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Giles HV, Karunanithi K. Performance Characteristics and Limitations of the Available Assays for the Detection and Quantitation of Monoclonal Free Light Chains and New Emerging Methodologies. Antibodies (Basel) 2024; 13:19. [PMID: 38534209 DOI: 10.3390/antib13010019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 02/26/2024] [Accepted: 03/05/2024] [Indexed: 03/28/2024] Open
Abstract
Light chain measurements form an essential component of the testing strategy for the detection and monitoring of patients with suspected and/or proven plasma cell disorders. Urine-based electrophoretic assays remain at the centre of the international guidelines for response assessment but the supplementary role of serum-free light chain (FLC) assays in response assessment and the detection of disease progression due to their increased sensitivity has been increasingly recognised since their introduction in 2001. Serum FLC assays have also been shown to be prognostic across the spectrum of plasma cell disorders and are now incorporated into risk stratification scores for patients with monoclonal gammopathy of undetermined significance (MGUS), smouldering multiple myeloma, and light chain amyloidosis (AL amyloidosis), as well as being incorporated into the criteria for defining symptomatic multiple myeloma. There are now multiple different commercially available serum FLC assays available with differing performance characteristics, which are discussed in this review, along with the implications of these for patient monitoring. Finally, newer methodologies for the identification and characterisation of monoclonal FLC, including modifications to electrophoretic techniques, mass spectrometry-based assays and Amylite, are also described along with the relevant published data available regarding the performance of each assay.
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Affiliation(s)
- Hannah V Giles
- Department of Clinical Haematology, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2SY, UK
- Instute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK
| | - Kamaraj Karunanithi
- Department of Clinical Haematology, University Hospitals North Midlands NHS Trust, Royal Stoke Hospital, Newcastle Road, Stoke-on-Trent ST4 6QG, UK
- School of Medicine, Keele University, Keele, Newcastle-under-Lyme ST5 5BG, UK
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Geng Q, Li J, Li X, Zhang W, Zhang G, Ge L, Liang L. A case report: Nonsecretory multiple myeloma presenting with bone pain. Medicine (Baltimore) 2024; 103:e36951. [PMID: 38306571 PMCID: PMC10843415 DOI: 10.1097/md.0000000000036951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 12/21/2023] [Indexed: 02/04/2024] Open
Abstract
RATIONALE Nonsecretory multiple myeloma (NSMM) is a rare subtype of multiple myelom, occurring in 1% to 2% of multiple myelom and characterized by the inability of clonal plasma cells to synthesize or secrete immunoglobulins. We describe a 71-year-old male patient who began with bone pain and was referred to hospital several times, but was not properly diagnosed and effectively treated. PATIENT CONCERNS A 71-year-old male patient visited our hematology department, complaining of lumbago for 1 year and back pain for half a year. DIAGNOSES Low-dose whole-body bone computed tomography: multiple bone destruction of the sternum, ribs, multiple vertebrae and accessories of the spine, pelvis, bilateral humerus, and proximal femur. Monoclonal plasma cells accounted for 17.5% of nuclear cells in bone marrow puncture smear. Fluorescence in situ hybridization detected amplification of CKS1B (1q21) gene. Immunofixation electrophoresis negative. About 10.72% of monoclonal plasma cells were detected by flow cytometry. Finally, he was diagnosed with NSMM. INTERVENTIONS The patients received VCD chemotherapy (bortezomib 1.3 mg/m2, d1, d4, d8, d11; cyclophosphamide 300 mg/m2, d1-2, d8-9; dexamethasone sodium phosphate 20 mg, d1-2, d4-5, d8-9, d11-12, once every 21 days). OUTCOMES After 2 cycles of VCD treatment, the symptoms of bone pain were significantly relieved, and the efficacy was evaluated as partial response. Follow-up chemotherapy will continue to be completed on schedule. We will continue to follow up to further evaluate the overall survival and progression-free survival. LESSONS This case shows that NSMM is easily missed or misdiagnosed.
