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Yamamoto M, Shindo M, Funayama T, Sumi C, Saito T, Toki Y, Hatayama M, Ono Y, Sato K, Mizukami Y, Okumura T. Monitoring mutant KRAS in plasma cell-free DNA can predict disease progression in a patient with multiple myeloma: A case report. Clin Chim Acta 2023; 551:117590. [PMID: 37837907 DOI: 10.1016/j.cca.2023.117590] [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: 02/09/2023] [Revised: 06/27/2023] [Accepted: 10/08/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND AND AIMS Multiple myeloma (MM), a neoplasm of plasma cells (PCs), is a highly heterogeneous disease with multifocal dissemination throughout the body. Minimal residual disease (MRD) detected using PCs in bone marrow (BM) is important for MM management; however, frequent invasive examinations impose a significant burden on patients. METHODS Analysis using plasma cell-free DNA (cfDNA) might represent an alternative tool for disease monitoring. In this study, we observed the disease status in a patient with MM by examining the KRAS mutation allele frequency (MAF) in plasma cfDNA using digital PCR. RESULTS During treatment, the MAF was correlated with serum immunoglobulin A and free light chain-kappa levels. After the second autologous peripheral blood stem cell transplantation, the KRAS MAF became immediately positive after confirming MRD negativity using PCs from BM. Shortly thereafter, the patient experienced clinical relapse primarily involving bone lesions. CONCLUSION Mutant KRAS monitoring in cfDNA using serial blood collection might reflect the disease status more accurately than invasive BM examinations, especially in patients with MM whose primary lesions have extra-BM locations. It could also help predict treatment responses and outcomes.
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Affiliation(s)
- Masayo Yamamoto
- Division of Metabolism and Biosystemic Science, Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa, Japan.
| | - Motohiro Shindo
- Division of Metabolism and Biosystemic Science, Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Takuya Funayama
- Division of Metabolism and Biosystemic Science, Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Chihiro Sumi
- Division of Metabolism and Biosystemic Science, Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Takeshi Saito
- Division of Metabolism and Biosystemic Science, Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Yasumichi Toki
- Division of Metabolism and Biosystemic Science, Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Mayumi Hatayama
- Division of Metabolism and Biosystemic Science, Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Yusuke Ono
- Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Kazuya Sato
- Department of Hematology/Oncology, Asahikawa Kosei Hospital, Asahikawa, Japan
| | - Yusuke Mizukami
- Division of Metabolism and Biosystemic Science, Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa, Japan; Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Toshikatsu Okumura
- Division of Metabolism and Biosystemic Science, Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
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Roshal M, Gao Q. Flow Cytometry in Diagnosis, Prognostication, and Monitoring of Multiple Myeloma and Related Disorders. Clin Lab Med 2023; 43:363-375. [PMID: 37481317 DOI: 10.1016/j.cll.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
Flow cytometry plays a critical role in the diagnosis, prognostication, therapy response evaluation, and clinical management of plasma cell neoplasms. The review summarizes how flow cytometry is used in the initial evaluation to distinguish primary and secondary clonal plasma cell populations from each other and from reactive plasma cells. We further illustrate the kinds of prognostic information the assessment can provide at diagnosis and disease follow-up of primary plasma cell neoplasms. Technical requirements for MRD assays and their use in therapy efficacy assessment and clinical decision-making in multi-myeloma are discussed.
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Affiliation(s)
- Mikhail Roshal
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center.
| | - Qi Gao
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center
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3
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Steps towards a Multiple Myeloma Cure? J Pers Med 2022; 12:jpm12091451. [PMID: 36143236 PMCID: PMC9504254 DOI: 10.3390/jpm12091451] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/01/2022] [Accepted: 09/02/2022] [Indexed: 11/17/2022] Open
Abstract
Multiple myeloma survival has increased in last 20 years because of new treatments, better clinical management due to novel diagnostic tools such as imaging, and better understanding of the disease, biologically and genetically. Novel drugs have been introduced that act with different therapeutic mechanisms, but so have novel therapeutic strategies such as consolidation and maintenance after autologous stem cell transplant. Imaging (such as PET-CT and MRI) has been applied at diagnosis and after therapy for minimal residual disease monitoring. Multiparametric flow and molecular NGS may detect, with high-sensitivity, residual monoclonal plasma cells in the bone marrow. With this novel therapeutic and biological approach, a considerable fraction of multiple myeloma patients can achieve durable remission or even MGUS-like regression, which can ultimately lead to disease disappearance. The big dogma, “Myeloma is an incurable disease”, is hopefully fading.
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4
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Soh KT, Came N, Otteson GE, Jevremovic D, Shi M, Olteanu H, Natoni A, Lagoo A, Theakston E, Óskarsson JÞ, Gorniak M, Grigoriadis G, Arroz M, Fletcher M, Lin P, Ludwig P, Tembhare P, Matuzeviciene R, Radzevicius M, Kay S, Chen W, Cabrita C, Wallace PK. Evaluation of multiple myeloma measurable residual disease by high sensitivity flow cytometry: An international harmonized approach for data analysis. CYTOMETRY PART B: CLINICAL CYTOMETRY 2022; 102:88-106. [PMID: 35005838 PMCID: PMC10105368 DOI: 10.1002/cyto.b.22053] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/15/2021] [Accepted: 12/21/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Multiple myeloma (MM) measurable residual disease (MRD) evaluated by flow cytometry is a surrogate for progression-free and overall survival in clinical trials. However, analysis and reporting between centers lack uniformity. We designed and evaluated a consensus protocol for MM MRD analysis to reduce inter-laboratory variation in MM MRD reporting. METHODS Seventeen participants from 13 countries performed blinded analysis of the same eight de-identified flow cytometry files from patients with/without MRD using their own method (Stage 1). A consensus gating protocol was then designed following survey and discussions, and the data re-analyzed for MRD and other bone marrow cells (Stage 2). Inter-laboratory variation using the consensus strategy was reassessed for another 10 cases and compared with earlier results (Stage 3). RESULTS In Stage 1, participants agreed on MRD+/MRD- status 89% and 68% of the time respectively. Inter-observer variation was high for total numbers of analyzed cells, total and normal plasma cells (PCs), limit of detection, lower limit of quantification, and enumeration of cell populations that determine sample adequacy. The identification of abnormal PCs remained relatively consistent. By consensus method, average agreement on MRD- status improved to 74%. Better consistency enumerating all parameters among operators resulted in near-unanimous agreement on sample adequacy. CONCLUSION Uniform flow cytometry data analysis substantially reduced inter-laboratory variation in reporting multiple components of the MM MRD assay. Adoption of a harmonized approach would meet an important need for conformity in reporting MM MRD for clinical trials, and wider acceptance of MM MRD as a surrogate clinical endpoint.
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Affiliation(s)
- Kah Teong Soh
- Roswell Park Comprehensive Cancer Center Buffalo New York USA
| | - Neil Came
- Peter MacCallum Cancer Centre Melbourne Victoria Australia
| | | | | | - Min Shi
- Mayo Clinic Rochester Minnesota USA
| | | | | | - Anand Lagoo
- Duke University Medical Center Durham North Carolina USA
| | | | | | | | | | - Maria Arroz
- Centro Hospitalar de Lisboa Ocidental Hospital S. Francisco Xavier Lisbon Portugal
| | - Matthew Fletcher
- UK NEQAS for Leucocyte Immunophenotyping, Department of Haematology Royal Hallamshire Hospital Sheffield UK
| | - Pei Lin
- MD Anderson Cancer Center Houston Texas USA
| | | | | | - Reda Matuzeviciene
- Institute of Biomedical Sciences, Department of Physiology, Biochemistry, Microbiology and Laboratory Medicine, Faculty of Medicine Vilnius University Vilnius Lithuania
- Laboratory Medicine Centre Vilnius University Hospital Santaros Clinics Vilnius Lithuania
| | - Mantas Radzevicius
- Institute of Biomedical Sciences, Department of Physiology, Biochemistry, Microbiology and Laboratory Medicine, Faculty of Medicine Vilnius University Vilnius Lithuania
- Laboratory Medicine Centre Vilnius University Hospital Santaros Clinics Vilnius Lithuania
| | - Sigi Kay
- Tel‐Aviv Sourasky Medical Center Tel‐Aviv Israel
| | - Weina Chen
- University of Texas Southwestern Medical Center Dallas Texas USA
| | | | - Paul K. Wallace
- Roswell Park Comprehensive Cancer Center Buffalo New York USA
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5
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Ding H, Xu J, Lin Z, Huang J, Wang F, Yang Y, Cui Y, Luo H, Gao Y, Zhai X, Pang W, Zhang L, Zheng Y. Minimal residual disease in multiple myeloma: current status. Biomark Res 2021; 9:75. [PMID: 34649622 PMCID: PMC8515655 DOI: 10.1186/s40364-021-00328-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 09/17/2021] [Indexed: 02/08/2023] Open
Abstract
Multiple myeloma (MM) is a treatable plasma cell cancer with no cure. Clinical evidence shows that the status of minimal residual disease (MRD) after treatment is an independent prognostic factor of MM. MRD indicates the depth of post-therapeutic remission. In this review article, we outlined the major clinical trials that have determined the prognostic value of MRD in MM. We also reviewed different methods that were used for MM MRD assessment. Most important, we reviewed our current understanding of MM MRD biology. MRD studies strongly indicate that MRD is not a uniform declination of whole MM tumor population. Rather, MM MRD exhibits unique signatures of cytogenetic aberration and gene expression profiles, unlike those of MM cells before therapy. Diagnostic high-risk MM and low-risk MM exhibited a diversity of MRD features. Clonal evaluation may occur at the MRD stage in MM. The dynamics from the diagnostic MM to MRD correlate with the disease prognosis. Lastly, on the aspect of omics, we performed data-based analysis to address the biological features underlying the course of diagnostic-to-MRD MM. To summarize, the MRD stage of disease represents a critical step in MM pathogenesis and progression. Demonstration of MM MRD biology should help us to deal with the curative difficulties.
