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Kreiniz N, Gertz MA. Bad players in AL amyloidosis in the current era of treatment. Expert Rev Hematol 2023; 16:33-49. [PMID: 36620914 PMCID: PMC9905376 DOI: 10.1080/17474086.2023.2166924] [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: 11/09/2022] [Accepted: 01/06/2023] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Systemic AL amyloidosis (ALA) is a clonal plasma cell (PC) disease characterized by deposition of amyloid fibrils in different organs and tissues. Traditionally, the prognosis of ALA is poor and is primarily defined by cardiac involvement. The modern prognostic models are based on cardiac markers and free light chain difference (dFLC). Cardiac biomarkers have low specificity and are dependent on renal function, volume status, and cardiac diseases other than ALA. New therapies significantly improved the prognosis of the disease. The advancements in technologies - cardiac echocardiography (ECHO) and cardiac MRI (CMR), as well as new biological markers, relying on cardiac injury, inflammation, endothelial damage, and clonal and non-clonal PC markers are promising. AREAS COVERED An update on the prognostic significance of cardiac ALA, number of involved organs, response to treatment, including minimal residual disease (MRD), ECHO, MRI, and new biological markers will be discussed. The literature search was done in PubMed and Google Scholar, and the most recent and relevant data are included. EXPERT OPINION Prospective multicenter trials, evaluating multiple clinical and laboratory parameters, should be done to improve the risk assessment models in ALA in the modern era of therapy.
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Affiliation(s)
- Natalia Kreiniz
- Division of Hematology, Bnai Zion Medical Centre, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
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Tumor cells in light-chain amyloidosis and myeloma show different transcriptional rewiring of normal plasma cell development. Blood 2021; 138:1583-1589. [PMID: 34133718 DOI: 10.1182/blood.2020009754] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 06/09/2021] [Indexed: 11/20/2022] Open
Abstract
Although light-chain amyloidosis (AL) and multiple myeloma (MM) are characterized by tumor plasma cell (PC) expansion in bone marrow (BM), their clinical presentation differs. Previous attempts to identify unique pathogenic mechanisms behind such differences were unsuccessful, but there are no studies investigating the differentiation stage of tumor PCs in patients with AL and MM. We sought to define a transcriptional atlas of normal PC development (n=11) in secondary lymphoid organs (SLO), peripheral blood (PB) and BM for comparison with the transcriptional programs (TPs) of tumor PCs in AL (n=37), MM (n=46) and MGUS (n=6). Based on bulk and single-cell RNAseq, we observed thirteen TPs during transition of normal PCs throughout SLO, PB and BM; that CD39 outperforms CD19 to discriminate new-born from long-lived BM-PCs; that tumor PCs expressed the most advantageous TPs of normal PC differentiation; that AL shares greater similarity to SLO-PCs whereas MM is transcriptionally closer to PB-PCs and new-born BM-PCs; that AL and MM patients enriched in immature TPs had inferior survival; and that TPs related with protein N-linked glycosylation are upregulated in AL. Collectively, we provide a novel resource to understand normal PC development and the transcriptional reorganization of AL and other monoclonal gammopathies.