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Affiliation(s)
- Qianshuang Geng
- Department of Hematology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, China
| | - Jie Li
- Department of Oncology and Hematology, Liuyang Hospital of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha, China
| | - Xi Li
- Department of Nephrology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, China
| | - Wenjie Zhang
- Department of Image, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, China
| | - Guoxiang Zhang
- Department of Hematology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, China
| | - Li Ge
- Department of Hematology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, China
| | - Li Liang
- Department of Hematology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, China
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Ouzzif Z, Eddair Y, Laassara W, El Maaroufi H, Mahtat EM. Non-Secretory Multiple Myeloma: A New Observation and Review of the Literature. Cureus 2024; 16:e54479. [PMID: 38510859 PMCID: PMC10954289 DOI: 10.7759/cureus.54479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2024] [Indexed: 03/22/2024] Open
Abstract
Non-secreting multiple myeloma is a rare variant of multiple myeloma that affects a relatively young population. It is characterized by the non-secretory nature of malignant plasma cells. The following case report describes the history of a 54-year-old patient with non-secretory myeloma revealed by mechanical and inflammatory low back pain. The bone and neurological involvement, the presence of diffuse osteolytic lesions and the increase in the serum kappa free light chains (FLC) level prompted a myelogram. This finds medullary invasion by dystrophic plasma cells. The absence of detection of complete or incomplete monoclonal immunoglobulin in the blood and urine, as well as the revelation of cytogenetic abnormalities of plasma cells, allows the diagnosis of non-secreting multiple myeloma to be made. This clinical case aims to describe the unusual presentation of this rare form of multiple myeloma.
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Affiliation(s)
- Zohra Ouzzif
- Biochemistry, Metabolic and Molecular Unit, Faculty of Medicine and Pharmacy, Mohammed V Military Training Hospital, Mohammed V University, Rabat, MAR
| | - Yassine Eddair
- Hematology and Immunohematology Laboratory, Faculty of Medicine and Pharmacy, Mohammed V Military Training Hospital, Mohammed V University, Rabat, MAR
| | - Wissal Laassara
- Hematology and Immunohematology Laboratory, Faculty of Medicine and Pharmacy, Mohammed V Military Training Hospital, Mohammed V University, Rabat, MAR
| | - Hicham El Maaroufi
- Department of Clinical Hematology, Faculty of Medicine and Pharmacy, Mohammed V Military Training Hospital, Mohammed V University, Rabat, MAR
| | - El Mehdi Mahtat
- Department of Clinical Hematology, Faculty of Medicine and Pharmacy, Mohammed V Military Training Hospital, Mohammed V University, Rabat, MAR
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Sun H, Liu A, Liu L, Wang W, Cai Z, Yan H, Chen L, Gao G, Wang F, Liao A, Chen B, Feng J, Li J, Huang DP, Gao D, Zhang QK, Luo J, Fu R, Du J, Lu J. Outcome and characteristics of nonsecretory multiple myeloma compared with secretory multiple myeloma: a retrospective multicenter study from China. BMC Cancer 2023; 23:930. [PMID: 37784037 PMCID: PMC10546718 DOI: 10.1186/s12885-023-11223-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 07/25/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Nonsecretory multiple myeloma (NSMM) is a rare type of multiple myeloma (MM). Few studies have described the clinical features and outcomes of NSMM in novel agents. Additionally, the prognostic characteristics have remained controversial in recent years. PURPOSE To investigate the clinical and prognostic features of NSMM and explore the prognostic value of