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Affiliation(s)
- Hong Ding
- Department of Hematology, West China Hospital, and State Key Laboratory of Biotherapy and Cancer Center, Sichuan University, #37 GuoXue Xiang Street, Chengdu, China
| | - Juan Xu
- Department of Hematology, West China Hospital, and State Key Laboratory of Biotherapy and Cancer Center, Sichuan University, #37 GuoXue Xiang Street, Chengdu, China
| | - Zhimei Lin
- Department of Hematology, West China Hospital, and State Key Laboratory of Biotherapy and Cancer Center, Sichuan University, #37 GuoXue Xiang Street, Chengdu, China.,Department of Hematology, The Affiliated Hospital of Chengdu University, Chengdu, China
| | - Jingcao Huang
- Department of Hematology, West China Hospital, and State Key Laboratory of Biotherapy and Cancer Center, Sichuan University, #37 GuoXue Xiang Street, Chengdu, China
| | - Fangfang Wang
- Department of Hematology, West China Hospital, and State Key Laboratory of Biotherapy and Cancer Center, Sichuan University, #37 GuoXue Xiang Street, Chengdu, China
| | - Yan Yang
- Department of Hematology, West China Hospital, and State Key Laboratory of Biotherapy and Cancer Center, Sichuan University, #37 GuoXue Xiang Street, Chengdu, China
| | - Yushan Cui
- Department of Hematology, West China Hospital, and State Key Laboratory of Biotherapy and Cancer Center, Sichuan University, #37 GuoXue Xiang Street, Chengdu, China
| | - Hongmei Luo
- Department of Hematology, West China Hospital, and State Key Laboratory of Biotherapy and Cancer Center, Sichuan University, #37 GuoXue Xiang Street, Chengdu, China
| | - Yuhan Gao
- Department of Hematology, West China Hospital, and State Key Laboratory of Biotherapy and Cancer Center, Sichuan University, #37 GuoXue Xiang Street, Chengdu, China
| | - Xinyu Zhai
- Department of Hematology, West China Hospital, and State Key Laboratory of Biotherapy and Cancer Center, Sichuan University, #37 GuoXue Xiang Street, Chengdu, China
| | - Weicui Pang
- Department of Hematology, West China Hospital, and State Key Laboratory of Biotherapy and Cancer Center, Sichuan University, #37 GuoXue Xiang Street, Chengdu, China
| | - Li Zhang
- Department of Hematology, West China Hospital, and State Key Laboratory of Biotherapy and Cancer Center, Sichuan University, #37 GuoXue Xiang Street, Chengdu, China.
| | - Yuhuan Zheng
- Department of Hematology, West China Hospital, and State Key Laboratory of Biotherapy and Cancer Center, Sichuan University, #37 GuoXue Xiang Street, Chengdu, China.
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Medina A, Jiménez C, Puig N, Sarasquete ME, Flores-Montero J, García-Álvarez M, Prieto-Conde I, Chillón C, Alcoceba M, González-Calle V, Gutiérrez NC, Jacobsen A, Vigil E, Hutt K, Huang Y, Orfao A, González M, Miller J, García-Sanz R. Interlaboratory Analytical Validation of a Next-Generation Sequencing Strategy for Clonotypic Assessment and Minimal Residual Disease Monitoring in Multiple Myeloma. Arch Pathol Lab Med 2021; 146:862-871. [PMID: 34619755 DOI: 10.5858/arpa.2021-0088-oa] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Minimal residual disease (MRD) is a major prognostic factor in multiple myeloma, although validated technologies are limited. OBJECTIVE.— To standardize the performance of the LymphoTrack next-generation sequencing (NGS) assays (Invivoscribe), targeting clonal immunoglobulin rearrangements, in order to reproduce the detection of tumor clonotypes and MRD quantitation in myeloma. DESIGN.— The quantification ability of the assay was evaluated through serial dilution experiments. Paired samples from 101 patients were tested by LymphoTrack, using Sanger sequencing and EuroFlow's next-generation flow (NGF) assay as validated references for diagnostic and follow-up evaluation, respectively. MRD studies using LymphoTrack were performed in parallel at 2 laboratories to evaluate reproducibility. RESULTS.— Sensitivity was set as 1.3 tumor cells per total number of input cells. Clonality was confirmed in 99% and 100% of cases with Sanger and NGS, respectively, showing great concordance (97.9%), although several samples had minor discordances in the nucleotide sequence of rearrangements. Parallel NGS was performed in 82 follow-up cases, achieving a median sensitivity of 0.001%, while for NGF, median sensitivity was 0.0002%. Reproducibility of LymphoTrack-based MRD studies (85.4%) and correlation with NGF (R2 > 0.800) were high. Bland-Altman tests showed highly significant levels of agreement between flow and sequencing. CONCLUSIONS.— Taken together, we have shown that LymphoTrack is a suitable strategy for clonality detection and MRD evaluation, with results comparable to gold standard procedures.
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Affiliation(s)
- Alejandro Medina
- From Departamento de Hematología, Hospital Universitario de Salamanca (HUSAL/IBSAL), Centro de Investigación del Cáncer - IBMCC (USAL-CSIC), CIBERONC-CB16/12/00233, Salamanca, Spain (Medina, Jiménez, Puig, Sarasquete, García-Álvarez, Prieto-Conde, Chillón, Alcoceba, González-Calle, Gutiérrez, González, García-Sanz)
| | - Cristina Jiménez
- From Departamento de Hematología, Hospital Universitario de Salamanca (HUSAL/IBSAL), Centro de Investigación del Cáncer - IBMCC (USAL-CSIC), CIBERONC-CB16/12/00233, Salamanca, Spain (Medina, Jiménez, Puig, Sarasquete, García-Álvarez, Prieto-Conde, Chillón, Alcoceba, González-Calle, Gutiérrez, González, García-Sanz)
| | - Noemí Puig
- From Departamento de Hematología, Hospital Universitario de Salamanca (HUSAL/IBSAL), Centro de Investigación del Cáncer - IBMCC (USAL-CSIC), CIBERONC-CB16/12/00233, Salamanca, Spain (Medina, Jiménez, Puig, Sarasquete, García-Álvarez, Prieto-Conde, Chillón, Alcoceba, González-Calle, Gutiérrez, González, García-Sanz)
| | - María Eugenia Sarasquete
- From Departamento de Hematología, Hospital Universitario de Salamanca (HUSAL/IBSAL), Centro de Investigación del Cáncer - IBMCC (USAL-CSIC), CIBERONC-CB16/12/00233, Salamanca, Spain (Medina, Jiménez, Puig, Sarasquete, García-Álvarez, Prieto-Conde, Chillón, Alcoceba, González-Calle, Gutiérrez, González, García-Sanz)
| | - Juan Flores-Montero
- Departamento de Citometría de Flujo, Laboratorio 11, Centro de Investigación del Cáncer - IBMCC (USAL-CSIC), CIBERONC-CB16/12/00400, Salamanca, Spain (Flores-Montero, Orfao)
| | - María García-Álvarez
- From Departamento de Hematología, Hospital Universitario de Salamanca (HUSAL/IBSAL), Centro de Investigación del Cáncer - IBMCC (USAL-CSIC), CIBERONC-CB16/12/00233, Salamanca, Spain (Medina, Jiménez, Puig, Sarasquete, García-Álvarez, Prieto-Conde, Chillón, Alcoceba, González-Calle, Gutiérrez, González, García-Sanz)
| | - Isabel Prieto-Conde
- From Departamento de Hematología, Hospital Universitario de Salamanca (HUSAL/IBSAL), Centro de Investigación del Cáncer - IBMCC (USAL-CSIC), CIBERONC-CB16/12/00233, Salamanca, Spain (Medina, Jiménez, Puig, Sarasquete, García-Álvarez, Prieto-Conde, Chillón, Alcoceba, González-Calle, Gutiérrez, González, García-Sanz)
| | - Carmen Chillón
- From Departamento de Hematología, Hospital Universitario de Salamanca (HUSAL/IBSAL), Centro de Investigación del Cáncer - IBMCC (USAL-CSIC), CIBERONC-CB16/12/00233, Salamanca, Spain (Medina, Jiménez, Puig, Sarasquete, García-Álvarez, Prieto-Conde, Chillón, Alcoceba, González-Calle, Gutiérrez, González, García-Sanz)
| | - Miguel Alcoceba
- From Departamento de Hematología, Hospital Universitario de Salamanca (HUSAL/IBSAL), Centro de Investigación del Cáncer - IBMCC (USAL-CSIC), CIBERONC-CB16/12/00233, Salamanca, Spain (Medina, Jiménez, Puig, Sarasquete, García-Álvarez, Prieto-Conde, Chillón, Alcoceba, González-Calle, Gutiérrez, González, García-Sanz)
| | - Verónica González-Calle
- From Departamento de Hematología, Hospital Universitario de Salamanca (HUSAL/IBSAL), Centro de Investigación del Cáncer - IBMCC (USAL-CSIC), CIBERONC-CB16/12/00233, Salamanca, Spain (Medina, Jiménez, Puig, Sarasquete, García-Álvarez, Prieto-Conde, Chillón, Alcoceba, González-Calle, Gutiérrez, González, García-Sanz)
| | - Norma C Gutiérrez
