1
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Zhou P, Li W, Zuo S, Ma R, Yuan X, Zhu Z. Pathogenesis, clinical characteristics and personalized managements of multiple myeloma with chromosome 1 abnormalities. Leuk Lymphoma 2023; 64:1373-1388. [PMID: 37300424 DOI: 10.1080/10428194.2023.2216325] [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: 01/30/2023] [Revised: 05/13/2023] [Accepted: 05/15/2023] [Indexed: 06/12/2023]
Abstract
Multiple myeloma (MM) is a biologically heterogeneous malignancy defined by the proliferation of monoclonal plasma cells. Despite the tremendous advancement in MM treatment over the past decades, relapse remains a major problem which is inevitable for most patients. In particular, a partial of patients with early relapse and poor outcomes are classified as a high-risk group. Apart from the clinical stage, genetic aberrations are now recognized as important prognostic factors for identifying high-risk patients. Chromosome 1 abnormalities (C1As), particularly 1q21 gain or amplification, have been identified as common genetic aberrations in patients with MM and are often considered unfavorable prognostic markers for progression-free survival and overall survival. However, more effective therapeutic approaches are still needed to overcome the negative impact of C1As. Therefore, we summarize the prevalence, pathogenesis, clinical significance and present therapeutic condition of C1As in MM, and attempt to conclude the precise and personalized management for patients with C1As.
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Affiliation(s)
- Pan Zhou
- Department of Hematology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, P.R. China
| | - Weiya Li
- Department of Hematology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, P.R. China
| | - Suqiong Zuo
- Department of Hematology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, P.R. China
| | - Rongjun Ma
- Department of Hematology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, P.R. China
| | - Xiaoli Yuan
- Department of Hematology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, P.R. China
| | - Zunmin Zhu
- Department of Hematology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, P.R. China
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2
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ILF2 enhances the DNA cytosine deaminase activity of tumor mutator APOBEC3B in multiple myeloma cells. Sci Rep 2022; 12:2278. [PMID: 35145187 PMCID: PMC8831623 DOI: 10.1038/s41598-022-06226-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 01/19/2022] [Indexed: 11/08/2022] Open
Abstract
DNA cytosine deaminase APOBEC3B (A3B) is an endogenous source of mutations in many human cancers, including multiple myeloma. A3B proteins form catalytically inactive high molecular mass (HMM) complexes in nuclei, however, the regulatory mechanisms of A3B deaminase activity in HMM complexes are still unclear. Here, we performed mass spectrometry analysis of A3B-interacting proteins from nuclear extracts of myeloma cell lines and identified 30 putative interacting proteins. These proteins are involved in RNA metabolism, including RNA binding, mRNA splicing, translation, and regulation of gene expression. Except for SAFB, these proteins interact with A3B in an RNA-dependent manner. Most of these interacting proteins are detected in A3B HMM complexes by density gradient sedimentation assays. We focused on two interacting proteins, ILF2 and SAFB. We found that overexpressed ILF2 enhanced the deaminase activity of A3B by 30%, while SAFB did not. Additionally, siRNA-mediated knockdown of ILF2 suppressed A3B deaminase activity by 30% in HEK293T cell lysates. Based on these findings, we conclude that ILF2 can interact with A3B and enhance its deaminase activity in HMM complexes.
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3
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Basset M, Kimmich CR, Schreck N, Krzykalla J, Dittrich T, Veelken K, Goldschmidt H, Seckinger A, Hose D, Jauch A, Müller-Tidow C, Benner A, Hegenbart U, Schönland SO. Lenalidomide and dexamethasone in relapsed/refractory immunoglobulin light chain (AL) amyloidosis: results from a large cohort of patients with long follow-up. Br J Haematol 2021; 195:230-243. [PMID: 34341985 DOI: 10.1111/bjh.17685] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 12/14/2022]
Abstract
Lenalidomide and dexamethasone (RD) is a standard treatment in relapsed/refractory immunoglobulin light chain (AL) amyloidosis (RRAL). We retrospectively investigated toxicity, efficacy and prognostic markers in 260 patients with RRAL. Patients received a median of two prior treatment lines (68% had been bortezomib-refractory; 33% had received high-dose melphalan). The median treatment duration was four cycles. The 3-month haematological response rate was 31% [very good haematological response (VGHR) in 18%]. The median follow-up was 56·5 months and the median overall survival (OS) and haematological event-free survival (haemEFS) were 32 and 9 months. The 2-year dialysis rate was 15%. VGHR resulted in better OS (62 vs. 26 months, P < 0·001). Cardiac progression predicted worse survival (22 vs. 40 months, P = 0·027), although N-terminal prohormone of brain natriuretic peptide (NT-proBNP) increase was frequently observed. Multivariable analysis identified these prognostic factors: NT-proBNP for OS [hazard ratio (HR) 1·71; P < 0·001]; gain 1q21 for haemEFS (HR 1·68, P = 0·014), with a trend for OS (HR 1·47, P = 0·084); difference between involved and uninvolved free light chains (dFLC) and light chain isotype for OS (HR 2·22, P < 0·001; HR 1·62, P = 0·016) and haemEFS (HR 1·88, P < 0·001; HR 1·59, P = 0·008). Estimated glomerular filtration rate (HR 0·71, P = 0·004) and 24-h proteinuria (HR 1·10, P = 0·004) were prognostic for renal survival. In conclusion, clonal and organ biomarkers at baseline identify patients with favourable outcome, while VGHR and cardiac progression define prognosis during RD treatment.
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Affiliation(s)
- Marco Basset
- Division of Hematology/Oncology, Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany.,Amyloidosis Center, Heidelberg University Hospital, Heidelberg, Germany.,Department of Molecular Medicine, Amyloidosis Research and Treatment Center, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Christoph R Kimmich
- Division of Hematology/Oncology, Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany.,Amyloidosis Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Nicholas Schreck
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Julia Krzykalla
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Tobias Dittrich
- Division of Hematology/Oncology, Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany.,Amyloidosis Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Kaya Veelken
- Division of Hematology/Oncology, Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany.,Amyloidosis Center, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Anja Seckinger
- Division of Hematology/Oncology, Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany.,Laboratory of Hematology and Immunology & Labor für Myelomforschung, Vrije Universiteit Brussel (VUB), Jette, Belgium
| | - Dirk Hose
- Division of Hematology/Oncology, Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany.,Laboratory of Hematology and Immunology & Labor für Myelomforschung, Vrije Universiteit Brussel (VUB), Jette, Belgium
| | - Anna Jauch
- Institute of Human Genetics, University Heidelberg, Heidelberg, Germany
| | - Carsten Müller-Tidow
- Division of Hematology/Oncology, Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - Axel Benner
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ute Hegenbart
- Division of Hematology/Oncology, Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany.,Amyloidosis Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan O Schönland
- Division of Hematology/Oncology, Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany.,Amyloidosis Center, Heidelberg University Hospital, Heidelberg, Germany
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4
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Zou Z, Guo T, Cui J, Tang W, Li Y, Wang F, Dong T, Yang Y, Feng Y, Ho M, Zhang L, Pan L, Niu T. Real-world data combined with studies on Regulatory B Cells for newly diagnosed Multiple Myeloma from a tertiary referral Hospital in South-Western China. J Cancer 2021; 12:2633-2642. [PMID: 33854623 PMCID: PMC8040702 DOI: 10.7150/jca.53209] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 01/30/2021] [Indexed: 02/05/2023] Open
Abstract
Multiple myeloma (MM) is a heterogeneous disease that remains incurable with significant interpatient variability in outcomes. Regulatory B cells (Bregs) were observed to be involved into specific defects in MM. Here, we provide our risk-adapted approach to newly diagnosed MM (NDMM), combining with the fundamental dysfunction of Bregs. We reported one hundred consecutive patients with NDMM from South-Western China, primarily treated with bortezomib plus dexamethasone with or without a 3rd agent, were enrolled from 2017. Bone marrow aspirates were obtained and flow cytometry (FCM) was used to quantify the percentage of Bregs from the bone marrow. The correlation between Bregs and clinical characters were further analyzed. This study found using bortezomib plus dexamethasone as backbone showed promising efficacy with acceptable tolerability in NDMM. The relatively compromised progression free survival (PFS) points to the essential synergy of bortezomib and lenalidomide here. This study also found that altered proportions of Bregs were closely correlated with treatment efficacy and prognosis in MM. Further understanding of Bregs biology might provide new opportunities to develop immunotherapy, which could prove beneficial in treating MM.
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Affiliation(s)
- Zhongqing Zou
- Department of Hematology, West China Hospital, Sichuan University, China
- Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Tingting Guo
- Department of Hematology, West China Hospital, Sichuan University, China
- Center for Precision Medicine, West China Hospital, Sichuan University, China
| | - Jian Cui
- Department of Hematology, West China Hospital, Sichuan University, China
| | - Wenjiao Tang
- Department of Hematology, West China Hospital, Sichuan University, China
| | - Yan Li
- Department of Hematology, West China Hospital, Sichuan University, China
| | - Fangfang Wang
- Department of Hematology, West China Hospital, Sichuan University, China
- Hematology Research Laboratory, Department of Hematology, West China Hospital, Sichuan University, China
| | - Tian Dong
- Department of Hematology, West China Hospital, Sichuan University, China
| | - Yunfan Yang
- Department of Hematology, West China Hospital, Sichuan University, China
| | - Yan Feng
- Department of Hematology, West China Hospital, Sichuan University, China
| | - Matthew Ho
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Li Zhang
- Department of Hematology, West China Hospital, Sichuan University, China
| | - Ling Pan
- Department of Hematology, West China Hospital, Sichuan University, China
| | - Ting Niu
- Department of Hematology, West China Hospital, Sichuan University, China
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5
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Hanamura I. Gain/Amplification of Chromosome Arm 1q21 in Multiple Myeloma. Cancers (Basel) 2021; 13:cancers13020256. [PMID: 33445467 PMCID: PMC7827173 DOI: 10.3390/cancers13020256] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/07/2021] [Accepted: 01/09/2021] [Indexed: 02/06/2023] Open
Abstract
Simple Summary Multiple myeloma (MM), a plasma cell neoplasm, is an incurable hematological malignancy. Gain/amplification of chromosome arm 1q21 (1q21+) is the most common adverse genomic abnormality associated with disease progression and drug resistance. While possible mechanisms of 1q21+ occurrence and candidate genes in the 1q21 amplicon have been suggested, the precise pathogenesis of MM with 1q21+ is unknown. Herein, we review the current knowledge about the clinicopathological features of 1q21+ MM, which can assist in effective therapeutic approaches for MM patients with 1q21+. Abstract Multiple myeloma (MM), a plasma cell neoplasm, is an incurable hematological malignancy characterized by complex genetic and prognostic heterogeneity. Gain or amplification of chromosome arm 1q21 (1q21+) is the most frequent adverse chromosomal aberration in MM, occurring in 40% of patients at diagnosis. It occurs in a subclone of the tumor as a secondary genomic event and is more amplified as the tumor progresses and a risk factor for the progression from smoldering multiple myeloma to MM. It can be divided into either 1q21 gain (3 copies) or 1q21 amplification (≥4 copies), and it has been suggested that the prognosis is worse in cases of amplification than gain. Trisomy of chromosome 1, jumping whole-arm translocations of chromosome1q, and tandem duplications lead to 1q21+ suggesting that its occurrence is not consistent at the genomic level. Many studies have reported that genes associated with the malignant phenotype of MM are situated on the 1q21 amplicon, including CKS1B, PSMD4, MCL1, ANP32E, and others. In this paper, we review the current knowledge regarding the clinical features, prognostic implications, and the speculated pathology of 1q21+ in MM, which can provide clues for an effective treatment approach to MM patients with 1q21+.
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Affiliation(s)
- Ichiro Hanamura
- Division of Hematology, Department of Internal Medicine, Aichi Medical University School of Medicine, 1-1, Karimata, Yazako, Nagakute, Aichi 480-1195, Japan
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6
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Usmani SZ, Hoering A, Ailawadhi S, Sexton R, Lipe B, Hita SF, Valent J, Rosenzweig M, Zonder JA, Dhodapkar M, Callander N, Zimmerman T, Voorhees PM, Durie B, Rajkumar SV, Richardson PG, Orlowski RZ. Bortezomib, lenalidomide, and dexamethasone with or without elotuzumab in patients with untreated, high-risk multiple myeloma (SWOG-1211): primary analysis of a randomised, phase 2 trial. LANCET HAEMATOLOGY 2020; 8:e45-e54. [PMID: 33357482 DOI: 10.1016/s2352-3026(20)30354-9] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND The introduction of immunomodulatory agents, proteasome inhibitors, and autologous haematopoietic stem-cell transplantation has improved outcomes for patients with multiple myeloma, but patients with high-risk multiple myeloma have a poor long-term prognosis. We aimed to address optimal treatment for these patients. METHODS SWOG-1211 is a randomised phase 2 trial comparing eight cycles of lenalidomide (25 mg orally on days 1-14 every 21 days), bortezomib (1·3 mg/m2 subcutaneously on days 1, 4, 8, and 11 every 21 days), and dexamethasone (20 mg orally on days 1, 2, 4, 5, 8, 9, 11, and 12 every 21 days; RVd) induction followed by dose-attenuated RVd maintenance (bortezomib 1 mg/m2 subcutaneously on days 1, 8, and 15; lenalidomide 15 mg orally on days 1-21; dexamethasone 12 mg orally on days 1, 18, and 15 every 28 days) until disease progression with or without elotuzumab (10 mg/kg intravenously on days 1, 8, and 15 for cycles 1-2, on days 1 and 11 for cycles 3-8, and on days 1 and 15 during maintenance). Patients were randomly assigned (1:1) to either RVd or RVd-elotuzumab. High-risk multiple myeloma was defined by one of the following: gene expression profiling high risk (GEPhi), t(14;16), t(14;20), del(17p) or amp1q21, primary plasma cell leukaemia and elevated serum lactate dehydrogenase (two times the upper limit of normal or more). The primary endpoint was progression-free survival, and all analyses were done on intention-to-treat basis among eligible patients who were evaluable for response. This study is registered with ClinicalTrials.gov, NCT01668719. FINDINGS 100 (RVd n=52, RVd-elotuzumab n=48) patients were enrolled between Oct 27, 2013, and May 15, 2016, across 26 cooperative group institutions in the USA. Median age was 64 years (IQR 57-70, range 36-85). 74 (75%) of 99 had International Staging System stage II or stage III disease, 47 (47%) of 99 had amp1q21, 37 (37%) of 100 had del17p, 11 (11%) of 100 had t(14;16), eight (9%) of 90 were GEPhi, seven (7%) of 100 had primary plasma cell leukaemia, five (5%) of 100 had t(14;20), four (4%) of 100 had elevated serum lactate dehydrogenase, and 17 (17%) had two or more features. With a median follow-up of 53 months (IQR 46-59), no difference in median progression-free survival was observed (RVd 33·64 months [95% CI 19·55-not reached], RVd-elotuzumab 31·47 months [18·56-53·98]; hazard ratio 0·968 [80% CI 0·697-1·344]; one-sided p=0·45]. 37 (71%) of 52 patients in the RVd group and 37 (77%) of 48 in the RVd-elotuzumab group had grade 3 or worse adverse events. No significant differences in the safety profile were observed, although some notable results included grade 3-5 infections (four [8%] of 52 in the RVd group, eight [17%] of 48 in the RVd-elotuzumab group), sensory neuropathy (four [8%] of 52 in the RVd group, six [13%] of 48 in the RVd-elotuzumab group), and motor neuropathy (one [2%] of 52 in the RVd group, four [8%] of 48 in the RVd-elotuzumab group). There were no treatment-related deaths in the RVd group and one death in the RVd-elotuzumab group for which study treatment was listed as possibly contributing by the investigator. INTERPRETATION In the first randomised study of high-risk multiple myeloma reported to date, the addition of elotuzumab to RVd induction and maintenance did not improve patient outcomes. However, progression-free survival in both study groups exceeded the original statistical assumptions and supports the role for continuous proteasome inhibitors and immunomodulatory drug combination maintenance therapy for this patient population. FUNDING National Institutes of Health, National Cancer Institute, Bristol Myers Squibb, Celgene, Leukemia and Lymphoma Society.
