1
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Wong XY, Chng WJ, Aziz MIA, Ng K. Cost-effectiveness of daratumumab in combination with lenalidomide and dexamethasone for relapsed and/or refractory multiple myeloma. Expert Rev Pharmacoecon Outcomes Res 2021; 22:207-215. [PMID: 34904498 DOI: 10.1080/14737167.2022.2017285] [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: 10/19/2022]
Abstract
OBJECTIVE This study evaluates the cost-effectiveness of daratumumab (D) in combination with lenalidomide and dexamethasone (Rd) for treatment of relapsed and/or refractory multiple myeloma in patients who have received at least one prior therapy in Singapore. METHODS A 3-state partitioned survival model was developed to evaluate the cost-effectiveness of lenalidomide and dexamethasone with or without daratumumab from a healthcare system perspective over 10 years. Clinical inputs were obtained from the POLLUX trial. Health state utilities were derived from the literature and direct medical costs obtained from public healthcare institutions. Sensitivity and scenario analyses were conducted to explore uncertainties. RESULTS DRd was associated with a high base-case incremental cost-effectiveness ratio (ICER) of US$576,247 per quality-adjusted life year (QALY) gained, compared with Rd. According to one-way sensitivity analysis, ICER was most heavily influenced by time horizon, discount rate for outcomes, progression-free utility and cost of daratumumab. Regardless of the variation, DRd remained not cost-effective. Even when the cost of both daratumumab and lenalidomide dropped by 20% and 80%, the ICERs remained high at US$470,400 and US$152,860 per QALY gained. CONCLUSIONS At current prices, the addition of daratumumab to lenalidomide and dexamethasone does not represent cost-effective use of healthcare resources in Singapore.
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Affiliation(s)
- Xin Yi Wong
- Agency for Care Effectiveness, Ministry of Health, Singapore
| | - Wee Joo Chng
- Division of Haematology, Department of Haematology-Oncology, National University Cancer Institute, Singapore.,Cancer Science Institute of Singapore, National University of Singapore (NUS), Singapore.,Yong Loo Lin School of Medicine, NUS, Singapore
| | | | - Kwong Ng
- Agency for Care Effectiveness, Ministry of Health, Singapore
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2
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Sharma P, Singh Sachdeva MU, Varma N, Bose P, Aggarwal R, Malhotra P. Utility and feasibility of a six-color multiparametric flow cytometry for measurable residual disease analysis in plasma cell myeloma in resource-limited settings with 5-year survival data. J Cancer Res Ther 2021; 17:1515-1520. [PMID: 34916387 DOI: 10.4103/jcrt.jcrt_1027_19] [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: 11/04/2022]
Abstract
Introduction Treatment of multiple myeloma (MM) has evolved over decades with the introduction of novel therapeutic strategies. Response rates has significantly improved; however, there is a need for more sensitive techniques to study the residual disease other than conventional means. We evaluated the feasibility and utility of a two-tube six color multiparametric flow cytometry (MFC) assay for measurable residual disease (MRD) detection in MM patients on treatment. Methodology Pretitrated cocktails containing antibodies against CD38, CD138, CD45, CD19, CD56, CD81, CD27, and cytoplasmic kappa and lambda light chains were used in the combination of two tubes and were acquired on a flow cytometer. Limit of detection was determined through dilution and spiking experiments with a limit of 0.01%. Results Of the 62 patients screened, 58 patients were included in the final study cohort (day 100 postautologous stem cell transplant and at the end of induction chemotherapy). Twenty-eight patients (48%) revealed the presence of MRD in bone marrow on MFC (median = 0.12, range = 0.01-5.89%). Out of 28 MFC-MRD positive patients, only 16 patients showed M band on immunofixation-electrophoresis (IFE) (MRD+/IFE+, 57%), and rest of them were IFE negative (MRD+/IFE-, 42%). Patients with MRD positive status at the end of induction chemotherapy or day 100 posttransplant had an inferior overall survival (P = 0.009) and progression-free survival (P = 0.0002) than those with MRD negativity. Conclusion We have demonstrated the impact of MRD testing in MM using MFC with a long follow-up data, suggesting its routine incorporation in monitoring the disease independent of the immunofixation status.
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Affiliation(s)
- Praveen Sharma
- Department of Hematology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Man Updesh Singh Sachdeva
- Department of Hematology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Neelam Varma
- Department of Hematology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Parveen Bose
- Department of Hematology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritu Aggarwal
- Department of Immunopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Malhotra
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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3
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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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4
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Takasu M, Kondo S, Akiyama Y, Takahashi Y, Maeda S, Baba Y, Kawase T, Ichinohe T, Awai K. Assessment of early treatment response on MRI in multiple myeloma: Comparative study of whole-body diffusion-weighted and lumbar spinal MRI. PLoS One 2020; 15:e0229607. [PMID: 32106239 PMCID: PMC7046272 DOI: 10.1371/journal.pone.0229607] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 02/10/2020] [Indexed: 12/17/2022] Open
Abstract
Objectives To compare remission status at completion of chemotherapy for multiple myeloma (MM) with changes in total diffusion volume (tDV) calculated from whole-body diffusion-weighted imaging (WB-DWI) and fat fraction (FF) of lumbar bone marrow (BM) by modified Dixon Quant (mDixon Quant) soon after induction of chemotherapy, and to assess the predictive value of MRI. Methods Fifty patients (mean age, 66.9 ± 10.5 years) with symptomatic myeloma were examined before and after two cycles of chemotherapy. From WB-DWI data, tDV was obtained with the threshold for positive BM involvement. Mean FF was calculated from lumbar BM using the mDixon Quant sequence. At the completion of chemotherapy, patients were categorized into a CR/very good PR (VGPR) group (n = 15; mean age, 67.6 ± 10.3 years) and a PR, SD or PD group (n = 35; mean age, 69.1 ± 8.6 years). ROC curves were plotted to assess performance in predicting achievement of CR/VGPR. Results At second examination, serum M protein, β2-microglobulin, and tDV were significantly decreased and hemoglobin, mean ADC, and FF were significantly increased in the CR/VGPR group and serum M protein was significantly increased in the PR/SD/PD group. The general linear model demonstrated that percentage changes in FF and M protein contributed significantly to achieving CR/VGPR (P = 0.02, P = 0.04, respectively). AUCs of ROC curves were 0.964 for FF and 0.847 for M protein. Conclusions Early change in FF of lumbar BM and serum M protein soon after induction of chemotherapy contributed significantly to prediction of CR/VGPR.