involved free light chain (FLC) levels in NSMM patients in the Chinese population. METHODS We retrospectively enrolled 176 newly diagnosed NSMM cases between January 2005 and December 2021 from 19 clinical centers in China. The control group was selected using a 1:4 propensity score matching technique of newly diagnosed secretory MM, with age, sex and diagnosis time as the matching variables. RESULTS The median age of NSMM patients was 60 years, and 22.6% of patients were classified as ISS stage 3. The ORR of the NSMM patients was 87.4%, and the CR was 65.8%. Compared to the matched secretory MM patients, more NSMM patients achieved CR after first-line treatment (65.8% vs. 36%, p = 0.000). The ORR of first-line treatment was not significantly different between NSMM and secretory MM (89.45% vs. 84.7%, p = 0.196). The first-line PFS was 27.5 m and 23 m (p = 0.063), and the median OS was 81 m and 70 months (p = 0.401). However, for CR-achieved NSMM and CR-not-achieved NSMM patients, the median PFS was 37 m vs. 16 m (p = 0.021), while the median OS showed no difference (107 m vs. 87 m, p = 0.290). In multivariate analysis, the significant factors for PFS were age ≥ 65 and ISS-3. ISS-3 was the only independent prognostic factor of OS. The iFLC ≥ 50 mg/L group had a high ORR of 97.3%, and the median PFS and OS were 48 m and NR, respectively. Compared to the matched secretory MM, the iFLC ≥ 50 mg/L group also showed more CR and longer OS (NR vs. 70 m, p = 0.006) and PFS (48 m vs. 23 m, p = 0.003). CONCLUSIONS Our results revealed that Chinese NSMM patients are younger and have a higher CR but not superior survival. The subgroup of NSMM patients with iFLC ≥ 50 mg/L had better outcomes than secretory MM.
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Affiliation(s)
- Hailu Sun
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, P.R. China
| | - Aijun Liu
- Department of Hematology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, P.R. China
| | - Lihong Liu
- Department of Hematology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Wei Wang
- Department of Hematology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, P.R. China
| | - Zhen Cai
- Bone Marrow Transplantation Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, P.R. China
| | - Hua Yan
- Department of Hematology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P.R. China
| | - Lijuan Chen
- Department of Hematology, Jiangsu Province Hospital, The First Affiliated Hospital With Nanjing Medical University, Nanjing, Jiangsu, P.R. China
| | - Guangxun Gao
- Department of Hematology, Xijing Hospital, Air Force Medical University, Xi'an, Shanxi, P.R. China
| | - Fang Wang
- Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
| | - Aijun Liao
- Haematology Department of Shengjing Hospital, China Medical University, Shenyang, Liaoning, P.R. China
| | - Bing Chen
- Department of Hematology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, P.R. China
| | - Jia Feng
- Department of Hematology, Peking University Shenzhen Hospital, Shenzhen, Guangdong, P.R. China
| | - Juan Li
- Department of Hematology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, P.R. China
| | - Dong-Ping Huang
- Department of Hematology, Yijishan Hospital, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, P.R. China
| | - Da Gao
- Department of Hematology, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, P.R. China
| | - Qi-Ke Zhang
- Department of Hematology, People's Hospital of Gansu Province, Lanzhou, Gansu, P.R. China
| | - Jun Luo
- The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, P.R. China
| | - Rong Fu
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin, P.R. China.
| | - Juan Du
- Department of Hematology, Myeloma & Lymphoma Center, Shanghai Changzheng Hospital, Naval medical University, Shanghai, P.R. China.
| | - Jin Lu
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, P.R. China.