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Affiliation(s)
- Saad Z Usmani
- Levine Cancer Institute, Atrium Health, Charlotte, NC, USA.
| | | | | | | | - Brea Lipe
- University of Rochester Medical Center, Rochester, NY, USA
| | | | - Jason Valent
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | | | - Jeffrey A Zonder
- Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA
| | | | | | - Todd Zimmerman
- Department of Hematology Oncology, University of Chicago, Chicago, IL, USA; BeiGene Pharma, Chicago, IL, USA
| | | | - Brian Durie
- Cedar-Sinai Medical Center, Los Angeles, CA, USA
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7
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Du C, Mao X, Xu Y, Yan Y, Yuan C, Du X, Liu J, Fan H, Wang Q, Sui W, Deng S, Fu M, Li Z, Li C, Zhao J, Yi S, Liu L, Hao M, Zou D, Zhao Y, Qiu L, An G. 1q21 gain but not t(4;14) indicates inferior outcomes in multiple myeloma treated with bortezomib. Leuk Lymphoma 2019; 61:1201-1210. [PMID: 31842644 DOI: 10.1080/10428194.2019.1700503] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Chenxing Du
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Xuehan Mao
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Yan Xu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Yuting Yan
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Chenglu Yuan
- Qilu Hospital of Shandong University (Qingdao), Qingdao, China
| | - Xin Du
- Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Jiahui Liu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Huishou Fan
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Qi Wang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Weiwei Sui
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Shuhui Deng
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Mingwei Fu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Zengjun Li
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Chengwen Li
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Jiawei Zhao
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Shuhua Yi
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Lanting Liu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Mu Hao
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Dehui Zou
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Yaozhong Zhao
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Lugui Qiu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Gang An
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
- Qilu Hospital of Shandong University (Qingdao), Qingdao, China
- Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
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8
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Yoshida T, Ri M, Fujinami H, Oshima Y, Tachita T, Marumo Y, Sasaki H, Kinoshita S, Totani H, Narita T, Masaki A, Ito A, Kusumoto S, Ishida T, Komatsu H, Iida S. Impact of chromosomal abnormalities on the efficacy of lenalidomide plus dexamethasone treatment in patients with relapsed/refractory multiple myeloma. Int J Hematol 2019; 110:228-236. [PMID: 31119611 DOI: 10.1007/s12185-019-02669-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 05/15/2019] [Accepted: 05/15/2019] [Indexed: 12/11/2022]
Abstract
Lenalidomide is an effective therapeutic agent for multiple myeloma (MM). However, its efficacy in the context of chromosomal abnormalities (CA) is poorly understood. We retrospectively analyzed 83 patients with relapsed/refractory (RR) MM, who received lenalidomide plus low-dose dexamethasone (Ld), in the context of CA. The median age and number of prior therapies were 69 and 2, respectively. Three, 11, 45, and 19 patients achieved complete response, very good partial response, partial response, and stable disease, respectively. Median progression-free survival (PFS) and overall survival (OS) were 11.1 and 38.8 months, respectively. Seventy-two patients were evaluated for frequently observed translocations; median PFS was 24.4 months in 20 patients with t(11;14), 13.0 months in 16 patients with t(4;14), and 3.7 months in seven patients with t(14;16). G-banded karyotype analysis detected 11 hypodiploid patients, who had shorter PFS and OS (2.5 and 6.2 months, respectively) compared to others (13.0 and 43.7 months, respectively). Hypodiploid patients showed poor clinical outcome, whereas patients with t(11;14) showed favorable outcome. In summary, the present study presents the clinical impact of chromosomal abnormalities on the outcome of Ld therapy, and contributes to understanding the appropriate choice of lenalidomide-based therapy to achieve effective treatment of RR MM.
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Affiliation(s)
- Takashi Yoshida
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Masaki Ri
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan.
| | - Haruna Fujinami
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Yoshiko Oshima
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Takuto Tachita
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan.,Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, 5 Zaifu-chou, Hirosaki, Aomori, 036-8216, Japan
| | - Yoshiaki Marumo
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Hirokazu Sasaki
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Shiori Kinoshita
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Haruhito Totani
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Tomoko Narita
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Ayako Masaki
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Asahi Ito
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Shigeru Kusumoto
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Takashi Ishida
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Hirokazu Komatsu
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Shinsuke Iida
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
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9
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Caers J, Garderet L, Kortüm KM, O'Dwyer ME, van de Donk NWCJ, Binder M, Dold SM, Gay F, Corre J, Beguin Y, Ludwig H, Larocca A, Driessen C, Dimopoulos MA, Boccadoro M, Gramatzki M, Zweegman S, Einsele H, Cavo M, Goldschmidt H, Sonneveld P, Delforge M, Auner HW, Terpos E, Engelhardt M. European Myeloma Network recommendations on tools for the diagnosis and monitoring of multiple myeloma: what to use and when. Haematologica 2018; 103:1772-1784. [PMID: 30171031 PMCID: PMC6278986 DOI: 10.3324/haematol.2018.189159] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 08/27/2018] [Indexed: 01/04/2023] Open
Abstract
The diagnosis of multiple myeloma can be challenging, even for experienced physicians, and requires close collaboration between numerous disciplines (orthopedics, radiology, nuclear medicine, radiation therapy, hematology and oncology) before the final diagnosis of myeloma is made. The definition of multiple myeloma is based on the presence of clinical, biochemical, histopathological, and radiological markers of disease. Specific tests are needed both at presentation and during follow-up in order to reach the correct diagnosis and characterize the disease precisely. These tests can also serve prognostic purposes and are useful for follow-up of myeloma patients. Molecular analyses remain pivotal for defining high-risk myeloma and are used in updated patient stratifications, while minimal residual disease assessment via flow cytometry, molecular techniques and radiological approaches provides additional prognostic information on patients' long-term outcome. This pivotal information will guide our future treatment decisions in forthcoming clinical trials. The European Myeloma Network group updated their guidelines on different diagnostic recommendations, which should be of value to enable appropriate use of the recommendations both at diagnosis and during follow-up.
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Affiliation(s)
- Jo Caers
- Department of Hematology, University Hospital of Liege, Belgium .,Laboratory of Hematology, GIGA-I3, University of Liège, Belgium
| | | | - K Martin Kortüm
- Department of Internal Medicine II, University Hospital of Wuerzburg, Germany
| | - Michael E O'Dwyer
- Department of Hematology, National University of Ireland Galway, Ireland
| | | | - Mascha Binder
- Department of Internal Medicine II, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sandra Maria Dold
- Department of Medicine I, Hematology, Oncology & Stem Cell Transplantation, Medical Center, Faculty of Medicine, University of Freiburg, Germany
| | - Francesca Gay
- Department of Hematology-Oncology, University Hospital Città della Salute e della Scienza, Torino, Italy
| | - Jill Corre
- Unit for Genomics in Myeloma, Institut Universitaire du Cancer - Oncopole, Toulouse, France
| | - Yves Beguin
- Department of Hematology, University Hospital of Liege, Belgium.,Laboratory of Hematology, GIGA-I3, University of Liège, Belgium
| | - Heinz Ludwig
- Wilhelminen Cancer Research Institute, Vienna, Austria
| | - Alessandra Larocca
- Department of Hematology-Oncology, University Hospital Città della Salute e della Scienza, Torino, Italy
| | - Christoph Driessen
- Department of Oncology and Hematology, Cantonal Hospital St. Gallen, Switzerland
| | | | - Mario Boccadoro
- Department of Hematology-Oncology, University Hospital Città della Salute e della Scienza, Torino, Italy
| | - Martin Gramatzki
- Division of Stem Cell Transplantation and Immunotherapy, University of Kiel, Germany
| | - Sonja Zweegman
- Department of Hematology, VU University Medical Center, Amsterdam, the Netherlands
| | - Hermann Einsele
- Department of Internal Medicine II, University Hospital of Wuerzburg, Germany
| | - Michele Cavo
- Seragnoli 'Institute of Hematology, Bologna University School of Medicine, Italy
| | - Hartmut Goldschmidt
- Department of Hematology, Rheumatology and Oncology, University Hospital Heidelberg, Germany.,National Center for Tumor Diseases, Heidelberg Medical University, Germany
| | - Pieter Sonneveld
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Michel Delforge
- Department of Hematology, University Hospital Leuven, Belgium
| | - Holger W Auner
- Centre for Haematology, Hammersmith Hospital, Imperial College London, UK
| | - Evangelos Terpos
- School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Monika Engelhardt
- Department of Medicine I, Hematology, Oncology & Stem Cell Transplantation, Medical Center, Faculty of Medicine, University of Freiburg, Germany
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10
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Mansilla C, Soria E, Vallejo M, Valiente A, Perez-Juana A, Zabalza A, Hurtado G, Sala F, Ramírez N. Combined Selection System to Lower the Cutoff for Plasma Cell Enrichment Applied to iFISH Analysis in Multiple Myeloma. Transl Oncol 2018; 11:647-652. [PMID: 29604510 PMCID: PMC6054590 DOI: 10.1016/j.tranon.2018.02.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 02/12/2018] [Accepted: 02/12/2018] [Indexed: 12/17/2022] Open
Abstract
Multiple myeloma (MM) is a very heterogeneous disease, characterized by multiple cytogenetic aberrations on plasma cells (PC) that have been traditionally used to predict the outcome of the disease. A mayor issue on the analysis of PC is the sometimes low infiltration of these cells in the bone marrow that hampers cytogenetic studies. To solve this problem we have optimized a selection strategy based on PC immunomagnetic isolation that has allowed us to lower to 1% the minimal PC infiltration requirement without loss of purity, enabling to perform genetic analysis. In this study, we have analyzed 153 bone marrow samples of patients suspected of MM, collected from February 2015 to May 2017 by the Genetics service of the Complejo Hospitalario de Navarra. Clinical characteristics of the patients and PC immunophenotyping, conventional cytogenetics and interphase fluorescence in situ hybridization (iFISH) analyses have been assessed on these samples. In our cohort 90% of the samples had cytogenetic abnormalities, among them 50% presented immunoglobulin rearrangements, 41.9% showed 1q gains, 29.7% showed 1p deletions and 33% presented TP53 deletion.
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Affiliation(s)
- Cristina Mansilla
- Oncohematology Research Group, Navarrabiomed, Complejo Hospitalario de Navarra, Universidad Pública de Navarra, IdiSNA
| | - Elena Soria
- Oncohematology Research Group, Navarrabiomed, Complejo Hospitalario de Navarra, Universidad Pública de Navarra, IdiSNA
| | - Miren Vallejo
- Oncohematology Research Group, Navarrabiomed, Complejo Hospitalario de Navarra, Universidad Pública de Navarra, IdiSNA
| | - Alberto Valiente
- Genetics Service, Complejo Hospitalario de Navarra, IdiSNA (Navarra's Health Research Institute), Pamplona, Spain
| | - Aránzazu Perez-Juana
- Genetics Service, Complejo Hospitalario de Navarra, IdiSNA (Navarra's Health Research Institute), Pamplona, Spain
| | - Amaya Zabalza
- Oncohematology Research Group, Navarrabiomed, Complejo Hospitalario de Navarra, Universidad Pública de Navarra, IdiSNA; Hematology Department, Complejo Hospitalario de Navarra, IdiSNA, Pamplona, Spain
| | - Guillermina Hurtado
- Cytometry Service, Hematology Department, Complejo Hospitalario de Navarra, IdiSNA, Pamplona, Spain
| | - Francisco Sala
- Cytometry Service, Hematology Department, Complejo Hospitalario de Navarra, IdiSNA, Pamplona, Spain
| | - Natalia Ramírez
- Oncohematology Research Group, Navarrabiomed, Complejo Hospitalario de Navarra, Universidad Pública de Navarra, IdiSNA.
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11
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Klairmont MM, Cheng J, Martin MG, Gradowski JF. Recurrent Cytogenetic Abnormalities in Intravascular Large B-Cell Lymphoma. Am J Clin Pathol 2018; 150:18-26. [PMID: 29767679 DOI: 10.1093/ajcp/aqy023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Data characterizing the cytogenetic landscape of intravascular large B-cell lymphoma (ILBCL) are limited. Here, we developed a comprehensive karyotypic data set to identify recurrent cytogenetic abnormalities in ILBCL. METHODS Cases of ILBCL with complete cytogenetic analysis were identified from an institutional database and the literature. The combined data were systematically reviewed for the presence of recurrent abnormalities. RESULTS Four new cases were identified and combined with 25 karyotypes previously published in the literature. Karyotypes were uniformly complex with a median of 10 aberrations. In total, 72.4% had abnormalities involving chromosome 1, with 31.0% involving rearrangements of 1p13 or 1q21; 58.6% had abnormalities involving chromosome 6, which in almost all cases involved 6q; 34.5% had abnormalities involving chromosome 14, with 27.6% involving rearrangements of 14q32; and 55.2% had abnormalities of chromosome 18, with 37.9% harboring trisomy 18. CONCLUSIONS Recurrent cytogenetic abnormalities involving chromosomes 1, 6q, and 18 are present in greater than 50% of ILBCL.
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Affiliation(s)
- Matthew M Klairmont
- Department of Pathology and Laboratory Medicine, University of Tennessee Health Science Center, Memphis
| | - Jinjun Cheng
- Department of Pathology and Laboratory Medicine, University of Tennessee Health Science Center, Memphis
| | - Mike G Martin
- Department of Hematology/Oncology, West Cancer Center/University of Tennessee Health Science Center, Memphis
| | - Joel F Gradowski
- Department of Pathology and Laboratory Medicine, University of Tennessee Health Science Center, Memphis
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12
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Aida S, Hozumi M, Ichikawa D, Iida K, Yonemura Y, Tabata N, Yamada T, Matsushita M, Sugai T, Yanagawa H, Hattori Y. A novel phenylphthalimide derivative, pegylated TC11, improves pharmacokinetic properties and induces apoptosis of high-risk myeloma cells via G2/M cell-cycle arrest. Biochem Biophys Res Commun 2017; 493:514-520. [DOI: 10.1016/j.bbrc.2017.08.159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 08/31/2017] [Indexed: 11/30/2022]
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13
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Marchesini M, Ogoti Y, Fiorini E, Aktas Samur A, Nezi L, D'Anca M, Storti P, Samur MK, Ganan-Gomez I, Fulciniti MT, Mistry N, Jiang S, Bao N, Marchica V, Neri A, Bueso-Ramos C, Wu CJ, Zhang L, Liang H, Peng X, Giuliani N, Draetta G, Clise-Dwyer K, Kantarjian H, Munshi N, Orlowski R, Garcia-Manero G, DePinho RA, Colla S. ILF2 Is a Regulator of RNA Splicing and DNA Damage Response in 1q21-Amplified Multiple Myeloma. Cancer Cell 2017; 32:88-100.e6. [PMID: 28669490 PMCID: PMC5593798 DOI: 10.1016/j.ccell.2017.05.011] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 01/20/2017] [Accepted: 05/22/2017] [Indexed: 12/21/2022]
Abstract
Amplification of 1q21 occurs in approximately 30% of de novo and 70% of relapsed multiple myeloma (MM) and is correlated with disease progression and drug resistance. Here, we provide evidence that the 1q21 amplification-driven overexpression of ILF2 in MM promotes tolerance of genomic instability and drives resistance to DNA-damaging agents. Mechanistically, elevated ILF2 expression exerts resistance to genotoxic agents by modulating YB-1 nuclear localization and interaction with the splicing factor U2AF65, which promotes mRNA processing and the stabilization of transcripts involved in homologous recombination in response to DNA damage. The intimate link between 1q21-amplified ILF2 and the regulation of RNA splicing of DNA repair genes may be exploited to optimize the use of DNA-damaging agents in patients with high-risk MM.