- From Departamento de Hematología, Hospital Universitario de Salamanca (HUSAL/IBSAL), Centro de Investigación del Cáncer - IBMCC (USAL-CSIC), CIBERONC-CB16/12/00233, Salamanca, Spain (Medina, Jiménez, Puig, Sarasquete, García-Álvarez, Prieto-Conde, Chillón, Alcoceba, González-Calle, Gutiérrez, González, García-Sanz)
| | - Austin Jacobsen
- Invivoscribe, Inc, San Diego, California (Jacobsen, Vigil, Hutt, Huang, Miller)
| | - Edgar Vigil
- Invivoscribe, Inc, San Diego, California (Jacobsen, Vigil, Hutt, Huang, Miller)
| | - Kasey Hutt
- Invivoscribe, Inc, San Diego, California (Jacobsen, Vigil, Hutt, Huang, Miller)
| | - Ying Huang
- Invivoscribe, Inc, San Diego, California (Jacobsen, Vigil, Hutt, Huang, Miller)
| | - Alberto Orfao
- Departamento de Citometría de Flujo, Laboratorio 11, Centro de Investigación del Cáncer - IBMCC (USAL-CSIC), CIBERONC-CB16/12/00400, Salamanca, Spain (Flores-Montero, Orfao)
| | - Marcos González
- From Departamento de Hematología, Hospital Universitario de Salamanca (HUSAL/IBSAL), Centro de Investigación del Cáncer - IBMCC (USAL-CSIC), CIBERONC-CB16/12/00233, Salamanca, Spain (Medina, Jiménez, Puig, Sarasquete, García-Álvarez, Prieto-Conde, Chillón, Alcoceba, González-Calle, Gutiérrez, González, García-Sanz)
| | - Jeffrey Miller
- Invivoscribe, Inc, San Diego, California (Jacobsen, Vigil, Hutt, Huang, Miller)
| | - Ramón García-Sanz
- From Departamento de Hematología, Hospital Universitario de Salamanca (HUSAL/IBSAL), Centro de Investigación del Cáncer - IBMCC (USAL-CSIC), CIBERONC-CB16/12/00233, Salamanca, Spain (Medina, Jiménez, Puig, Sarasquete, García-Álvarez, Prieto-Conde, Chillón, Alcoceba, González-Calle, Gutiérrez, González, García-Sanz)
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7
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Oliva S, Bruinink DHO, Rihova L, D'Agostino M, Pantani L, Capra A, van der Holt B, Troia R, Petrucci MT, Villanova T, Vsianska P, Jugooa R, Brandt-Hagens C, Gilestro M, Offidani M, Ribolla R, Galli M, Hajek R, Gay F, Cavo M, Omedé P, van der Velden VHJ, Boccadoro M, Sonneveld P. Minimal residual disease assessment by multiparameter flow cytometry in transplant-eligible myeloma in the EMN02/HOVON 95 MM trial. Blood Cancer J 2021; 11:106. [PMID: 34083504 PMCID: PMC8175611 DOI: 10.1038/s41408-021-00498-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 03/25/2021] [Accepted: 04/12/2021] [Indexed: 12/19/2022] Open
Abstract
Minimal residual disease (MRD) by multiparameter flow cytometry (MFC) is the most effective tool to define a deep response in multiple myeloma (MM). We conducted an MRD correlative study of the EMN02/HO95 MM phase III trial in newly diagnosed MM patients achieving a suspected complete response before maintenance and every 6 months during maintenance. Patients received high-dose melphalan (HDM) versus bortezomib-melphalan-prednisone (VMP) intensification, followed by bortezomib-lenalidomide-dexamethasone (VRd) versus no consolidation, and lenalidomide maintenance. Bone marrow (BM) samples were processed in three European laboratories, applying EuroFlow-based MFC protocols (eight colors, two tubes) with 10-4-10-5 sensitivity. At enrollment in the MRD correlative study, 76% (244/321) of patients were MRD-negative. In the intention-to-treat analysis, after a median follow-up of 75 months, 5-year progression-free survival was 66% in MRD-negative versus 31% in MRD-positive patients (HR 0.39; p < 0.001), 5-year overall survival was 86% versus 69%, respectively (HR 0.41; p < 0.001). MRD negativity was associated with reduced risk of progression or death in all subgroups, including ISS-III (HR 0.37) and high-risk fluorescence in situ hybridization (FISH) patients (HR 0.38;). In the 1-year maintenance MRD population, 42% of MRD-positive patients at pre-maintenance became MRD-negative after lenalidomide exposure. In conclusion, MRD by MFC is a strong prognostic factor. Lenalidomide maintenance further improved MRD-negativity rate.
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Affiliation(s)
- Stefania Oliva
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy.
| | - Davine Hofste Op Bruinink
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
- Laboratory Medical Immunology, Department of Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Lucie Rihova
- Department of Clinical Hematology, University Hospital Brno, Brno, Czech Republic
| | - Mattia D'Agostino
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Lucia Pantani
- Azienda Ospedaliero-Universitaria di Bologna, Seràgnoli Institute of Hematology, Department of Experimental, Diagnostic and Specialty Medicine, Bologna University School of Medicine, S Orsola Malpighi Hospital, Bologna, Italy
| | - Andrea Capra
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Bronno van der Holt
- HOVON Data Center, Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Rossella Troia
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Maria Teresa Petrucci
- Hematology, Department of Translational and Precision Medicine, Azienda Ospedaliera Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Tania Villanova
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Pavla Vsianska
- Department of Clinical Hematology, University Hospital Brno, Brno, Czech Republic
| | - Romana Jugooa
- Department of Immunology, Laboratory Medical Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Claudia Brandt-Hagens
- Department of Immunology, Laboratory Medical Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Milena Gilestro
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Massimo Offidani
- Clinica di Ematologia, Azienda Ospedaliero Universitaria Ospedali Riuniti Umberto I-G.M. Lancisi-G. Salesi di Ancona, Ancona, Italy
| | - Rossella Ribolla
- Division of Hematology, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Monica Galli
- Dipartimento di Oncologia ed Ematologia, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Roman Hajek
- Department of Haematooncology, University Hospital Ostrava, Ostrava, Czech Republic
- Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Francesca Gay
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Michele Cavo
- Azienda Ospedaliero-Universitaria di Bologna, Seràgnoli Institute of Hematology, Department of Experimental, Diagnostic and Specialty Medicine, Bologna University School of Medicine, S Orsola Malpighi Hospital, Bologna, Italy
| | - Paola Omedé
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Vincent H J van der Velden
- Department of Immunology, Laboratory Medical Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Mario Boccadoro
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Pieter Sonneveld
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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8
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Diamond BT, Rustad E, Maclachlan K, Thoren K, Ho C, Roshal M, Ulaner GA, Landgren CO. Defining the undetectable: The current landscape of minimal residual disease assessment in multiple myeloma and goals for future clarity. Blood Rev 2021; 46:100732. [PMID: 32771227 PMCID: PMC9928431 DOI: 10.1016/j.blre.2020.100732] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/05/2020] [Accepted: 07/06/2020] [Indexed: 01/19/2023]
Abstract
Multiple Myeloma, the second most prevalent hematologic malignancy, yet lacks an established curative therapy. However, overall response rate to modern four-drug regimens approaches 100%. Major efforts have thus focused on the measurement of minute quantities of residual disease (minimal residual disease or MRD) for prognostic metrics and therapeutic response evaluation. Currently, MRD is assessed by flow cytometry or by next generation sequencing to track tumor-specific immunoglobulin V(D)J rearrangements. These bone marrow-based methods can reach sensitivity thresholds of the identification of one neoplastic cell in 1,000,000 (10-6). New technologies are being developed to be used alone or in conjunction with established methods, including peripheral blood-based assays, mass spectrometry, and targeted imaging. Data is also building for MRD as a surrogate endpoint for overall survival. Here, we will address the currently utilized MRD assays, challenges in validation across labs and clinical trials, techniques in development, and future directions for successful clinical application of MRD in multiple myeloma.
