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Maura F, Landgren O, Morgan GJ. Designing Evolutionary-based Interception Strategies to Block the Transition from Precursor Phases to Multiple Myeloma. Clin Cancer Res 2021; 27:15-23. [PMID: 32759358 PMCID: PMC7785564 DOI: 10.1158/1078-0432.ccr-20-1395] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/17/2020] [Accepted: 07/31/2020] [Indexed: 11/16/2022]
Abstract
The development of next-generation sequencing technology has dramatically improved our understanding of the genetic landscape of multiple myeloma. Several new drivers and recurrent events have been reported and linked to a potential driver role. This complex landscape is enhanced by intraclonal mutational heterogeneity and variability introduced through the dimensions of time and space. The evolutionary history of multiple myeloma is driven by both the accumulation of different genomic drivers and by the activity of different mutational processes active overtime. In this review, we describe how these new findings and sequencing technologies have been progressively allowed to understand and reshape our knowledge of the complexity of multiple myeloma at each of its developmental stages: premalignant, at diagnosis, and in relapsed/refractory states. We discuss how these evolutionary concepts can be utilized in the clinic to alter evolutionary trajectories providing a framework for therapeutic intervention at early-disease stages.
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Affiliation(s)
- Francesco Maura
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Ola Landgren
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Gareth J Morgan
- Perlmutter Cancer Center, New York University Langone Health, New York, New York.
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Gao SS, Wang YJ, Zhang GX, Zhang WT. Potential diagnostic value of circulating miRNA for multiple myeloma: A meta-analysis. J Bone Oncol 2020; 25:100327. [PMID: 33145153 PMCID: PMC7596263 DOI: 10.1016/j.jbo.2020.100327] [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: 08/26/2020] [Revised: 09/29/2020] [Accepted: 10/12/2020] [Indexed: 12/15/2022] Open
Abstract
This meta-analysis is a comprehensively studies of microRNA in MM. MicroRNA clusters helped to distinguish MM and healthy people. MicroRNA is a potential noninvasive biomarker in early diagnosis of MM.
Background Multiple myeloma (MM) is the second incurable hematological malignancy. In recent years, due to the rise of microRNA (miRNA), many scholars have participated in the study of its value in the diagnosis of MM, and have obtained good but inconsistent results. Therefore, in order to determine the role of miRNA in the early diagnosis of MM, we performed this meta-analysis. Methods We searched for related studies including PubMed, Web of Science, EMBASE, Cochrane Library, China National Knowledge Infrastructure (CNKI) and Wanfang Database as of July 20, 2020 to conduct this meta-analysis. To improve the accuracy, the quality assessment of Diagnostic Accuracy Study 2 (QUADAS-2) was used. We also applied random effects models to summarize sensitivity and specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and area under the curve (AUC) to measure diagnostic values, and subgroup analysis used to discover potential sources of heterogeneity. Results We finally collected 32 studies from 15 articles that included a total of 2053 MM patients and 1118 healthy controls in this meta-analysis. The overall sensitivity, specificity, PLR, NLR, DOR and AUC were 0.81, 0.85, 5.5, 0.22, 25 and 0.90, respectively. Subgroup analysis shows that the down-regulation of microRNA clusters with larger samples size of plasma type could carry out a better diagnostic accuracy of MM patients. In addition, publication bias was not found. Conclusions Circulating miRNA could be a potential non-invasive biomarker for early diagnosis of MM. However, multi-center, more rigorous, and larger-scale studies are needed to verify our conclusions.