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Affiliation(s)
- Matteo Marchesini
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Yamini Ogoti
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Elena Fiorini
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Anil Aktas Samur
- Department of Biostatistics and Computational Biology, Dana Farber Cancer Institute and Harvard Medical School, Boston, MA 02215, USA
| | - Luigi Nezi
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Marianna D'Anca
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Paola Storti
- Department of Clinical and Experimental Medicine, University of Parma, Parma 43100, Italy
| | - Mehmet Kemal Samur
- Department of Biostatistics and Computational Biology, Dana Farber Cancer Institute and Harvard Medical School, Boston, MA 02215, USA
| | - Irene Ganan-Gomez
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Maria Teresa Fulciniti
- LeBow Institute for Myeloma Therapeutics and Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA 02215, USA
| | - Nipun Mistry
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Shan Jiang
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Naran Bao
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Valentina Marchica
- Department of Clinical and Experimental Medicine, University of Parma, Parma 43100, Italy
| | - Antonino Neri
- Department of Oncology and Hemato-Oncology, University of Milano, Milan 20122, Italy
| | - Carlos Bueso-Ramos
- Department of Hematopathology, The University of Texas MD Cancer Center, Houston, TX 77030, USA
| | - Chang-Jiun Wu
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Li Zhang
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Han Liang
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Xinxin Peng
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Nicola Giuliani
- Department of Clinical and Experimental Medicine, University of Parma, Parma 43100, Italy
| | - Giulio Draetta
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Karen Clise-Dwyer
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Hagop Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Nikhil Munshi
- LeBow Institute for Myeloma Therapeutics and Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA 02215, USA
| | - Robert Orlowski
- Department of Lymphoma/Myeloma, The University of Texas MD Cancer Center, Houston, TX 77030, USA
| | - Guillermo Garcia-Manero
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Ronald A DePinho
- Department of Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Simona Colla
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
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14
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Dingli D, Ailawadhi S, Bergsagel PL, Buadi FK, Dispenzieri A, Fonseca R, Gertz MA, Gonsalves WI, Hayman SR, Kapoor P, Kourelis T, Kumar SK, Kyle RA, Lacy MQ, Leung N, Lin Y, Lust JA, Mikhael JR, Reeder CB, Roy V, Russell SJ, Sher T, Stewart AK, Warsame R, Zeldenrust SR, Rajkumar SV, Chanan Khan AA. Therapy for Relapsed Multiple Myeloma: Guidelines From the Mayo Stratification for Myeloma and Risk-Adapted Therapy. Mayo Clin Proc 2017; 92:578-598. [PMID: 28291589 PMCID: PMC5554888 DOI: 10.1016/j.mayocp.2017.01.003] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 12/12/2016] [Accepted: 01/04/2017] [Indexed: 12/13/2022]
Abstract
Life expectancy in patients with multiple myeloma is increasing because of the availability of an increasing number of novel agents with various mechanisms of action against the disease. However, the disease remains incurable in most patients because of the emergence of resistant clones, leading to repeated relapses of the disease. In 2015, 5 novel agents were approved for therapy for relapsed multiple myeloma. This surfeit of novel agents renders management of relapsed multiple myeloma more complex because of the occurrence of multiple relapses, the risk of cumulative and emergent toxicity from previous therapies, as well as evolution of the disease during therapy. A group of physicians at Mayo Clinic with expertise in the care of patients with multiple myeloma regularly evaluates the evolving literature on the biology and therapy for multiple myeloma and issues guidelines on the optimal care of patients with this disease. In this article, the latest recommendations on the diagnostic evaluation of relapsed multiple myeloma and decision trees on how to treat patients at various stages of their relapse (off study) are provided together with the evidence to support them.
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Affiliation(s)
- David Dingli
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
| | | | - P Leif Bergsagel
- Division of Hematology and Oncology, Mayo Clinic, Scottsdale, AZ
| | - Francis K Buadi
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Angela Dispenzieri
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Rafael Fonseca
- Division of Hematology and Oncology, Mayo Clinic, Scottsdale, AZ
| | - Morie A Gertz
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Wilson I Gonsalves
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Susan R Hayman
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Prashant Kapoor
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Taxiarchis Kourelis
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Shaji K Kumar
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Robert A Kyle
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Martha Q Lacy
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Nelson Leung
- Division of Nephrology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Yi Lin
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - John A Lust
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Joseph R Mikhael
- Division of Hematology and Oncology, Mayo Clinic, Scottsdale, AZ
| | - Craig B Reeder
- Division of Hematology and Oncology, Mayo Clinic, Scottsdale, AZ
| | - Vivek Roy
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL
| | - Stephen J Russell
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Taimur Sher
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL
| | - A Keith Stewart
- Division of Hematology and Oncology, Mayo Clinic, Scottsdale, AZ
| | - Rahma Warsame
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Stephen R Zeldenrust
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - S Vincent Rajkumar
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
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15
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Carfilzomib-dexamethasone vs bortezomib-dexamethasone in relapsed or refractory multiple myeloma by cytogenetic risk in the phase 3 study ENDEAVOR. Leukemia 2016; 31:1368-1374. [PMID: 28025582 PMCID: PMC5467042 DOI: 10.1038/leu.2016.390] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 11/23/2016] [Accepted: 12/05/2016] [Indexed: 12/30/2022]
Abstract
The randomized phase 3 study ENDEAVOR demonstrated a statistically significant and clinically meaningful improvement in progression-free survival (PFS) for carfilzomib and dexamethasone (Kd) vs bortezomib and dexamethasone (Vd) in relapsed or refractory multiple myeloma (MM). We conducted a preplanned subgroup analysis of ENDEAVOR to evaluate Kd vs Vd by cytogenetic risk. Of 785 patients with known cytogenetics, 210 (27%) had high-risk cytogenetics (Kd, n=97 (25%); Vd, n=113 (28%)) and 575 (73%) had standard-risk cytogenetics (Kd, n=284 (75%); Vd, n=291 (72%)). Median PFS in the high-risk group was 8.8 months for Kd vs 6.0 months for Vd (hazard ratio (HR), 0.65; 95% confidence interval (CI), 0.45-0.92; P=0.0075). Median PFS in the standard-risk group was not estimable for Kd vs 10.2 months for Vd (HR, 0.44; 95% CI, 0.33-0.58; P<0.0001). Overall response rates were 72.2% (Kd) vs 58.4% (Vd) in the high-risk group and 79.2% (Kd) vs 66.0% (Vd) in the standard-risk group. In the high-risk group, 15.5% (Kd) vs 4.4% (Vd) achieved a complete response (CR) or better. In the standard-risk group, 13.0% (Kd) vs 7.9% (Vd) achieved ⩾CR. This preplanned subgroup analysis found that Kd was superior to Vd in relapsed or refractory MM, regardless of cytogenetic risk.
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16
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Nolte F, Mossner M, Jann JC, Nowak D, Boch T, Müller NZ, Hofmann WK, Metzgeroth G. Concomitant MDS with isolated 5q deletion and MGUS: case report and review of molecular aspects. Eur J Haematol 2016; 98:302-310. [PMID: 27862375 DOI: 10.1111/ejh.12827] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2016] [Indexed: 12/23/2022]
Abstract
Patients with monoclonal gammopathy of undetermined significance (MGUS) have a higher risk for the development of concomitant primary cancers such as multiple myeloma (MM) and myelodysplastic syndrome (MDS). We report the case of patient initially suffering from MGUS of the IgG lambda subtype for more than 10 yr, which evolved to MM and MDS with deletion (5q) with severe pancytopenia. Due to pancytopenia, he received dose-reduced treatment with lenalidomide and dexamethasone. He achieved an ongoing transfusion independency after about 1 month of treatment. Bone marrow taken 14 months after start of treatment showed a complete cytogenetic response of the del(5q) clone and a plasma cell infiltration below 5%. In contrast to the development of MM in MGUS patients, the subsequent occurrence of MDS after diagnosis of MGUS is infrequent. Moreover, the biological association of MDS with MGUS is not sufficiently understood, but the non-treatment-related occurrence supports the pathogenetic role of pre-existing alterations of stem cells. Here, we summarize data on concomitant MDS and MGUS/MM with particular emphasis on molecular aspects.
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Affiliation(s)
- Florian Nolte
- Medical faculty Mannheim of the University of Heidelberg, Mannheim, Germany.,Department of Internal Medicine, Hematology and Oncology, St. Hedwig Hospital, Berlin, Germany
| | - Maximilian Mossner
- Medical faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | | | - Daniel Nowak
- Medical faculty Mannheim of the University of Heidelberg, Mannheim, Germany.,Department of Hematology and Oncology, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Tobias Boch
- Medical faculty Mannheim of the University of Heidelberg, Mannheim, Germany.,Department of Hematology and Oncology, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Nadine Zoe Müller
- Medical faculty Mannheim of the University of Heidelberg, Mannheim, Germany.,Department of Hematology and Oncology, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Wolf-Karsten Hofmann
- Medical faculty Mannheim of the University of Heidelberg, Mannheim, Germany.,Department of Hematology and Oncology, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Georgia Metzgeroth
- Medical faculty Mannheim of the University of Heidelberg, Mannheim, Germany.,Department of Hematology and Oncology, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
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17
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Qin Y, Zhang S, Deng S, An G, Qin X, Li F, Xu Y, Hao M, Yang Y, Zhou W, Chang H, Qiu L. Epigenetic silencing of miR-137 induces drug resistance and chromosomal instability by targeting AURKA in multiple myeloma. Leukemia 2016; 31:1123-1135. [PMID: 27857131 DOI: 10.1038/leu.2016.325] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 07/26/2016] [Accepted: 09/01/2016] [Indexed: 12/12/2022]
Abstract
Multiple myeloma (MM) is the second most prevalent hematologic malignancy. Aberrant microRNAs (miRNAs) expression has been shown to be involved in the pathogenesis of MM. In this study, we further demonstrated that miR-137 was significantly downregulated in MM and negatively correlated with clinical prognosis. Moreover, we described the epigenetic regulation of miR-137 and its association with progression-free survival in MM patients. Furthermore, overexpression of miR-137 in MM cell line (miR-137 OE) increased its sensitivity to bortezomib and eprirubicin in vitro. Also, some high-risk genetic abnormalities in MM, including deletion of chromosome 1p22.2, 14q or 17p13, and gain of chromosome 1p22.2 were detected in NCI-H929 empty vector (NCI-H929 EV) treated cells but not in the NCI-H929 miR-137 overexpression (NCI-H929 miR-137 OE) cells. Luciferase reporter assays demonstrated that miR-137 targeted AURKA. Ectopic expression of miR-137 strongly reduced the expression of AURKA and p-ATM/Chk2 in MM cells, and increased the expression of p53, and p21. Importantly, miR-137 overexpression together with bortezomib treatment significantly inhibited tumor growth in MM xenograft model. Taken together, this study demonstrates that miR-137 is epigenetically silenced in MM, and overexpression of miR-137 could reduce drug resistance and overcome chromosomal instability of the MM cells via affecting the apoptosis and DNA damage pathways.
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Affiliation(s)
- Y Qin
- Department of Lymphoma and Myeloma, State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, China.,Department of Diagnostics, College of Basic Medical Science, Tianjin Medical University, Tianjin, China
| | - S Zhang
- Department of Lymphoma and Myeloma, State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, China
| | - S Deng
- Department of Lymphoma and Myeloma, State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, China
| | - G An
- Department of Lymphoma and Myeloma, State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, China
| | - X Qin
- Department of Lymphoma and Myeloma, State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, China
| | - F Li
- Department of Lymphoma and Myeloma, State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, China
| | - Y Xu
- Department of Lymphoma and Myeloma, State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, China
| | - M Hao
- Department of Lymphoma and Myeloma, State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, China
| | - Y Yang
- Division of Molecular and Cellular Biology, Department of Laboratory Hematology, Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada.,School of Chemical Engineering and Technology, Tianjin University, Tianjin, China
| | - W Zhou
- Department of Lymphoma and Myeloma, State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, China.,Key Laboratory of Carcinogenesis, Ministry of Health, Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Xiangya Hospital; Cancer Research Institute, School of Basic Medicine, Central South University, Changsha, Hunan, China
| | - H Chang
- Department of Lymphoma and Myeloma, State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, China.,Division of Molecular and Cellular Biology, Department of Laboratory Hematology, Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
| | - L Qiu
- Department of Lymphoma and Myeloma, State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, China
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Carfilzomib significantly improves the progression-free survival of high-risk patients in multiple myeloma. Blood 2016; 128:1174-80. [PMID: 27439911 DOI: 10.1182/blood-2016-03-707596] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 06/16/2016] [Indexed: 12/31/2022] Open
Abstract
The presence of certain high-risk cytogenetic abnormalities, such as translocations (4;14) and (14;16) and deletion (17p), are known to have a negative impact on survival in multiple myeloma (MM). The phase 3 study ASPIRE (N = 792) demonstrated that progression-free survival (PFS) was significantly improved with carfilzomib, lenalidomide, and dexamethasone (KRd), compared with lenalidomide and dexamethasone (Rd) in relapsed MM. This preplanned subgroup analysis of ASPIRE was conducted to evaluate KRd vs Rd by baseline cytogenetics according to fluorescence in situ hybridization. Of 417 patients with known cytogenetic risk status, 100 patients (24%) were categorized with high-risk cytogenetics (KRd, n = 48; Rd, n = 52) and 317 (76%) were categorized with standard-risk cytogenetics (KRd, n = 147; Rd, n = 170). For patients with high-risk cytogenetics, treatment with KRd resulted in a median PFS of 23.1 months, a 9-month improvement relative to treatment with Rd. For patients with standard-risk cytogenetics, treatment with KRd led to a 10-month improvement in median PFS vs Rd. The overall response rates for KRd vs Rd were 79.2% vs 59.6% (high-risk cytogenetics) and 91.2% vs 73.5% (standard-risk cytogenetics); approximately fivefold as many patients with high- or standard-risk cytogenetics achieved a complete response or better with KRd vs Rd (29.2% vs 5.8% and 38.1% vs 6.5%, respectively). KRd improved but did not abrogate the poor prognosis associated with high-risk cytogenetics. This regimen had a favorable benefit-risk profile in patients with relapsed MM, irrespective of cytogenetic risk status, and should be considered a standard of care in these patients. This trial was registered at www.clinicaltrials.gov as #NCT01080391.
