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Chili LH, Mackraj I, Rapiti N. Profile and outcome of multiple myeloma with and without HIV treated at a tertiary hospital in KwaZulu-Natal, South Africa. PLoS One 2023; 18:e0287304. [PMID: 37878638 PMCID: PMC10599510 DOI: 10.1371/journal.pone.0287304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/03/2023] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVES To profile the outcome of multiple myeloma (MM) patients treated at a South African tertiary hospital in KwaZulu-Natal (KZN) and to compare MM in HIV-negative patients and MM in people living with HIV (PLWH). METHODS A retrospective analysis of patients with MM was conducted over 5 years (2015-2020). Patient demographics, presenting complaints, symptom duration, disease stage, molecular profile, treatment, and survival data were captured. Statistical analysis was conducted using R Statistical software of the R Core Team, 2020, version 3.6.3. RESULTS 135 patients; 79% (n = 106) HIV-negative and 21% (n = 29) PLWH were investigated. 54% (n = 74) females and 57% (n = 76) 51-70-year-olds. The 40-50-year-old patient group had a significantly higher proportion of PLWH (p = 0.032). Pathological fractures were the commonest presenting complaint, 47% (n = 57 and 49% (n = 49) had International Staging System, stage III disease. Fluorescent in-situ hybridization (FISH) MM profiling was completed in 58% (n = 78). Positivity for del 11q22 was found in 23.7% (n = 14) with significantly more HIV-negative patients having the mutation (p = 0.027). Overall, 42.2% (n = 57) achieved 2-year overall survival (OS). There were no significant differences in treatment (p = 0.926) and 2-year survival outcome (p = 0.792) between the two groups. CONCLUSION The incidence of HIV in newly diagnosed MM patients in KZN was increasing. KZN patient profile differed from other reports by showing female predominance but was similar in advanced-stage presentation and bone fracture predominance. Statistically significant differences between the HIV-negative patients and PLWH were observed in age distribution and mutational landscape. Further studies are required in this area.
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Affiliation(s)
- Lungisile Hildegard Chili
- Haematology Department, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu Natal, Durban, KwaZulu-Natal, South Africa
- Haematology Department, National Health Laboratory Services, Durban, KwaZulu-Natal, South Africa
| | - Irene Mackraj
- Haematology Department, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu Natal, Durban, KwaZulu-Natal, South Africa
| | - Nadine Rapiti
- Haematology Department, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu Natal, Durban, KwaZulu-Natal, South Africa
- Haematology Department, National Health Laboratory Services, Durban, KwaZulu-Natal, South Africa
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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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Jean J, Vergara-Lluri M, Chambliss AB. No Monoclonal Protein in a Patient with CRAB Features. Clin Chem 2021; 67:1584-1588. [PMID: 34850841 DOI: 10.1093/clinchem/hvab235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 04/07/2021] [Indexed: 11/12/2022]
Affiliation(s)
- Jeffrey Jean
- Department of Pathology, Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA
| | - Maria Vergara-Lluri
- Department of Pathology, Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA.,Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Allison B Chambliss
- Department of Pathology, Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA.,Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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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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