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Chyra Z, Sevcikova T, Vojta P, Puterova J, Brozova L, Growkova K, Filipova J, Zatopkova M, Grosicki S, Barchnicka A, Jedrzejczak WW, Waszczuk-Gajda A, Jungova A, Mikulasova A, Hajduch M, Mokrejs M, Pour L, Stork M, Harvanova L, Mistrik M, Mikala G, Robak P, Czyz A, Debski J, Usnarska-Zubkiewicz L, Jurczyszyn A, Stejskal L, Morgan G, Kryukov F, Budinska E, Simicek M, Jelinek T, Hrdinka M, Hajek R. Heterogenous mutation spectrum and deregulated cellular pathways in aberrant plasma cells underline molecular pathology of light-chain amyloidosis. Haematologica 2021; 106:601-604. [PMID: 32381580 PMCID: PMC7849586 DOI: 10.3324/haematol.2019.239756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 04/09/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Zuzana Chyra
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Tereza Sevcikova
- Dpt. of Clinical studies, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Petr Vojta
- Institute of Molecular and Translational Medicine, Palacky University, Olomouc, Czech Republic
| | - Janka Puterova
- Brno University of Technology, Centre of Excellence IT4Innovations, Brno, Czech Republic
| | - Lucie Brozova
- Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
| | - Katerina Growkova
- Dpt. of Clinical studies, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Jana Filipova
- Department of Biology and Ecology, Faculty of Science, University of Ostrava, Czech Republic
| | - Martina Zatopkova
- Dpt. of Clinical studies, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Sebastian Grosicki
- Dept. of Hematology and Cancer Prevention, Medical University of Silesia in Katowice, Poland
| | - Agnieszka Barchnicka
- Dept. of Hematology and Cancer Prevention, Medical University of Silesia in Katowice, Poland
| | | | - Anna Waszczuk-Gajda
- Department of Haematology, Oncology and Internal Diseases, Medical University of Warsaw, Poland
| | | | - Aneta Mikulasova
- Biosciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Marian Hajduch
- Institute of Molecular and Translational Medicine, Palacky University, Olomouc, Czech Republic
| | - Martin Mokrejs
- IT4Innovations, VSB, Technical University of Ostrava, Ostrava, Czech Republic
| | - Ludek Pour
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Czech Republic
| | - Martin Stork
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Czech Republic
| | - Lubica Harvanova
- Department of Haematology and Transfusiology, University Hospital Bratislava, Slovakia
| | - Martin Mistrik
- Department of Haematology and Transfusiology, University Hospital Bratislava, Slovakia
| | - Gabor Mikala
- Dept. of Haematology and Stem Cell Transplantation, South Pest Central Hospital, Budapest, Hungary
| | - Pawel Robak
- Department of Haematology, Medical University of Lodz, Copernicus Memorial Hospital, Łódź, Poland
| | - Anna Czyz
- Dept. and Clinic of Haematology, Blood Neoplasms, Wroclaw Medical University, Poland
| | - Jakub Debski
- Dept. and Clinic of Haematology, Blood Neoplasms, Wroclaw Medical University, Poland
| | | | | | | | - Gareth Morgan
- Dpt. of Medicine, Multiple Myeloma Research Perlmutter Cancer Center, NYU School of Medicine, USA
| | - Fedor Kryukov
- Department of Haematooncology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Eva Budinska
- RECETOX, Faculty of Science, Masaryk university in Brno, Brno, Czech Republic
| | - Michal Simicek
- Dpt. of Clinical studies, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Tomas Jelinek
- Department of Haematooncology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Matous Hrdinka
- Dpt. of Clinical studies, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Roman Hajek
- Department of Haematooncology, University Hospital Ostrava, Ostrava, Czech Republic
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Wang Y, Xu L, Liu Y, Hu Y, Shi Q, Jin L, Yang L, Wang P, Zhang K, Huang X, Ge Q, Lu J. Transcriptional heterogeneity of clonal plasma cells and immune evasion in immunoglobulin light chain amyloidosis. Int J Hematol 2020; 113:231-242. [PMID: 33040275 DOI: 10.1007/s12185-020-03016-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/16/2020] [Accepted: 09/28/2020] [Indexed: 01/01/2023]
Abstract
Immunoglobulin light chain amyloidosis (AL amyloidosis) is characterized by the presence of B cells producing amyloidogenic immunoglobulin light chains (LCs). The low frequency of aberrant B cells in AL is often masked by a polyclonal B cell background, making it difficult for treatment. We analyzed the single-cell RNA sequencing data from GEO database to compare the plasma cell (PCs) in four individuals with AL amyloidosis, one AL subject after treatment, and six healthy controls. High interindividual variability in AL-derived PCs in their expression pattern of known overexpressed genes in multiple myeloma and their usage of V regions in LCs was demonstrated. We also found overexpression of MHC class I molecules as one of the common features of clonal PCs in individuals with AL amyloidosis. Significantly reduced frequencies of circulating natural killer (NK) cells were also observed in a small cohort of AL patients when compared to healthy controls. These data demonstrate that aberrant PCs in AL has a highly diverse transcriptome, an upregulation of MHC, and a dampened capability of immunosurveillance by reduction of circulating NK frequencies. The analysis of clonal PCs at single cell level may provide a better approach for precise molecular profiling and diagnosis of AL amyloidosis.