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Leiba M, Duek A, Amariglio N, Avigdor A, Benyamini N, Hardan I, Zilbershats I, Ganzel C, Shevetz O, Novikov I, Cohen Y, Ishoev G, Rozic G, Nagler A, Trakhtenbrot L. Translocation t(11;14) in newly diagnosed patients with multiple myeloma: Is it always favorable? Genes Chromosomes Cancer 2016; 55:710-8. [DOI: 10.1002/gcc.22372] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 05/02/2016] [Accepted: 05/03/2016] [Indexed: 12/20/2022] Open
Affiliation(s)
- Merav Leiba
- Division of Hematology and Bone Marrow Transplantation; and the Cancer Research Center, The Chaim Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University; Tel Aviv Israel
| | - Adrian Duek
- Division of Hematology and Bone Marrow Transplantation; and the Cancer Research Center, The Chaim Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University; Tel Aviv Israel
| | - Ninette Amariglio
- Division of Hematology and Bone Marrow Transplantation; and the Cancer Research Center, The Chaim Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University; Tel Aviv Israel
| | - Abraham Avigdor
- Division of Hematology and Bone Marrow Transplantation; and the Cancer Research Center, The Chaim Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University; Tel Aviv Israel
| | - Noam Benyamini
- Department of Hematology and Bone Marrow Transplantation; Rambam Health Care Campus; Haifa Israel
| | - Izhar Hardan
- Department of Hematology; Meir Medical Center; Kfar Saba Israel
| | | | - Chezi Ganzel
- Department of Hematology; Shaare Zedek Medical Center; Jerusalem Israel
| | - Olga Shevetz
- Department of Hematology; Kaplan Medical Center; Rehovot Israel
| | - Ilya Novikov
- Biostatistical Unit; Gertner Institute of Epidemiology and Health Policy Research; Ramat Gan Israel
| | - Yossi Cohen
- Department of Hematology; Laniyado Hospital; Netanya Israel
| | - Galina Ishoev
- Division of Hematology and Bone Marrow Transplantation; and the Cancer Research Center, The Chaim Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University; Tel Aviv Israel
| | - Gabriela Rozic
- Division of Hematology and Bone Marrow Transplantation; and the Cancer Research Center, The Chaim Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University; Tel Aviv Israel
| | - Arnon Nagler
- Division of Hematology and Bone Marrow Transplantation; and the Cancer Research Center, The Chaim Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University; Tel Aviv Israel
| | - Luba Trakhtenbrot
- Division of Hematology and Bone Marrow Transplantation; and the Cancer Research Center, The Chaim Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University; Tel Aviv Israel
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Lehners N, Hayden PJ, Goldschmidt H, Raab MS. Management of high-risk Myeloma: an evidence-based review of treatment strategies. Expert Rev Hematol 2016; 9:753-65. [PMID: 27337562 DOI: 10.1080/17474086.2016.1204908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Despite the progress made in the treatment of patients with multiple myeloma over recent decades, a significant cohort with high-risk disease as defined by specific clinical and genetic criteria continue to respond poorly to standard treatment. These patients represent a particular challenge to the treating physician and require early identification as well as personalized treatment strategies. AREAS COVERED In this review, we discuss the prognostic impact of adverse clinical, radiological and genetic factors, evaluate available scoring systems and highlight key aspects of the therapeutic management of high-risk myeloma. MEDLINE and recent scientific meetings' databases were searched for the keywords 'high-risk' and 'multiple myeloma' and relevant studies relating to both diagnostic and therapeutic approaches were identified. Expert commentary: A case is made for intensive induction using combinations of novel agents, early high-dose therapy supported by autologous stem cell transplantation and the widespread use of maintenance therapies. Novel therapeutic options, especially in the field of immunotherapy, are currently explored in clinical trials and have the potential to further improve outcomes for patients with high-risk multiple myeloma.
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Affiliation(s)
- Nicola Lehners
- a Department of Hematology , University Hospital of Heidelberg , Heidelberg , Germany
| | - Patrick J Hayden
- b Academic Department of Haematology , St. James's Hospital, Trinity College Dublin, College Green , Dublin 2 , Ireland
| | - Hartmut Goldschmidt
- a Department of Hematology , University Hospital of Heidelberg , Heidelberg , Germany
| | - Marc-Steffen Raab
- a Department of Hematology , University Hospital of Heidelberg , Heidelberg , Germany
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21
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Zhang J, Xiao X, Liu J. The role of circulating miRNAs in multiple myeloma. SCIENCE CHINA-LIFE SCIENCES 2015; 58:1262-9. [PMID: 26607481 DOI: 10.1007/s11427-015-4969-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 09/06/2015] [Indexed: 12/18/2022]
Abstract
Multiple myeloma (MM) is a common malignant hematological disease. Dysregulation of microRNAs (miRNAs) in MM cells and bone marrow microenviroment has important impacts on the initiation and progression of MM and drug resistance in MM cells. Recently, it was reported that MM patient serum and plasma contained sufficiently stable miRNA signatures, and circulating miRNAs could be identified and measured accurately from body fluid. Compared to conventional diagnostic parameters, the circulating miRNA profile is appropriate for the diagnosis of MM and estimates patient progression and therapeutic outcome with higher specificity and sensitivity. In this review, we mainly focus on the potential of circulating miRNAs as diagnostic, prognostic, and predictive biomarkers for MM and summarize the general strategies and methodologies for identification and measurement of circulating miRNAs in various cancers. Furthermore, we discuss the correlation between circulating miRNAs and the cytogenetic abnormalities and biochemical parameters assessed in multiple myeloma.
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Affiliation(s)
- Ji Zhang
- Department of Hematology, The First Affiliated Hospital, University of South China, Hengyang, 421001, China.,State Key Laboratory of Medical Genetics & School of Life Sciences, Central South University, Changsha, 410078, China
| | - XiaoJuan Xiao
- State Key Laboratory of Medical Genetics & School of Life Sciences, Central South University, Changsha, 410078, China
| | - Jing Liu
- State Key Laboratory of Medical Genetics & School of Life Sciences, Central South University, Changsha, 410078, China.
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22
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Walker BA, Boyle EM, Wardell CP, Murison A, Begum DB, Dahir NM, Proszek PZ, Johnson DC, Kaiser MF, Melchor L, Aronson LI, Scales M, Pawlyn C, Mirabella F, Jones JR, Brioli A, Mikulasova A, Cairns DA, Gregory WM, Quartilho A, Drayson MT, Russell N, Cook G, Jackson GH, Leleu X, Davies FE, Morgan GJ. Mutational Spectrum, Copy Number Changes, and Outcome: Results of a Sequencing Study of Patients With Newly Diagnosed Myeloma. J Clin Oncol 2015; 33:3911-20. [PMID: 26282654 PMCID: PMC6485456 DOI: 10.1200/jco.2014.59.1503] [Citation(s) in RCA: 412] [Impact Index Per Article: 45.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE At the molecular level, myeloma is characterized by copy number abnormalities and recurrent translocations into the immunoglobulin heavy chain locus. Novel methods, such as massively parallel sequencing, have begun to describe the pattern of tumor-acquired mutations, but their clinical relevance has yet to be established. METHODS We performed whole-exome sequencing for 463 patients who presented with myeloma and were enrolled onto the National Cancer Research Institute Myeloma XI trial, for whom complete molecular cytogenetic and clinical outcome data were available. RESULTS We identified 15 significantly mutated genes: IRF4, KRAS, NRAS, MAX, HIST1H1E, RB1, EGR1, TP53, TRAF3, FAM46C, DIS3, BRAF, LTB, CYLD, and FGFR3. The mutational spectrum is dominated by mutations in the RAS (43%) and nuclear factor-κB (17%) pathways, but although they are prognostically neutral, they could be targeted therapeutically. Mutations in CCND1 and DNA repair pathway alterations (TP53, ATM, ATR, and ZNFHX4 mutations) are associated with a negative impact on survival. In contrast, those in IRF4 and EGR1 are associated with a favorable overall survival. We combined these novel mutation risk factors with the recurrent molecular adverse features and international staging system to generate an international staging system mutation score that can identify a high-risk population of patients who experience relapse and die prematurely. CONCLUSION We have refined our understanding of genetic events in myeloma and identified clinically relevant mutations that may be used to better stratify patients at presentation.
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Affiliation(s)
- Brian A Walker
- Brian A. Walker, Eileen M. Boyle, Christopher P. Wardell, Alex Murison, Dil B. Begum, Nasrin M. Dahir, Paula Z. Proszek, David C. Johnson, Martin F. Kaiser, Lorenzo Melchor, Lauren I. Aronson, Charlotte Pawlyn, Fabio Mirabella, John R. Jones, Annamaria Brioli, Faith E. Davies, and Gareth J. Morgan, The Institute of Cancer Research, London; Matthew Scales, The Institute of Cancer Research, Surrey; David A. Cairns, Walter M. Gregory, and Ana Quartilho, University of Leeds; Gordon Cook, St James's University Hospital, Leeds; Mark T. Drayson, University of Birmingham, Birmingham; Nigel Russell, Nottingham University Hospital, Nottingham; Graham H. Jackson, Newcastle University, Newcastle upon Tyne, United Kingdom; Aneta Mikulasova, Masaryk University, Brno, Czech Republic; and Xavier Leleu, Hôpital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Eileen M Boyle
- Brian A. Walker, Eileen M. Boyle, Christopher P. Wardell, Alex Murison, Dil B. Begum, Nasrin M. Dahir, Paula Z. Proszek, David C. Johnson, Martin F. Kaiser, Lorenzo Melchor, Lauren I. Aronson, Charlotte Pawlyn, Fabio Mirabella, John R. Jones, Annamaria Brioli, Faith E. Davies, and Gareth J. Morgan, The Institute of Cancer Research, London; Matthew Scales, The Institute of Cancer Research, Surrey; David A. Cairns, Walter M. Gregory, and Ana Quartilho, University of Leeds; Gordon Cook, St James's University Hospital, Leeds; Mark T. Drayson, University of Birmingham, Birmingham; Nigel Russell, Nottingham University Hospital, Nottingham; Graham H. Jackson, Newcastle University, Newcastle upon Tyne, United Kingdom; Aneta Mikulasova, Masaryk University, Brno, Czech Republic; and Xavier Leleu, Hôpital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Christopher P Wardell
- Brian A. Walker, Eileen M. Boyle, Christopher P. Wardell, Alex Murison, Dil B. Begum, Nasrin M. Dahir, Paula Z. Proszek, David C. Johnson, Martin F. Kaiser, Lorenzo Melchor, Lauren I. Aronson, Charlotte Pawlyn, Fabio Mirabella, John R. Jones, Annamaria Brioli, Faith E. Davies, and Gareth J. Morgan, The Institute of Cancer Research, London; Matthew Scales, The Institute of Cancer Research, Surrey; David A. Cairns, Walter M. Gregory, and Ana Quartilho, University of Leeds; Gordon Cook, St James's University Hospital, Leeds; Mark T. Drayson, University of Birmingham, Birmingham; Nigel Russell, Nottingham University Hospital, Nottingham; Graham H. Jackson, Newcastle University, Newcastle upon Tyne, United Kingdom; Aneta Mikulasova, Masaryk University, Brno, Czech Republic; and Xavier Leleu, Hôpital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Alex Murison
- Brian A. Walker, Eileen M. Boyle, Christopher P. Wardell, Alex Murison, Dil B. Begum, Nasrin M. Dahir, Paula Z. Proszek, David C. Johnson, Martin F. Kaiser, Lorenzo Melchor, Lauren I. Aronson, Charlotte Pawlyn, Fabio Mirabella, John R. Jones, Annamaria Brioli, Faith E. Davies, and Gareth J. Morgan, The Institute of Cancer Research, London; Matthew Scales, The Institute of Cancer Research, Surrey; David A. Cairns, Walter M. Gregory, and Ana Quartilho, University of Leeds; Gordon Cook, St James's University Hospital, Leeds; Mark T. Drayson, University of Birmingham, Birmingham; Nigel Russell, Nottingham University Hospital, Nottingham; Graham H. Jackson, Newcastle University, Newcastle upon Tyne, United Kingdom; Aneta Mikulasova, Masaryk University, Brno, Czech Republic; and Xavier Leleu, Hôpital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Dil B Begum
- Brian A. Walker, Eileen M. Boyle, Christopher P. Wardell, Alex Murison, Dil B. Begum, Nasrin M. Dahir, Paula Z. Proszek, David C. Johnson, Martin F. Kaiser, Lorenzo Melchor, Lauren I. Aronson, Charlotte Pawlyn, Fabio Mirabella, John R. Jones, Annamaria Brioli, Faith E. Davies, and Gareth J. Morgan, The Institute of Cancer Research, London; Matthew Scales, The Institute of Cancer Research, Surrey; David A. Cairns, Walter M. Gregory, and Ana Quartilho, University of Leeds; Gordon Cook, St James's University Hospital, Leeds; Mark T. Drayson, University of Birmingham, Birmingham; Nigel Russell, Nottingham University Hospital, Nottingham; Graham H. Jackson, Newcastle University, Newcastle upon Tyne, United Kingdom; Aneta Mikulasova, Masaryk University, Brno, Czech Republic; and Xavier Leleu, Hôpital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Nasrin M Dahir
- Brian A. Walker, Eileen M. Boyle, Christopher P. Wardell, Alex Murison, Dil B. Begum, Nasrin M. Dahir, Paula Z. Proszek, David C. Johnson, Martin F. Kaiser, Lorenzo Melchor, Lauren I. Aronson, Charlotte Pawlyn, Fabio Mirabella, John R. Jones, Annamaria Brioli, Faith E. Davies, and Gareth J. Morgan, The Institute of Cancer Research, London; Matthew Scales, The Institute of Cancer Research, Surrey; David A. Cairns, Walter M. Gregory, and Ana Quartilho, University of Leeds; Gordon Cook, St James's University Hospital, Leeds; Mark T. Drayson, University of Birmingham, Birmingham; Nigel Russell, Nottingham University Hospital, Nottingham; Graham H. Jackson, Newcastle University, Newcastle upon Tyne, United Kingdom; Aneta Mikulasova, Masaryk University, Brno, Czech Republic; and Xavier Leleu, Hôpital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Paula Z Proszek
- Brian A. Walker, Eileen M. Boyle, Christopher P. Wardell, Alex Murison, Dil B. Begum, Nasrin M. Dahir, Paula Z. Proszek, David C. Johnson, Martin F. Kaiser, Lorenzo Melchor, Lauren I. Aronson, Charlotte Pawlyn, Fabio Mirabella, John R. Jones, Annamaria Brioli, Faith E. Davies, and Gareth J. Morgan, The Institute of Cancer Research, London; Matthew Scales, The Institute of Cancer Research, Surrey; David A. Cairns, Walter M. Gregory, and Ana Quartilho, University of Leeds; Gordon Cook, St James's University Hospital, Leeds; Mark T. Drayson, University of Birmingham, Birmingham; Nigel Russell, Nottingham University Hospital, Nottingham; Graham H. Jackson, Newcastle University, Newcastle upon Tyne, United Kingdom; Aneta Mikulasova, Masaryk University, Brno, Czech Republic; and Xavier Leleu, Hôpital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - David C Johnson
- Brian A. Walker, Eileen M. Boyle, Christopher P. Wardell, Alex Murison, Dil B. Begum, Nasrin M. Dahir, Paula Z. Proszek, David C. Johnson, Martin F. Kaiser, Lorenzo Melchor, Lauren I. Aronson, Charlotte Pawlyn, Fabio Mirabella, John R. Jones, Annamaria Brioli, Faith E. Davies, and Gareth J. Morgan, The Institute of Cancer Research, London; Matthew Scales, The Institute of Cancer Research, Surrey; David A. Cairns, Walter M. Gregory, and Ana Quartilho, University of Leeds; Gordon Cook, St James's University Hospital, Leeds; Mark T. Drayson, University of Birmingham, Birmingham; Nigel Russell, Nottingham University Hospital, Nottingham; Graham H. Jackson, Newcastle University, Newcastle upon Tyne, United Kingdom; Aneta Mikulasova, Masaryk University, Brno, Czech Republic; and Xavier Leleu, Hôpital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Martin F Kaiser