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Affiliation(s)
- Miyuki Takasu
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
- * E-mail:
| | - Shota Kondo
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuji Akiyama
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuji Takahashi
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Shogo Maeda
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Yasutaka Baba
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Takakazu Kawase
- Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Tatsuo Ichinohe
- Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Kazuo Awai
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
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Saltarella I, Morabito F, Giuliani N, Terragna C, Omedè P, Palumbo A, Bringhen S, De Paoli L, Martino E, Larocca A, Offidani M, Patriarca F, Nozzoli C, Guglielmelli T, Benevolo G, Callea V, Baldini L, Grasso M, Leonardi G, Rizzo M, Falcone AP, Gottardi D, Montefusco V, Musto P, Petrucci MT, Dammacco F, Boccadoro M, Vacca A, Ria R. Prognostic or predictive value of circulating cytokines and angiogenic factors for initial treatment of multiple myeloma in the GIMEMA MM0305 randomized controlled trial. J Hematol Oncol 2019; 12:4. [PMID: 30626425 PMCID: PMC6327520 DOI: 10.1186/s13045-018-0691-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 12/25/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Several new drugs are approved for treatment of patients with multiple myeloma (MM), but no validated biomarkers are available for the prediction of a clinical outcome. We aimed to establish whether pretreatment blood and bone marrow plasma concentrations of major cytokines and angiogenic factors (CAFs) of patients from a phase 3 trial of a MM treatment could have a prognostic and predictive value in terms of response to therapy and progression-free and overall survival and whether these patients could be stratified for their prognosis. METHODS Blood and bone marrow plasma levels of Ang-2, FGF-2, HGF, VEGF, PDGF-β, IL-8, TNF-α, TIMP-1, and TIMP-2 were determined at diagnosis in MM patients enrolled in the GIMEMA MM0305 randomized controlled trial by an enzyme-linked immunosorbent assay (ELISA). These levels were correlated both reciprocally and with the type of therapy and patients' characteristics and with a group of non-MM patients as controls. RESULTS No significant differences were detected between the blood and bone marrow plasma levels of angiogenic cytokines. A cutoff for each CAF was established. The therapeutic response of patients with blood plasma levels of CAFs lower than the cutoff was better than the response of those with higher levels in terms of percentage of responding patients and quality of response. CONCLUSION FGF-2, HGF, VEGF, and PDGF-β plasma levels at diagnosis have predictive significance for response to treatment. The stratification of patients based on the levels of CAFs at diagnosis and their variations after therapy is useful to characterize different risk groups concerning outcome and response to therapy. TRIAL REGISTRATION Clinical trial information can be found at the following link: NCT01063179.
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Affiliation(s)
- Ilaria Saltarella
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Fortunato Morabito
- Biothecnology Research Unit, Aprigliano, Cosenza, Italy.,Hemato-oncology Department Augusta Victoria Hospital, Jerusalem, Israel
| | - Nicola Giuliani
- Department of Clinical and Experimental Medicine, Myeloma Unit, University of Parma, Parma, Italy
| | - Carolina Terragna
- "Seràgnoli" Institute of Hematology, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Bologna University School of Medicine, Bologna, Italy
| | - Paola Omedè
- Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Antonio Palumbo
- Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Sara Bringhen
- Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | | | - Enrica Martino
- Division of Hematology, AOU "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Alessandra Larocca
- Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | | | | | - Chiara Nozzoli
- Cellular Therapies and Transfusion Medicine Unit, AOU Careggi, Florence, Italy
| | | | - Giulia Benevolo
- SC Hematology AO Città della Salute e della Scienza, Turin, Italy
| | - Vincenzo Callea
- Divisione di Ematologia, Ospedali Riuniti, Reggio di Calabria, Italy
| | - Luca Baldini
- Hematology Unit, Fondazione IRCCS, Cà Granda, OM Policlinico, DIPO, University of Milan, Milan, Italy
| | | | - Giovanna Leonardi
- Department of Oncology and Hematology AOU, Hematology Unit, Modena, Italy
| | | | | | - Daniela Gottardi
- A.O.U. S. Giovanni Battista A.O. Mauriziano-Umberto I, Turin, Italy
| | | | - Pellegrino Musto
- IRCCS Centro di Riferimento Oncologico della Basilicata, Rionero in Vulture, Italy
| | - Maria Teresa Petrucci
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Rome, Italy
| | - Franco Dammacco
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Mario Boccadoro
- Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Angelo Vacca
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Roberto Ria
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro" Medical School, Bari, Italy. .,Internal Medicine "G. Baccelli", Myeloma Unit, University of Bari "Aldo Moro" Medical School, Azienda Ospedaliero-Universitaria Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy.
