytometry, a method commonly used to detect plasma cell phenotypes, was used to analyze seven bone marrow immune cell groups by change gate-strategy. RESULTS First, for all the 7 immune cell groups, the percentage of immature B cells was significantly lower in stage III patients than in stage I patients, while the trend was reversed in memory B cells in both the International Staging System(p = 0.004) and Revised International Staging System(p = 0.018). Second, the percentage of naïve B cells were significantly lower in patients with severe anemia, while the percentage of memory B cells had reversed trend. The percentage of immature B cells were lower in patients with Cr ≥ 2 mg/dL than in patients with Cr < 2 mg/dL. Then we followed the treatment efficacy of 152 patients who received four cycles of induction therapy (bortezomib + dexamethasone or bortezomib + lenalidomide + dexamethasone) and analyzed the relationship between bone marrow lymphocyte subsets at the initial stage and treatment response datasets. We found that both the percentage of B cells(p<0.001) and immature B(p = 0.002) were increased in patients who achieved very good partial remission(VGPR) after four cycles of induction therapy. The ROC results indicated the combination of the multiple immune subgroups had predictive values (AUC = 0.802, p<0.001) in the treatment effect after four cycles of induction therapy. CONCLUSIONS Overall, these results suggest that the analysis of lymphocyte subsets along with plasma cell immunophenotyping could be a potential index for determining the prognosis of MM patients.
Collapse
Affiliation(s)
- Zhaoyun Liu
- Department of Hematology, Tianjin Medical University General Hospital, 154 Anshan Street, Heping District, Tianjin 300052, PR China; Tianjin Key Laboratory of Bone Marrow Failure and Malignant Hemopoietic Clone Control, Tianjin 300052 P. R. China.
| | - Hongli Shen
- Department of Hematology, Tianjin Medical University General Hospital, 154 Anshan Street, Heping District, Tianjin 300052, PR China; Tianjin Key Laboratory of Bone Marrow Failure and Malignant Hemopoietic Clone Control, Tianjin 300052 P. R. China
| | - Mei Han
- Department of Hematology, Tianjin Medical University General Hospital, 154 Anshan Street, Heping District, Tianjin 300052, PR China; Tianjin Key Laboratory of Bone Marrow Failure and Malignant Hemopoietic Clone Control, Tianjin 300052 P. R. China
| | - Xianghong Zhao
- Department of Hematology, Tianjin Medical University General Hospital, 154 Anshan Street, Heping District, Tianjin 300052, PR China; Tianjin Key Laboratory of Bone Marrow Failure and Malignant Hemopoietic Clone Control, Tianjin 300052 P. R. China
| | - Hui Liu
- Department of Hematology, Tianjin Medical University General Hospital, 154 Anshan Street, Heping District, Tianjin 300052, PR China; Tianjin Key Laboratory of Bone Marrow Failure and Malignant Hemopoietic Clone Control, Tianjin 300052 P. R. China
| | - Kai Ding
- Department of Hematology, Tianjin Medical University General Hospital, 154 Anshan Street, Heping District, Tianjin 300052, PR China; Tianjin Key Laboratory of Bone Marrow Failure and Malignant Hemopoietic Clone Control, Tianjin 300052 P. R. China
| | - Jia Song
- Department of Hematology, Tianjin Medical University General Hospital, 154 Anshan Street, Heping District, Tianjin 300052, PR China; Tianjin Key Laboratory of Bone Marrow Failure and Malignant Hemopoietic Clone Control, Tianjin 300052 P. R. China
| | - Rong Fu
- Department of Hematology, Tianjin Medical University General Hospital, 154 Anshan Street, Heping District, Tianjin 300052, PR China; Tianjin Key Laboratory of Bone Marrow Failure and Malignant Hemopoietic Clone Control, Tianjin 300052 P. R. China.