- Brian A. Walker, Eileen M. Boyle, Christopher P. Wardell, Alex Murison, Dil B. Begum, Nasrin M. Dahir, Paula Z. Proszek, David C. Johnson, Martin F. Kaiser, Lorenzo Melchor, Lauren I. Aronson, Charlotte Pawlyn, Fabio Mirabella, John R. Jones, Annamaria Brioli, Faith E. Davies, and Gareth J. Morgan, The Institute of Cancer Research, London; Matthew Scales, The Institute of Cancer Research, Surrey; David A. Cairns, Walter M. Gregory, and Ana Quartilho, University of Leeds; Gordon Cook, St James's University Hospital, Leeds; Mark T. Drayson, University of Birmingham, Birmingham; Nigel Russell, Nottingham University Hospital, Nottingham; Graham H. Jackson, Newcastle University, Newcastle upon Tyne, United Kingdom; Aneta Mikulasova, Masaryk University, Brno, Czech Republic; and Xavier Leleu, Hôpital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Lorenzo Melchor
- Brian A. Walker, Eileen M. Boyle, Christopher P. Wardell, Alex Murison, Dil B. Begum, Nasrin M. Dahir, Paula Z. Proszek, David C. Johnson, Martin F. Kaiser, Lorenzo Melchor, Lauren I. Aronson, Charlotte Pawlyn, Fabio Mirabella, John R. Jones, Annamaria Brioli, Faith E. Davies, and Gareth J. Morgan, The Institute of Cancer Research, London; Matthew Scales, The Institute of Cancer Research, Surrey; David A. Cairns, Walter M. Gregory, and Ana Quartilho, University of Leeds; Gordon Cook, St James's University Hospital, Leeds; Mark T. Drayson, University of Birmingham, Birmingham; Nigel Russell, Nottingham University Hospital, Nottingham; Graham H. Jackson, Newcastle University, Newcastle upon Tyne, United Kingdom; Aneta Mikulasova, Masaryk University, Brno, Czech Republic; and Xavier Leleu, Hôpital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Lauren I Aronson
- Brian A. Walker, Eileen M. Boyle, Christopher P. Wardell, Alex Murison, Dil B. Begum, Nasrin M. Dahir, Paula Z. Proszek, David C. Johnson, Martin F. Kaiser, Lorenzo Melchor, Lauren I. Aronson, Charlotte Pawlyn, Fabio Mirabella, John R. Jones, Annamaria Brioli, Faith E. Davies, and Gareth J. Morgan, The Institute of Cancer Research, London; Matthew Scales, The Institute of Cancer Research, Surrey; David A. Cairns, Walter M. Gregory, and Ana Quartilho, University of Leeds; Gordon Cook, St James's University Hospital, Leeds; Mark T. Drayson, University of Birmingham, Birmingham; Nigel Russell, Nottingham University Hospital, Nottingham; Graham H. Jackson, Newcastle University, Newcastle upon Tyne, United Kingdom; Aneta Mikulasova, Masaryk University, Brno, Czech Republic; and Xavier Leleu, Hôpital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Matthew Scales
- Brian A. Walker, Eileen M. Boyle, Christopher P. Wardell, Alex Murison, Dil B. Begum, Nasrin M. Dahir, Paula Z. Proszek, David C. Johnson, Martin F. Kaiser, Lorenzo Melchor, Lauren I. Aronson, Charlotte Pawlyn, Fabio Mirabella, John R. Jones, Annamaria Brioli, Faith E. Davies, and Gareth J. Morgan, The Institute of Cancer Research, London; Matthew Scales, The Institute of Cancer Research, Surrey; David A. Cairns, Walter M. Gregory, and Ana Quartilho, University of Leeds; Gordon Cook, St James's University Hospital, Leeds; Mark T. Drayson, University of Birmingham, Birmingham; Nigel Russell, Nottingham University Hospital, Nottingham; Graham H. Jackson, Newcastle University, Newcastle upon Tyne, United Kingdom; Aneta Mikulasova, Masaryk University, Brno, Czech Republic; and Xavier Leleu, Hôpital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Charlotte Pawlyn
- Brian A. Walker, Eileen M. Boyle, Christopher P. Wardell, Alex Murison, Dil B. Begum, Nasrin M. Dahir, Paula Z. Proszek, David C. Johnson, Martin F. Kaiser, Lorenzo Melchor, Lauren I. Aronson, Charlotte Pawlyn, Fabio Mirabella, John R. Jones, Annamaria Brioli, Faith E. Davies, and Gareth J. Morgan, The Institute of Cancer Research, London; Matthew Scales, The Institute of Cancer Research, Surrey; David A. Cairns, Walter M. Gregory, and Ana Quartilho, University of Leeds; Gordon Cook, St James's University Hospital, Leeds; Mark T. Drayson, University of Birmingham, Birmingham; Nigel Russell, Nottingham University Hospital, Nottingham; Graham H. Jackson, Newcastle University, Newcastle upon Tyne, United Kingdom; Aneta Mikulasova, Masaryk University, Brno, Czech Republic; and Xavier Leleu, Hôpital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Fabio Mirabella
- Brian A. Walker, Eileen M. Boyle, Christopher P. Wardell, Alex Murison, Dil B. Begum, Nasrin M. Dahir, Paula Z. Proszek, David C. Johnson, Martin F. Kaiser, Lorenzo Melchor, Lauren I. Aronson, Charlotte Pawlyn, Fabio Mirabella, John R. Jones, Annamaria Brioli, Faith E. Davies, and Gareth J. Morgan, The Institute of Cancer Research, London; Matthew Scales, The Institute of Cancer Research, Surrey; David A. Cairns, Walter M. Gregory, and Ana Quartilho, University of Leeds; Gordon Cook, St James's University Hospital, Leeds; Mark T. Drayson, University of Birmingham, Birmingham; Nigel Russell, Nottingham University Hospital, Nottingham; Graham H. Jackson, Newcastle University, Newcastle upon Tyne, United Kingdom; Aneta Mikulasova, Masaryk University, Brno, Czech Republic; and Xavier Leleu, Hôpital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - John R Jones
- Brian A. Walker, Eileen M. Boyle, Christopher P. Wardell, Alex Murison, Dil B. Begum, Nasrin M. Dahir, Paula Z. Proszek, David C. Johnson, Martin F. Kaiser, Lorenzo Melchor, Lauren I. Aronson, Charlotte Pawlyn, Fabio Mirabella, John R. Jones, Annamaria Brioli, Faith E. Davies, and Gareth J. Morgan, The Institute of Cancer Research, London; Matthew Scales, The Institute of Cancer Research, Surrey; David A. Cairns, Walter M. Gregory, and Ana Quartilho, University of Leeds; Gordon Cook, St James's University Hospital, Leeds; Mark T. Drayson, University of Birmingham, Birmingham; Nigel Russell, Nottingham University Hospital, Nottingham; Graham H. Jackson, Newcastle University, Newcastle upon Tyne, United Kingdom; Aneta Mikulasova, Masaryk University, Brno, Czech Republic; and Xavier Leleu, Hôpital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Annamaria Brioli
- Brian A. Walker, Eileen M. Boyle, Christopher P. Wardell, Alex Murison, Dil B. Begum, Nasrin M. Dahir, Paula Z. Proszek, David C. Johnson, Martin F. Kaiser, Lorenzo Melchor, Lauren I. Aronson, Charlotte Pawlyn, Fabio Mirabella, John R. Jones, Annamaria Brioli, Faith E. Davies, and Gareth J. Morgan, The Institute of Cancer Research, London; Matthew Scales, The Institute of Cancer Research, Surrey; David A. Cairns, Walter M. Gregory, and Ana Quartilho, University of Leeds; Gordon Cook, St James's University Hospital, Leeds; Mark T. Drayson, University of Birmingham, Birmingham; Nigel Russell, Nottingham University Hospital, Nottingham; Graham H. Jackson, Newcastle University, Newcastle upon Tyne, United Kingdom; Aneta Mikulasova, Masaryk University, Brno, Czech Republic; and Xavier Leleu, Hôpital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Aneta Mikulasova
- Brian A. Walker, Eileen M. Boyle, Christopher P. Wardell, Alex Murison, Dil B. Begum, Nasrin M. Dahir, Paula Z. Proszek, David C. Johnson, Martin F. Kaiser, Lorenzo Melchor, Lauren I. Aronson, Charlotte Pawlyn, Fabio Mirabella, John R. Jones, Annamaria Brioli, Faith E. Davies, and Gareth J. Morgan, The Institute of Cancer Research, London; Matthew Scales, The Institute of Cancer Research, Surrey; David A. Cairns, Walter M. Gregory, and Ana Quartilho, University of Leeds; Gordon Cook, St James's University Hospital, Leeds; Mark T. Drayson, University of Birmingham, Birmingham; Nigel Russell, Nottingham University Hospital, Nottingham; Graham H. Jackson, Newcastle University, Newcastle upon Tyne, United Kingdom; Aneta Mikulasova, Masaryk University, Brno, Czech Republic; and Xavier Leleu, Hôpital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - David A Cairns
- Brian A. Walker, Eileen M. Boyle, Christopher P. Wardell, Alex Murison, Dil B. Begum, Nasrin M. Dahir, Paula Z. Proszek, David C. Johnson, Martin F. Kaiser, Lorenzo Melchor, Lauren I. Aronson, Charlotte Pawlyn, Fabio Mirabella, John R. Jones, Annamaria Brioli, Faith E. Davies, and Gareth J. Morgan, The Institute of Cancer Research, London; Matthew Scales, The Institute of Cancer Research, Surrey; David A. Cairns, Walter M. Gregory, and Ana Quartilho, University of Leeds; Gordon Cook, St James's University Hospital, Leeds; Mark T. Drayson, University of Birmingham, Birmingham; Nigel Russell, Nottingham University Hospital, Nottingham; Graham H. Jackson, Newcastle University, Newcastle upon Tyne, United Kingdom; Aneta Mikulasova, Masaryk University, Brno, Czech Republic; and Xavier Leleu, Hôpital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Walter M Gregory
- Brian A. Walker, Eileen M. Boyle, Christopher P. Wardell, Alex Murison, Dil B. Begum, Nasrin M. Dahir, Paula Z. Proszek, David C. Johnson, Martin F. Kaiser, Lorenzo Melchor, Lauren I. Aronson, Charlotte Pawlyn, Fabio Mirabella, John R. Jones, Annamaria Brioli, Faith E. Davies, and Gareth J. Morgan, The Institute of Cancer Research, London; Matthew Scales, The Institute of Cancer Research, Surrey; David A. Cairns, Walter M. Gregory, and Ana Quartilho, University of Leeds; Gordon Cook, St James's University Hospital, Leeds; Mark T. Drayson, University of Birmingham, Birmingham; Nigel Russell, Nottingham University Hospital, Nottingham; Graham H. Jackson, Newcastle University, Newcastle upon Tyne, United Kingdom; Aneta Mikulasova, Masaryk University, Brno, Czech Republic; and Xavier Leleu, Hôpital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Ana Quartilho
- Brian A. Walker, Eileen M. Boyle, Christopher P. Wardell, Alex Murison, Dil B. Begum, Nasrin M. Dahir, Paula Z. Proszek, David C. Johnson, Martin F. Kaiser, Lorenzo Melchor, Lauren I. Aronson, Charlotte Pawlyn, Fabio Mirabella, John R. Jones, Annamaria Brioli, Faith E. Davies, and Gareth J. Morgan, The Institute of Cancer Research, London; Matthew Scales, The Institute of Cancer Research, Surrey; David A. Cairns, Walter M. Gregory, and Ana Quartilho, University of Leeds; Gordon Cook, St James's University Hospital, Leeds; Mark T. Drayson, University of Birmingham, Birmingham; Nigel Russell, Nottingham University Hospital, Nottingham; Graham H. Jackson, Newcastle University, Newcastle upon Tyne, United Kingdom; Aneta Mikulasova, Masaryk University, Brno, Czech Republic; and Xavier Leleu, Hôpital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Mark T Drayson
- Brian A. Walker, Eileen M. Boyle, Christopher P. Wardell, Alex Murison, Dil B. Begum, Nasrin M. Dahir, Paula Z. Proszek, David C. Johnson, Martin F. Kaiser, Lorenzo Melchor, Lauren I. Aronson, Charlotte Pawlyn, Fabio Mirabella, John R. Jones, Annamaria Brioli, Faith E. Davies, and Gareth J. Morgan, The Institute of Cancer Research, London; Matthew Scales, The Institute of Cancer Research, Surrey; David A. Cairns, Walter M. Gregory, and Ana Quartilho, University of Leeds; Gordon Cook, St James's University Hospital, Leeds; Mark T. Drayson, University of Birmingham, Birmingham; Nigel Russell, Nottingham University Hospital, Nottingham; Graham H. Jackson, Newcastle University, Newcastle upon Tyne, United Kingdom; Aneta Mikulasova, Masaryk University, Brno, Czech Republic; and Xavier Leleu, Hôpital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Nigel Russell
- Brian A. Walker, Eileen M. Boyle, Christopher P. Wardell, Alex Murison, Dil B. Begum, Nasrin M. Dahir, Paula Z. Proszek, David C. Johnson, Martin F. Kaiser, Lorenzo Melchor, Lauren I. Aronson, Charlotte Pawlyn, Fabio Mirabella, John R. Jones, Annamaria Brioli, Faith E. Davies, and Gareth J. Morgan, The Institute of Cancer Research, London; Matthew Scales, The Institute of Cancer Research, Surrey; David A. Cairns, Walter M. Gregory, and Ana Quartilho, University of Leeds; Gordon Cook, St James's University Hospital, Leeds; Mark T. Drayson, University of Birmingham, Birmingham; Nigel Russell, Nottingham University Hospital, Nottingham; Graham H. Jackson, Newcastle University, Newcastle upon Tyne, United Kingdom; Aneta Mikulasova, Masaryk University, Brno, Czech Republic; and Xavier Leleu, Hôpital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Gordon Cook
- Brian A. Walker, Eileen M. Boyle, Christopher P. Wardell, Alex Murison, Dil B. Begum, Nasrin M. Dahir, Paula Z. Proszek, David C. Johnson, Martin F. Kaiser, Lorenzo Melchor, Lauren I. Aronson, Charlotte Pawlyn, Fabio Mirabella, John R. Jones, Annamaria Brioli, Faith E. Davies, and Gareth J. Morgan, The Institute of Cancer Research, London; Matthew Scales, The Institute of Cancer Research, Surrey; David A. Cairns, Walter M. Gregory, and Ana Quartilho, University of Leeds; Gordon Cook, St James's University Hospital, Leeds; Mark T. Drayson, University of Birmingham, Birmingham; Nigel Russell, Nottingham University Hospital, Nottingham; Graham H. Jackson, Newcastle University, Newcastle upon Tyne, United Kingdom; Aneta Mikulasova, Masaryk University, Brno, Czech Republic; and Xavier Leleu, Hôpital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Graham H Jackson
- Brian A. Walker, Eileen M. Boyle, Christopher P. Wardell, Alex Murison, Dil B. Begum, Nasrin M. Dahir, Paula Z. Proszek, David C. Johnson, Martin F. Kaiser, Lorenzo Melchor, Lauren I. Aronson, Charlotte Pawlyn, Fabio Mirabella, John R. Jones, Annamaria Brioli, Faith E. Davies, and Gareth J. Morgan, The Institute of Cancer Research, London; Matthew Scales, The Institute of Cancer Research, Surrey; David A. Cairns, Walter M. Gregory, and Ana Quartilho, University of Leeds; Gordon Cook, St James's University Hospital, Leeds; Mark T. Drayson, University of Birmingham, Birmingham; Nigel Russell, Nottingham University Hospital, Nottingham; Graham H. Jackson, Newcastle University, Newcastle upon Tyne, United Kingdom; Aneta Mikulasova, Masaryk University, Brno, Czech Republic; and Xavier Leleu, Hôpital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Xavier Leleu
- Brian A. Walker, Eileen M. Boyle, Christopher P. Wardell, Alex Murison, Dil B. Begum, Nasrin M. Dahir, Paula Z. Proszek, David C. Johnson, Martin F. Kaiser, Lorenzo Melchor, Lauren I. Aronson, Charlotte Pawlyn, Fabio Mirabella, John R. Jones, Annamaria Brioli, Faith E. Davies, and Gareth J. Morgan, The Institute of Cancer Research, London; Matthew Scales, The Institute of Cancer Research, Surrey; David A. Cairns, Walter M. Gregory, and Ana Quartilho, University of Leeds; Gordon Cook, St James's University Hospital, Leeds; Mark T. Drayson, University of Birmingham, Birmingham; Nigel Russell, Nottingham University Hospital, Nottingham; Graham H. Jackson, Newcastle University, Newcastle upon Tyne, United Kingdom; Aneta Mikulasova, Masaryk University, Brno, Czech Republic; and Xavier Leleu, Hôpital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Faith E Davies
- Brian A. Walker, Eileen M. Boyle, Christopher P. Wardell, Alex Murison, Dil B. Begum, Nasrin M. Dahir, Paula Z. Proszek, David C. Johnson, Martin F. Kaiser, Lorenzo Melchor, Lauren I. Aronson, Charlotte Pawlyn, Fabio Mirabella, John R. Jones, Annamaria Brioli, Faith E. Davies, and Gareth J. Morgan, The Institute of Cancer Research, London; Matthew Scales, The Institute of Cancer Research, Surrey; David A. Cairns, Walter M. Gregory, and Ana Quartilho, University of Leeds; Gordon Cook, St James's University Hospital, Leeds; Mark T. Drayson, University of Birmingham, Birmingham; Nigel Russell, Nottingham University Hospital, Nottingham; Graham H. Jackson, Newcastle University, Newcastle upon Tyne, United Kingdom; Aneta Mikulasova, Masaryk University, Brno, Czech Republic; and Xavier Leleu, Hôpital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Gareth J Morgan
- Brian A. Walker, Eileen M. Boyle, Christopher P. Wardell, Alex Murison, Dil B. Begum, Nasrin M. Dahir, Paula Z. Proszek, David C. Johnson, Martin F. Kaiser, Lorenzo Melchor, Lauren I. Aronson, Charlotte Pawlyn, Fabio Mirabella, John R. Jones, Annamaria Brioli, Faith E. Davies, and Gareth J. Morgan, The Institute of Cancer Research, London; Matthew Scales, The Institute of Cancer Research, Surrey; David A. Cairns, Walter M. Gregory, and Ana Quartilho, University of Leeds; Gordon Cook, St James's University Hospital, Leeds; Mark T. Drayson, University of Birmingham, Birmingham; Nigel Russell, Nottingham University Hospital, Nottingham; Graham H. Jackson, Newcastle University, Newcastle upon Tyne, United Kingdom; Aneta Mikulasova, Masaryk University, Brno, Czech Republic; and Xavier Leleu, Hôpital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France.