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Key Words
- AUC, Area under the curve
- CI, confidence interval
- DOR, Diagnostic odds ratio
- Diagnosis
- MGUS, Monoclonal gammopathy of undetermined significance
- MM, Multiple myeloma
- Meta-analysis
- MicroRNAs
- Multiple myeloma
- NLR, Negative likelihood ratio
- PCL, Plasma cell leukemia
- PLR, Positive likelihood ratio
- QUADAS-2, Quality Assessment of Diagnostic Accuracy Study 2
- SE, Sensitivity
- SP, Specificity
- microRNA, miRNA
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Affiliation(s)
- Shuai-Shuai Gao
- Department of Traumatology and Orthopedic Surgery, Xi'an Daxing Hospital, Shaanxi, China
- International Doctoral School, University of Seville, Spain
| | - Yan-Jun Wang
- Department of Traumatology and Orthopedic Surgery, Xi'an Daxing Hospital, Shaanxi, China
| | - Guo-Xun Zhang
- International Doctoral School, University of Seville, Spain
| | - Wen-Ting Zhang
- International Doctoral School, University of Seville, Spain
- Corresponding author at: Plaza Comunidad Castilla la Mancha, No.6, 41008, Seville, Spain.
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Sfeir JG, Pena Guzman TD, Bedatsova L, Broski SM, Drake MT. Use of trabecular bone score for risk stratification of patients with monoclonal gammopathy of undetermined significance. Bone 2020; 137:115394. [PMID: 32360588 PMCID: PMC7354210 DOI: 10.1016/j.bone.2020.115394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/08/2020] [Accepted: 04/25/2020] [Indexed: 11/24/2022]
Abstract
Monoclonal gammopathy of undetermined significance (MGUS) is a common finding in clinical practice. The risk for developing MGUS increases with aging in parallel with age-associated increases in fracture risk. Although there is good evidence that patients with MGUS suffer from increased fracture risk, no standardized guidelines exist for the evaluation and/or management of skeletal health in patients with MGUS. Trabecular bone score (TBS), a texture index derived from lumbar spine (LS) dual-energy x-ray absorptiometry (DXA) images, provides information about trabecular microarchitecture independent of bone mineral density (BMD). We retrospectively identified 155 adult patients diagnosed with MGUS between 2005 and 2018. This group was matched 1:1 to a control group for sex, age and BMI. TBS was performed retrospectively, and values categorized as low (≤1.23), intermediate (1.23-1.31) or normal (>1.31). Patients had a mean ± SD age of 69.6 ± 10.0. BMD was performed within a median of 28 months (IQR 1-78) of MGUS diagnosis. Cases had a non-statistically significant higher rate of fractures compared to control subjects (27 vs. 17, respectively, p = 0.1). Patients with MGUS had a significantly lower TBS (1.31 ± 0.13 vs. 1.34 ± 0.12, respectively, p < 0.05) and lower LS BMD (1.215 ± 0.223 vs. 1.275 ± 0.247, p < 0.05) compared to controls. Although fractures occurred more commonly in those control subjects with significantly lower TBS values, this was not the case in subjects with MGUS (TBS 1.299 vs. 1.313 in cases with vs. without fractures p = 0.313). Similarly, there was no difference in T-scores in cases with or without fractures (-1.33 vs. -1.37, respectively, p = 0.56). Despite patients with MGUS having a significantly increased fracture risk compared to age-, sex- and BMI-matched control subjects, neither assessment of BMD nor TBS, obtained within two years of MGUS diagnosis, were able to accurately risk stratify MGUS patients. Unlike control subjects, patients with MGUS tend to fracture despite normal BMD and intermediate or normal TBS values, suggesting that deterioration of cortical rather than trabecular skeletal components may be more important for the increased fracture risk seen in MGUS.
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Affiliation(s)
- Jad G Sfeir
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, - Rochester, MN, United States of America; Division of Geriatric Medicine and Gerontology, Mayo Clinic, - Rochester, MN, United States of America; Robert and Arlene Kogod Center on Aging, Mayo Clinic, - Rochester, MN, United States of America
| | - Tito D Pena Guzman
- Division of General Internal Medicine, Mayo Clinic, - Rochester, MN, United States of America
| | - Lucia Bedatsova
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, - Rochester, MN, United States of America
| | - Stephen M Broski
- Division of Musculoskeletal Radiology, Mayo Clinic, - Rochester, MN, United States of America
| | - Matthew T Drake
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, - Rochester, MN, United States of America; Robert and Arlene Kogod Center on Aging, Mayo Clinic, - Rochester, MN, United States of America; Division of Hematology, Mayo Clinic, - Rochester, MN, United States of America.