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Affiliation(s)
| | | | | | | | - Caleb Ho
- Memorial Sloan Kettering Cancer Center, USA
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9
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Kazandjian D, Mo CC, Landgren O, Richardson PG. The role of high-dose melphalan with autologous stem-cell transplant in multiple myeloma: is it time for a paradigm shift? Br J Haematol 2020; 191:692-703. [PMID: 32501533 PMCID: PMC8505046 DOI: 10.1111/bjh.16764] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 04/29/2020] [Indexed: 02/06/2023]
Abstract
Recent advances in multiple myeloma include numerous approvals of novel therapies with unprecedented efficacy, a rapid and sustained tempo of new drug development, and further refinements to prognostication to include minimal residual disease (MRD) testing and improved risk stratification. The upfront use of immunomodulatory drug and proteasome inhibitor combinations followed by maintenance has resulted in transformative clinical benefit. Four-drug regimens incorporating monoclonal antibodies are reporting unprecedented rates of complete response and MRD negativity in the absence of intensification. In the context of these advances, the added value of high-dose melphalan with autologous stem-cell transplant (HDM-ASCT) is a key question. From a safety standpoint, HDM-ASCT is associated with both acute toxicities that reduce quality of life and long-term toxicities that may limit life expectancy for some patients. The present review discusses the recent advances in induction therapy, the impact of these advances on HDM-ASCT, the evolving role of MRD testing and the short- and long-term risks of HDM-ASCT. Recognising that prospective data remains limited, we suggest that HDM-ASCT not be considered mandatory for eligible newly diagnosed patients who are treated with highly efficacious regimens and achieve deep responses, but rather be held in reserve without early exposure to the clinical and genomic toxicity inherent to this approach.
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Affiliation(s)
- Dickran Kazandjian
- Multiple Myeloma Program, Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Clifton C. Mo
- Department of Medical Oncology, Dana-Farber Cancer Institute, Jerome Lipper Multiple Myeloma Center, Boston, MA
| | - Ola Landgren
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY
| | - Paul G. Richardson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Jerome Lipper Multiple Myeloma Center, Boston, MA, USA
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10
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Medina A, Puig N, Flores-Montero J, Jimenez C, Sarasquete ME, Garcia-Alvarez M, Prieto-Conde I, Chillon C, Alcoceba M, Gutierrez NC, Oriol A, Rosinol L, Bladè J, Gironella M, Hernandez MT, Gonzalez-Calle V, Cedena MT, Paiva B, San-Miguel JF, Lahuerta JJ, Mateos MV, Martinez-Lopez J, Orfao A, Gonzalez M, Garcia-Sanz R. Comparison of next-generation sequencing (NGS) and next-generation flow (NGF) for minimal residual disease (MRD) assessment in multiple myeloma. Blood Cancer J 2020; 10:108. [PMID: 33127891 PMCID: PMC7603393 DOI: 10.1038/s41408-020-00377-0] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/14/2020] [Accepted: 10/02/2020] [Indexed: 12/12/2022] Open
Abstract
Detecting persistent minimal residual disease (MRD) allows the identification of patients with an increased risk of relapse and death. In this study, we have evaluated MRD 3 months after transplantation in 106 myeloma patients using a commercial next-generation sequencing (NGS) strategy (LymphoTrack®), and compared the results with next-generation flow (NGF, EuroFlow). The use of different marrow pulls and the need of concentrating samples for NGS biased the applicability for MRD evaluation and favored NGF. Despite that, correlation between NGS and NGF was high (R2 = 0.905). The 3-year progression-free survival (PFS) rates by NGS and NGF were longer for undetectable vs. positive patients (NGS: 88.7% vs. 56.6%; NGF: 91.4% vs. 50%; p < 0.001 for both comparisons), which resulted in a 3-year overall survival (OS) advantage (NGS: 96.2% vs. 77.3%; NGF: 96.6% vs. 74.9%, p < 0.01 for both comparisons). In the Cox regression model, NGS and NGF negativity had similar results but favoring the latter in PFS (HR: 0.20, 95% CI: 0.09–0.45, p < 0.001) and OS (HR: 0.21, 95% CI: 0.06–0.75, p = 0.02). All these results reinforce the role of MRD detection by different strategies in patient prognosis and highlight the use of MRD as an endpoint for multiple myeloma treatment.
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Affiliation(s)
- Alejandro Medina
- Departamento de Hematología, Hospital Universitario de Salamanca (HUSA/IBSAL), CIBERONC, CIC-IBMCC (USAL-CSIC), Salamanca, Spain
| | - Noemi Puig
- Departamento de Hematología, Hospital Universitario de Salamanca (HUSA/IBSAL), CIBERONC, CIC-IBMCC (USAL-CSIC), Salamanca, Spain
| | - Juan Flores-Montero
- Centro de Investigación del Cáncer-IBMCC (USAL-CSIC), CIBERONC, Salamanca, Spain
| | - Cristina Jimenez
- Departamento de Hematología, Hospital Universitario de Salamanca (HUSA/IBSAL), CIBERONC, CIC-IBMCC (USAL-CSIC), Salamanca, Spain
| | - M-Eugenia Sarasquete
- Departamento de Hematología, Hospital Universitario de Salamanca (HUSA/IBSAL), CIBERONC, CIC-IBMCC (USAL-CSIC), Salamanca, Spain.
| | - María Garcia-Alvarez
- Departamento de Hematología, Hospital Universitario de Salamanca (HUSA/IBSAL), CIBERONC, CIC-IBMCC (USAL-CSIC), Salamanca, Spain
| | - Isabel Prieto-Conde
- Departamento de Hematología, Hospital Universitario de Salamanca (HUSA/IBSAL), CIBERONC, CIC-IBMCC (USAL-CSIC), Salamanca, Spain
| | - Carmen Chillon
- Departamento de Hematología, Hospital Universitario de Salamanca (HUSA/IBSAL), CIBERONC, CIC-IBMCC (USAL-CSIC), Salamanca, Spain
| | - Miguel Alcoceba
- Departamento de Hematología, Hospital Universitario de Salamanca (HUSA/IBSAL), CIBERONC, CIC-IBMCC (USAL-CSIC), Salamanca, Spain
| | - Norma C Gutierrez
- Departamento de Hematología, Hospital Universitario de Salamanca (HUSA/IBSAL), CIBERONC, CIC-IBMCC (USAL-CSIC), Salamanca, Spain
| | - Albert Oriol
- Hospital Germans Trias i Pujol, Institut Català d'Oncología (ICO), Institut Josep Carreras, Badalona, Spain
| | - Laura Rosinol
- Hospital Clínic i Provincial, Institut de Investicacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Joan Bladè
- Hospital Clínic i Provincial, Institut de Investicacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | | | | - Veronica Gonzalez-Calle
- Departamento de Hematología, Hospital Universitario de Salamanca (HUSA/IBSAL), CIBERONC, CIC-IBMCC (USAL-CSIC), Salamanca, Spain
| | - Maria-Teresa Cedena
- Hospital 12 de Octubre, i + 12, CNIO, Universidad Complutense, Madrid, Spain
| | - Bruno Paiva
- Clínica Universidad de Navarra (CUN), Centro de Investigación Médica Aplicada, IDISNA, CIBERONC, Pamplona, Spain
| | - Jesus F San-Miguel
- Clínica Universidad de Navarra (CUN), Centro de Investigación Médica Aplicada, IDISNA, CIBERONC, Pamplona, Spain
| | - Juan-Jose Lahuerta
- Hospital 12 de Octubre, i + 12, CNIO, Universidad Complutense, Madrid, Spain
| | - Maria-Victoria Mateos
- Departamento de Hematología, Hospital Universitario de Salamanca (HUSA/IBSAL), CIBERONC, CIC-IBMCC (USAL-CSIC), Salamanca, Spain
| | | | - Alberto Orfao
- Centro de Investigación del Cáncer-IBMCC (USAL-CSIC), CIBERONC, Salamanca, Spain
| | - Marcos Gonzalez
- Departamento de Hematología, Hospital Universitario de Salamanca (HUSA/IBSAL), CIBERONC, CIC-IBMCC (USAL-CSIC), Salamanca, Spain
| | - Ramon Garcia-Sanz
- Departamento de Hematología, Hospital Universitario de Salamanca (HUSA/IBSAL), CIBERONC, CIC-IBMCC (USAL-CSIC), Salamanca, Spain
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11
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Gozzetti A, Raspadori D, Bacchiarri F, Sicuranza A, Pacelli P, Ferrigno I, Tocci D, Bocchia M. Minimal Residual Disease in Multiple Myeloma: State of the Art and Applications in Clinical Practice. J Pers Med 2020; 10:jpm10030120. [PMID: 32927719 PMCID: PMC7565263 DOI: 10.3390/jpm10030120] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 09/03/2020] [Accepted: 09/08/2020] [Indexed: 12/14/2022] Open
Abstract
Novel drugs have revolutionized multiple myeloma therapy in the last 20 years, with median survival that has doubled to up to 8–10 years. The introduction of therapeutic strategies, such as consolidation and maintenance after autologous stem cell transplants, has also ameliorated clinical results. The goal of modern therapies is becoming not only complete remission, but also the deepest possible remission. In this context, the evaluation of minimal residual disease by techniques such as next-generation sequencing (NGS) and next-generation flow (NGF) is becoming part of all new clinical trials that test drug efficacy. This review focuses on minimal residual disease approaches in clinical trials, with particular attention to real-world practices.