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Stella F, Pedrazzini E, Agazzoni M, Ballester O, Slavutsky I. Cytogenetic Alterations in Multiple Myeloma: Prognostic Significance and the Choice of Frontline Therapy. Cancer Invest 2015; 33:496-504. [DOI: 10.3109/07357907.2015.1080833] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Dimopoulos MA, Weisel KC, Song KW, Delforge M, Karlin L, Goldschmidt H, Moreau P, Banos A, Oriol A, Garderet L, Cavo M, Ivanova V, Alegre A, Martinez-Lopez J, Chen C, Spencer A, Knop S, Bahlis NJ, Renner C, Yu X, Hong K, Sternas L, Jacques C, Zaki MH, San Miguel JF. Cytogenetics and long-term survival of patients with refractory or relapsed and refractory multiple myeloma treated with pomalidomide and low-dose dexamethasone. Haematologica 2015; 100:1327-33. [PMID: 26250580 DOI: 10.3324/haematol.2014.117077] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 07/24/2015] [Indexed: 12/31/2022] Open
Abstract
Patients with refractory or relapsed and refractory multiple myeloma who no longer receive benefit from novel agents have limited treatment options and short expected survival. del(17p) and t(4;14) are correlated with shortened survival. The phase 3 MM-003 trial demonstrated significant progression-free and overall survival benefits from treatment with pomalidomide plus low-dose dexamethasone compared to high-dose dexamethasone among patients in whom bortezomib and lenalidomide treatment had failed. At an updated median follow-up of 15.4 months, the progression-free survival was 4.0 versus 1.9 months (HR, 0.50; P<0.001), and median overall survival was 13.1 versus 8.1 months (HR, 0.72; P=0.009). Pomalidomide plus low-dose dexamethasone, compared with high-dose dexamethasone, improved progression-free survival in patients with del(17p) (4.6 versus 1.1 months; HR, 0.34; P <0.001), t(4;14) (2.8 versus 1.9 months; HR, 0.49; P=0.028), and in standard-risk patients (4.2 versus 2.3 months; HR, 0.55; P<0.001). Although the majority of patients treated with high-dose dexamethasone took pomalidomide after discontinuation, the overall survival of patients treated with pomalidomide plus low-dose dexamethasone or high-dose dexamethasone was 12.6 versus 7.7 months (HR, 0.45; P=0.008) in patients with del(17p), 7.5 versus 4.9 months (HR, 1.12; P=0.761) in those with t(4;14), and 14.0 versus 9.0 months (HR, 0.85; P=0.380) in standard-risk subjects. The overall response rate was higher in patients treated with pomalidomide plus low-dose dexamethasone than in those treated with high-dose dexamethasone both among standard-risk patients (35.2% versus 9.7%) and those with del(17p) (31.8% versus 4.3%), whereas it was similar in patients with t(4;14) (15.9% versus 13.3%). The safety of pomalidomide plus low-dose dexamethasone was consistent with initial reports. In conclusion, pomalidomide plus low-dose dexamethasone is efficacious in patients with relapsed/refractory multiple myeloma and del(17p) and/or t(4;14). This study is registered at ClinicalTrials.gov as NCT01311687 and with EudraCT as 2010-019820-30.
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Affiliation(s)
| | - Katja C Weisel
- Hematology & Oncology, Department of Medicine, University Hospital Tübingen, Germany
| | - Kevin W Song
- Vancouver General Hospital, Vancouver, BC, Canada
| | - Michel Delforge
- Department of Hematology, University Hospital Leuven, Belgium
| | - Lionel Karlin
- Centre Hospitalier Lyon Sud/Hospices Civils de Lyon, Pierre-Bénite, France
| | - Hartmut Goldschmidt
- University Hospital Heidelberg and German Cancer Research Center, Heidelberg, Germany
| | | | - Anne Banos
- Hematology, Centre Hospitalier de la Côte Basque, Bayonne, France
| | - Albert Oriol
- Institut Catala d'Oncologia, HGTiP, Barcelona, Spain
| | | | - Michele Cavo
- Seràgnoli Institute of Hematology, Bologna University School of Medicine, Italy
| | | | | | | | | | | | | | | | | | - Xin Yu
- Celgene Corporation, Summit, NJ, USA
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25
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Dimopoulos MA, Sonneveld P, Siegel D, Palumbo A, San-Miguel J. Carfilzomib and pomalidomide in patients with relapsed and/or refractory multiple myeloma with baseline risk factors. Ann Oncol 2015. [PMID: 26216385 DOI: 10.1093/annonc/mdv325] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
While survival times have increased over the last decade, most patients with multiple myeloma (MM) eventually relapse and become refractory to therapy. The treatment of patients with relapsed and/or refractory MM is frequently further complicated by the presence of pre-existing comorbidities that arise from an advanced disease state and of toxicities stemming from prior antimyeloma treatment. Carfilzomib and pomalidomide have recently been approved for the treatment of patients with relapsed and refractory MM. While these agents represent important additions to the available treatment options, the identification of patients who may best benefit from the use of each of therapy is still being investigated. A number of patient-related and disease-related factors may impact treatment efficacy and/or tolerability, and the clinical presentation and medical history of each patient must be carefully considered to optimize treatment. Here, we review results from carfilzomib and pomalidomide clinical trials in patients with relapsed and/or refractory MM who also have baseline comorbidities or treatment-induced or disease-induced complications (including the presence of renal impairment, cardiac risk factors, peripheral neuropathy, or high-risk chromosomal abnormalities) to evaluate the safety and efficacy of the two agents in these difficult-to-treat patients and to provide treatment recommendations specific to each scenario.
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Affiliation(s)
- M A Dimopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - P Sonneveld
- Erasmus University Medical Center, Rotterdam, The Netherlands
| | - D Siegel
- John Theurer Cancer Center, Hackensack, USA
| | - A Palumbo
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - J San-Miguel
- Centre of Applied Medical Research, Clinica Universidad de Navarra, Navarra, Spain
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26
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Nahi H, Våtsveen TK, Lund J, Heeg BM, Preiss B, Alici E, Møller MB, Wader KF, Møller HE, Grøseth LA, Østergaard B, Dai HY, Holmberg E, Gahrton G, Waage A, Abildgaard N. Proteasome inhibitors and IMiDs can overcome some high-risk cytogenetics in multiple myeloma but not gain 1q21. Eur J Haematol 2015; 96:46-54. [DOI: 10.1111/ejh.12546] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2015] [Indexed: 12/31/2022]
Affiliation(s)
- Hareth Nahi
- Department of Medicine; Karolinska Institutet; Stockholm Sweden
| | - Thea Kristin Våtsveen
- KG Jebsen Center for Myeloma Research; Department of Cancer Research and Molecular Medicine; Norwegian University of Science and Technology; Trondheim Norway
- Department of Pathology; St Olavs Hospital; Trondheim Norway
| | - Johan Lund
- Department of Medicine; Karolinska Institutet; Stockholm Sweden
| | - Bart M.S. Heeg
- PharmacoEpidemiology & PharmacoEconomics (PE2); University of Groningen; Groningen The Netherlands
- Department of Epidemiology; University Medical Center Groningen; Groningen The Netherlands
| | - Birgitte Preiss
- Department of Pathology; Odense University Hospital; Odense Denmark
| | - Evren Alici
- Department of Medicine; Karolinska Institutet; Stockholm Sweden
| | | | - Karin Fahl Wader
- KG Jebsen Center for Myeloma Research; Department of Cancer Research and Molecular Medicine; Norwegian University of Science and Technology; Trondheim Norway
- Department of Oncology; St Olavs Hospital; Trondheim Norway
| | | | - Lill Anny Grøseth
- KG Jebsen Center for Myeloma Research; Department of Cancer Research and Molecular Medicine; Norwegian University of Science and Technology; Trondheim Norway
- Department of Hematology; St Olavs Hospital; Trondheim Norway
| | - Brian Østergaard
- Department of Hematology; Odense University Hospital; Odense Denmark
| | - Hong Yan Dai
- Department of Pathology; St Olavs Hospital; Trondheim Norway
| | - Erik Holmberg
- Department of Oncology; Institute of Clinical Sciences; Sahlgrenska Academy at University of Gothenburg; Gothenburg Sweden
| | - Gösta Gahrton
- Department of Medicine; Karolinska Institutet; Stockholm Sweden
| | - Anders Waage
- KG Jebsen Center for Myeloma Research; Department of Cancer Research and Molecular Medicine; Norwegian University of Science and Technology; Trondheim Norway
- Department of Hematology; St Olavs Hospital; Trondheim Norway
| | - Niels Abildgaard
- Department of Hematology; Odense University Hospital; Odense Denmark
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Kuroda J, Kobayashi T, Taniwaki M. Prognostic indicators of lenalidomide for multiple myeloma: consensus and controversy. Expert Rev Anticancer Ther 2015; 15:787-804. [PMID: 25947283 DOI: 10.1586/14737140.2015.1044249] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The long-term outcome of multiple myeloma (MM) has been greatly improved through new agents, one being lenalidomide (LEN). Based upon the findings of in vitro experiments, its mode of action against MM occurs through a combination of direct tumoricidal effects on myeloma cells, modulatory effects on tumor immunity and tumor microenvironment-regulatory effects. However, it has not been clearly defined whether the clinical response and long-term outcome of MM with LEN treatment truly reflect the mechanisms of action of LEN proposed by in vitro studies. To ascertain what is known and what remains to be elucidated with LEN, we review the current literature on the mode of action of LEN in association with myeloma pathophysiology, and discuss the prognostic indicators in the treatment of MM with LEN.
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Affiliation(s)
- Junya Kuroda
- Department of Medicine, Division of Hematology and Oncology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-Ku, Kyoto, 602-8566, Japan
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28
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The clinical characteristics and prognosis of IGH deletion in multiple myeloma. Leuk Res 2015; 39:515-9. [DOI: 10.1016/j.leukres.2015.02.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 02/09/2015] [Accepted: 02/22/2015] [Indexed: 12/12/2022]
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Caltagirone S, Ruggeri M, Aschero S, Gilestro M, Oddolo D, Gay F, Bringhen S, Musolino C, Baldini L, Musto P, Petrucci MT, Gaidano G, Passera R, Bruno B, Palumbo A, Boccadoro M, Omedè P. Chromosome 1 abnormalities in elderly patients with newly diagnosed multiple myeloma treated with novel therapies. Haematologica 2014; 99:1611-7. [PMID: 25015938 DOI: 10.3324/haematol.2014.103853] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Multiple myeloma is a plasma cell disorder characterized by malignant plasma cell infiltration in the bone marrow, serum and/or urine monoclonal protein and organ damage. The aim of this study was to investigate the impact of chromosome 1 abnormalities in a group of elderly patients (>65 years) with newly diagnosed multiple myeloma enrolled in the GIMEMA-MM-03-05 trial and treated with bortezomib, melphalan and prednisone or bortezomib, melphalan, prednisone and thalidomide followed by bortezomib and thalidomide maintenance. We also evaluated the link between chromosome 1 abnormalities and other clinical, genetic and immunophenotypic features by a multivariate logistic regression model. Interphase fluorescence in situ hybridization on immunomagnetically purified plasma cells and bone marrow multiparameter flow cytometry were employed. A multivariate Cox model showed that chromosome 1 abnormalities, age >75 years and a CD19(+)/CD117(-) immunophenotype of bone marrow plasma cells were independent risk factors for overall survival in elderly patients with newly diagnosed multiple myeloma. Moreover, a detrimental effect of thalidomide, even when administered in association with bortezomib, was observed in patients with abnormal chromosome 1 as well as in those with 17p deletion, while the benefit of adding thalidomide to the bortezomib-melphalan-prednisone regimen was noted in patients carrying an aggressive CD19(+)/CD117(-) bone marrow plasma cell immunophenotype. This trial was registered at www.clinicaltri-als.gov as #NCT01063179.