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Maura F, Rustad EH, Boyle EM, Morgan GJ. Reconstructing the evolutionary history of multiple myeloma. Best Pract Res Clin Haematol 2020; 33:101145. [PMID: 32139011 PMCID: PMC7389821 DOI: 10.1016/j.beha.2020.101145] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 01/09/2020] [Indexed: 02/08/2023]
Abstract
Multiple myeloma is the second most common lymphoproliferative disorder, characterized by aberrant expansion of monoclonal plasma cells. In the last years, thanks to novel next generation sequencing technologies, multiple myeloma has emerged as one of the most complex hematological cancers, shaped over time by the activity of multiple mutational processes and by the acquisition of key driver events. In this review, we describe how whole genome sequencing is emerging as a key technology to decipher this complexity at every stage of myeloma development: precursors, diagnosis and relapsed/refractory. Defining the time windows when driver events are acquired improves our understanding of cancer etiology and paves the way for early diagnosis and ultimately prevention.
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Affiliation(s)
- Francesco Maura
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Even H Rustad
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eileen M Boyle
- NYU Langone, Perlmutter Cancer Center, New York, NY, USA
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Monari M, Bianchi P, Maura F, Motta L, Martellasio G, Leone FP, Montanelli A. Typing of Four Cases of Monoclonal Gammopathy: A Revival of Immunosubstraction Role. Health (London) 2017. [DOI: 10.4236/health.2017.913134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Lust JA, Lacy MQ, Zeldenrust SR, Witzig TE, Moon-Tasson LL, Dinarello CA, Donovan KA. Reduction in C-reactive protein indicates successful targeting of the IL-1/IL-6 axis resulting in improved survival in early stage multiple myeloma. Am J Hematol 2016; 91:571-4. [PMID: 26945843 DOI: 10.1002/ajh.24352] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 03/02/2016] [Indexed: 11/08/2022]
Abstract
We report the long-term follow-up results of a phase II trial of IL-1 receptor antagonist and low-dose dexamethasone for early stage multiple myeloma (MM). Patients were eligible if they had smoldering multiple myeloma (SMM) or indolent multiple myeloma (IMM) without the need for immediate therapy. Forty seven patients were enrolled and subsequently treated with IL-1Ra; in 25/47 low-dose dexamethasone (20 mg weekly) was added. The primary endpoint was progression-free survival (PFS). In the clinical trial, three patients achieved a minor response (MR) to IL-1Ra alone; five patients a partial response (PR) and four patients an MR after addition of dexamethasone. Seven patients showed a decrease in the plasma cell labeling index (PCLI) which paralleled a decrease in the high sensitivity C-reactive protein (hs-CRP). The median PFS for the 47 patients was 1116 days (37.2 months). The median PFS for patients without (n = 22) and with (n = 25) a decrease in their baseline hs-CRP was 326 days (11 months) vs. 3139 days (104 months) respectively (P <0.0001). The median overall survival (OS) for the 47 patients was 3482 days (9.5 years). The median OS for patients without and with a decrease in their baseline hs-CRP was 2885 days (7.9 years) vs. median not reached, respectively (P = 0.001). In SMM/IMM patients at risk for progression to active myeloma, reduction in the hs-CRP indicates successful targeting of the IL-1/IL-6 axis resulting in improved PFS and OS. (Clinical Trials.gov Identifier: NCT00635154) Am. J. Hematol. 91:571-574, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- John A. Lust
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | - Martha Q. Lacy
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | | | | | | | - Charles A. Dinarello
- Department of Medicine; University of Colorado; 12700 East 19 Ave, B168 Aurora Colorado 80045
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Abstract
This article presents a review of multiple myeloma, precursor states, and related plasma cell disorders. The clinical roles of fluorodeoxyglucose PET/computed tomography (CT) and the potential to improve the management of patients with multiple myeloma are discussed. The clinical and research data supporting the utility of PET/CT use in evaluating myeloma and other plasma cell dyscrasias continues to grow.