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6
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Cordone I, Marchesi F, Masi S, Summa V, Pisani F, Merola R, Cigliana G, Orlandi G, Gumenyuk S, Palombi F, Romano A, Spadea A, Renzi D, Papa E, Canfora M, Conti L, Petti MC, Mengarelli A. Flow cytometry remission by Ig light chains ratio is a powerful marker of outcome in multiple myeloma after tandem autologous transplant: a real-life study. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2016; 35:49. [PMID: 26992692 PMCID: PMC4799564 DOI: 10.1186/s13046-016-0324-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 03/11/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND The achievement of complete response (CR) significantly correlates with a better clinical outcome in multiple myeloma (MM) patients treated with autologous stem cell transplant (ASCT). The depth of response is one of the most relevant factors to predict patient's outcome, however the definition of CR through standard criteria has shown several limitations. METHODS In this study we evaluated the minimal residual disease (MRD) in 50 consecutive MM patients who underwent an up-front tandem ASCT in our center, using a single-tube six-colors flow cytometry assay (FC) based on intra-cytoplasmic immunoglobulin (cy-Ig) light chains ratio evaluated on patient-specific plasma cells (PC) immune profile, in a real-life setting. RESULTS With a sensitivity up to 10(-5), clonal-PC were documented by FC in 36.4% (12/33) of patients in conventional CR after second transplant. The number of flow MRD-negative patients significantly increased after induction and first ASCT, but not between first and second transplant. The 5-years progression-free survival (5ys-PFS) of flow MRD-negative patients after second transplant was significantly better than patients who remained MRD-positive considering both all patients (5ys-PFS: 70% vs 5%) and patients in CR according to standard criteria (5ys-PFS: 67% vs 0%). CONCLUSIONS FC remission through cy-Ig light ratio on PC sub-populations is a sensitive, highly informative, low-cost and routinely applicable MRD assay, a powerful tool in treatment response evaluation and a crucial marker of outcome in MM.
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Affiliation(s)
- Iole Cordone
- Clinical Pathology, Regina Elena National Cancer Institute, Rome, Italy. .,Clinical Pathology, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.
| | - Francesco Marchesi
- Hematology and Stem Cell Transplant Unit, Regina Elena National Cancer Institute, Rome, Italy
| | - Serena Masi
- Clinical Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Valentina Summa
- Clinical Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Francesco Pisani
- Hematology and Stem Cell Transplant Unit, Regina Elena National Cancer Institute, Rome, Italy
| | - Roberta Merola
- Clinical Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Giovanni Cigliana
- Clinical Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Giulia Orlandi
- Clinical Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Svitlana Gumenyuk
- Hematology and Stem Cell Transplant Unit, Regina Elena National Cancer Institute, Rome, Italy
| | - Francesca Palombi
- Hematology and Stem Cell Transplant Unit, Regina Elena National Cancer Institute, Rome, Italy
| | - Atelda Romano
- Hematology and Stem Cell Transplant Unit, Regina Elena National Cancer Institute, Rome, Italy
| | - Antonio Spadea
- Hematology and Stem Cell Transplant Unit, Regina Elena National Cancer Institute, Rome, Italy
| | - Daniela Renzi
- Hematology and Stem Cell Transplant Unit, Regina Elena National Cancer Institute, Rome, Italy
| | - Elena Papa
- Hematology and Stem Cell Transplant Unit, Regina Elena National Cancer Institute, Rome, Italy
| | - Marco Canfora
- Scientific Direction, Regina Elena National Cancer Institute, Rome, Italy
| | - Laura Conti
- Clinical Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Maria Concetta Petti
- Hematology and Stem Cell Transplant Unit, Regina Elena National Cancer Institute, Rome, Italy
| | - Andrea Mengarelli
- Hematology and Stem Cell Transplant Unit, Regina Elena National Cancer Institute, Rome, Italy
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7
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Wang L, Zhang S, Ou J, Bai H. [Cytotoxity of pomalidomide combined CAR-T cell for multiple myeloma cell RPMI8226 and U266]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2016; 36:497-500. [PMID: 26134016 PMCID: PMC7343067 DOI: 10.3760/cma.j.issn.0253-2727.2015.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
目的 观察CD138-CAR-T细胞对人多发性骨髓瘤(MM)细胞株RPMI8226和U266细胞的杀伤作用,探讨泊马度胺对CD138-CAR-T细胞及其杀伤作用的影响。 方法 采用CFSE/7-AAD双标法检测CD138-CAR-T细胞及其联合泊马度胺对RPMI8226、U266细胞的杀伤活性。ELISA法检测CD138-CAR-T细胞分泌IFN-γ的变化。 结果 CD138-CAR-T细胞作用18 h后,对RPMI8226、U266细胞的杀伤活性分别为(55.2±3.9)%、(85.1±2.4)%,对照组分别为(7.0±1.5)%、(12.5±2.1)%,差异均有统计学意义(P值均<0.01);与CD138-CAR-T细胞组比较,CD138-CAR-T细胞联合泊马度胺(2.5 µg/ml)作用18 h后,对RPMI8226、U266细胞的杀伤活性差异无统计学意义(P值均>0.05)。与CD138-CAR-T细胞组比较,CD138-CAR-T细胞和MM细胞共培养组IFN-γ分泌水平显著增高;与共培养组比较,加入泊马度胺后能显著促进IFN-γ的释放,差异均有统计学意义(P值均<0.01)。 结论 CD138-CAR-T细胞对MM细胞及耐药细胞株均有明显的杀伤作用;其与MM细胞共培养能促进后者IFN-γ的分泌;泊马度胺能促进CD138-CAR-T细胞分泌IFN-γ。
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Affiliation(s)
- Lei Wang
- Department of Hematology, Center of Hematologic Diseases of Chinese PLA; Lanzhou Military Area General Hospital, Lanzhou 730050, China
| | - Shuting Zhang
- Department of Hematology, Center of Hematologic Diseases of Chinese PLA; Lanzhou Military Area General Hospital, Lanzhou 730050, China
| | - Jianfeng Ou
- Department of Hematology, Center of Hematologic Diseases of Chinese PLA; Lanzhou Military Area General Hospital, Lanzhou 730050, China
| | - Hai Bai
- Department of Hematology, Center of Hematologic Diseases of Chinese PLA; Lanzhou Military Area General Hospital, Lanzhou 730050, China
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8
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Bergen HR, Dasari S, Dispenzieri A, Mills JR, Ramirez-Alvarado M, Tschumper RC, Jelinek DF, Barnidge DR, Murray DL. Clonotypic Light Chain Peptides Identified for Monitoring Minimal Residual Disease in Multiple Myeloma without Bone Marrow Aspiration. Clin Chem 2015; 62:243-51. [PMID: 26430073 DOI: 10.1373/clinchem.2015.242651] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 07/09/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Analytically sensitive techniques for measuring minimal residual disease (MRD) in multiple myeloma (MM) currently require invasive and costly bone marrow aspiration. These methods include immunohistochemistry (IHC), flow cytometry, quantitative PCR, and next-generation sequencing. An ideal MM MRD test would be a serum-based test sensitive enough to detect low concentrations of Ig secreted from multifocal lesions. METHODS Patient serum with abundant M-protein before treatment was separated on a 1-dimensional SDS-PAGE gel, and the Ig light-chain (LC) band was excised, trypsin digested, and analyzed on a Q Exactive mass spectrometer by LC-MS/MS. We used the peptide's abundance and sequence to identify tryptic peptides that mapped to complementary determining regions of Ig LCs. The clonotypic target tryptic peptides were used to monitor MRD in subsequent serum samples with prior affinity enrichment. RESULTS Sixty-two patients were tested, 20 with no detectable disease by IHC and 42 with no detectable disease by 6-color flow cytometry. A target peptide that could be monitored was identified in 57 patients (91%). Of these 57, detectable disease by LC-MS/MS was found in 52 (91%). CONCLUSIONS The ability to use LC-MS/MS to measure disease in patients who are negative by bone marrow-based methodologies indicates that a serum-based approach has more analytical sensitivity and may be useful for measuring deeper responses to MM treatment. The method requires no bone marrow aspiration.