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12
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Patel DA, Gopalakrishnan R, Engelhardt BG, McArthur E, Sengsayadeth S, Culos KA, Byrne M, Goodman S, Savani BN, Chinratanalab W, Jagasia M, Mosse CA, Cornell RF, Kassim AA. Minimal residual disease negativity and lenalidomide maintenance therapy are associated with superior survival outcomes in multiple myeloma. Bone Marrow Transplant 2020; 55:1137-1146. [PMID: 31992845 DOI: 10.1038/s41409-020-0791-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 12/02/2019] [Accepted: 01/13/2020] [Indexed: 12/19/2022]
Abstract
Modern combinations of therapies for multiple myeloma have led to improvement in survival outcomes with near 100% overall response rate and 25% complete response rates, particularly with autologous hematopoietic cell transplant (AHCT). Minimal residual disease (MRD) assessment with multiparameter flow cytometry is a valid prognostic biomarker for progression-free survival (PFS) and overall survival (OS). However, few data exist regarding whether MRD positivity or negativity will meaningfully influence treatment decisions. We evaluated 433 patients who received induction therapy, followed by AHCT. Participants had MRD assessment by multiparameter flow cytometry before and at days +100 and +365 following AHCT. They also received either lenalidomide, bortezomib, or no maintenance therapy following AHCT. Maintenance treatment with lenalidomide improved MRD negativity at day +365 compared to bortezomib (92.9% vs 41.6%, p = 0.01), or no maintenance therapy (92.9% vs 24.4%, p = 0.012). The median PFS for patients who were MRD negative at day + 365 was 42 vs 17.5 months (p < 0.001) and median OS was 80.6 vs 59 months (p = 0.02). Maintenance therapy following AHCT for multiple myeloma improves the depth of response as assessed by MRD.
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Affiliation(s)
- Dilan A Patel
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ragisha Gopalakrishnan
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Brian G Engelhardt
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Medicine, Division of Hematology/Oncology, Hematology and Stem Cell Transplant, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Evonne McArthur
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Salyka Sengsayadeth
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Medicine, Division of Hematology/Oncology, Hematology and Stem Cell Transplant, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Katie A Culos
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael Byrne
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Medicine, Division of Hematology/Oncology, Hematology and Stem Cell Transplant, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Stacey Goodman
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Medicine, Division of Hematology/Oncology, Hematology and Stem Cell Transplant, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bipin N Savani
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Medicine, Division of Hematology/Oncology, Hematology and Stem Cell Transplant, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Wichai Chinratanalab
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Medicine, Division of Hematology/Oncology, Hematology and Stem Cell Transplant, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Madan Jagasia
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Medicine, Division of Hematology/Oncology, Hematology and Stem Cell Transplant, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Claudio A Mosse
- Department of Pathology, Microbiology, Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
- Pathology and Laboratory Medicine, VA Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Robert F Cornell
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Medicine, Division of Hematology/Oncology, Hematology and Stem Cell Transplant, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Adetola A Kassim
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA.
- Department of Medicine, Division of Hematology/Oncology, Hematology and Stem Cell Transplant, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA.
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13
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Roshal M. Measurable disease evaluation in patients with myeloma. Best Pract Res Clin Haematol 2020; 33:101154. [PMID: 32139019 DOI: 10.1016/j.beha.2020.101154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 01/30/2020] [Indexed: 01/09/2023]
Abstract
Recent years saw significant breakthroughs in treatment of multiple myeloma. Durable remissions are now seen in a significant proportion of patients with the previously uniformly incurable and progressive disease. Yet because of deep suppression of the neoplastic myeloma clones by the newer therapies, older disease monitoring techniques are insufficient to distinguish between the patients at high risk of imminent relapse and those in whom durable remission is expected. This review briefly describes prognostic and therapeutic implications of measurable disease (MRD) evaluation, explains why deep MRD evaluation is needed for patients without morphologic evidence of disease, and reviews the state of the art of evaluation of myeloma MRD by flow cytometry.
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Affiliation(s)
- Mikhail Roshal
- Hematopathology Service, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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14
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Dass J, Dhingra G, Gupta N, Kotwal J. Myelomatous ascites: Flow cytometric diagnosis and evolution of phenotype. INDIAN J PATHOL MICR 2020; 63:154-156. [DOI: 10.4103/ijpm.ijpm_450_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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15
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Liu H, Yang Y, Jiang J, Wang X, Zhang C, Jiang Y, Hong L, Huang H. Coexistence Of A Huge Venous Thromboembolism And Bleeding Tendency In Cytokine Release Syndrome During CAR-T Therapy. Onco Targets Ther 2019; 12:8955-8960. [PMID: 31802905 PMCID: PMC6826178 DOI: 10.2147/ott.s223697] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 10/10/2019] [Indexed: 01/16/2023] Open
Abstract
Chimeric antigen receptor (CAR)-modified T cell therapy is increasingly administered for hematological malignancies. Cytokine release syndrome (CRS) is a common and severe complication of CAR-T therapy. In the present case, a 62-year-old male patient was diagnosed with relapsed and refractory multiple myeloma (RRMM). Treated with CART-CD19/BCMA therapy, his symptoms remitted, during which occasional but severe CRS associated with coagulation disorder still appeared, as evidenced by the coexistence of a huge thrombosis and bleeding tendency. Through the First Generation Sequencing, we extracted genomic DNA from the patient’s peripheral blood to analyze the distribution of polymorphism at the –572C/G site of the promoter of IL-6 gene. The results showed that the genotype of –572C/G promoter polymorphism was CC, indicating that high level of IL-6 and –572C/G polymorphism might be associated with the risk of thrombotic disorders. We concluded that immediate diagnosis and appropriate treatment of coagulopathy could reduce CRS-related mortality.
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Affiliation(s)
- Haiyan Liu
- Department of Hematology, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, People's Republic of China
| | - Ye Yang
- School of Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210023, People's Republic of China
| | - Jie Jiang
- Department of Hematology, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, People's Republic of China
| | - Xinfeng Wang
- Department of Hematology, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, People's Republic of China
| | - Chenlu Zhang
- Department of Hematology, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, People's Republic of China
| | - Yijing Jiang
- Department of Hematology, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, People's Republic of China
| | - Lemin Hong
- Department of Hematology, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, People's Republic of China
| | - Hongming Huang
- Department of Hematology, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, People's Republic of China
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16
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Avet-Loiseau H, Ludwig H, Landgren O, Paiva B, Morris C, Yang H, Zhou K, Ro S, Mateos MV. Minimal Residual Disease Status as a Surrogate Endpoint for Progression-free Survival in Newly Diagnosed Multiple Myeloma Studies: A Meta-analysis. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 20:e30-e37. [PMID: 31780415 DOI: 10.1016/j.clml.2019.09.622] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 08/05/2019] [Accepted: 09/29/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Therapeutic advances have greatly extended survival times in patients with multiple myeloma, necessitating increasingly lengthy trials when using survival outcomes as primary endpoints. A surrogate endpoint that can more rapidly predict survival could accelerate drug development. We conducted a meta-analysis to evaluate minimal residual disease (MRD) status as a valid progression-free survival (PFS) surrogate in patients with newly diagnosed multiple myeloma (NDMM). MATERIALS AND METHODS We searched abstracts in PubMed, The American Society of Hematology, and the European Hematology Association for "myeloma," "minimal residual disease," and "clinical trial." Because of the need to evaluate the treatment effect on MRD response, only randomized studies for subjects with NDMM were included. Details on the MRD-tested populations were required. The meta-analysis was performed by principles outlined at the 2013 United States Food and Drug Administration workshop on MRD in acute myeloid leukemia.42 For samples that were not measured for MRD and within the subset specified for MRD assessment, their MRD status was imputed from the samples that had known MRD status. Patients that were excluded from planned MRD assessment were considered MRD-positive. RESULTS Six randomized studies, representing 3283 patients and 2208 MRD samples, met analysis inclusion criteria. MRD negativity rates ranged from 0.06 to 0.70. The treatment effect on the odds ratio for MRD-negative response strongly correlated with the hazard ratio for PFS with a coefficient of determination for the weighted regression line of 0.97. Our meta-analysis suggested that MRD status met both the Prentice criteria for PFS surrogacy. CONCLUSIONS These results support the claim that MRD status can be used as a surrogate for PFS in NDMM.