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Affiliation(s)
- Patrick J Peller
- Eka Medical Center - Jakarta, Central Business District Lot IX, BSD City, Tangerang 15321, Indonesia.
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Drake MT. unveiling skeletal fragility in patients diagnosed with MGUS: no longer a condition of undetermined significance? J Bone Miner Res 2014; 29:2529-33. [PMID: 25319751 PMCID: PMC4268401 DOI: 10.1002/jbmr.2387] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 10/09/2014] [Accepted: 10/13/2014] [Indexed: 01/11/2023]
Abstract
Monoclonal gammopathy of undetermined significance (MGUS) is a common finding in clinical practice, affecting greater than 3% of adults aged 50 years and older. As originally described, the term MGUS reflected the inherent clinical uncertainty of distinguishing patients with a benign stable monoclonal plasma cell disorder from subjects destined to progress to malignancy. There is now clear epidemiologic evidence, however, that patients with MGUS suffer from a significantly increased fracture risk and that the prevalence of MGUS is increased in patients with osteoporosis. Despite this relationship, no clinical care guidelines exist for the routine evaluation or treatment of the skeletal health of patients with MGUS. Recent work has demonstrated that circulating levels of at least two cytokines (CCL3/MIP-1α and DKK1) with well-recognized roles in bone disease in the related monoclonal gammopathy multiple myeloma are also increased in patients with MGUS. Further, recent imaging studies using high-resolution peripheral quantitative CT have documented that patients with MGUS have substantial skeletal microarchitectural deterioration and deficits in biomechanical bone strength that likely underlie the increased skeletal fragility in these patients. Accordingly, this Perspective provides evidence that the "undetermined significance" portion of the MGUS acronym may be best replaced in favor of the term "monoclonal gammopathy of skeletal significance" (MGSS) in order to more accurately reflect the enhanced skeletal risks inherent in this condition.
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Affiliation(s)
- Matthew T Drake
- Division of Endocrinology, Metabolism, Nutrition and Diabetes, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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Lwin ST, Olechnowicz SWZ, Fowler JA, Edwards CM. Diet-induced obesity promotes a myeloma-like condition in vivo. Leukemia 2014; 29:507-10. [PMID: 25287992 DOI: 10.1038/leu.2014.295] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- S T Lwin
- 1] Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK [2] Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK [3] Vanderbilt Center for Bone Biology, Vanderbilt University, Nashville, TN, USA
| | - S W Z Olechnowicz
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - J A Fowler
- Vanderbilt Center for Bone Biology, Vanderbilt University, Nashville, TN, USA
| | - C M Edwards
- 1] Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK [2] Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK [3] Vanderbilt Center for Bone Biology, Vanderbilt University, Nashville, TN, USA
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Bhatnagar V, Badros A. The role of clonal evolution in smoldering multiple myeloma. Leuk Lymphoma 2013; 55:464-6. [PMID: 23865829 DOI: 10.3109/10428194.2013.821704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Vishal Bhatnagar
- M & S Greenebaum Cancer Center, University of Maryland School of Medicine , Baltimore, MD , USA
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Paladini I, Pieretti G, Giuntoli M, Abbruzzese G, Menchini U, Mencucci R. Crystalline corneal deposits in monoclonal gammopathy: in-vivo confocal microscopy. Semin Ophthalmol 2013; 28:37-40. [PMID: 23305440 DOI: 10.3109/08820538.2012.730102] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To describe the in-vivo confocal microscopy corneal findings in a patient with bilateral corneal deposits caused by an underlying monoclonal gammopathy. METHODS A 68-year-old man came to our center for an ophthalmologic examination. Besides visual acuity, the examination included slit-lamp biomicroscopy, intraocular pressure, and fundoscopy. Confocal microscopy was performed using Confoscan 4 (Nidek Technologies Padova, Italy) with a 40× lens because of the presence of bilateral crystalline corneal deposits. Serological tests were also performed. RESULTS Every layer of the cornea is interested by deposits with high reflectivity,especially the epithelium and anterior stroma. The emathological tests evidenced a monoclonal gammopathy of undetermined significance with high levels of Immunoglobulin M. CONCLUSION Crystalline corneal deposits in monoclonal gammopathycan be usefully evaluated by confocal microscopy. These manifestations may be evaluated long before systemic signs of the pathology appear, so the early diagnosis is mandatory.