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Affiliation(s)
- Simona Caltagirone
- Divisione di Ematologia, Università di Torino, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Italy Scuola di specializzazione in medicina clinica, Università di Torino, Italy
| | - Marina Ruggeri
- Divisione di Ematologia, Università di Torino, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Italy
| | - Simona Aschero
- Divisione di Ematologia, Università di Torino, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Italy
| | - Milena Gilestro
- Divisione di Ematologia, Università di Torino, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Italy
| | - Daniela Oddolo
- Divisione di Ematologia, Università di Torino, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Italy
| | - Francesca Gay
- Divisione di Ematologia, Università di Torino, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Italy
| | - Sara Bringhen
- Divisione di Ematologia, Università di Torino, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Italy
| | - Caterina Musolino
- Divisione di Ematologia, Dipartimento di Chirurgia Generale e Oncologia, A.O.U. Policlinico G. Martino, Messina, Italy
| | - Luca Baldini
- Divisione di Ematologia, Fondazione IRCCS Ca Granda, OM Policlinico, Università di Milano, Italy
| | - Pellegrino Musto
- Direzione Scientifica, IRCCS - CROB, Centro di riferimento ongcologico della Basilicata, Rionero in Vulture, Italy
| | - Maria T Petrucci
- Dipartimento di Biotecnologia cellulare e di Ematologia, Università"La Sapienza" di Roma, Italy
| | - Gianluca Gaidano
- Divisione di Ematologia, Dipartimento di Medicina Traslazionale, Università degli studi del Piemonte Orientale "Amedeo Avogadro", Novara, Italy
| | - Roberto Passera
- Divisione di medicina nucleare, Università di Torino, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Università di Torino, Italy
| | - Benedetto Bruno
- Divisione di Ematologia, Università di Torino, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Italy
| | - Antonio Palumbo
- Divisione di Ematologia, Università di Torino, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Italy
| | - Mario Boccadoro
- Divisione di Ematologia, Università di Torino, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Italy
| | - Paola Omedè
- Divisione di Ematologia, Università di Torino, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Italy
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30
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Stella F, Pedrazzini E, Baialardo E, Fantl DB, Schutz N, Slavutsky I. Quantitative analysis of CKS1B mRNA expression and copy number gain in patients with plasma cell disorders. Blood Cells Mol Dis 2014; 53:110-7. [PMID: 24973170 DOI: 10.1016/j.bcmd.2014.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 05/19/2014] [Indexed: 12/28/2022]
Abstract
In this study, we have examined CKS1B gene expression and copy number in a total of 114- patients at diagnosis: 83 with multiple myeloma (MM) and 31 with monoclonal gammopathy of undetermined significance (MGUS). Results were correlated with cytogenetics, FISH and clinical characteristic. Significant CKS1B mRNA levels in MM compared to MGUS cases (p<0.048) were detected. In MM, the frequency of 1q21 (CKS1B) copy gain was significantly higher in cases with abnormal karyotype compared to patients with normal karyotype (p=0.021). Global analysis showed a positive correlation between CKS1B expression and 1q21 copy number (p<0.0001). No association between CKS1B mRNA expression and clinical parameters was found. However, a significantly higher level of β2 microglobulin in cases with 1q21 gains than those without (p=0.0094) was observed. Overall survival was shorter in cases with 1q21 gain compared to those with normal 1q21 region (p=0.0082). Our results suggest a role for CKS1B in the multiple step process of progression of MGUS to MM and show that CKS1B copy gain has a more significant prognostic value than its overexpression. This adverse impact on survival probably reflects the genetic instability associated to chromosome 1q alterations resulting in a more aggressive behavior of the disease.
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Affiliation(s)
- Flavia Stella
- Laboratorio de Genética de Neoplasias Linfoides, Instituto de Medicina Experimental, CONICET-Academia Nacional de Medicina, Buenos Aires, Argentina.
| | - Estela Pedrazzini
- Laboratorio de Genética de Neoplasias Linfoides, Instituto de Medicina Experimental, CONICET-Academia Nacional de Medicina, Buenos Aires, Argentina; Universidad Nacional del Noroeste de la Provincia de Buenos Aires (UNNOBA), Argentina
| | | | - Dorotea Beatriz Fantl
- Departamento de Clínica Médica, Sección Hematología, Hospital Italiano de Buenos Aires, Argentina
| | - Natalia Schutz
- Departamento de Clínica Médica, Sección Hematología, Hospital Italiano de Buenos Aires, Argentina
| | - Irma Slavutsky
- Laboratorio de Genética de Neoplasias Linfoides, Instituto de Medicina Experimental, CONICET-Academia Nacional de Medicina, Buenos Aires, Argentina
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Bochtler T, Hegenbart U, Kunz C, Benner A, Seckinger A, Dietrich S, Granzow M, Neben K, Goldschmidt H, Ho AD, Hose D, Jauch A, Schönland SO. Gain of chromosome 1q21 is an independent adverse prognostic factor in light chain amyloidosis patients treated with melphalan/dexamethasone. Amyloid 2014; 21:9-17. [PMID: 24455967 DOI: 10.3109/13506129.2013.854766] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Chromosomal aberrations of plasma cells are well established pathogenetic and prognostic factors in multiple myeloma, but their prognostic implication in systemic light chain (AL) amyloidosis is unclear. Therefore, the aim of this study was to identify prognostic cytogenetic risk factors by interphase FISH in a series of 103 consecutive AL amyloidosis patients treated uniformly with melphalan/dexamethasone as first-line therapy. Detection of gain of 1q21 was predictive for a poor overall survival (OS) (median 12.5 versus 38.2 months, p = 0.002). Hematologic event free survival (hem EFS) for gain of 1q21 was 5.0 versus 8.5 months in median (p = 0.08) and haematologic remission rates (≥VGPR) after three cycles were 5% versus 25% (p = 0.06). Most important, in multivariate concordance analyses the adverse prognosis carried by gain of 1q21 was retained as an independent prognostic factor (OS: p = 0.003, average hazard ratio (AHR) = 3.64, hemEFS: p = 0.008, AHR = 2.35), along with the well established Mayo cardiac staging. Patients with t(11;14) had a longer median OS with 38.2 months versus 17.5 months, though no statistical significance was reached. Deletion 13q14 and hyperdiploidy turned out to be prognostically neutral. In conclusion, we have identified gain of 1q21 as an independent adverse prognostic factor in AL amyloidosis patients treated with standard chemotherapy.
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Affiliation(s)
- Tilmann Bochtler
- Amyloidosis Center, Department of Internal Medicine, University of Heidelberg , Heidelberg, Germany
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Jumping translocations of 1q12 in multiple myeloma: a novel mechanism for deletion of 17p in cytogenetically defined high-risk disease. Blood 2014; 123:2504-12. [PMID: 24497533 DOI: 10.1182/blood-2013-12-546077] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Multiple myeloma (MM) is a B-cell malignancy driven in part by increasing copy number alterations (CNAs) during disease progression. Prognostically significant CNAs accumulate during clonal evolution and include gains of 1q21 and deletions of 17p, among others. Unfortunately, the mechanisms underlying the accumulation of CNAs and resulting subclonal heterogeneity in high-risk MM are poorly understood. To investigate the impact of jumping translocations of 1q12 (JT1q12) on receptor chromosomes (RCs) and subsequent clonal evolution, we analyzed specimens from 86 patients selected for unbalanced 1q12 aberrations by G-banding. Utilizing spectral karyotyping and locus-specific fluorescence in situ hybridization, we identified 10 patients with unexpected focal amplifications of an RC that subsequently translocated as part of a sequential JT1q12 to one or more additional RCs. Four patients exhibited amplification and translocation of 8q24 (MYC), 3 showed amplification of 16q11, and 1 each displayed amplification of 18q21.3 (BCL2), 18q23, or 4p16 (FGFR3). Unexpectedly, in 6 of 14 patients with the combination of the t(4;14) and deletion of 17p, we identified the loss of 17p as resulting from a JT1q12. Here, we provide evidence that the JT1q12 is a mechanism for the simultaneous gain of 1q21 and deletion of 17p in cytogenetically defined high-risk disease.
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Cytogenetic and clinical risk factors for assessment of ultra high-risk multiple myeloma. Leuk Res 2014; 38:188-93. [DOI: 10.1016/j.leukres.2013.11.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 10/31/2013] [Accepted: 11/08/2013] [Indexed: 11/17/2022]
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Kim K, Kim SJ, Voelter V, Suh C, Yoon SS, Lee JJ, Kwak JY, Ryoo HM, Kim YS, Moon JH, Park SK, Kim SH, Mun YC, Kim JS, Eom HS, Jo DY, Jun HJ, Kim KH, Lee JO, Lee JH, Min CK. Lenalidomide with dexamethasone treatment for relapsed/refractory myeloma patients in Korea-experience from 110 patients. Ann Hematol 2013; 93:113-21. [PMID: 24026427 DOI: 10.1007/s00277-013-1893-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 08/23/2013] [Indexed: 01/06/2023]
Abstract
We conducted a retrospective analysis of lenalidomide with dexamethasone for patients with relapsed/refractory multiple myeloma (RRMM) who were treated within the Korean patient access program. Lenalidomide has been approved for RRMM for several years in Europe and North America, but has not been accessible to Asian patients in the past. Between 2008 and 2012, 110 patients from 20 hospitals were enrolled. The overall response rate (ORR) was 43.6 % with 15.4 % of very good partial response (VGPR) or better. The median time to progression (TTP) in this heavily pretreated patient population was 8.0 months, and median overall survival (OS) was 23 months. Hematologic toxicities, fatigue, anorexia, and constipation were the most common adverse events. The number of previous treatment lines, previous exposure to thalidomide, refractoriness to thalidomide and bortezomib, pretreatment white blood cell count (WBC), platelet count, t(14;16), and 17p deletion were significant prognostic factors for TTP, and creatinine clearance, refractoriness to thalidomide and bortezomib, performance status, platelet count, and 17p deletion were significant for OS in univariate analysis. In multivariate analysis, WBC and platelet count were significant prognostic factors for TTP and performance status for OS. For Korean myeloma patients, lenalidomide showed considerable efficacy, and toxicities were comparable to the data published in Europe and North America.
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Affiliation(s)
- Kihyun Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, South Korea,
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Vallet S, Podar K. New insights, recent advances, and current challenges in the biological treatment of multiple myeloma. Expert Opin Biol Ther 2013; 13 Suppl 1:S35-53. [PMID: 23768134 DOI: 10.1517/14712598.2013.807337] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The availability of thalidomide, lenalidomide, and bortezomib has radically changed multiple myeloma (MM) treatment and significantly improved patients' outcome. Nevertheless, MM is still an incurable disease due to the development of resistance and relapse practically in all patients. Unraveling MM pathogenesis, identifying prognostically high-risk patient populations, and optimizing current treatment strategies are among the challenges we are facing to reach a cure for this disease. AREAS COVERED This article reviews recent advances of the genomic analysis of malignant plasma cells and summarizes new insights into the pathophysiologic role of the MM microenvironment and the clinical assessment of derived novel therapeutic strategies. Moreover, current efforts to improve risk stratification and drug development are discussed, and most recent results of Phase II and III clinical trials that aim to optimize existing treatment regimens and to assess the next-generation anti-MM strategies are discussed. A systematic search was conducted of the Pubmed Medline, Embase, and Cochrane Library databases for primary articles, as well as of conference abstracts (e.g., of the American Society of Hematology, the American Society of Clinical Oncology, the American Association of Cancer Research, the European Hematology Association, and the Multiple Myeloma Workshop 2013), practice guidelines, and registries of clinical trials. EXPERT OPINION Given continuing advances to overcome current treatment challenges in MM, we are confident that long-lasting responses can be expected in many of our patients within the next decade.
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Affiliation(s)
- Sonia Vallet
- University of Heidelberg, National Center for Tumor Diseases (NCT) and German Cancer Research Center (DKFZ), Heidelberg, Germany
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Veillette A, Guo H. CS1, a SLAM family receptor involved in immune regulation, is a therapeutic target in multiple myeloma. Crit Rev Oncol Hematol 2013; 88:168-77. [PMID: 23731618 DOI: 10.1016/j.critrevonc.2013.04.003] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Revised: 04/19/2013] [Accepted: 04/26/2013] [Indexed: 10/26/2022] Open
Abstract
Signaling lymphocytic activation molecule (SLAM) family receptors have been implicated in normal immunity, immunodeficiencies and autoimmunity. CS1 (also known as CRACC, CD319 and SLAMF7) is a member of the SLAM family expressed on several normal hematopoietic cell types. It is also highly and nearly universally expressed on multiple myeloma (MM) cells. This review focuses on the biology of CS1, both in normal hematopoietic cells and in MM cells. It also discusses the preclinical and clinical data on the use of a humanized anti-CS1 monoclonal antibody, elotuzumab, for the treatment of MM. Based on current knowledge, CS1 is a compelling new target for the treatment of MM.
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Affiliation(s)
- André Veillette
- Laboratory of Molecular Oncology, Institut de recherches cliniques de Montréal (IRCM), Montréal, Québec, Canada H2W 1R7; Department of Medicine, McGill University, Montréal, Québec, Canada H3G 1Y6; Department of Medicine, University of Montréal, Montréal, Québec, Canada H3T 1J4.
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Treatment outcomes in patients with relapsed and refractory multiple myeloma and high-risk cytogenetics receiving single-agent carfilzomib in the PX-171-003-A1 study. Leukemia 2013; 27:2351-6. [PMID: 23670297 PMCID: PMC3865533 DOI: 10.1038/leu.2013.152] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 04/12/2013] [Accepted: 04/24/2013] [Indexed: 12/28/2022]
Abstract
Several cytogenetic abnormalities are associated with poor outcomes in multiple myeloma (MM). We prospectively analyzed the impact of cytogenetic abnormalities on outcomes during the phase 2 PX-171-003-A1 study of single-agent carfilzomib for relapsed and refractory MM. In the response-evaluable population (257/266), fluorescence in situ hybridization (FISH)/conventional cytogenetic profiles were available for 229 patients; 62 (27.1%) had high-risk cytogenetics—del 17p13, t(4;14) or t(14;16) by interphase FISH or deletion 13 or hypodiploidy by metaphase cytogenetics—and 167 (72.9%) had standard-risk profiles. Generally, baseline characteristics were similar between the subgroups, but International Staging System stage III disease was more common in high- vs standard-risk patients (41.9% vs 27.5%) as was Eastern Cooperative Oncology Group performance status 1/2 (85.5% vs 68.3%). Overall response was comparable between the subgroups (25.8% vs 24.6%, respectively; P=0.85), while time-to-event end points showed a trend of shorter duration in high-risk patients, including median duration of response (5.6 months (95% confidence interval (CI) 3.7–7.8) vs 8.3 months (95% CI 5.6–12.3)) and overall survival (9.3 (95% CI 6.5–13.0) vs 19.0 months (95% CI 15.4–NE); P=0.0003). Taken together, these findings demonstrate that single-agent carfilzomib is efficacious and has the potential to at least partially overcome the impact of high-risk cytogenetics in heavily pre-treated patients with MM.