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Affiliation(s)
- Hervé Avet-Loiseau
- Unité de Génomique du Myélome, University of Toulouse, Toulouse, France.
| | - Heinz Ludwig
- Wilhelminen Cancer Research Institute, Wilhelminenspital, Vienna, Austria
| | - Ola Landgren
- Myeloma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Bruno Paiva
- Clinica Universidad de Navarra, Centro de Investigacion Medica Aplicada (CIMA), Instituto de Investigacion Sanitaria de Navarra (IDISNA), CIBER-ONC number CB16/12/00369, Pamplona, Spain
| | - Chris Morris
- Global Biostatistical Science, Amgen, Inc, Thousand Oaks, CA
| | - Hui Yang
- Global Biostatistical Science, Amgen, Inc, Thousand Oaks, CA
| | - Kefei Zhou
- Global Biostatistical Science, Amgen, Inc, Thousand Oaks, CA
| | - Sunhee Ro
- Global Biostatistical Science, Amgen, Inc, Thousand Oaks, CA
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17
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Requirand G, Robert N, Boireau S, Vincent L, Seckinger A, Bouhya S, Ceballos P, Cartron G, Hose D, Klein B, Moreaux J. BrdU incorporation in multiparameter flow cytometry: A new cell cycle assessment approach in multiple myeloma. CYTOMETRY PART B-CLINICAL CYTOMETRY 2018; 96:209-214. [PMID: 30417559 DOI: 10.1002/cyto.b.21730] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 07/19/2018] [Accepted: 07/27/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND Mutiple myeloma (MM) is a neoplasia characterized by the accumulation of malignant plasma cells (PC) in the bone marrow. Although proliferation markers have been studied in MM, none of the current staging systems include them. Moreover, approaches used to analyze proliferation do not separate MM cells (MMCs) from normal PC. METHODS In this study, we combined multiparameter flow cytometry and BrdU incorporation or Ki67 staining to analyze MM cell proliferation in 44 monoclonal gammopathy of undetermined significance (MGUS), 153 newly diagnosed MM patients and 69 MM patients at relapse. The prognostic value of proliferation assessment was analyzed in 60 newly diagnosed patients treated with high-dose chemotherapy supported by autologous hematopoietic stem cell transplantation. RESULTS The median number of proliferating malignant PC significantly increases during MM disease progression. MM patients with a percentage of proliferating MMCs greater than 1.42% using BrdU/DAPI or greater than 1.1% using ki67/DAPI, are associated with a significantly shorter event free survival compared with patients with a lower percentage of proliferating MMCs. CONCLUSIONS Combination of flow cytometry with BrdU or ki67/DAPI staining could become a standard for the determination of MM cell proliferation. Furthermore, in the context of new effective myeloma treatment options, assessment of MM cell proliferation may be valuable, in clinical trials, to identify novel agents that could significantly affect the small proliferative compartment of MM cells. © 2018 International Clinical Cytometry Society.
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Affiliation(s)
- Guilhem Requirand
- CHU Montpellier, Department of Biological Hematology, Montpellier, France.,IGH, CNRS, University of Montpellier, Montpellier, France
| | - Nicolas Robert
- CHU Montpellier, Department of Biological Hematology, Montpellier, France.,IGH, CNRS, University of Montpellier, Montpellier, France
| | - Stéphanie Boireau
- CHU Montpellier, Department of Biological Hematology, Montpellier, France.,IGH, CNRS, University of Montpellier, Montpellier, France
| | - Laure Vincent
- CHU Montpellier, Department of Clinical Hematology, Montpellier, France
| | - Anja Seckinger
- Medizinische Klinik und Poliklinik V, Universitätsklinikum Heidelberg, Heidelberg, Germany.,Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany
| | | | - Patrice Ceballos
- CHU Montpellier, Department of Clinical Hematology, Montpellier, France
| | - Guillaume Cartron
- CHU Montpellier, Department of Clinical Hematology, Montpellier, France.,University of Montpellier, UFR de Médecine, Montpellier, France
| | - Dirk Hose
- Medizinische Klinik und Poliklinik V, Universitätsklinikum Heidelberg, Heidelberg, Germany.,Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany
| | - Bernard Klein
- CHU Montpellier, Department of Biological Hematology, Montpellier, France.,IGH, CNRS, University of Montpellier, Montpellier, France.,University of Montpellier, UFR de Médecine, Montpellier, France
| | - Jérôme Moreaux
- CHU Montpellier, Department of Biological Hematology, Montpellier, France.,IGH, CNRS, University of Montpellier, Montpellier, France.,University of Montpellier, UFR de Médecine, Montpellier, France.,UMR CNRS 5235, University of Montpellier, Montpellier, France
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18
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Huang SY, Lin HH, Lin CW, Li CC, Yao M, Tang JL, Hou HA, Tsay W, Chou SJ, Cheng CL, Tien HF. Soluble PD-L1: A biomarker to predict progression of autologous transplantation in patients with multiple myeloma. Oncotarget 2018; 7:62490-62502. [PMID: 27566569 PMCID: PMC5308741 DOI: 10.18632/oncotarget.11519] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 08/11/2016] [Indexed: 12/31/2022] Open
Abstract
Autologous hematopoietic stem cell transplantation (AuHSCT) is standard in treating eligible multiple myeloma (MM) patients. However, the outcome after treatment is highly variable. We used ELISA to analyze the levels of soluble PD-L1 (suPD-L1) in bone marrow (BM) plasma from 61 patients with MM at 100 days after AuHSCT. Patients were classified into high (H) and normal-to-low (NL) groups depending on their suPD-L1 levels. Among patients who had a very good partial response (VGPR) or better after AuHSCT, those in the H-group had a shorter response period (RpSCT) as well as shorter overall survival (OS) than those in the NL-group. Multivariate analyses confirmed that a high suPD-L1 level and high-risk cytogenetic abnormalities are independent factors for RpSCT. Our data suggest that suPD-L1 in the BM plasma of MM patients who have VGPR or better after AuHSCT could be used as a biomarker to predict outcome.
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Affiliation(s)
- Shang-Yi Huang
- Department of Internal Medicine, National Taiwan University, Medical College and Hospital, Taipei, Taiwan
| | - Hsiu-Hsia Lin
- Department of Internal Medicine, National Taiwan University, Medical College and Hospital, Taipei, Taiwan
| | - Chung-Wu Lin
- Department of Pathology, National Taiwan University, Medical College and Hospital, Taipei, Taiwan
| | - Chi-Cheng Li
- Tai-Cheng Stem Cell Therapy Center, National Taiwan University, Taipei, Taiwan
| | - Ming Yao
- Department of Internal Medicine, National Taiwan University, Medical College and Hospital, Taipei, Taiwan
| | - Jih-Luh Tang
- Department of Internal Medicine, National Taiwan University, Medical College and Hospital, Taipei, Taiwan.,Tai-Cheng Stem Cell Therapy Center, National Taiwan University, Taipei, Taiwan
| | - Hsin-An Hou
- Department of Internal Medicine, National Taiwan University, Medical College and Hospital, Taipei, Taiwan
| | - Woei Tsay
- Department of Internal Medicine, National Taiwan University, Medical College and Hospital, Taipei, Taiwan
| | - Sheng-Je Chou
- Department of Internal Medicine, National Taiwan University, Medical College and Hospital, Taipei, Taiwan
| | - Chieh-Lung Cheng
- Department of Internal Medicine, National Taiwan University, Medical College and Hospital, Taipei, Taiwan
| | - Hwei-Fang Tien
- Department of Internal Medicine, National Taiwan University, Medical College and Hospital, Taipei, Taiwan
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19
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Roshal M. Minimal Residual Disease Detection by Flow Cytometry in Multiple Myeloma: Why and How? Semin Hematol 2018; 55:4-12. [PMID: 29759152 DOI: 10.1053/j.seminhematol.2018.02.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 02/27/2018] [Indexed: 11/11/2022]
Abstract
The outlook for myeloma patients has steadily improved with the introduction of newer drug combinations in recent years. Unlike older therapies that largely achieved only modest levels of neoplastic clone reduction, the newer drug combinations have led to deeper suppression of myeloma clones in most patients. Frequently the neoplastic clones become undetectable with traditional disease evaluation approaches. Recent studies using ultrasensitive disease monitoring have demonstrated that patients with disease undetectable by traditional techniques show wide heterogeneity in disease levels varying by several orders of magnitude. Moreover, measurement of the depth of disease suppression even at very low level has emerged as the most powerful prognostication tool in myeloma. Minimal (or measurable) residual disease (MRD) evaluation has also been proposed as a relevant tool in assessment of drug efficacy and in selection of further therapeutic options. In the face of the robust MRD measurement utility data, it has become critical to develop widely applicable disease monitoring techniques that can be applied to more patients in a variety of clinical setting. Both DNA-based and flow cytometry-based approaches have been successfully developed for this purpose achieving sensitivity approaching 1 neoplastic cell in a million. This review article focuses on the theoretical and practical aspects and challenges of deep MRD monitoring in myeloma by flow cytometry. Challenges of flow cytometric disease monitoring in the era of antigen-directed therapy are also discussed.
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Affiliation(s)
- Mikhail Roshal
- Hematopathology Service, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY.
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20
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Abstract
The primary hurdle in the path to curing multiple myeloma (MM) is defining a validated minimal residual disease (MRD) and its utility in the therapeutic decision making. A better definition of MRD will aid in tailoring MM therapy further to address the clonal heterogeneity and genomic instability and overcome patient's ineffective immune surveillance. MRD analysis can define the logical endpoint for maintenance therapy, in addition also aids in providing a better clinical end point for studies comparing novel agents in myeloma. MRD is a surrogate for the survival in MM. Guidelines for global incorporation of MRD in myeloma are fraught with lack of standardization, universal availability and abridged physicians' understanding of MRD modalities. We aimed at addressing some of the frequently asked questions in the MRD assessment and will also place in perspective some arguments in favor of MRD assessment in routine practice and clinical trial scenario.