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Affiliation(s)
| | | | - Angela Dispenzieri
- Division of Hematology, Department of Medicine, Department of Laboratory Medicine and Pathology, and
| | - John R Mills
- Department of Laboratory Medicine and Pathology, and
| | - Marina Ramirez-Alvarado
- Department of Biochemistry and Molecular Biology, Department of Immunology, Mayo Clinic, Rochester, MN
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9
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Ludwig H, Greil R, Masszi T, Spicka I, Shpilberg O, Hajek R, Dmoszynska A, Paiva B, Vidriales MB, Esteves G, Stoppa AM, Robinson D, Chaturvedi S, Ataman O, Enny C, Feng H, van de Velde H, Viterbo L. Bortezomib, thalidomide and dexamethasone, with or without cyclophosphamide, for patients with previously untreated multiple myeloma: 5-year follow-up. Br J Haematol 2015; 171:344-54. [PMID: 26153365 PMCID: PMC4758383 DOI: 10.1111/bjh.13582] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Accepted: 06/14/2015] [Indexed: 01/10/2023]
Abstract
This follow-up extension of a randomised phase II study assessed differences in long-term outcomes between bortezomib-thalidomide-dexamethasone (VTD) and VTD-cyclophosphamide (VTDC) induction therapy in multiple myeloma. Newly diagnosed patients (n = 98) were randomised 1:1 to intravenous bortezomib (1·3 mg/m(2); days 1, 4, 8, 11), thalidomide (100 mg; days 1-21), and dexamethasone (40 mg; days 1-4, 9-12), with/without cyclophosphamide (400 mg/m(2); days 1, 8), for four 21-day cycles before stem-cell mobilisation/transplantation. After a median follow-up of 64·8 months, median time-to-next therapy was 51·8 and 47·9 months with VTD and VTDC, respectively. Type of subsequent therapy was similar in both arms. After adjusting for asymmetric censoring, median time to progression was not significantly different between VTD and VTDC [35·7 vs. 34·5 months; Hazard ratio (HR) 1·26, 95% confidence interval: 0·76-2·09; P = 0·370]. Five-year survival was 69·1% and 65·3% with VTD and VTDC, respectively. When analysed by minimal residual disease (MRD) status, overall survival was longer in MRD-negative versus MRD-positive patients with bone marrow-confirmed complete response (HR 3·66, P = 0·0318). VTD induction followed by transplantation provides long-term disease control and, consistent with the primary analysis, there is no additional benefit from adding cyclophosphamide. This study was registered at ClinicalTrials.gov (NCT00531453).
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Affiliation(s)
- Heinz Ludwig
- c/o First Department of Medicine, Centre for Oncology, Haematology and Palliative Care, Wilhelminen Cancer Research Institute, Wilhelminenspital, Vienna, Austria
| | - Richard Greil
- Landeskrankenhaus, Universitätsklinik für Innere Medizin III, Salzburg, Austria
| | - Tamas Masszi
- Department of Haematology and Stem Cell Transplantation, St István and St László Hospital, Budapest, Hungary
| | - Ivan Spicka
- First Faculty of Medicine, First Medical Department, Clinical Department of Haematology, Charles University in Prague, Prague, Czech Republic
| | - Ofer Shpilberg
- Institute of Haematology, Assuta Medical Centre, Tel-Aviv, Israel
| | - Roman Hajek
- Department of Haemato-oncology, FN Ostrava and Faculty of Medicine, Ostrava, Czech Republic
| | | | - Bruno Paiva
- Centro de Investigación Médica Aplicada (CIMA), Clínica Universidad de Navarra, Pamplona, Spain
| | | | - Graca Esteves
- Hospital de Dia de Hematologia, Hospital de Santa Maria, Lisbon, Portugal
| | | | | | | | - Ozlem Ataman
- Division of Janssen-Cilag Limited, Janssen Research & Development, High Wycombe, UK
| | | | - Huaibao Feng
- Janssen Research & Development, LLC, Spring House, PA, USA
| | - Helgi van de Velde
- Janssen Research & Development, Division of Janssen Pharmaceutica NV, Beerse, Belgium
| | - Luisa Viterbo
- Serviço de Onco-Hematologia, Instituto Português de Oncologia do Porto Francisco Gentil, Entidade Pública Empresarial (IPOPFG, EPE), Porto, Portugal
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10
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Jensen JL, Rakhmilevich A, Heninger E, Broman AT, Hope C, Phan F, Miyamoto S, Maroulakou I, Callander N, Hematti P, Chesi M, Bergsagel PL, Sondel P, Asimakopoulos F. Tumoricidal Effects of Macrophage-Activating Immunotherapy in a Murine Model of Relapsed/Refractory Multiple Myeloma. Cancer Immunol Res 2015; 3:881-90. [PMID: 25941352 DOI: 10.1158/2326-6066.cir-15-0025-t] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 04/22/2015] [Indexed: 12/23/2022]
Abstract
Myeloma remains a virtually incurable malignancy. The inevitable evolution of multidrug-resistant clones and widespread clonal heterogeneity limit the potential of traditional and novel therapies to eliminate minimal residual disease (MRD), a reliable harbinger of relapse. Here, we show potent anti-myeloma activity of macrophage-activating immunotherapy (αCD40+CpG) that resulted in prolongation of progression-free survival (PFS) and overall survival (OS) in an immunocompetent, preclinically validated, transplant-based model of multidrug-resistant, relapsed/refractory myeloma (t-Vκ*MYC). αCD40+CpG was effective in vivo in the absence of cytolytic natural killer, T, or B cells and resulted in expansion of M1-polarized (cytolytic/tumoricidal) macrophages in the bone marrow. Moreover, we show that concurrent loss/inhibition of Tpl2 kinase (Cot, Map3k8), a MAP3K that is recruited to activated CD40 complex and regulates macrophage activation/cytokine production, potentiated direct, ex vivo anti-myeloma tumoricidal activity of αCD40+CpG-activated macrophages, promoted production of antitumor cytokine IL12 in vitro and in vivo, and synergized with αCD40+CpG to further prolong PFS and OS in vivo. Our results support the combination of αCD40-based macrophage activation and TPL2 inhibition for myeloma immunotherapy. We propose that αCD40-mediated activation of innate antitumor immunity may be a promising approach to control/eradicate MRD following cytoreduction with traditional or novel anti-myeloma therapies.