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5
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[Analysis of clinical characteristics and prognosis of non-secretory multiple myeloma]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2022; 43:861-864. [PMID: 36709202 PMCID: PMC9669626 DOI: 10.3760/cma.j.issn.0253-2727.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Ling VYH, Reddivari S, Joseph AM, Cox R. Oligosecretory myeloma with gastrointestinal tract involvement: an unusual presentation and literature review. BMJ Case Rep 2022; 15:e247742. [PMID: 35365468 PMCID: PMC8977735 DOI: 10.1136/bcr-2021-247742] [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] [Accepted: 03/23/2022] [Indexed: 11/04/2022] Open
Abstract
A woman in her 70s with vague gastrointestinal (GI) symptoms and unintentional weight loss was referred to endoscopy clinic for investigation and consideration of GI malignancy. CT of the thorax, abdomen and pelvis showed a suspicious mass in the oesophago-gastric junction with a lytic lesion on S1-S2 sacrum. A subsequent upper GI endoscopy revealed two raised, ulcerated tumours on the lesser curvature of the stomach. By the time an MRI of the whole spine was done which revealed multiple metastases involving thoracic, lumbar and sacral skeleton, she had developed leg weakness and paraesthesias, consistent with the imaging findings. A positron emission tomography/CT scan further confirmed the above findings. The initial working diagnosis was primary GI tumour with bony metastases. However, she was later referred to the haematology team after the immunohistochemistry of the tumour showed that it was of a plasma cell origin (CD138 positive) associated with lambda light chain deposits. Serum-free light chain showed a raised lambda light chain of 272 mg/L and kappa light chain of 11.3 mg/L and involved/uninvolved light chain ratio of 24. Bone marrow biopsy confirmed a plasma cell myeloma with moderate disease burden. Monoclonal lambda chains were demonstrated on immunofixation but negative on serum protein electrophoresis and hence a diagnosis of oligosecretory myeloma with GI involvement was made. Subsequent management involved physiotherapy, pain management and chemotherapy, where this woman was commenced on Velcade (generically known as bortezomib), thalidomide and dexamethasone and she continued to experience clinical and biochemical improvement.
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Affiliation(s)
- Victor Yu Han Ling
- Haematology Department, Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - Sreekanth Reddivari
- Haematology Department, Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - Angel Mary Joseph
- Haematology Department, Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - Rosie Cox
- Haematology Department, Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, UK
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7
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Zhang B, Bian B, Zhang Y, Zhang L, Zhang R, Wang J. The Apparent Diffusion Coefficient of Diffusion-Weighted Whole-Body Magnetic Resonance Imaging Affects the Survival of Multiple Myeloma Independently. Front Oncol 2022; 12:780078. [PMID: 35311101 PMCID: PMC8931198 DOI: 10.3389/fonc.2022.780078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 02/07/2022] [Indexed: 02/03/2023] Open
Abstract
Background Diffusion-weighted whole-body MRI (DW-MRI) is increasingly used to evaluate bone diseases of multiple myeloma (MM), but there is lack of quantitative indicator for DW-MRI to reflect the prognosis of MM. Apparent diffusion coefficient (ADC) values in DW-MRI has potential correlations between some indexes of MM, but the influence of ADC on MM survival needs to be further verified. Methods A total of 381 newly diagnosed MM patients were enrolled in the study to analyze the effect of ADC values in DW-MRI on progression-free survival (PFS) and overall survival (OS). The Kaplan–Meier method was used to perform univariate survival analysis, and the Cox proportional hazards model was used for multivariate analysis. In addition to the ADC value, genetic and serological indexes were also included. Results The survivals were observed in univariate ADC stratification with median PFS of 52.0, 45.0, 34.0, and 26.0 months (the unit of ADC value was 10−3 mm2/s; the ADC ranges were ADC < 0.4886, 0.4886 ≤ ADC < 0.6545, 0.6545 ≤ ADC < 0.7750, and ADC ≥ 0.7750; 95% CI, 43.759–62.241, 46.336–53.664, 39.753–46.247, and 27.812–32.188). The OS were 81.0, 61.0, 47.0, and 36.0 months (p < 0.001; 95% CI, 71.356–82.644, 67.630–70.370, 57.031–60.969, and 36.107–43.893). In Cox proportional hazards model, the ADC value was considered to be an independent risk factor affecting PFS and OS of MM (both p < 0.001). Conclusions This study supports that ADC in DW-MRI may independently stratify MM patients and better predict their prognosis. The combined use of DW-MRI and other parameters allows more accurate evaluation of MM survival. Trial Registration http://www.chictr.org.cn/showproj.aspx?proj=49012, ChiCTR2000029587.