| |
Collapse
|
2
|
Cui J, Lv R, Yu T, Yan W, Xu J, Fan H, Li L, Liu Y, Du C, Deng S, Sui W, Xu Y, Yi S, Zou D, Qiu L, An G. Minor clone of del(17p) provides a reservoir for relapse in multiple myeloma. Haematologica 2024; 109:591-603. [PMID: 37534514 PMCID: PMC10828782 DOI: 10.3324/haematol.2023.283533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 07/27/2023] [Indexed: 08/04/2023] Open
Abstract
The deletion of chromosome 17p (del(17p)) is considered a crucial prognostic factor at the time of diagnosis in patients with multiple myeloma (MM). However, the impact of del(17p) on survival at different clonal sizes at relapse, as well as the patterns of clonal evolution between diagnosis and relapse and their prognostic value, has not been well described. To address these issues, we analyzed the interphase fluorescence in situ hybridization (iFISH) results of 995 newly diagnosed MM (NDMM) patients and 293 patients with MM at their first relapse. Among these patients, 197 had paired iFISH data at diagnosis and first relapse. Our analysis of paired iFISH revealed that a minor clone of del(17p) at relapse but not at diagnosis was associated with poor prognosis in MM (hazard ratio for median overall survival 1.64 vs. 1.44). Fifty-six and 12 patients developed one or more new cytogenetic abnormalities at relapse, mainly del(17p) and gain/amp(1q), respectively. We classified the patients into six groups based on the change patterns in the clonal size of del(17p) between the two time points. Patients who did not have del(17p) during follow-up showed the best outcomes, whereas those who acquired del(17p) during their disease course, experienced compromised survival (median overall survival: 61.3 vs. 49.4 months; hazard ratio =1.64; 95% confidence interval: 1.06-2.56; P<0.05). In conclusion, our data confirmed the adverse impact of a minor clone of del(17p) at relapse and highlighted the importance of designing optimal therapeutic strategies to eliminate high-risk cytogenetic abnormalities (clinicaltrials gov. identifier: NCT04645199).
Collapse
Affiliation(s)
- Jian Cui
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin 300020, China; Tianjin Institutes of Health Science, Tianjin 301600
| | - Rui Lv
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin 300020, China; Tianjin Institutes of Health Science, Tianjin 301600
| | - Tengteng Yu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin 300020, China; Tianjin Institutes of Health Science, Tianjin 301600, China; LeBow Institute for Myeloma Therapeutics and Jerome Lipper Center for Multiple Myeloma Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Wenqiang Yan
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin 300020, China; Tianjin Institutes of Health Science, Tianjin 301600
| | - Jingyu Xu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin 300020, China; Tianjin Institutes of Health Science, Tianjin 301600
| | - Huishou Fan
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin 300020, China; Tianjin Institutes of Health Science, Tianjin 301600
| | - Lingna Li
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin 300020, China; Tianjin Institutes of Health Science, Tianjin 301600
| | - Yuntong Liu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin 300020, China; Tianjin Institutes of Health Science, Tianjin 301600
| | - Chenxing Du
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin 300020, China; Tianjin Institutes of Health Science, Tianjin 301600
| | - Shuhui Deng
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin 300020, China; Tianjin Institutes of Health Science, Tianjin 301600
| | - Weiwei Sui
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin 300020, China; Tianjin Institutes of Health Science, Tianjin 301600
| | - Yan Xu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin 300020, China; Tianjin Institutes of Health Science, Tianjin 301600
| | - Shuhua Yi
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin 300020, China; Tianjin Institutes of Health Science, Tianjin 301600
| | - Dehui Zou
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin 300020, China; Tianjin Institutes of Health Science, Tianjin 301600
| | - Lugui Qiu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin 300020, China; Tianjin Institutes of Health Science, Tianjin 301600.
| | - Gang An
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin 300020, China; Tianjin Institutes of Health Science, Tianjin 301600.