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Affiliation(s)
- Jeffrey Lee Jensen
- Department of Medicine, Division of Hematology/Oncology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin. University of Wisconsin Carbone Cancer Center, Madison, Wisconsin
| | - Alexander Rakhmilevich
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin. Department of Human Oncology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Erika Heninger
- Department of Medicine, Division of Hematology/Oncology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin. University of Wisconsin Carbone Cancer Center, Madison, Wisconsin
| | - Aimee Teo Broman
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, Wisconsin
| | - Chelsea Hope
- Department of Medicine, Division of Hematology/Oncology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin. University of Wisconsin Carbone Cancer Center, Madison, Wisconsin
| | - Funita Phan
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin. Department of Oncology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Shigeki Miyamoto
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin. Department of Oncology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Ioanna Maroulakou
- Department of Molecular Biology and Genetics, Democritus University of Thrace, Alexandroupolis, Greece
| | - Natalie Callander
- Department of Medicine, Division of Hematology/Oncology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin. University of Wisconsin Carbone Cancer Center, Madison, Wisconsin
| | - Peiman Hematti
- Department of Medicine, Division of Hematology/Oncology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin. University of Wisconsin Carbone Cancer Center, Madison, Wisconsin
| | | | | | - Paul Sondel
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin. Department of Human Oncology, University of Wisconsin-Madison, Madison, Wisconsin. Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Fotis Asimakopoulos
- Department of Medicine, Division of Hematology/Oncology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin. University of Wisconsin Carbone Cancer Center, Madison, Wisconsin.
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11
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Keeney M, Halley JG, Rhoads DD, Ansari MQ, Kussick SJ, Karlon WJ, Mehta KU, Dorfman DM, Linden MA. Marked Variability in Reported Minimal Residual Disease Lower Level of Detection of 4 Hematolymphoid Neoplasms: A Survey of Participants in the College of American Pathologists Flow Cytometry Proficiency Testing Program. Arch Pathol Lab Med 2015; 139:1276-80. [DOI: 10.5858/arpa.2014-0543-cp] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context
Flow cytometry is often applied to minimal residual disease (MRD) testing in hematolymphoid neoplasia. Because flow-based MRD tests are developed in the laboratory, testing methodologies and lower levels of detection (LODs) are laboratory dependent.
Objectives
To broadly survey flow cytometry laboratories about MRD testing in laboratories, if performed, including indications and reported LODs.
Design
Voluntary supplemental questions were sent to the 549 laboratories participating in the College of American Pathologists (CAP) FL3-A Survey (Flow Cytometry—Immunophenotypic Characterization of Leukemia/Lymphoma) in the spring of 2014.
Results
A total of 500 laboratories (91%) responded to the supplemental questions as part of the FL3-A Survey by April 2014; of those 500 laboratories, 167 (33%) currently perform MRD for lymphoblastic leukemia, 118 (24%) for myeloid leukemia, 99 (20%) for chronic lymphocytic leukemia, and 91 (18%) for plasma cell myeloma. Other indications include non-Hodgkin lymphoma, hairy cell leukemia, neuroblastoma, and myelodysplastic syndrome. Most responding laboratories that perform MRD for lymphoblastic leukemia reported an LOD of 0.01%. For myeloid leukemia, chronic lymphocytic leukemia, and plasma cell myeloma, most laboratories indicated an LOD of 0.1%. Less than 3% (15 of 500) of laboratories reported LODs of 0.001% for one or more MRD assays performed.
Conclusions
There is major heterogeneity in the reported LODs of MRD testing performed by laboratories subscribing to the CAP FL3-A Survey. To address that heterogeneity, changes to the Flow Cytometry Checklist for the CAP Laboratory Accreditation Program are suggested that will include new requirements that each laboratory (1) document how an MRD assay's LOD is measured, and (2) include the LOD or lower limit of enumeration for flow-based MRD assays in the final diagnostic report.