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Affiliation(s)
- Bei Zhang
- Department of Radiology, First Hospital of Jilin University, Changchun, China
| | - Bingyang Bian
- Department of Radiology, First Hospital of Jilin University, Changchun, China
| | - Yanjiao Zhang
- Department of Radiology, First Hospital of Jilin University, Changchun, China
| | - Li Zhang
- Department of Radiology, First Hospital of Jilin University, Changchun, China
| | - Rongkui Zhang
- Department of Hematology, First Hospital of Jilin University, Changchun, China
| | - Jiping Wang
- Department of Radiology, First Hospital of Jilin University, Changchun, China
- *Correspondence: Jiping Wang,
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Utility of PET/CT in Assessing Early Treatment Response in Patients With Newly Diagnosed Multiple Myeloma. Blood Adv 2022; 6:2763-2772. [PMID: 35235951 PMCID: PMC9092399 DOI: 10.1182/bloodadvances.2022007052] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 02/20/2022] [Indexed: 11/20/2022] Open
Abstract
Multiple Myeloma (MM) is a plasma cell malignancy characterized by diverse clinical presentations. While biochemical assessment of disease activity is commonly utilized to monitor treatment response, findings on magnetic resonance imaging and positron emission tomography/computed tomography (PET/CT), among other imaging modalities, have proven to harbor prognostic value. We sought to corroborate these findings by examining the prognostic significance of Fluorodeoxyglucose (FDG) PET/CT scanning in the setting of newly diagnosed MM. We retrospectively analyzed 195 patients with a PET/CT available both at diagnosis and at 6 months post-treatment to examine the value of PET/CT results as an adjuvant metric to conventional hematologic responses in terms of time to next treatment (TTNT) and overall survival (OS). The median TTNT and OS for the entire cohort were 24.6 (95% CI=20.4-29.1) and 79 (95% CI=63.1-119.1) months, respectively. When comparing PET/CT (-) with PET/CT (+) patients, we found significantly prolonged median TTNT (55.2 vs. 17.8 months, p<0.0001) and OS (unreached vs. 60.8 months, p<0.0001) for the PET/CT (-) group. We then examined the additive value of PET/CT on the hematologic response achieved at 6 months, and we found that PET/CT (-) is associated with significantly increased median TTNT and OS for both the very good partial response (VGPR) group and the less than VGPR group. Importantly, PET/CT retained prognostic significance after adjusting for multiple other predictive variables. We conclude that a PET/CT (-) at 6 months confers a significant prognostic advantage for newly diagnosed MM patients and adds significant value to the hematologic response assessment.
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Redefining Non-measurable Multiple Myeloma Using Mass Spectrometry. Blood 2021; 139:946-950. [PMID: 34871382 DOI: 10.1182/blood.2021013794] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 11/15/2021] [Indexed: 11/20/2022] Open
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10
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Non secretory myeloma in young man mimicking the Gorham disease: case report and the literature review. ROMANIAN JOURNAL OF INTERNAL MEDICINE = REVUE ROUMAINE DE MÉDECINE INTERNE 2021; 60:77-84. [PMID: 34610233 DOI: 10.2478/rjim-2021-0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Indexed: 11/20/2022]
Abstract
Multiple myeloma is a neoplasm of plasma cells affecting mostly the elderly with incidence peaks between 60 and 70 years. This disease is exceedingly rare in younger people, especially in adults under 30-year-old. Non-secretory multiple myeloma accounts for 1-5% of all cases of multiple myeloma. It is also a rare condition in young adult patients, and only six cases have been reported [1]. We herein describe a rare case of non-secretory myeloma in a 22- year-old male, explaining from chest wall pain, without general manifestation. Plain radiography and CT scans revealed diffuse osteolytic lesion mimicking the Gorham disease. A bone marrow biopsy was conducted, revealing the diagnosis of myeloma.