| |
Collapse
|
3
|
Singh RK, Jones RJ, Shirazi F, Qin L, Zou J, Hong S, Wang H, Lee HC, Patel KK, Wan J, Choudhary RK, Kuiatse I, Pahl A, Orlowski RZ. Novel Anti-B-cell Maturation Antigen Alpha-Amanitin Antibody-drug Conjugate HDP-101 Shows Superior Activity to Belantamab Mafodotin and Enhanced Efficacy in Deletion 17p Myeloma Models. RESEARCH SQUARE 2024:rs.3.rs-3843028. [PMID: 38260385 PMCID: PMC10802748 DOI: 10.21203/rs.3.rs-3843028/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
B-cell maturation antigen (BCMA) plays a pathobiologic role in myeloma and is a validated target with five BCMA-specific therapeutics having been approved for relapsed/refractory disease. However, these drugs are not curative, and responses are inferior in patients with molecularly-defined high-risk disease, including those with deletion 17p (del17p) involving the tumor suppressor TP53, supporting the need for further drug development. Del17p has been associated with reduced copy number and gene expression of RNA polymerase II subunit alpha (POLR2A) in other tumor types. We therefore studied the possibility that HDP-101, an anti-BCMA antibody drug conjugate (ADC) with the POLR2A poison α-amanitin could be an attractive agent in myeloma, especially with del17p. HDP-101 reduced viability in myeloma cell lines representing different molecular disease subtypes, and overcame adhesion-mediated and both conventional and novel drug resistance. After confirming that del17p is associated with reduced POLR2A levels in publicly available myeloma patient databases, we engineered TP53 wild-type cells with a TP53 knockout (KO), POLR2A knockdown (KD), or both, the latter to mimic del17p. HDP-101 showed potent anti-myeloma activity against all tested cell lines, and exerted enhanced efficacy against POLR2A KD and dual TP53 KO/POLR2A KD cells. Mechanistic studies showed HDP-101 up-regulated the unfolded protein response, activated apoptosis, and induced immunogenic cell death. Notably, HDP-101 impacted CD138-positive but not-negative primary cells, showed potent efficacy against aldehyde dehydrogenase-positive clonogenic cells, and eradicated myeloma in an in vivo cell line-derived xenograft (CDX). Interestingly, in the CDX model, prior treatment with HDP-101 precluded subsequent engraftment on tumor cell line rechallenge in a manner that appeared to be dependent in part on natural killer cells and macrophages. Finally, HDP-101 was superior to the BCMA-targeted ADC belantamab mafodotin against cell lines and primary myeloma cells in vitro, and in an in vivo CDX. Together, the data support the rationale for translation of HDP-101 to the clinic, where it is now undergoing Phase I trials, and suggest that it could emerge as a more potent ADC for myeloma with especially interesting activity against the high-risk del17p myeloma subtype.
Collapse
Affiliation(s)
| | | | | | - Li Qin
- The University of Texas MD Anderson Cancer Center
| | - Jianxuan Zou
- The University of Texas MD Anderson Cancer Center
| | - Samuel Hong
- The University of Texas MD Anderson Cancer Center
| | - Hua Wang
- The University of Texas MD Anderson Cancer Center
| | - Hans C Lee
- The University of Texas MD Anderson Cancer Center
| | | | - Jie Wan
- The University of Texas MD Anderson Cancer Center
| | | | | | | | | |
Collapse
|
4
|
Lin CM, Chang LC, Shau WY, Chen CL, Yao CY, Tien FM. Treatment benefit of upfront autologous stem cell transplantation for newly diagnosed multiple myeloma: a systematic review and meta-analysis. BMC Cancer 2023; 23:446. [PMID: 37193978 DOI: 10.1186/s12885-023-10907-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 04/30/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Upfront high-dose therapy (HDT) followed by autologous stem cell transplantation (ASCT) remains a profitable strategy for newly diagnosed multiple myeloma (MM) patients in the context of novel agents. However, current knowledge demonstrates a discrepancy between progression-free survival (PFS) and overall survival (OS) benefit with HDT/ASCT. METHODS We conducted a systematic review and meta-analysis that included both randomized controlled trials (RCTs) and observational studies evaluating the benefit of upfront HDT/ASCT published during 2012 to 2023. Further sensitivity analysis and meta-regression were also performed. RESULTS Among the 22 enrolled studies, 7 RCTs and 9 observational studies had a low or moderate risk of bias, while the remaining 6 observational studies had a serious risk of bias. HDT/ASCT revealed advantages in complete response (CR) with an odds ratio (OR) of 1.24 and 95% confidence interval (CI) 1.02 ~ 1.51, PFS with a hazard ratio (HR) of 0.53 (95% CI 0.46 ~ 0.62), and OS with an HR of 0.58 (95% CI 0.50 ~ 0.69). Sensitivity analysis excluding the studies with serious risk of bias and trim-and-fill imputation fundamentally confirmed these findings. Older age, increased percentage of patients with International Staging System (ISS) stage III or high-risk genetic features, decreased proteasome inhibitor (PI) or combined PI/ immunomodulatory drugs (IMiD) utilization, and decreased follow-up duration or percentage of males were significantly related to a greater survival advantage with HDT/ASCT. CONCLUSIONS Upfront ASCT remains a beneficial treatment for newly diagnosed MM patients in the period of novel agents. Its advantage is especially acute in high-risk MM populations, such as elderly individuals, males, those with ISS stage III or high-risk genetic features, but is attenuated with PI or combined PI/IMiD utilization, contributing to divergent survival outcomes.