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Affiliation(s)
- Michael Keeney
- From the Department of Hematology, London Health Sciences Centre, London, Ontario, Canada (Mr Keeney); the Department of Surveys, College of American Pathologists, Northfield, Illinois (Ms Halley); the Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Dr Rhoads); the Department of Clinical Pathology, Cleveland Clinic, Cleveland, Ohio (Dr Ansari); PhenoPat
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12
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Hourigan CS, McCarthy P, de Lima M. Reprint of: Back to the future! The evolving role of maintenance therapy after hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 2014; 20:S8-S17. [PMID: 24485019 DOI: 10.1016/j.bbmt.2014.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 11/21/2013] [Indexed: 11/26/2022]
Abstract
Relapse is a devastating event for patients with hematologic cancers treated with hematopoietic stem cell transplantation. In most situations, relapse treatment options are limited. Maintenance therapy offers the possibility of delaying or avoiding disease recurrence, but its role remains unclear in most conditions that we treat with transplantation. Here, Dr. Hourigan presents an overview of minimal residual disease (MRD) measurement in hematologic malignancies and the applicability of MRD-based post-transplantation interventions. Dr. McCarthy reviews current knowledge of maintenance therapy in the autologous transplantation context, with emphasis on immunologic interventions and immune modulation strategies designed to prevent relapse. Dr. de Lima discusses current lines of investigation in disease recurrence prevention after allogeneic transplantation, focusing on acute myeloid leukemia and myelodysplastic syndrome.
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Affiliation(s)
- Christopher S Hourigan
- Myeloid Malignancies Section, Hematology Branch, National Heart, Lung and Blood Institute, Bethesda, Maryland
| | - Philip McCarthy
- Blood and Marrow Transplant Program, Roswell Park Cancer Institute, Buffalo, New York
| | - Marcos de Lima
- University Hospitals Case Medical Center, Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio.
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13
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Silvennoinen R, Lundan T, Kairisto V, Pelliniemi TT, Putkonen M, Anttila P, Huotari V, Mäntymaa P, Siitonen S, Uotila L, Penttilä TL, Juvonen V, Selander T, Remes K. Comparative analysis of minimal residual disease detection by multiparameter flow cytometry and enhanced ASO RQ-PCR in multiple myeloma. Blood Cancer J 2014; 4:e250. [PMID: 25303369 PMCID: PMC4220647 DOI: 10.1038/bcj.2014.69] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Accepted: 08/28/2014] [Indexed: 01/02/2023] Open
Abstract
Multiparameter flow cytometry (MFC) and allele-specific oligonucleotide real-time quantitative PCR (ASO RQ-PCR) are the two most sensitive methods to detect minimal residual disease (MRD) in multiple myeloma (MM). We compared these methods in 129 paired post-therapy samples from 22 unselected, consecutive MM patients in complete/near complete remission. Appropriate immunophenotypic and ASO RQ-PCR-MRD targets could be detected and MRD analyses constructed for all patients. The high PCR coverage could be achieved by gradual widening of the primer sets used for clonality detection. In addition, for 13 (55%) of the patients, reverse orientation of the ASO primer and individual design of the TaqMan probe improved the sensitivity and specificity of ASO RQ-PCR analysis. A significant nonlinear correlation prevailed between MFC-MRD and PCR-MRD when both were positive. Discordance between the methods was found in 32 (35%) paired samples, which were negative by MFC-MRD, but positive by ASO RQ-PCR. The findings suggest that with the described technique, ASO RQ-PCR can be constructed for all patients with MM. ASO RQ-PCR is slightly more sensitive in MRD detection than 6-10-color flow cytometry. Owing to technical demands ASO RQ-PCR could be reserved for patients in immunophenotypic remission, especially in efficacy comparisons between different drugs and treatment modalities.
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Affiliation(s)
- R Silvennoinen
- 1] Department of Medicine, Tampere University Hospital, Tampere, Finland [2] Department of Medicine and Hematology, Kuopio University Hospital, Kuopio, Finland
| | - T Lundan
- TYKSLAB, Laboratory of Molecular Genetics, Turku University Hospital, Turku, Finland
| | - V Kairisto
- TYKSLAB, Laboratory of Molecular Genetics, Turku University Hospital, Turku, Finland
| | - T-T Pelliniemi
- 1] Fimlab Medical Laboratories Ltd, Tampere University Hospital, Tampere, Finland [2] Department of Clinical Chemistry, Turku University, Turku, Finland
| | - M Putkonen
- Department of Internal Medicine, Turku University Hospital, Turku University, Turku, Finland
| | - P Anttila
- Helsinki University Hospital, Helsinki, Finland
| | - V Huotari
- 1] NordLab Oulu, Oulu University Hospital, Oulu, Finland [2] Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - P Mäntymaa
- Laboratory of Eastern Finland, Kuopio University Hospital, Kuopio, Finland
| | - S Siitonen
- HUSLAB, Laboratory of Clinical Chemistry, Helsinki University Hospital, Helsinki, Finland
| | - L Uotila
- HUSLAB, Laboratory of Clinical Chemistry, Helsinki University Hospital, Helsinki, Finland
| | - T-L Penttilä
- TYKSLAB, Laboratory of Clinical Haematology, Turku University Hospital, Turku, Finland
| | - V Juvonen
- TYKSLAB, Laboratory of Molecular Genetics, Turku University Hospital, Turku, Finland
| | - T Selander
- Science Services Center, Kuopio University Hospital, Kuopio, Finland
| | - K Remes
- Department of Internal Medicine, Turku University Hospital, Turku University, Turku, Finland
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14
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What We Mean When We Talk About MRD in Myeloma. A Review of Current Methods. Part 1 of a Two-Part Series. Curr Hematol Malig Rep 2014; 9:379-88. [DOI: 10.1007/s11899-014-0238-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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15
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Jiang H, Zhang W, Shang P, Zhang H, Fu W, Ye F, Zeng T, Huang H, Zhang X, Sun W, Man-Yuen Sze D, Yi Q, Hou J. Transfection of chimeric anti-CD138 gene enhances natural killer cell activation and killing of multiple myeloma cells. Mol Oncol 2013; 8:297-310. [PMID: 24388357 DOI: 10.1016/j.molonc.2013.12.001] [Citation(s) in RCA: 192] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 12/04/2013] [Accepted: 12/04/2013] [Indexed: 12/13/2022] Open
Abstract
Reprogramming of NK cells with a chimeric antigen receptor (CAR) proved an effective strategy to increase NK cell reactivity and recognition specificity toward tumor cells. To enhance the cytotoxicity of NK cells against CD138-positive multiple myeloma (MM) cells, we generated genetically modified NK-92MI cells carrying a CAR that consists of an anti-CD138 single-chain variable fragment (scFv) fused to the CD3ζ chain as a signaling moiety. The genetic modification through a lentiviral vector did not affect the intrinsic cytolytic activity of NK-92MI toward human erythroleukemic cell line K562 cells or CD138-negative targets. However, these retargeted NK-92MI (NK-92MI-scFv) displayed markedly enhanced cytotoxicity against CD138-positive human MM cell lines (RPMI8226, U266 and NCI-H929) and primary MM cells at various effector-to-target ratios (E:T) as compared to the empty vector-transfected NK-92MI (NK-92MI-mock). In line with the enhanced cytotoxicity of NK-92MI-scFv, significant elevations in the secretion of granzyme B, interferon-γ and proportion of CD107a expression were also found in NK-92MI-scFv in response to CD138-positive targets compared with NK-92MI-mock. Most importantly, the enhancement in the cytotoxicity of NK-92MI-scFv did not attenuate with 10Gy-irradiation that sufficiently blocked cell proliferation. Moreover, the irradiated NK-92MI-scFv exerted definitely intensified anti-tumor activity toward CD138-positive MM cells than NK-92MI-mock in the xenograft NOD-SCID mouse model. This study provides the rationale and feasibility for adoptive immunotherapy with CD138-specific CAR-modified NK cells in CD138-positive plasmacytic malignancies, which potentially further improves remission quality and prolongs the remission duration of patients with MM after upfront chemotherapy.