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Wang J, Zhang B, Zhang R, Zhang L, Jiang W, Jiang Y. Role of whole-body diffusion-weighted imaging in evaluation of multiple myeloma. Medicine (Baltimore) 2021; 100:e27131. [PMID: 34477159 PMCID: PMC8415940 DOI: 10.1097/md.0000000000027131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 08/18/2021] [Indexed: 01/05/2023] Open
Abstract
The evaluation of bone disease in multiple myeloma (MM) is an important topic in imaging. This study retrospectively investigated whole-body diffusion-weighted imaging (WB-DWI) in the evaluation of bone marrow infiltration and treatment response in MM.A total of 126 patients with MM who underwent WB-DWI between January 2016 and December 2020 were enrolled. All the patients received 4-course induction chemotherapy. WB-DWI was performed before and after chemotherapy to measure the apparent diffusion coefficient (ADC) values. According to gender and Revised International Staging System (RISS) staging groups, the relationship between ADC value and bone marrow plasma cell infiltration ratio before treatment were explored using Spearman and Pearson correlation coefficients. Comparison of ADC values before and after treatment according to different chemotherapy regimens and treatment response was performed by 2-independent samples non-parametric tests and t test.There was a negative correlation between the ADC value and the degree of bone marrow infiltration and this was statistically significant (r = -0.843, P < .001). In different gender and RISS groups, ADC value before treatment was negatively correlated with the proportion of plasma cell infiltration (male, r = -0.849; female, r = -0.836; Stage I, r = -0.659; Stage II, r = -0.870; Stage III, r = -0.745; all P < .001). The ADC values of all subjects increased to varying degrees after 4-course induction chemotherapy, including different chemotherapy regimens and treatment responses (all P < .05 except for progressive disease group).The ADC value was negatively correlated with the degree of bone marrow infiltration in different gender and RISS stages. The ADC value increased after treatment, but it was not consistent with progressive disease group. The increase of ADC value may indicate the disease burden and outcome of MM induced chemotherapy.
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Affiliation(s)
- Jiping Wang
- Department of Radiology, First Hospital of Jilin University, Changchun, China
| | - Bei Zhang
- Department of Radiology, First Hospital of Jilin University, Changchun, China
| | - Rongkui Zhang
- Department of Radiology, First Hospital of Jilin University, Changchun, China
| | - Li Zhang
- Department of Radiology, First Hospital of Jilin University, Changchun, China
| | - Wenyan Jiang
- Department of Radiology, First Hospital of Jilin University, Changchun, China
| | - Yaqiu Jiang
- Department of Cardiovascular Center, First Hospital of Jilin University, Changchun, China
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O'Brien A, O'Halloran F, Mykytiv V. Minimal Residual Disease in Multiple Myeloma: Potential for Blood-Based Methods to Monitor Disease. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2021; 22:e34-e40. [PMID: 34470720 DOI: 10.1016/j.clml.2021.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/25/2021] [Accepted: 07/29/2021] [Indexed: 10/20/2022]
Abstract
In recent years, the life expectancy of Multiple Myeloma (MM) patients has substantially improved, but this cancer remains incurable with increasing incidence in the developed world. Most MM patients will eventually relapse due to residual drug-resistant cancerous cells that survive treatment, commonly referred to as minimal residual disease (MRD). Methods to improve MRD detection in MM patients are generating considerable interest as a means of monitoring patients' response to treatment. In clinical laboratories, these methods currently require bone marrow aspirates which are invasive and frequently miss detection of localised disease due to the spatial heterogeneity of disease infiltration. By simplifying serial sampling and allowing for the detection of extramedullary disease, a blood-based method could significantly impact treatment duration and intensity and minimise chemotherapy-induced toxicity. This review will describe the current blood-based techniques available to detect MRD in MM and compare their potential to evaluate patient prognosis and drive therapeutic decisions.