Collapse
Affiliation(s)
- Chi-Maw Lin
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Otolaryngology, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin, Taiwan
| | - Lih-Chyun Chang
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Division of Hospital Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Yi Shau
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chi-Ling Chen
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chi-Yuan Yao
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Zhongzheng Dist., Taipei City, 100225, Taiwan
| | - Feng-Ming Tien
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Zhongzheng Dist., Taipei City, 100225, Taiwan.
| |
Collapse
|
5
|
Nikolaou A, Hogea C, Samyshkin Y, Maiese EM, Sansbury L, Oguz M, Cid-Ruzafa J, Kapoor R, Wang F. An Epidemiology Model for Estimating the Numbers of US Patients With Multiple Myeloma by Line of Therapy and Treatment Exposure. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1977-1985. [PMID: 35963840 DOI: 10.1016/j.jval.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 03/09/2022] [Accepted: 05/04/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Estimates on the distribution of patients with multiple myeloma (MM) by line of therapy (LOT) are scarce and get outdated quickly as new treatments become available. The objective of this study was to estimate the number of patients with MM by LOT and the number of patients who have received at least 4 previous LOTs including proteasome inhibitors, immunomodulatory agents, and anti-CD38 monoclonal antibodies (mAbs). METHODS A compartmental model was developed to calculate the number of patients by LOT. Two pathways were considered based on stem cell transplant eligibility, and at each pathway, treatments were stratified in 2 types: anti-CD38 mAbs or other. The model population was stratified into 4 subgroups based on age and cytogenetic risk. Model inputs were informed from real-world evidence. RESULTS The model estimated that, in 2020, 126 869 patients were living with MM in the United States. Of these, 105 701 received treatment in any LOT, with 56 959, 27 252, 11 258, and 5217 in lines 1 to 4, respectively, and 5015 in line 5 or beyond. The model estimated that 3497 patients received at least 4 previous LOTs including proteasome inhibitors, immunomodulatory agents, and anti-CD38 mAbs. The model overall prevalence predictions aligned well with publicly available estimates. CONCLUSIONS This study proposes a novel framework to estimate MM prevalence. It can assist clinicians to understand future trends in MM epidemiology, healthcare systems to plan for future resource use allocation, and payers to quantify the budget impact of new treatments.