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Affiliation(s)
- Hua Jiang
- Department of Hematology, The Myeloma and Lymphoma Center, Changzheng Hospital, The Second Military Medical University, 415 Fengyang Rd, Shanghai 200003, China
| | - Wenhao Zhang
- Department of Hematology, The Myeloma and Lymphoma Center, Changzheng Hospital, The Second Military Medical University, 415 Fengyang Rd, Shanghai 200003, China
| | - Peipei Shang
- Department of Hematology, The Myeloma and Lymphoma Center, Changzheng Hospital, The Second Military Medical University, 415 Fengyang Rd, Shanghai 200003, China
| | - Hui Zhang
- Department of Hematology, The Myeloma and Lymphoma Center, Changzheng Hospital, The Second Military Medical University, 415 Fengyang Rd, Shanghai 200003, China
| | - Weijun Fu
- Department of Hematology, The Myeloma and Lymphoma Center, Changzheng Hospital, The Second Military Medical University, 415 Fengyang Rd, Shanghai 200003, China
| | - Fei Ye
- Department of Hematology, The Myeloma and Lymphoma Center, Changzheng Hospital, The Second Military Medical University, 415 Fengyang Rd, Shanghai 200003, China
| | - Tianmei Zeng
- Department of Hematology, The Myeloma and Lymphoma Center, Changzheng Hospital, The Second Military Medical University, 415 Fengyang Rd, Shanghai 200003, China
| | - Hejing Huang
- Department of Hematology, The Myeloma and Lymphoma Center, Changzheng Hospital, The Second Military Medical University, 415 Fengyang Rd, Shanghai 200003, China
| | - Xueguang Zhang
- Institute of Biotechnology and Clinical Immunology, Research Laboratory of Jiangsu Province, Soochow University, Suzhou 215007, China
| | - Wanping Sun
- Institute of Biotechnology and Clinical Immunology, Research Laboratory of Jiangsu Province, Soochow University, Suzhou 215007, China
| | - Daniel Man-Yuen Sze
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong Special Administrative Region
| | - Qing Yi
- Department of Lymphoma/Myeloma, Division of Cancer Medicine, and Center for Cancer Immunology Research, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Jian Hou
- Department of Hematology, The Myeloma and Lymphoma Center, Changzheng Hospital, The Second Military Medical University, 415 Fengyang Rd, Shanghai 200003, China.
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Abstract
Multiple myeloma (MM), a heterogeneous plasma cell dyscrasia with a variety of clinical presentations and outcomes, is undergoing a treatment renaissance. While new drug classes have been discovered, a subset of high-risk MM remains relatively refractory to treatment. Current risk stratifications models, such as Durie-Salmon and the International Staging System, estimate disease burden and prognosis. Cytogenetics and gene expression profiles can help further identify more aggressive disease. Additionally, molecular and immunophenotypic assessment of minimal residual disease (MRD) and different imaging studies can identify patients at higher risk for relapse. It is now an opportune time to develop algorithms to combine all of the currently available clinical and genomic information to begin to inform specific therapeutic intervention in individual patients or at least smaller subgroups with similarly behaving disease.
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Affiliation(s)
- Saulius Girnius
- Boston Veterans Affairs Healthcare System, Boston, MA; Boston Medical Center, Boston, MA
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17
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Avigan D, Hari P, Battiwalla M, Bishop MR, Giralt SA, Hardy NM, Kröger N, Wayne AS, Hsu KC. Proceedings from the National Cancer Institute's Second International Workshop on the Biology, Prevention, and Treatment of Relapse after Hematopoietic Stem Cell Transplantation: part II. Autologous Transplantation-novel agents and immunomodulatory strategies. Biol Blood Marrow Transplant 2013; 19:1661-9. [PMID: 24018393 PMCID: PMC3914636 DOI: 10.1016/j.bbmt.2013.08.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Accepted: 08/30/2013] [Indexed: 12/11/2022]
Abstract
In the National Cancer Institute's Second International Workshop on the Biology, Prevention, and Treatment of Relapse after Hematopoietic Stem Cell Transplantation, the Scientific/Educational Session on Autologous Transplantation addressed the role of novel agents and immunomodulatory strategies in management of relapse after autologous hematopoietic stem cell transplantation (AHSCT). Concepts were illustrated through in-depth discussion of multiple myeloma, with broader discussion of areas relevant for relapse of other malignancies as well as in the setting of allogeneic transplantation. Dr. Hari provided an overview of the epidemiology of relapse after AHSCT in multiple myeloma, addressing clinical patterns, management implications, and treatment options at relapse, highlighting the implications of novel therapeutic agents in initial, maintenance, and relapse treatment. Dr. Avigan discussed current concepts in tumor vaccine design, including whole cell and antigen-specific strategies, use of an AHSCT platform to reverse tumor-associated immunosuppression and tolerance, and combining vaccines with immunomodulatory agents to promote establishment of durable antitumor immunity. Dr. Hsu reviewed the immunogenetics of natural killer (NK) cells and general NK biology, the clinical importance of autologous NK activity (eg, lymphoma and neuroblastoma), the impact of existing therapies on promotion of NK cell activity (eg, immunomodulatory drugs, monoclonal antibodies), and strategies for enhancing autologous and allogeneic NK cell effects through NK cell gene profiling.