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Affiliation(s)
- Aisling O'Brien
- Dept. of Biological Sciences, Munster Technological University, Cork, Ireland; Dept. of Immunology, Cork University Hospital, Cork, Ireland.
| | - Fiona O'Halloran
- Dept. of Biological Sciences, Munster Technological University, Cork, Ireland
| | - Vitaliy Mykytiv
- Dept. of Haematology, Cork University Hospital, Cork, Ireland; Dept. of Medicine, University College Cork, Cork, Ireland
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Lawless S, Sbianchi G, Morris C, Iacobelli S, Bosman P, Blaise D, Reményi P, Byrne JL, Mayer J, Apperley J, Lund J, Kobbe G, Schaap N, Isaksson C, Lenhoff S, Basak G, Touzeau C, Wilson KMO, González Muñiz S, Scheid C, Browne P, Anagnostopoulos A, Rambaldi A, Jantunen E, Kröger N, Schönland S, Yakoub-Agha I, Garderet L. IgD Subtype But Not IgM or Non-Secretory Is a Prognostic Marker for Poor Survival Following Autologous Hematopoietic Cell Transplantation in Multiple Myeloma. Results From the EBMT CALM (Collaboration to Collect Autologous Transplant Outcomes in Lymphomas and Myeloma) Study. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2021; 21:686-693. [PMID: 34158265 DOI: 10.1016/j.clml.2021.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 05/12/2021] [Accepted: 05/16/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The Collaboration to Collect Autologous Transplant Outcomes in Lymphoma and Myeloma (CALM) study has provided an opportunity to evaluate the real-world outcomes of patients with myeloma. The aim of this study was to compare the outcome according to the different subtypes of myeloma using CALM data. PATIENTS This study compared overall survival (OS), progression-free survival (PFS), and complete remission (CR) and the impact of novel versus non-novel drug containing induction regimens prior to autologous hematopoietic cell transplantation (HCT) of 2802 patients with "usual" and "rare" myelomas. RESULTS Our data suggest that IgM and non-secretory myeloma have superior PFS and OS compared with IgD myeloma and outcomes comparable to those for usual myeloma. Patients who received novel agent induction had higher rates of CR prior to transplant. Non-novel induction regimens were associated with inferior PFS but no difference in OS. Although not the primary focus of this study, we show that poor mobilization status is associated with reduced PFS and OS, but these differences disappear in multivariate analysis suggesting that poor mobilization status is a surrogate for other indicators of poor prognosis. CONCLUSION We confirm that IgD myeloma is associated with the worst prognosis and inferior outcomes compared with the other isotypes.
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Affiliation(s)
- Sarah Lawless
- Belfast City Hospital, Belfast, Northern Ireland, United Kingdom.
| | | | - Curly Morris
- Queens University of Belfast, Belfast, Northern Ireland United Kingdom
| | | | - Paul Bosman
- EBMT Data Office Leiden, Leiden, Netherlands
| | | | | | - J L Byrne
- Nottingham University, Nottingham, United Kingdom
| | - Jiri Mayer
- University Hospital Brno, Brno, Czech Republic
| | | | - Johan Lund
- Karolinska University Hospital, Stockholm, Sweden
| | - Guido Kobbe
- Heinrich Heine Universität Düsseldorf, Düsseldorf, Germany
| | | | | | | | | | | | - Keith M O Wilson
- St. James's University Hospital of Wales, Cardiff, Wales, United Kingdom
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Brown JE, Russell EB, Moore AR, Oscos-Snowball A, Stent A, Courtman NF. Hypoglobulinemia in a dog with disseminated plasma cell neoplasia: Case report and review of the diagnostic criteria. Vet Clin Pathol 2021; 50:227-235. [PMID: 33913178 DOI: 10.1111/vcp.12948] [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: 05/28/2020] [Revised: 08/13/2020] [Accepted: 09/03/2020] [Indexed: 01/01/2023]
Abstract
This is the first reported case of hypoglobulinemia in a dog with disseminated plasma cell neoplasia. A 6-year-old male intact Rottweiler was referred to the U-Vet Animal Hospital (Werribee, Vic, Australia) for weight loss, hyporexia, lethargy, vomiting, and soft stools. Examination of a buffy coat preparation and splenic and liver aspirates revealed a monomorphic population of plasmacytoid cells, and the same cells comprised approximately 90% of bone marrow samples submitted for cytologic and histologic evaluation. Biochemistry revealed a hypoglobulinemia, and the presence of an M-protein was not supported by serum and urine protein electrophoresis or serum immunofixation. Immunohistochemistry demonstrated strong nuclear labeling for MUM-1.