Collapse
Affiliation(s)
| | - Cosmina Hogea
- Value Evidence and Outcomes, GlaxoSmithKline, Upper Providence, PA, USA
| | - Yevgeniy Samyshkin
- Value Evidence and Outcomes, GlaxoSmithKline, Brentford, Middlesex, England, UK
| | - Eric M Maiese
- Value Evidence and Outcomes, GlaxoSmithKline, Philadelphia, PA, USA
| | - Leah Sansbury
- Value Evidence and Outcomes, GlaxoSmithKline, Research Triangle Park, NC, USA
| | - Mustafa Oguz
- Real-World Evidence, Evidera, London, England, UK
| | | | - Ritika Kapoor
- Modelling and Simulation, Evidera, London, England, UK
| | - Feng Wang
- Value Evidence and Outcomes, GlaxoSmithKline, Upper Providence, PA, USA
| |
Collapse
|
6
|
Rojas EA, Corchete LA, De Ramón C, Krzeminski P, Quwaider D, García‐Sanz R, Martínez‐López J, Oriol A, Rosiñol L, Bladé J, Lahuerta JJ, San Miguel JF, González M, Mateos MV, Bourdon J, Misiewicz‐Krzeminska I, Gutiérrez NC. Expression of p53 protein isoforms predicts survival in patients with multiple myeloma. Am J Hematol 2022; 97:700-710. [PMID: 35188691 PMCID: PMC9313569 DOI: 10.1002/ajh.26507] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/21/2022] [Accepted: 02/15/2022] [Indexed: 12/20/2022]
Abstract
Loss and/or mutation of the TP53 gene are associated with short survival in multiple myeloma, but the p53 landscape goes far beyond. At least 12 p53 protein isoforms have been identified as a result of a combination of alternative splicing, alternative promoters and/or alternative transcription site starts, which are grouped as α, β, γ, from transactivation domain (TA), long, and short isoforms. Nowadays, there are no studies evaluating the expression of p53 isoforms and its clinical relevance in multiple myeloma (MM). We used capillary nanoimmunoassay to quantify the expression of p53 protein isoforms in CD138-purified samples from 156 patients with newly diagnosed MM who were treated as part of the PETHEMA/GEM2012 clinical trial and investigated their prognostic impact. Quantitative real-time polymerase chain reaction was used to corroborate the results at RNA levels. Low and high levels of expression of short and TAp53β/γ isoforms, respectively, were associated with adverse prognosis in MM patients. Multivariate Cox models identified high levels of TAp53β/γ (hazard ratio [HR], 4.49; p < .001) and high-risk cytogenetics (HR, 2.69; p < .001) as independent prognostic factors associated with shorter time to progression. The current cytogenetic-risk classification was notably improved when expression levels of p53 protein isoforms were incorporated, whereby high-risk MM expressing high levels of short isoforms had significantly longer survival than high-risk patients with low levels of these isoforms. This is the first study that demonstrates the prognostic value of p53 isoforms in MM patients, providing new insights on the role of p53 protein dysregulation in MM biology.
Collapse
Affiliation(s)
- Elizabeta A. Rojas
- Hematology Department University Hospital of Salamanca, IBSAL Salamanca Spain
- Cancer Research Center‐IBMCC (USAL‐CSIC) Salamanca Spain
| | - Luis A. Corchete
- Hematology Department University Hospital of Salamanca, IBSAL Salamanca Spain
- Cancer Research Center‐IBMCC (USAL‐CSIC) Salamanca Spain
| | - Cristina De Ramón
- Hematology Department University Hospital of Salamanca, IBSAL Salamanca Spain
| | - Patryk Krzeminski
- Hematology Department University Hospital of Salamanca, IBSAL Salamanca Spain
- Cancer Research Center‐IBMCC (USAL‐CSIC) Salamanca Spain
- Department of Nanobiotechnology and Experimental Ecology, Institute of Biology Warsaw University of Life Sciences Warsaw Poland
| | - Dalia Quwaider
- Hematology Department University Hospital of Salamanca, IBSAL Salamanca Spain
- Cancer Research Center‐IBMCC (USAL‐CSIC) Salamanca Spain
| | - Ramón García‐Sanz
- Hematology Department University Hospital of Salamanca, IBSAL Salamanca Spain
- Cancer Research Center‐IBMCC (USAL‐CSIC) Salamanca Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), CB16/12/00233 Salamanca Spain