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Affiliation(s)
- David Avigan
- Division of Hematology Oncology, Hematologic Malignancies/Bone Marrow Transplant Program, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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18
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Three-dimensional Nuclear Telomere Organization in Multiple Myeloma. Transl Oncol 2013; 6:749-56. [PMID: 24466378 DOI: 10.1593/tlo.13613] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 11/19/2013] [Accepted: 11/22/2013] [Indexed: 12/27/2022] Open
Abstract
Multiple myeloma (MM) is preceded by monoclonal gammopathy of undetermined significance (MGUS). Up to date, it is difficult to predict an individual's time to disease progression and the treatment response. To examine whether the nuclear telomeric architecture will unravel some of these questions, we carried out. Three-dimensional (3D) telomere analysis on samples from patients diagnosed with MGUS and MM, as well as from patients who went into relapse. Telomere signal intensity, number of telomere aggregates, nuclear volume, and the overall nuclear telomere distribution (a/c ratio) were analyzed. The telomeric profiles allowed for the differentiation of the disease stages. The telomeric profiles of myeloma cells obtained from blood and bone marrow aspirates were identical. Based on this study, we discuss the use of 3D telomere profiling as a potential future tool for risk stratification and personalized treatment decisions.
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19
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Hourigan CS, McCarthy P, de Lima M. Back to the future! The evolving role of maintenance therapy after hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 2013; 20:154-63. [PMID: 24291784 DOI: 10.1016/j.bbmt.2013.11.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 11/21/2013] [Indexed: 12/28/2022]
Abstract
Relapse is a devastating event for patients with hematologic cancers treated with hematopoietic stem cell transplantation. In most situations, relapse treatment options are limited. Maintenance therapy offers the possibility of delaying or avoiding disease recurrence, but its role remains unclear in most conditions that we treat with transplantation. Here, Dr. Hourigan presents an overview of minimal residual disease (MRD) measurement in hematologic malignancies and the applicability of MRD-based post-transplantation interventions. Dr. McCarthy reviews current knowledge of maintenance therapy in the autologous transplantation context, with emphasis on immunologic interventions and immune modulation strategies designed to prevent relapse. Dr. de Lima discusses current lines of investigation in disease recurrence prevention after allogeneic transplantation, focusing on acute myeloid leukemia and myelodysplastic syndrome.
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Affiliation(s)
- Christopher S Hourigan
- Myeloid Malignancies Section, Hematology Branch, National Heart, Lung and Blood Institute, Bethesda, Maryland
| | - Philip McCarthy
- Blood and Marrow Transplant Program, Roswell Park Cancer Institute, Buffalo, New York
| | - Marcos de Lima
- University Hospitals Case Medical Center, Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio.
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Korthals M, Sehnke N, Kronenwett R, Schroeder T, Strapatsas T, Kobbe G, Haas R, Fenk R. Molecular Monitoring of Minimal Residual Disease in the Peripheral Blood of Patients with Multiple Myeloma. Biol Blood Marrow Transplant 2013; 19:1109-15. [DOI: 10.1016/j.bbmt.2013.04.025] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Accepted: 04/26/2013] [Indexed: 10/26/2022]
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Asimakopoulos F, Kim J, Denu RA, Hope C, Jensen JL, Ollar SJ, Hebron E, Flanagan C, Callander N, Hematti P. Macrophages in multiple myeloma: emerging concepts and therapeutic implications. Leuk Lymphoma 2013; 54:2112-21. [PMID: 23432691 DOI: 10.3109/10428194.2013.778409] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Multiple myeloma, a clonal plasma cell malignancy, has long provided a prototypic model to study regulatory interactions between malignant cells and their microenvironment. Myeloma-associated macrophages have historically received limited scrutiny, but recent work points to central and non-redundant roles in myeloma niche homeostasis. The evidence supports a paradigm of complex, dynamic and often mutable interactions between macrophages and other cellular constituents of the niche. We and others have shown that macrophages support myeloma cell growth, viability and drug resistance through both contact-mediated and non-contact-mediated mechanisms. These tumor-beneficial roles have evolved in opposition to, or in parallel with, intrinsic pro-inflammatory and tumoricidal properties. Thus, simple blockade of protective "don't eat me" signals on the surface of myeloma cells leads to macrophage-mediated myeloma cell killing. Macrophages also enhance the tumor-supportive role of mesenchymal stem/stromal cells (MSCs) in the niche: importantly, this interaction is bidirectional, producing a distinct state of macrophage polarization that we termed "MSC-educated macrophages." The intriguing pattern of cross-talk between macrophages, MSCs and tumor cells highlights the myeloma niche as a dynamic multi-cellular structure. Targeted reprogramming of these interactions harbors significant untapped therapeutic potential, particularly in the setting of minimal residual disease, the main obstacle toward a cure.
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Affiliation(s)
- Fotis Asimakopoulos
- Division of Hematology/Oncology, Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health , Madison, WI , USA and University of Wisconsin Carbone Cancer Center , Madison, WI , USA
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