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Affiliation(s)
- Iacopo Paladini
- Department of Oto-Neuro-Ophthalmological Surgical Sciences, Eye Clinic, University of Florence, Policlinic of Careggi, Florence, Italy.
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First-Time-in-Human Study With GSK249320, a Myelin-Associated Glycoprotein Inhibitor, in Healthy Volunteers. Clin Pharmacol Ther 2012; 93:163-9. [DOI: 10.1038/clpt.2012.227] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Abstract
Multiple myeloma (MM) is a plasma cell dyscrasia characterized by the presence of multiple myelomatous "omas" throughout the skeleton, indicating that there is continuous trafficking of tumor cells to multiple areas in the bone marrow niches. MM may therefore represent one of the best models to study cell trafficking or cell metastasis. The process of cell metastasis is described as a multistep process, the invasion-metastasis cascade. This involves cell invasion, intravasation into nearby blood vessels, passage into the circulation, followed by homing into predetermined distant tissues, the formation of new foci of micrometastases, and finally the growth of micrometastasis into macroscopic tumors. This review discusses the significant advances that have been discovered in the complex process of invasion-metastasis in epithelial carcinomas and cell trafficking in hematopoietic stem cells and how this process relates to progression in MM. This progression is mediated by clonal intrinsic factors that mediate tumor invasiveness as well as factors present in the tumor microenvironment that are permissive to oncogenic proliferation. Therapeutic agents that target the different steps of cell dissemination and progression are discussed. Despite the significant advances in the treatment of MM, better therapeutic agents that target this metastatic cascade are urgently needed.
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López-Corral L, Mateos MV, Corchete LA, Sarasquete ME, de la Rubia J, de Arriba F, Lahuerta JJ, García-Sanz R, San Miguel JF, Gutiérrez NC. Genomic analysis of high-risk smoldering multiple myeloma. Haematologica 2012; 97:1439-43. [PMID: 22331267 DOI: 10.3324/haematol.2011.060780] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Smoldering myeloma is an asymptomatic plasma cell dyscrasia with a heterogeneous propensity to progress to active myeloma. In order to investigate the biology of smoldering myeloma patients with high risk of progression, we analyzed the genomic characteristics by FISH, SNP-arrays and gene expression profile of a group of patients with high-risk smoldering myeloma included in a multicenter randomized trial. Chromosomal abnormalities detected by FISH and SNP-arrays at diagnosis were not associated to risk of progression to symptomatic myeloma. However, the overexpression of four SNORD genes (SNORD25, SNORD27, SNORD30 and SNORD31) was correlated with shorter time to progression (P<0.03). When plasma cells from high-risk smoldering patients who progressed to symptomatic myeloma were sequentially analyzed, newly acquired lesions together with an increase in the proportion of plasma cells carrying a given abnormality were observed. These findings suggest that gene expression profiling is a valuable technique to identify smoldering myeloma patients with high risk of progression. (Clinical Trials NCT00443235).