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Affiliation(s)
- Juliet E Brown
- U-Vet Werribee Animal Hospital and Faculty of Veterinary and Agricultural Science, University of Melbourne, Werribee, Vic., Australia
| | - Elise B Russell
- U-Vet Werribee Animal Hospital and Faculty of Veterinary and Agricultural Science, University of Melbourne, Werribee, Vic., Australia
| | - A Russell Moore
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO, USA
| | - Astrid Oscos-Snowball
- U-Vet Werribee Animal Hospital and Faculty of Veterinary and Agricultural Science, University of Melbourne, Werribee, Vic., Australia
| | - Andrew Stent
- U-Vet Werribee Animal Hospital and Faculty of Veterinary and Agricultural Science, University of Melbourne, Werribee, Vic., Australia
| | - Natalie F Courtman
- U-Vet Werribee Animal Hospital and Faculty of Veterinary and Agricultural Science, University of Melbourne, Werribee, Vic., Australia
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Li X, Wu N, Zhang W, Liu Y, Ming Y. Differential diagnostic value of 18F-FDG PET/CT in osteolytic lesions. J Bone Oncol 2020; 24:100302. [PMID: 32760643 PMCID: PMC7393436 DOI: 10.1016/j.jbo.2020.100302] [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: 02/09/2020] [Revised: 05/30/2020] [Accepted: 06/01/2020] [Indexed: 12/21/2022] Open
Abstract
Background Both bone metastases and multiple myeloma (MM) are malignant diseases that can appear osteolytic on imaging and are difficult to differentiate. While positron emission tomography/computed tomography (PET/CT) has been demonstrated useful for the diagnosis of various bone lesions, correlations between PET/CT and histopathology and these diseases are unclear. This retrospective study investigated the optimal cutoff standardized uptake value (SUV) to differentiate MM and bone metastasis. Methods Patients with newly diagnosed osteolytic lesions (n = 344) and suspected malignancy underwent both fluorodeoxyglucose (FDG) PET/CT and biopsy/surgery. FDG uptake and morphologic changes (e.g., soft tissue mass formation) were compared with pathological results. Results A total of 8896 osteolytic lesions were evaluated. The SUVmax of MM osteolytic lesions (1.6 ± 0.7) was significantly lower than that of bone metastases (5.5 ± 2.7; p = 0.000). The best cutoff SUVmax for differentiating MM and bone metastasis was 2.65 (sensitivity 86.1%, specificity 94.7%; p = 0.000). The SUVmax of bone lesions of soft tissue mass was higher than that for pure osteolytic lesions (p = 0.000). A greater percentage of patients with bone metastasis had a soft tissue mass (7%) than did patients with MM (2%). The mean SUVmax of bone metastases was 5.5 ± 2.7 (0.4-30.4); that of primary tumors was 7.5 ± 4.2 (1.0-28.5). The SUVmax of bone metastases significantly correlated with the SUVmax of primary tumors (r = 0.532; p = 0.000). Conclusions FDG PET/CT is a valuable tool to differentiate osteolytic lesions. The best cutoff value of SUVmax for differentiating MM from bone metastasis is 2.65. The significant correlation between the SUVmax of bone metastasis and that of primary tumors is helpful for detecting primary tumors.
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Affiliation(s)
- Xiaomeng Li
- Department of PET/CT, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ning Wu
- Department of PET/CT, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenjie Zhang
- Department of PET/CT, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Liu
- Department of PET/CT, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yue Ming
- Department of PET/CT, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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