- Grupo Español de Mieloma (GEM) Barcelona Spain
| | - Joaquín Martínez‐López
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), CB16/12/00233 Salamanca Spain
- Grupo Español de Mieloma (GEM) Barcelona Spain
- Medicine Department Complutense University Madrid Spain
- Spanish National Cancer Research Center (CNIO) Madrid Spain
| | - Albert Oriol
- Grupo Español de Mieloma (GEM) Barcelona Spain
- University Hospital Germans Trias i Pujol Barcelona Spain
| | - Laura Rosiñol
- Grupo Español de Mieloma (GEM) Barcelona Spain
- Hospital Clinic of Barcelona Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS) Barcelona Spain
| | - Joan Bladé
- Grupo Español de Mieloma (GEM) Barcelona Spain
- Hospital Clinic of Barcelona Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS) Barcelona Spain
| | - Juan José Lahuerta
- Grupo Español de Mieloma (GEM) Barcelona Spain
- Hematology Department University Hospital 12 de Octubre Madrid Spain
| | - Jesús F. San Miguel
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), CB16/12/00233 Salamanca Spain
- Grupo Español de Mieloma (GEM) Barcelona Spain
- Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas (CIMA) Instituto de Investigación Sanitaria de Navarra (IdiSNA) Pamplona Spain
| | - Marcos González
- Hematology Department University Hospital of Salamanca, IBSAL Salamanca Spain
- Cancer Research Center‐IBMCC (USAL‐CSIC) Salamanca Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), CB16/12/00233 Salamanca Spain
| | - María Victoria Mateos
- Hematology Department University Hospital of Salamanca, IBSAL Salamanca Spain
- Cancer Research Center‐IBMCC (USAL‐CSIC) Salamanca Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), CB16/12/00233 Salamanca Spain
- Grupo Español de Mieloma (GEM) Barcelona Spain
| | | | - Irena Misiewicz‐Krzeminska
- Hematology Department University Hospital of Salamanca, IBSAL Salamanca Spain
- Cancer Research Center‐IBMCC (USAL‐CSIC) Salamanca Spain
- Experimental Hematology Department Institute of Hematology and Transfusion Medicine Warsaw Poland
| | - Norma C. Gutiérrez
- Hematology Department University Hospital of Salamanca, IBSAL Salamanca Spain
- Cancer Research Center‐IBMCC (USAL‐CSIC) Salamanca Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), CB16/12/00233 Salamanca Spain
- Grupo Español de Mieloma (GEM) Barcelona Spain
| |
Collapse
|
7
|
Lack of differential impact of del17p on survival in African Americans compared with White patients with multiple myeloma: a VA study. Blood Adv 2021; 5:3511-3514. [PMID: 34428278 DOI: 10.1182/bloodadvances.2020004001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/18/2021] [Indexed: 01/09/2023] Open
Abstract
Multiple myeloma (MM) is a heterogeneous disease that has an increased incidence in African Americans (AAs). We previously observed that, with equal access to health care, younger AA patients (age < 65 years) have superior overall survival (OS) compared with younger White patients. Because MM prognosis is influenced by 17p deletion (del17p), we investigated racial differences in its occurrence and impact in a large cohort of MM patients from the Veterans Affairs (VA) system. Among 2243 VA patients with MM for whom del17p data were available, del17p was present in 8.83% of all patients, with a significantly lower prevalence in AAs (5.56%) compared with Whites (10.52%; P < .001). The difference was even more pronounced among younger AAs (<65 years) vs younger Whites (4.34% vs 9.8%, respectively; P = .004). However, we did not observe any significant difference in survival between AA and White patients with del17p, regardless of age category, suggesting that del17p carries a poor prognosis across race and age. Interestingly, among patients without del17p, we still noted a significantly superior OS in younger AAs compared with younger Whites (7.75 vs 5.10 years; P = .042). Our study shows a lower incidence of del17p in AAs but suggests that the survival advantage for younger AAs is primarily due to factors other than del17p.