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Peng L, Yang Z, Tan C, Ren G, Chen J. Epigenetic inactivation of ADAMTS9 via promoter methylation in multiple myeloma. Mol Med Rep 2013; 7:1055-61. [PMID: 23358566 DOI: 10.3892/mmr.2013.1291] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Accepted: 01/21/2013] [Indexed: 11/06/2022] Open
Abstract
A disintegrin‑like and metalloprotease with thrombospondin type Ⅰ motifs (ADAMTS) are a family of 19 secreted mammalian metalloproteases. ADAMTS9 was reported to be a novel tumor suppressor gene and is downregulated in various types of human cancer due to hypermethylation of promoter CpG islands. In the present study, the silencing mechanism of the ADAMTS9 gene was analyzed in the multiple myeloma (MM) cell lines, KM3 and RPMI‑8226. Control and MM samples were obtained by conventional bone marrow (BM) biopsy of normal and MM adult BM, respectively. RT‑PCR revealed a high expression of the ADAMTS9 gene in normal samples and RPMI‑8226 cells while marked gene silencing of ADAMTS9 was observed in MM patients and KM3 cells. Promoter methylation of ADAMTS9 was detected in the KM3 cell line and 66% (37/56) MM patients by methylation‑specific PCR. In addition, the DNA demethylating agent, 5‑aza‑2'‑deoxycytidine and trichostatin A restored ADAMTS9 expression by suppressing promoter methylation in KM3 cells. Ectopic expression of ADAMTS9 in ADAMTS9‑silenced MM cells was found to significantly suppress cell colony formation and proliferation. In the present study, DNA methylation was found to play a key role in ADAMTS9 gene silencing and the biological behavior of myeloma cells. The results demonstrate that ADAMTS9 silencing by methylation may be a novel tumor marker for MM and the applicability of demethylating agents in the treatment of MM.
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Affiliation(s)
- Ling Peng
- Department of Hematology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, PR China
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39
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Becker N, Byl A, Friedrich S, Jauch A, Schnitzler P, Egerer G, Ho AD, Goldschmidt H, Neben K. Hepatitis B virus infection is associated with deletion of chromosome 8p in multiple myeloma. Eur J Haematol 2012; 90:279-85. [DOI: 10.1111/ejh.12018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2012] [Indexed: 12/11/2022]
Affiliation(s)
- Nikolaus Becker
- Clinical Cancer Registry; National Center of Tumor Diseases and German Cancer Research Center; Heidelberg; Germany
| | - Anne Byl
- Clinical Cancer Registry; National Center of Tumor Diseases and German Cancer Research Center; Heidelberg; Germany
| | - Susanne Friedrich
- Clinical Cancer Registry; National Center of Tumor Diseases and German Cancer Research Center; Heidelberg; Germany
| | - Anna Jauch
- Institute of Human Genetics; University of Heidelberg; Heidelberg; Germany
| | - Paul Schnitzler
- Department of Infectious Diseases, Virology; University of Heidelberg; Heidelberg; Germany
| | - Gerlinde Egerer
- Department of Internal Medicine V; University of Heidelberg; Heidelberg; Germany
| | - Anthony D Ho
- Department of Internal Medicine V; University of Heidelberg; Heidelberg; Germany
| | - Hartmut Goldschmidt
- Department of Internal Medicine V; University of Heidelberg and National Center for Tumor Diseases; Heidelberg; Germany
| | - Kai Neben
- Department of Internal Medicine V; University of Heidelberg; Heidelberg; Germany
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40
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Reece D, Kouroukis CT, LeBlanc R, Sebag M, Song K, Ashkenas J. Practical approaches to the use of lenalidomide in multiple myeloma: a canadian consensus. Adv Hematol 2012; 2012:621958. [PMID: 23097669 PMCID: PMC3477526 DOI: 10.1155/2012/621958] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 08/14/2012] [Indexed: 01/06/2023] Open
Abstract
In Canada, lenalidomide combined with dexamethasone (Len/Dex) is approved for use in relapsed or refractory multiple myeloma (RRMM). Our expert panel sought to provide an up-to-date practical guide on the use of lenalidomide in the managing RRMM within the Canadian clinical setting, including management of common adverse events (AEs). The panel concluded that safe, effective administration of Len/Dex treatment involves the following steps: (1) lenalidomide dose adjustment based on creatinine clearance and the extent of neutropenia or thrombocytopenia, (2) dexamethasone administered at 20-40 mg/week, and (3) continuation of treatment until disease progression or until toxicity persists despite dose reduction. Based on available evidence, the following precautions should reduce the risk of common Len/Dex AEs: (1) all patients treated with Len/Dex should receive thromboprophylaxis, (2) erythropoiesis-stimulating agents (ESAs) should be used cautiously, and (3) females of child-bearing potential and males in contact with such females must use multiple contraception methods. Finally, while Len/Dex can be administered irrespective of prior therapy and in all prognostic subsets, patients with chromosomal deletion 17(p13) have less favorable outcomes with all treatments, including Len/Dex. New directions for the use of lenalidomide in RRMM are also considered.
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Affiliation(s)
- Donna Reece
- Princess Margaret Hospital, University Health Network, 610 University Avenue, Toronto, ON, Canada M5G 2M9
| | - C. Tom Kouroukis
- Department of Oncology, Juravinski Cancer Centre, 699 Concession Street, Hamilton, ON, Canada L8V 5C2
| | - Richard LeBlanc
- Hôpital Maisonneuve-Rosemont, University of Montreal, Montreal, QC, Canada H1T 2M4
| | - Michael Sebag
- McGill University Health Centre, McGill University, Montreal, QC, Canada H3A 1A1
| | - Kevin Song
- Leukemia/BMT Program of British Columbia, Vancouver General Hospital, Vancouver, BC, Canada V5Z 1M9
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41
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Exome sequencing in tracking clonal evolution in multiple myeloma following therapy. Leukemia 2012; 27:1188-91. [PMID: 23147253 DOI: 10.1038/leu.2012.287] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Grzasko N, Hus M, Pluta A, Jurczyszyn A, Walter-Croneck A, Morawska M, Chocholska S, Hajek R, Dmoszynska A. Additional genetic abnormalities significantly worsen poor prognosis associated with 1q21 amplification in multiple myeloma patients. Hematol Oncol 2012; 31:41-8. [PMID: 22674819 DOI: 10.1002/hon.2018] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 05/06/2012] [Accepted: 05/09/2012] [Indexed: 01/03/2023]
Abstract
We investigated the prognostic value of amp(1q21) alone and in combination with other abnormalities in newly diagnosed myeloma patients. The study group consisted of 104 patients treated with various induction regimens, mostly thalidomide based (87 patients). Amp(1q21) was detected in 49 (47.1%) of patients; in 26 (25.0%) cases, it was combined with del(13q14), in 7 (6.7%) with del(17p13) and in 15 (14.4%) with t(4;14)(p16;q32). The response rate was significantly better in amp(1q21)-negative than in amp(1q21)-positive patients (74.5% vs 55.1%, p = 0.025; complete response 18.2% vs 4.1%, p = 0.024). The median progression-free survival (PFS) was 33.9 months in patients without amp(1q21) and 10.3 months with this aberration (p = 0.002). The presence of additional abnormalities resulted in significantly shortened PFS when compared with patients with isolated amp(1q21): coexisting del(13q14) resulted in 7.8 vs 29.0 months of PFS (p = 0.024) and del(17p13) resulted in 4.0 vs 24.9 months of PFS (p = 0.034). The presence of amp(1q21) significantly influenced overall survival (OS) as well as PFS resulting in the median OS of 26.6 vs 62.4 months (p = 0.018) in patients without amp(1q21). The presence of additional genetic abnormalities significantly affected OS when compared with patients carrying isolated amp(1q21): for del(13q14) 18.9 vs 58.4 months (p = 0.004) and for del(17p13) 12.0 vs 46.5 months (p = 0.036). On multivariate analysis amp(1q21), del(13q14) and del(17p13) were found to be an independent adverse predictors of shorter PFS and OS. Our results showed that the presence of amp(1q21) was associated with poor prognosis. Moreover additional genetic abnormalities made PFS and OS further shortened.
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Affiliation(s)
- Norbert Grzasko
- Department of Haematooncology and Bone Marrow Transplantation, Medical University of Lublin, Lublin, Poland
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Butler C, Wolff DJ, Kang Y, Stuart RK, Costa LJ. Association of age with fluorescence in situ hybridization abnormalities in multiple myeloma reveals higher rate of IGH translocations among older patients. Leuk Lymphoma 2012; 53:2444-8. [PMID: 22574971 DOI: 10.3109/10428194.2012.691483] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We utilized a cohort with a high frequency of young patients to explore the correlation between fluorescence in situ hybridization (FISH) detected chromosomal abnormalities (CA) and age in multiple myeloma (MM). One hundred and nineteen patients with MM were included in the analysis. The median age was 60 years, 51% of patients were female and 56% were Caucasian. Translocations involving the IGH gene on chromosome 14 were more likely to be detected in older (≥ 60 years) patients (32.8% vs. 15.5%, p = 0.03), particularly because of a higher frequency of t(4;14) (14.8% vs. 3.4%, p = 0.05). Myeloma cells from older patients were also three times more likely to have multiple CA. The presence of high-risk CA influenced survival in patients <60 but not in patients ≥ 60. Among standard-risk patients, survival was significantly superior for patients <60. No effect of age on survival was detected for high-risk patients.
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Affiliation(s)
- Charles Butler
- Division of Hematology/Oncology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
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44
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Abstract
Multiple myeloma (MM) is a malignancy of terminally differentiated plasma cells characterized by complex genetic aberrations and heterogeneous outcomes. Over the past 25 years, cytogenetic analysis has played a key role in the diagnosis and management of MM. This article reviews the conventional cytogenetics, molecular cytogenetics, and genomic diagnostics of MM and highlights a few recent clinical trials that demonstrate the impact of genetic risk stratification on the treatment of this plasma cell malignancy.
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Affiliation(s)
- Marilyn L Slovak
- Quest Diagnostics Nichols Institute, 14225 Newbrook Drive, Chantilly, VA 20151, USA.
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45
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Grzasko N, Hus M, Chocholska S, Pluta A, Hajek R, Dmoszynska A. 1q21 amplification with additional genetic abnormalities but not isolated 1q21 gain is a negative prognostic factor in newly diagnosed patients with multiple myeloma treated with thalidomide-based regimens. Leuk Lymphoma 2012; 53:2500-3. [PMID: 22497640 DOI: 10.3109/10428194.2012.684349] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Chromosome Aberrations
- Chromosome Deletion
- Chromosomes, Human, Pair 1/genetics
- Chromosomes, Human, Pair 13/genetics
- Chromosomes, Human, Pair 14/genetics
- Chromosomes, Human, Pair 17/genetics
- Chromosomes, Human, Pair 4/genetics
- Female
- Gene Amplification
- Humans
- In Situ Hybridization, Fluorescence
- Kaplan-Meier Estimate
- Male
- Middle Aged
- Multiple Myeloma/diagnosis
- Multiple Myeloma/drug therapy
- Multiple Myeloma/genetics
- Prognosis
- Thalidomide/administration & dosage
- Translocation, Genetic
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Chen MH, Qi CX, Saha MN, Chang H. p53 nuclear expression correlates with hemizygous TP53 deletion and predicts an adverse outcome for patients with relapsed/refractory multiple myeloma treated with lenalidomide. Am J Clin Pathol 2012; 137:208-12. [PMID: 22261445 DOI: 10.1309/ajcphc85dgaxzdbe] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
del(17p13)(TP53) seems to be an independent poor prognostic factor in patients with relapsed/refractory multiple myeloma (MM) receiving lenalidomide. However, whether aberrant p53 nuclear expression detected by immunohistochemical analysis can be used as a surrogate marker for del(17p13)(TP53) in prognostic evaluation of lenalidomide-treated relapsed/refractory MM remains unclear. The p53 expression in myeloma cells from 88 patients was evaluated by immunohistochemical analysis, and 17p13(TP53) gene status was examined by fluorescence in situ hybridization (FISH). FISH detected hemizygous del(17p13)(TP53) in 13 (15%), and immunohistochemical analysis detected p53 nuclear expression in 11 cases (13%). del(17p13) (TP53) and p53 expression were strongly correlated (P < .0001). Furthermore, patients with aberrant p53 nuclear expression had significantly shorter progression-free and overall survival than patients without this abnormality. Our results suggest that p53 nuclear expression is associated with adverse outcome in patients with relapsed/refractory MM receiving lenalidomide-based therapy and that p53 immunohistochemical analysis may serve as a simple, rapid method to predict del(17p13)(TP53) in this patient subgroup.
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Administration of bortezomib before and after autologous stem cell transplantation improves outcome in multiple myeloma patients with deletion 17p. Blood 2011; 119:940-8. [PMID: 22160383 DOI: 10.1182/blood-2011-09-379164] [Citation(s) in RCA: 276] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
In patients with multiple myeloma (MM), risk stratification by chromosomal abnormalities may enable a more rational selection of therapeutic approaches. In the present study, we analyzed the prognostic value of 12 chromosomal abnormalities in a series of 354 MM patients treated within the HOVON-65/GMMG-HD4 trial. Because of the 2-arm design of the study, we were able to analyze the effect of a bortezomib-based treatment before and after autologous stem cell transplantation (arm B) compared with standard treatment without bortezomib (arm A). For allanalyzed chromosomal aberrations, progression-free survival (PFS) and overall survival (OS) were at least equal or superior in the bortezomib arm compared with the standard arm. Strikingly, patients with del(17p13) benefited the most from the bortezomib-containing treatment: the median PFS in arm A was 12.0 months and in arm B it was 26.2 months (P = .024); the 3 year-OS for arm A was 17% and for arm B it was 69% (P = .028). After multivariate analysis, del(17p13) was an independent predictor for PFS (P < .0001) and OS (P < .0001) in arm A, whereas no statistically significant effect on PFS (P = .28) or OS (P = .12) was seen in arm B. In conclusion, the adverse impact of del(17p13) on PFS and OS could be significantly reduced by bortezomib-based treatment, suggesting that long-term administration of bortezomib should be recommended for patients carrying del(17p13).
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Hartmann L, Biggerstaff JS, Chapman DB, Scott JM, Johnson KR, Ghirardelli KM, Fritschle WK, Martinez DL, Bennington RK, de Baca ME, Wells DA, Loken MR, Zehentner BK. Detection of genomic abnormalities in multiple myeloma: the application of FISH analysis in combination with various plasma cell enrichment techniques. Am J Clin Pathol 2011; 136:712-20. [PMID: 22031309 DOI: 10.1309/ajcpf7nflw8uajep] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Multiple myeloma (MM) is a hematopoietic neoplasm characterized by malignant plasma cells (PCs) that accumulate in the bone marrow. A number of different genomic abnormalities are associated with MM; however, detection of these by fluorescence in situ hybridization (FISH) can be limited by the percentage of PCs in the specimen. In this study, we tested 20 bone marrow specimens with known MM and a low concentration of monoclonal PCs for the presence of genomic abnormalities using FISH in combination with various PC enrichment techniques: magnetic cell sorting, targeted manual scoring, and automated image analysis. In addition, flow cytometric cell sorting of PCs in combination with FISH analysis was also tested for minimal residual disease applications. Different parameters were evaluated when assessing the detection efficiency of each approach. FISH results are highly dependent on the chosen enrichment method. We describe the evaluation of different techniques applicable for various laboratory settings and specimen parameters.
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Affiliation(s)
- Luise Hartmann
- Department of Molecular Analysis, HematoLogics, Seattle, WA
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