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Affiliation(s)
- Yujia Wang
- Department of Immunology, School of Basic Medical Sciences, NHC Key Laboratory of Medical Immunology, Peking University, Beijing, China
| | - Lushuang Xu
- Department of Immunology, School of Basic Medical Sciences, NHC Key Laboratory of Medical Immunology, Peking University, Beijing, China
| | - Yang Liu
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University People's Hospital and Institute of Hematology, Beijing, 100044, China
| | - Yuzhe Hu
- Department of Immunology, School of Basic Medical Sciences, NHC Key Laboratory of Medical Immunology, Peking University, Beijing, China
| | - Qiang Shi
- School of Life Sciences, Center for Bioinformatics, Peking University, Beijing, 100871, China
| | - Lixue Jin
- Department of Immunology, School of Basic Medical Sciences, NHC Key Laboratory of Medical Immunology, Peking University, Beijing, China
| | - Lijun Yang
- Department of Immunology, School of Basic Medical Sciences, NHC Key Laboratory of Medical Immunology, Peking University, Beijing, China
| | - Pingzhang Wang
- Department of Immunology, School of Basic Medical Sciences, NHC Key Laboratory of Medical Immunology, Peking University, Beijing, China
| | - Kunshan Zhang
- Translational Stem Cell Research Center, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China
| | - Xiaojun Huang
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University People's Hospital and Institute of Hematology, Beijing, 100044, China
| | - Qing Ge
- Department of Immunology, School of Basic Medical Sciences, NHC Key Laboratory of Medical Immunology, Peking University, Beijing, China. .,Department of Integration of Chinese and Western Medicine, School of Basic Medical Sciences, Peking University, Beijing, 100191, China. .,Peking University Health Sciences Center, 38 Xue Yuan Road, Beijing, 100191, China.
| | - Jin Lu
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University People's Hospital and Institute of Hematology, Beijing, 100044, China. .,Collaborative Innovation Center of Haematology, Soochow University, Suzhou, Jiangsu, China.
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Jelinek T, Kryukova E, Kufova Z, Kryukov F, Hajek R. Proteasome inhibitors in AL amyloidosis: focus on mechanism of action and clinical activity. Hematol Oncol 2016; 35:408-419. [PMID: 27647123 DOI: 10.1002/hon.2351] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 08/08/2016] [Accepted: 08/10/2016] [Indexed: 11/11/2022]
Abstract
Proteasome inhibitors are the backbone in the treatment of multiple myeloma with 3 of its representatives (bortezomib, carfilzomib, and ixazomib) having already been approved. There is a different situation altogether in the treatment of amyloid light chain (AL) amyloidosis where owing to the rarity of this entity neither of these drugs has currently gained approval. Amyloid light chain plasma cells are possibly more vulnerable to bortezomib than myeloma plasmocytes because of a slightly distinct mechanism of action, which is described in depth in this manuscript. Bortezomib is highly active and rapidly effective as a single agent and even more potent in combination with dexamethasone and alkylators. Bortezomib-based regimens have become a standard part of the initial treatment of AL amyloidosis in the majority of centers. We have reviewed all available data on bortezomib in various combinations and settings. Carfilzomib seems to be effective but also toxic in these fragile patients with a high rate of cardiac events. Oral ixazomib has shown a surprisingly high efficacy with manageable toxicity and has received the Food and Drug Administration Breakthrough Therapy designation in 2014 for relapsed AL amyloidosis patients. In this review we have comprehensively described the current available knowledge of these 3 proteasome inhibitors and their use in AL amyloidosis.
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Affiliation(s)
- T Jelinek
- Department of Haematooncology, University Hospital Ostrava, Ostrava, Czech Republic.,Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - E Kryukova
- Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Z Kufova
- Department of Haematooncology, University Hospital Ostrava, Ostrava, Czech Republic.,Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - F Kryukov
- Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - R Hajek
- Department of Haematooncology, University Hospital Ostrava, Ostrava, Czech Republic.,Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
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