Collapse
|
8
|
Liu Z, Zeng Q, Xiang B. Bortezomib-based regimens improve the prognosis of newly diagnosed MM patients with chromosomal aberrations except for del(17q13): A retrospective study from a single center. Medicine (Baltimore) 2021; 100:e25834. [PMID: 33950994 PMCID: PMC8104214 DOI: 10.1097/md.0000000000025834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 04/16/2021] [Indexed: 02/05/2023] Open
Abstract
Chromosomal aberrations are generally considered to have a remarkable impact on the outcome of multiple myeloma. Bortezomib helps to achieve complete responses and leads to longer life expectancy in many multiple myeloma patients. This study was designed to clarify whether bortezomib can improve the poor prognosis resulting from del(17q13), del(13q14), amp(1q21), t(4,14), t(14,16) in patients with multiple myeloma. A total of 255 MM patients treated with bortezomib-based regimens were included in this study. All chromosomal aberrations were detected by interphase fluorescence in situ hybridization. Kaplan-Meier survival and Multivariable Cox regression analysis were employed to assess the prognostic situation in progression-free survival and overall survival. The result showed that the progression-free survival and overall survival of patients with del(17q13) were shorter than those without del(17q13) in multivariate analysis and patients with del(13q14), amp(1q21), t(4,14), t(14,16) were similar to patients without these chromosomal aberrations in progression-free survival and overall survival after receiving bortezomib-based regimens.In conclusion Bortezomib-based regimens can overcome the poor prognosis derived from del(13q14), amp(1q21), t(4,14), t(14,16) but not del(17q13).
Collapse
|
9
|
Kanas G, Clark O, Keeven K, Nersesyan K, Sansbury L, Hogea C. Estimate of multiple myeloma patients by line of therapy in the USA: population-level projections 2020-2025. Future Oncol 2020; 17:921-930. [PMID: 33200616 DOI: 10.2217/fon-2020-0970] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Aim: To report the results of a patient epidemiology model for multiple myeloma (MM) treatment by line of therapy (LOT) in the USA. Materials & methods: Surveillance, Epidemiology and End Results registry data and physician surveys were combined to project the incidence, prevalence and the number of MM patients treated with systemic therapy by LOT between 2020 and 2025. Results: Projected complete MM prevalence in the USA in 2020 was 144,922, increasing to 162,339 in 2025. Corresponding unique MM patients by LOT in 2020 were: 53,176 (1st; minimum-maximum: 47,304-59,212), 19,407 (2nd; 15,935-23,273), 6,481 (3rd; 5143-8877), 1649 (4th; 1146-2667) and 426 (5th; 217-876). Conclusion: MM incidence and prevalence by LOT is projected to continue to increase in the USA between 2020 and 2025.
Collapse
Affiliation(s)
- Gena Kanas
- Kantar, Health Division, New York, NY 10007, USA
| | - Otavio Clark
- Kantar, Health Division, New York, NY 10007, USA
| | - Katie Keeven
- Kantar, Health Division, New York, NY 10007, USA
| | | | | | | |
Collapse
|
10
|
Jurczyszyn A, Waszczuk-Gajda A, Castillo JJ, Krawczyk K, Stork M, Pour L, Usnarska-Zubkiewicz L, Potoczek S, Hus I, Davila Valls J, Hari P, Chhabra S, Gentile M, Mikala G, Varga G, Chim CS, Fiala M, Vij R, Schutz N, Rodzaj M, Porowska A, Vesole DH, Druzd-Sitek A, Walewski J, Nooka AK. Primary refractory multiple myeloma: a real-world experience with 85 cases. Leuk Lymphoma 2020; 61:2868-2875. [DOI: 10.1080/10428194.2020.1788014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Artur Jurczyszyn
- Department of Hematology, Jagiellonian University Medical College, Cracow, Poland
| | - Anna Waszczuk-Gajda
- Department of Hematology, Oncology and Internal Medicine, Warsaw Medical University, Warsaw, Poland
| | - Jorge J. Castillo
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Katarzyna Krawczyk
- Department of Hematology, Jagiellonian University Medical College, Cracow, Poland
| | - Martin Stork
- Department of Internal Medicine, Hematology and Oncology, University Hospital, Brno, Czech Republic
| | - Ludek Pour
- Department of Internal Medicine, Hematology and Oncology, University Hospital, Brno, Czech Republic
| | - Lidia Usnarska-Zubkiewicz
- Department of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - Stanisław Potoczek
- Department of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - Iwona Hus
- Medical University of Lublin, Lublin Poland
| | | | - Parameswaran Hari