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Affiliation(s)
- Uday Yanamandra
- a Department of Hematology and Stem Cell Transplant , Army Hospital - Research and Referral , New Delhi , India
| | - Shaji K Kumar
- b Department of Internal Medicine, Division of Hematology , Mayo Clinic , Rochester , MN , USA
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21
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Alaterre E, Raimbault S, Garcia JM, Rème T, Requirand G, Klein B, Moreaux J. Automated and simplified identification of normal and abnormal plasma cells in Multiple Myeloma by flow cytometry. CYTOMETRY PART B-CLINICAL CYTOMETRY 2017; 94:484-492. [DOI: 10.1002/cyto.b.21590] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 07/28/2017] [Accepted: 08/30/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Elina Alaterre
- HORIBA Medical; Montpellier France
- Institute of Human Genetics, UMR 9002 CNRS, University of Montpellier; Montpellier F-34396 France
| | | | | | - Thierry Rème
- Department of Biological Hematology; CHU Montpellier; Montpellier France
| | - Guilhem Requirand
- Department of Biological Hematology; CHU Montpellier; Montpellier France
| | - Bernard Klein
- Institute of Human Genetics, UMR 9002 CNRS, University of Montpellier; Montpellier F-34396 France
- Department of Biological Hematology; CHU Montpellier; Montpellier France
- University of Montpellier 1, UFR de Médecine; Montpellier France
| | - Jérôme Moreaux
- Institute of Human Genetics, UMR 9002 CNRS, University of Montpellier; Montpellier F-34396 France
- Department of Biological Hematology; CHU Montpellier; Montpellier France
- University of Montpellier 1, UFR de Médecine; Montpellier France
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22
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Nikolova T, Kiweler N, Krämer OH. Interstrand Crosslink Repair as a Target for HDAC Inhibition. Trends Pharmacol Sci 2017; 38:822-836. [PMID: 28687272 DOI: 10.1016/j.tips.2017.05.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 05/29/2017] [Accepted: 05/31/2017] [Indexed: 12/29/2022]
Abstract
DNA interstrand crosslinks (ICLs) covalently connect complementary DNA strands. Consequently, DNA replication and transcription are hampered, DNA damage responses (DDR) are initiated, and cell death is triggered. Therefore, drugs inducing ICLs are effective against rapidly growing cancer cells. However, tumors engage a complicated enzymatic machinery to repair and survive ICLs. Several factors, including the post-translational acetylation/deacetylation of lysine residues within proteins, control this network. Histone deacetylases (HDACs) modulate the expression and functions of DNA repair proteins which remove ICLs and control the accessibility of chromatin. Accordingly, histone deacetylase inhibitors (HDACi) are small, pharmacologically and clinically relevant molecules that sensitize cancer cells to ICL inducers. We discuss the mechanism of ICL repair and targets of HDACi within this pathway.
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Affiliation(s)
- Teodora Nikolova
- Institute of Toxicology, University Medical Center, Obere Zahlbacher Strasse 67, 55131 Mainz, Germany.
| | - Nicole Kiweler
- Institute of Toxicology, University Medical Center, Obere Zahlbacher Strasse 67, 55131 Mainz, Germany
| | - Oliver H Krämer
- Institute of Toxicology, University Medical Center, Obere Zahlbacher Strasse 67, 55131 Mainz, Germany.
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23
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Michallet M, Chapuis-Cellier C, Dejoie T, Lombard C, Caillon H, Sobh M, Moreau P, Attal M, Avet-Loiseau H. Heavy+light chain monitoring correlates with clinical outcome in multiple myeloma patients. Leukemia 2017; 32:376-382. [PMID: 28663581 PMCID: PMC5808078 DOI: 10.1038/leu.2017.209] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 05/23/2017] [Accepted: 06/20/2017] [Indexed: 01/09/2023]
Abstract
Novel anti-myeloma agents have improved patient response rates, which are historically based on reductions of the M-protein. These methods can be inaccurate for quantifying M-proteins at low concentrations. We compared the consistency and clinical impact of response assignment by electrophoretic and heavy+light chain (HLC) immunoassays post-consolidation in 463 newly diagnosed patients. The two methods gave similar assignments in patients with partial (PR; 79% agreement) or complete response (⩾CR; 92%). However, in patients achieving very good PR (VGPR) there was poor concordance between methods (45%). Median progression-free survival (PFS) for standard VGPR patients was 34.5 months; HLC responses stratified these patients further into PR, VGPR and ⩾CR, with median PFS of 21.3, 28.9 months and not reached, respectively; P<0.001. At this time, abnormal HLC ratios had better concordance with multiparametric flow cytometry (sensitivity 10−4) (37 and 34% positive, respectively), compared to immunofixation (62% positive). In addition, HLC-pair suppression was identified in 38% of patients and associated with shorter PFS (30.6 months vs not reached; P<0.001). We conclude that HLC monitoring could augment electrophoretic assessments in patients achieving VGPR. The prognostic significance of HLC responses might partly depend on the patients’ ability to recover their immune system, as determined by normalisation of HLC measurements.
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Affiliation(s)
- M Michallet
- Department of Hematology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Lyon, France
| | - C Chapuis-Cellier
- Immunological Laboratory, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Lyon, France
| | - T Dejoie
- Biochemistry Laboratory, University Hospital Nantes, Nantes, France
| | - C Lombard
- Immunological Laboratory, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Lyon, France
| | - H Caillon
- Biochemistry Laboratory, University Hospital Nantes, Nantes, France
| | - M Sobh
- Department of Hematology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Lyon, France
| | - P Moreau
- Department of Hematology, Nantes University Hospital, Nantes, France
| | - M Attal
- Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - H Avet-Loiseau
- Institut Universitaire du Cancer de Toulouse-Oncopole, Unite de Genomique du Myelome, Toulouse, France
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24
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Huhn S, Weinhold N, Nickel J, Pritsch M, Hielscher T, Hummel M, Bertsch U, Huegle-Doerr B, Vogel M, Angermund R, Hänel M, Salwender HJ, Weisel K, Dürig J, Görner M, Kirchner H, Peter N, Graeven U, Lordick F, Hoffmann M, Reimer P, Blau IW, Jauch A, Dembowsky K, Möhler T, Wuchter P, Goldschmidt H. Circulating tumor cells as a biomarker for response to therapy in multiple myeloma patients treated within the GMMG-MM5 trial. Bone Marrow Transplant 2017; 52:1194-1198. [PMID: 28504661 PMCID: PMC5543255 DOI: 10.1038/bmt.2017.91] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- S Huhn
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - N Weinhold
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany.,Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - J Nickel
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - M Pritsch
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - T Hielscher
- Division of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | - M Hummel
- Division of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | - U Bertsch
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Tumor Diseases Heidelberg, Heidelberg, Germany
| | - B Huegle-Doerr
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - M Vogel
- Janssen-Cilag, Neuss, Germany
| | | | - M Hänel
- Department of Internal Medicine III, Klinikum Chemnitz gGmbH, Chemnitz, Germany
| | - H J Salwender
- Department of Hematology/Oncology, Asklepios Klinik Altona, Hamburg, Germany
| | - K Weisel
- Department of Internal Medicine II-Hematology and Oncology, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - J Dürig
- Department of Hematology, University Hospital Essen, Essen, Germany
| | - M Görner
- Department of Hematology, Oncology and Palliative Care, Community Hospital Bielefeld, Bielefeld, Germany
| | - H Kirchner
- Medical Clinic III Hematology and Oncology, Städt. Krankenhaus Siloah, Hannover, Germany
| | - N Peter
- 2nd Medical Department, Academic Teaching Hospital of the Charité, Carl-Thiem-Klinikum Cottbus, Cottbus, Germany
| | - U Graeven
- Hematology, Oncology and Gastroenterology, Maria-Hilf-Krankenhaus, Mönchengladbach, Germany
| | - F Lordick
- 3rd Medical Department, Haematology and Oncology, Klinikum Braunschweig, Braunschweig, Germany.,University Cancer Center Leipzig (UCCL), University Medical Center Leipzig, Leipzig, Germany
| | - M Hoffmann
- Medical Clinic A, Klinikum der Stadt Ludwigshafen gGmbH, Ludwigshafen am Rhein, Germany
| | - P Reimer
- Hematology, Oncology and Stem Cell Transplantation, Evangelisches Krankenhaus Essen-Werden gGmbH, Essen, Germany
| | - I W Blau
- Medical Clinic III Hematology and Oncology, Charité University Medicine Berlin, Berlin, Germany
| | - A Jauch
- Institute of Human Genetics, University of Heidelberg, Heidelberg, Germany
| | | | - T Möhler
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany.,inVentiv Health, Boston, MA, USA
| | - P Wuchter
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany.,Institute of Transfusion Medicine and Immunology, German Red Cross Blood Service Baden-Württemberg-Hessen, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - H Goldschmidt
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Tumor Diseases Heidelberg, Heidelberg, Germany
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25
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Landgren O, Iskander K. Modern multiple myeloma therapy: deep, sustained treatment response and good clinical outcomes. J Intern Med 2017; 281:365-382. [PMID: 28205262 DOI: 10.1111/joim.12590] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In the USA at the beginning of this century, the average overall survival in patients with multiple myeloma was about 3 years. Around that time, three drugs (bortezomib, lenalidomide and thalidomide) were introduced for the treatment of multiple myeloma and, in 2012, carfilzomib received accelerated approval by the US Food and Drug Administration (FDA). Driven by access to better drugs, median overall survival in younger patients (aged <50 years) was >10 years by 2014. The FDA approved 14 new drugs for the treatment of cancer in 2015; four of these were approved for the treatment of myeloma (panobinostat, daratumumab, elotuzumab and ixazomib). In 2015 and 2016, expanded label indications were approved by the FDA for lenalidomide and carfilzomib, respectively. The recent increase in approved, highly effective combination therapies for patients with multiple myeloma has led the way to redefining the goals of therapy. Here, we review and provide a clinical perspective on the treatment goals and management of multiple myeloma in the era of modern therapy. Recent meta-analyses show that minimal residual disease (MRD) negativity is associated with longer progression-free and overall survival in patients with multiple myeloma. With the use of modern combination therapy, large proportions (>60-70%) of newly diagnosed multiple myeloma patients achieve complete responses and MRD negativity. Modern combination therapies induce rapid, deep and sustainable responses (including MRD negativity), supporting a treatment paradigm shift away from palliative two-drug combinations towards the use of modern, potent, three- or four-drug combination regimens in early lines of therapy. Data support the use of modern therapy upfront rather than reserving it for later stages of the disease. As survival time increases with modern combination therapies, development of early reliable surrogate end-points for survival, such as MRD negativity, are needed for expedited read-out of future randomized clinical trials.