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Affiliation(s)
- Lucía López-Corral
- Servicio de Hematología del Hospital Universitario de Salamanca y Centro de Investigación del Cáncer-IBMCC (USAl-CIC), Universidad de Salamanca, Salamanca, Spain
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Bone microstructural changes revealed by high-resolution peripheral quantitative computed tomography imaging and elevated DKK1 and MIP-1α levels in patients with MGUS. Blood 2011; 118:6529-34. [PMID: 22042700 DOI: 10.1182/blood-2011-04-351437] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Recent population-based studies demonstrate an increased fracture risk with monoclonal gammopathy of undetermined significance (MGUS). The etiology of this increased risk remains unclear, however, because areal bone mineral density (aBMD) measurements by dual-energy x-ray absorptiometry cannot assess bone microstructural properties critical to determining bone quality and strength. To better define the skeletal effects of MGUS, we performed aBMD and high-resolution peripheral quantitative computed tomography volumetric bone mineral density (vBMD) measurements in 50 MGUS patients (20 females, 30 males; mean ± SEM age, 70.5 ± 1.4 years) and 100 matched control subjects. Relative to controls, MGUS patients had decreased aBMD at the femoral neck (P = .05) and total femur (P < .05) but no differences at other sites. In contrast, high-resolution peripheral quantitative computed tomography showed markedly diminished cortical thickness (P < .05) and increased endocortical area (P < .01). Average vBMD (P < .01), cortical vBMD (P < .001), and trabecular thickness (P < .01) were all significantly decreased in MGUS patients, suggestive of impaired bone formation. Serum levels of the Wnt pathway inhibitor Dickkopf-related protein 1 (P < .001) and osteoclast-activating factor MIP-1α (P < .05) also were significantly elevated in MGUS patients. Our data provide the first evidence of altered bone microstructure in MGUS and suggest that cytokines elevated in osteolytic myeloma also may be associated with bone loss in MGUS.
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Noonan K, Borrello I. The immune microenvironment of myeloma. CANCER MICROENVIRONMENT 2011; 4:313-23. [PMID: 21866321 DOI: 10.1007/s12307-011-0086-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Accepted: 08/11/2011] [Indexed: 12/16/2022]
Abstract
The bone marrow (BM) is the site of disease in myeloma and possesses unique immune characteristics involved in the pathobiology of the disease. Interactions of plasma cells with stromal cells, osteoclasts, osteoblasts, myeloid and lymphoid cells make up the unique bone marrow milieu that mediates myeloma disease progression. Independently or through a complex network of interactions these cells impart immune changes leading to immune evasion and disease progression. The critical role of these factors in disease progression has led to the intense development of therapeutic strategies aimed at either disrupting the immune mechanisms mediating disease progression or augmenting those with anti-tumor benefits. This review discusses the major contributors of immunity in the bone marrow microenvironment, their interactions, and mechanisms whereby immune modulation can be translated into therapies with anti-myeloma efficacy.
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Affiliation(s)
- Kimberly Noonan
- Department of Oncology, Johns Hopkins University, 1650 Orleans St CRB-1, Rm 453, Baltimore, MD, 21231, USA
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Koo H, Oh DH, Chun YS, Kim JC. A case of crystalline keratopathy in monoclonal gammopathy of undetermined significance (MGUS). KOREAN JOURNAL OF OPHTHALMOLOGY 2011; 25:202-5. [PMID: 21655047 PMCID: PMC3102825 DOI: 10.3341/kjo.2011.25.3.202] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Accepted: 07/07/2010] [Indexed: 11/29/2022] Open
Abstract
A 62-year-old female visited our clinic with progressively decreased vision in both eyes beginning 12 years prior. Idiopathic corneal opacity in all layers of the cornea was found in both eyes. One year later, we performed penetrating keratoplasty on the undiagnosed right eye. During post-surgical follow-up, corneal edema and stromal opacity recurred, and penetrating keratoplasty was performed two more times. The patient's total serum protein level, which had previously been normal, was elevated prior to the final surgery. She was diagnosed with monoclonal gammopathy of undetermined significance. We made a final diagnosis of monoclonal gammopathy-associated crystalline keratopathy after corneal biopsy. Monoclonal gammopathy-associated crystalline keratopathy is difficult to diagnose and may lead to severe visual loss. A systemic work-up, including serologic tests like serum protein or cholesterol levels, is needed in patients with unexplainable corneal opacity.