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Saurabh Chhabra
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Gabor Mikala
- Department of Hematology and Stem Cell Transplantation, South-Pest Central Hospital, National Institute of Hematology and Infectology, Budapest, Hungary
| | - Gergely Varga
- 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Chor Sang Chim
- Division of Hematology and Medical Oncology, Queen Mary Hospital, Hong Kong, China
| | - Mark Fiala
- Washington University School of Medicine, St. Louis, MS, USA
| | - Ravi Vij
- Washington University School of Medicine, St. Louis, MS, USA
| | - Natalia Schutz
- Department of Internal Medicine, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Marek Rodzaj
- Department of Hematology, Regional Specialistic Hospital, Cracow, Poland
| | - Agnieszka Porowska
- Department of Oncology and Haematology, Central Clinical Hospital of the Ministry of the Interior, Warsaw, Poland
| | - David H. Vesole
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA
| | | | - Jan Walewski
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Ajay K. Nooka
- School of Medicine, Emory University, Atlanta, GA, USA
| |
Collapse
|
11
|
Assessment of TP53 lesions for p53 system functionality and drug resistance in multiple myeloma using an isogenic cell line model. Sci Rep 2019; 9:18062. [PMID: 31792264 PMCID: PMC6889167 DOI: 10.1038/s41598-019-54407-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 11/12/2019] [Indexed: 12/27/2022] Open
Abstract
Recent advances in molecular diagnostics have shown that lesions affecting both copies of the gene for tumor suppressor protein 53 (TP53) count among the most powerful predictors for high-risk disease in multiple myeloma (MM). However, the functional relevance and potential therapeutic implications of single hits to TP53 remain less well understood. Here, we have for the first time approximated the different constellations of mono- and bi-allelic TP53 lesions observed in MM patients within the frame of a single MM cell line model and assessed their potential to disrupt p53 system functionality and to impart drug resistance. Both types of common first hit: point mutation with expression of mutant p53 protein or complete loss of contribution from one of two wildtype alleles strongly impaired p53 system functionality and increased resistance to melphalan. Second hits abolished remaining p53 activity and increased resistance to genotoxic drugs even further. These results fit well with the clinical drive to TP53 single- and double-hit disease in MM patients, provide a rationale for the most commonly observed double-hit constellation (del17p+ TP53 point mutation), and underscore the potential increases in MM cell malignancy associated with any type of initial TP53 lesion.
Collapse
|
12
|
High subclonal fraction of 17p deletion is associated with poor prognosis in multiple myeloma. Blood 2019; 133:1217-1221. [PMID: 30692124 DOI: 10.1182/blood-2018-10-880831] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 01/02/2019] [Indexed: 12/12/2022] Open
Abstract
Deletions of chromosome 17p (del17p) that span the TP53 gene are associated with poor outcome in multiple myeloma (MM), but the prognostic value of del17p cancer clonal fraction (CCF) remains unclear. We applied uniform cytogenetic assessments in a large cohort of newly diagnosed MM (NDMM) patients carrying varying levels of del17p. Incremental CCF change was associated with shorter survival, and a robust CCF threshold of 0.55 was established in discovery and replication data sets. After stratification on the 0.55-CCF threshold, high-risk patients had statistically significantly poorer outcomes compared with low-risk patients (median progression-free survival [PFS] and overall survival [OS], 14 and 32 vs 23.1 and 76.2 months, respectively). Analyses of a third data set comprising whole-exome sequencing data from NDMM patients identified presence of TP53 deletions/mutations as a necessary requirement for high-risk stratification in addition to exceeding the del17p CCF threshold. Meta-analysis conducted across 3 data sets confirmed the robustness of the CCF threshold for PFS and OS. Our analyses demonstrate the feasibility of fluorescence in situ hybridization- and sequencing-based methods to identify TP53 deletions, estimate CCF, and establish that both CCF threshold of 0.55 and presence of TP53 deletion are necessary to identify del17p-carrying NDMM patients with poor prognosis.
Collapse
|