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Affiliation(s)
- O Landgren
- Myeloma Service, Division of Hematology Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - K Iskander
- Department of Clinical Development, Amgen, Thousand Oaks, CA, USA
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26
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Kazandjian D, Landgren O. A look backward and forward in the regulatory and treatment history of multiple myeloma: Approval of novel-novel agents, new drug development, and longer patient survival. Semin Oncol 2016; 43:682-689. [PMID: 28061986 DOI: 10.1053/j.seminoncol.2016.10.008] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Accepted: 10/28/2016] [Indexed: 12/16/2022]
Abstract
The past decade has seen significant advances in our understanding and treatment of multiple myeloma (MM) and its precursor diseases. These advances include gains in knowledge of the underlying pathobiology including molecular and cellular prognostic factors for disease progression. In parallel we have witnessed the availability of novel therapeutics. Together these advances have translated into improvements in long-term clinical benefit and survival in MM. Indeed, it has been shown that patients diagnosed in the last decade have experienced almost doubling of median survival time. We aim to review and give further insight into drug development and novel drug approvals that have revolutionized the treatment of MM.
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Affiliation(s)
- Dickran Kazandjian
- Myeloma program, Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health and the Office of Hematology and Oncology Products, Food and Drug Administration, Bethesda, MD.
| | - Ola Landgren
- Myeloma Service, Memorial Sloan-Kettering Cancer Center, New York, NY
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27
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Landgren O, Rajkumar SV. New Developments in Diagnosis, Prognosis, and Assessment of Response in Multiple Myeloma. Clin Cancer Res 2016; 22:5428-5433. [PMID: 28151710 PMCID: PMC5587183 DOI: 10.1158/1078-0432.ccr-16-0866] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 09/21/2016] [Accepted: 09/21/2016] [Indexed: 12/27/2022]
Abstract
Over the past few years, the management of multiple myeloma has changed. We have new guidelines regarding how to set the diagnosis, when to initiate therapy, and how to monitor treatment response. In 2014, the updated International Myeloma Working Group (IMWG) diagnostic criteria changed the definition of multiple myeloma from being a disease defined by symptoms to a disease defined by biomarkers. Today, modern combination therapies have reported up to 60% to 80% of patients reaching a complete response. As a logical and necessary step forward, investigators have explored strategies to detect minimal residual disease (MRD) and its correlation with clinical outcomes. Recent meta-analysis data show that MRD negativity is associated with longer progression-free survival and overall survival. In 2016, the updated IMWG response criteria include MRD as the deepest level of treatment response in multiple myeloma. Simultaneously, we are still quite behind in our understanding of the heterogeneous biology of multiple myeloma and its implications for therapy. Emerging DNA sequencing data show that newly diagnosed multiple myeloma patients have a broad range of mutations, which are distributed unevenly in multiple parallel subclones already present at diagnosis. To move beyond the ill-defined category of "high-risk multiple myeloma," which confers to approximately 25% of all newly diagnosed patients, prospective studies are needed to dissect tumor biology and define multiple myeloma subtypes, and, based on biology, seek to define rational therapies for individual subtypes. This article discusses novel insights and gives perspectives on diagnosis and MRD monitoring and future directions for prognosis and clinical management of multiple myeloma. Clin Cancer Res; 22(22); 5428-33. ©2016 AACR SEE ALL ARTICLES IN THIS CCR FOCUS SECTION, "MULTIPLE MYELOMA MULTIPLYING THERAPIES".
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Affiliation(s)
- Ola Landgren
- Myeloma Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York.
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28
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Preffer FI, Yuan CM, Lin P, Stetler-Stevenson M, Marti GE. Introduction to multiple myeloma special issue: The flow cytometric detection of minimal residual disease. CYTOMETRY PART B-CLINICAL CYTOMETRY 2016; 90:9-10. [PMID: 26780351 DOI: 10.1002/cyto.b.21342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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29
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Sales MM, Ferreira SIACP, Ikoma MRV, Sandes AF, Beltrame MP, Bacal NS, Silva MCA, Malvezzi M, Lorand-Metze IGH, Orfao A, Yamamoto M. Diagnosis of chronic lymphoproliferative disorders by flow cytometry using four-color combinations for immunophenotyping: A proposal of the brazilian group of flow cytometry (GBCFLUX). CYTOMETRY PART B-CLINICAL CYTOMETRY 2016; 92:398-410. [PMID: 27362793 DOI: 10.1002/cyto.b.21396] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 06/20/2016] [Accepted: 06/27/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Multiparametric flow cytometry (MFC) is a powerful tool for the diagnosis of hematological malignancies and has been useful for the classification of chronic lymphoproliferative disorders (CLPD) according to the WHO criteria. Following the purposes of the Brazilian Group of Flow Cytometry (GBCFLUX), the aim of this report was to standardize the minimum requirements to achieve an accurate diagnosis in CLPDs, considering the different economic possibilities of the laboratories in our country. Most laboratories in Brazil work with 4-fluorescence flow cytometers, which is why the GBCFLUX CLPD Committee has proposed 4-color monoclonal antibody (MoAb) panels. METHODS/RESULTS Panels for screening and diagnosis in B, T and NK lymphoproliferative disorders were developed based on the normal differentiation pathways of these cells and the most frequent phenotypic aberrations. Important markers for prognosis and for minimal residual disease (MRD) evaluation were also included. The MoAb panels presented here were designed based on the diagnostic expertise of the participating laboratories and an extensive literature review. CONCLUSION The 4-color panels presented to aid in the diagnosis of lymphoproliferative neoplasms by GBCFLUX aim to provide clinical laboratories with a systematic, step-wise, cost-effective, and reproducible approach to obtain an accurate immunophenotypic diagnosis of the most frequent of these disorders. © 2016 International Clinical Cytometry Society.
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Affiliation(s)
- M M Sales
- Hospital Das Clínicas Da Faculdade De Medicina Da Universidade De São Paulo, SP, Brazil
| | | | | | - A F Sandes
- Division of Hematology and Flow Cytometry, Fleury Group, São Paulo, SP, Brazil
| | - M P Beltrame
- Unidade De Apoio Diagnóstico, Hospital De Clínicas - UFPR, Brazil
| | - N S Bacal
- Hospital Albert Einstein, São Paulo, SP, Brazil
| | - M C A Silva
- Hospital Das Clínicas Da Faculdade De Medicina Da Universidade De São Paulo, SP, Brazil
| | - M Malvezzi
- Disciplina De Hematologia Do Departamento De Clínica Médica Da Universidade Federal Do Paraná, PR, Brazil
| | | | - A Orfao
- Cancer Research Centre (IBMCC, CSIC-USAL), Institute of Biomedical Research of Salamanca (IBSAL), Cytometry Service and Department of Medicine, University of Salamanca, Spain
| | - M Yamamoto
- Escola Paulista De Medicina, Universidade Federal De São Paulo (EPM-UNIFESP), SP, Brazil
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30
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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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MRD-driven treatment paradigm for newly diagnosed transplant eligible multiple myeloma patients. Bone Marrow Transplant 2016; 51:913-4. [PMID: 26926231 DOI: 10.1038/bmt.2016.24] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 01/15/2016] [Indexed: 11/08/2022]
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