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Affiliation(s)
- Hyun Koo
- Department of Ophthalmology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
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Weiss BM, Kuehl WM. Advances in understanding monoclonal gammopathy of undetermined significance as a precursor of multiple myeloma. Expert Rev Hematol 2011; 3:165-74. [PMID: 20473362 DOI: 10.1586/ehm.10.13] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Monoclonal gammopathy of undetermined significance (MGUS) affects at least 3% of the population above the age of 50 and is the precursor to multiple myeloma (MM), an incurable malignancy of plasma cells. Recent advances in MGUS include: an improved understanding of the pathogenesis of MGUS and its progression to MM, involving molecular events intrinsic to the malignant plasma cell as well as the microenvironment; novel techniques to assess risk for progression to MM using serum-free light-chain analysis and immunophenotyping; and a renewed interest in chemoprevention of MM. In the future, continued improvement in our understanding of MGUS will lead to the development of better biomarkers for prognosis and therapies for chemoprevention of MM.
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Affiliation(s)
- Brendan M Weiss
- Hematology-Oncology Service, Walter Reed Army Medical Center, 6900 Georgia Avenue N.W., Washington, DC 20307, USA.
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Huppmann AR, Liu ML, Nava VE. Concurrent diagnoses of Hodgkin lymphoma and biclonal myeloma in the bone marrow. Ann Diagn Pathol 2010; 14:268-72. [PMID: 20637433 DOI: 10.1016/j.anndiagpath.2009.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2009] [Revised: 09/14/2009] [Accepted: 09/19/2009] [Indexed: 11/25/2022]
Abstract
The diagnoses of Hodgkin lymphoma and multiple myeloma have rarely been made simultaneously in the same patient. We present a case of an 82-year-old man who rapidly developed pancytopenia and liver failure with coagulopathy. Serum protein electrophoresis and immunofixation revealed an unequivocal immunoglobulin Gkappa and immunoglobulin Glambda biclonal gammopathy. Bone marrow biopsy showed involvement by classic Hodgkin lymphoma with an inflammatory background including 49% mature plasma cells. Unfortunately, the patient died 14 days after admission. To our knowledge, a case of concurrent Hodgkin lymphoma and biclonal multiple myeloma has not previously been reported. Detection of severe bone marrow plasmacytosis in the background of Hodgkin lymphoma should alert the pathologist to the possibility of collision with a plasma cell neoplasm, warranting a complete diagnostic workup.
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Madan S, Greipp PR. The incidental monoclonal protein: Current approach to management of monoclonal gammopathy of undetermined significance (MGUS). Blood Rev 2009; 23:257-65. [DOI: 10.1016/j.blre.2009.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Abstract
Plasma cell myeloma is a heterogenous disease with variable clinical presentation and outcome. The prognosis is largely determined by tumor biology. Newer therapeutic agents are rapidly changing the survival outlook of myeloma patients.
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Affiliation(s)
- Pei Lin
- Department of Hematopathology, University of Texas-MD Anderson Cancer Center, Houston, TX 77070, USA.
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Zhou Y, Goodenbour JM, Godley LA, Wickrema A, Pan T. High levels of tRNA abundance and alteration of tRNA charging by bortezomib in multiple myeloma. Biochem Biophys Res Commun 2009; 385:160-4. [PMID: 19450555 DOI: 10.1016/j.bbrc.2009.05.031] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2009] [Accepted: 05/10/2009] [Indexed: 11/18/2022]
Abstract
In multiple myeloma (MM), malignant plasma cells produce large amounts of antibodies and have highly active protein translational machinery. It is not known whether regulation of the abundance and aminoacylation (charging) of transfer RNA (tRNA) takes place in myeloma cells to accommodate for the increased amount of protein translation. Using tRNA-specific microarrays, we demonstrate that tRNA levels are significantly elevated in MM cell lines compared to normal bone marrow cells. We furthermore show that the addition of the proteasome inhibitor, bortezomib (Velcade, PS-341) results in decreased charging levels of tRNAs, in particular those coding for hydrophobic amino acids. These results suggest that tRNA properties are altered in MM to accommodate for its increased need for protein translation, and that proteasome inhibition directly impacts protein synthesis in MM through effects on tRNA charging.
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Affiliation(s)
- Ying Zhou
- Department of Medicine, University of Chicago, Chicago, IL 60637, USA
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Lust JA, Lacy MQ, Zeldenrust SR, Dispenzieri A, Gertz MA, Witzig TE, Kumar S, Hayman SR, Russell SJ, Buadi FK, Geyer SM, Campbell ME, Kyle RA, Rajkumar SV, Greipp PR, Kline MP, Xiong Y, Moon-Tasson LL, Donovan KA. Induction of a chronic disease state in patients with smoldering or indolent multiple myeloma by targeting interleukin 1{beta}-induced interleukin 6 production and the myeloma proliferative component. Mayo Clin Proc 2009; 84:114-22. [PMID: 19181644 PMCID: PMC2664581 DOI: 10.4065/84.2.114] [Citation(s) in RCA: 208] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To conduct in vitro studies as well as a phase 2 clinical trial in patients with smoldering or indolent multiple myeloma to determine if interleukin 1 (IL-1) inhibitors can delay or prevent active myeloma. PATIENTS AND METHODS Stromal cells were cocultured with IL-1beta-expressing myeloma cells in the presence of dexamethasone, IL-1 receptor antagonist (IL-1Ra), or both. Levels of interleukin 6 (IL-6) and of apoptosis were also quantified. Between November 19, 2002, and May 24, 2007, 47 patients were enrolled in the study and subsequently treated with IL-1Ra. In 25 (53%) of the 47 study patients, low-dose dexamethasone (20 mg/wk) was added. The primary end point was progression-free survival (PFS). RESULTS In vitro, IL-1Ra was superior to dexamethasone at inhibiting IL-6 production; maximal IL-6 inhibition and apoptosis induction were achieved by addition of both IL-1Ra and dexamethasone. In the clinical trial, 3 patients achieved a minor response to IL-1Ra alone; 5 patients achieved a partial response and 4 patients a minor response after addition of dexamethasone. Seven patients showed a decrease in the plasma cell labeling index that paralleled a decrease in high-sensitivity C-reactive protein (hs-CRP) levels. The median overall PFS was 37.5 months. The median PFS for patients without (n=12) or with (n=35) a greater than 15% decrease in 6-month vs baseline hs-CRP levels was 6 months and more than 3 years, respectively (P=.002). Disease stability was maintained in 8 patients who received therapy for more than 4 years. CONCLUSION In patients with smoldering or indolent multiple myeloma who were at risk of progression to active myeloma, treatment with IL-1 inhibitors decreased the myeloma proliferative rate and hs-CRP levels in those who responded, leading to a chronic disease state and an improved PFS. TRIAL REGISTRATION clinicaltrials.gov identifier: NCT00635154.
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Affiliation(s)
- John A Lust
- Division of Hematology, Mayo Clinic, Rochester, MN 55905.
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Pathogenesis and progression of monoclonal gammopathy of undetermined significance. Leukemia 2008; 22:1651-7. [DOI: 10.1038/leu.2008.203] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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González García M, Fernández Álvarez C, Robles Marinas V, González Huerta A, Arias Miranda M, González Rodríguez A, García Casas J, Moris de La Tassa J, Fernández García J. Serie de 618 casos de gammapatías monoclonales de significado indeterminado (GMSI): factores predictivos de desaparición del componente monoclonal o de evolución a gammapatías malignas. Rev Clin Esp 2008; 208:288-94. [DOI: 10.1157/13123188] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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