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Catto MB, Safranauskas RMDSO, Datoguia TS, Kishimoto RK, Borri D, Cordeiro MG, Nascimento ACLD, Hamerschlak N, Velloso EDRP. Cytogenetic findings in testicular relapse of multiple myeloma: case report and literature review. Hematol Transfus Cell Ther 2024:S2531-1379(24)00006-3. [PMID: 38402033 DOI: 10.1016/j.htct.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 12/27/2023] [Indexed: 02/26/2024] Open
Affiliation(s)
- Marília Bazzo Catto
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade São Paulo, Ribeirão Preto, Brazil.
| | | | | | | | - Daniela Borri
- Hospital Israelita Albert Einstein, São Paulo, Brazil
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Guan J, Ma J, Chen B. Clinical and cytogenetic characteristics of primary and secondary plasma cell leukemia under the new IMWG definition criteria: a retrospective study. Hematology 2023; 28:2254556. [PMID: 37732631 DOI: 10.1080/16078454.2023.2254556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 08/29/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Plasma cell leukemia (PCL) is a rare and aggressive plasma cell disorder, exhibiting a more unfavorable prognosis than multiple myeloma. PCL is classified into pPCL and sPCL. Recently, the IMWG has recommended new PCL definition criteria, which require the presence of ≥5% circulating plasma cells in peripheral blood smears. Due to its low incidence, research on pPCL and sPCL is limited. METHODS We conducted a retrospective study and analyzed clinical and cytogenetic data of pPCL and sPCL patients. Overall survival (OS) and progression-free survival (PFS) were assessed by the Kaplan-Meier method, and survival distributions were compared using the log-rank test. RESULTS This is a small cohort comprising 23 pPCL and 9 sPCL patients. Notably, sPCL patients showed a higher incidence of extramedullary infiltration and a higher percentage of bone marrow plasma cells (p = 0.015 and 0.025, respectively). Although no significant difference was found between the two groups in OS and PFS, a trend emerged suggesting a superior survival outcome for pPCL patients, with a higher cumulative 1-year PFS rate (38.3% vs. 13.3%) and a lower early mortality rate (mortality rate at 3 months: 15% vs. 33%). We also suggested that pPCL patients carrying t(11;14) may have a longer median survival time than individuals with other cytogenetic abnormalities, but this was not confirmed due to the small sample size. CONCLUSION Our study revealed clinical and cytogenetic features of pPCL and sPCL patients according to the new diagnostic criteria. The findings suggested a generally better prognosis for pPCL than sPCL and the likelihood of t(11;14) translocation acting as a favorable prognostic factor in pPCL. It is important to note that our study had a limited sample size, which may lead to bias. We hope well-designed studies can be conducted to provide more results.
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Affiliation(s)
- Jiaheng Guan
- Department of Hematology and Oncology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, People's Republic of China
| | - Jinlong Ma
- Department of Hematology and Oncology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, People's Republic of China
| | - Baoan Chen
- Department of Hematology and Oncology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, People's Republic of China
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Lewis E, McCulloch S, Mahe E, Bahlis N, Neri P, Tay J, Duggan P, Jimenez-Zepeda VH. Effect of the Presence of t(11;14) for Patients With AL Amyloidosis Treated With Bortezomib-Containing Regimens: Experience From the Amyloidosis Program of Calgary. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2023; 23:e331-e334. [PMID: 37532664 DOI: 10.1016/j.clml.2023.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 08/04/2023]
Affiliation(s)
- Ellen Lewis
- Department of Medical Oncology and Hematology, Tom Baker Cancer Centre/University of Calgary, Calgary, AB, Canada
| | - Sylvia McCulloch
- Department of Medical Oncology and Hematology, Tom Baker Cancer Centre/University of Calgary, Calgary, AB, Canada
| | - Etienne Mahe
- Department of Medical Oncology and Hematology, Tom Baker Cancer Centre/University of Calgary, Calgary, AB, Canada; Department of Pathology and Lab Medicine, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Nizar Bahlis
- Department of Medical Oncology and Hematology, Tom Baker Cancer Centre/University of Calgary, Calgary, AB, Canada; Arnie Charbonneau Cancer Research Institute, University of Calgary, Calgary, AB, Canada
| | - Paola Neri
- Department of Medical Oncology and Hematology, Tom Baker Cancer Centre/University of Calgary, Calgary, AB, Canada; Arnie Charbonneau Cancer Research Institute, University of Calgary, Calgary, AB, Canada
| | - Jason Tay
- Department of Medical Oncology and Hematology, Tom Baker Cancer Centre/University of Calgary, Calgary, AB, Canada; Arnie Charbonneau Cancer Research Institute, University of Calgary, Calgary, AB, Canada
| | - Peter Duggan
- Department of Medical Oncology and Hematology, Tom Baker Cancer Centre/University of Calgary, Calgary, AB, Canada; Arnie Charbonneau Cancer Research Institute, University of Calgary, Calgary, AB, Canada
| | - Victor H Jimenez-Zepeda
- Department of Medical Oncology and Hematology, Tom Baker Cancer Centre/University of Calgary, Calgary, AB, Canada; Arnie Charbonneau Cancer Research Institute, University of Calgary, Calgary, AB, Canada.
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4
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Puertas B, González-Calle V, Sobejano-Fuertes E, Escalante F, Rey-Bua B, Padilla I, García-Sanz R, Puig N, Gutiérrez NC, Mateos MV. Multiple myeloma with t(11;14): impact of novel agents on outcome. Blood Cancer J 2023; 13:40. [PMID: 36935422 PMCID: PMC10025259 DOI: 10.1038/s41408-023-00807-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/23/2023] [Accepted: 02/27/2023] [Indexed: 03/21/2023] Open
Abstract
Multiple myeloma (MM) patients with t(11;14) present unique biological features and their prognosis is not well established. We report a retrospective study of 591 MM patients, 17.3% of whom had t(11;14). It was designed to determine the prognostic impact of this abnormality and the effect of novel agents on the response and outcomes. Three groups were established based on their cytogenetics: (1) t(11;14); (2) high-risk chromosomal abnormalities; and (3) standard risk (SR). After 80.1 months (1.2-273.8 months) of follow-up, no differences were observed in overall survival (OS) between the t(11;14) and SR groups (75.8 vs. 87.2 months; P = 0.438). Treatment of MM t(11;14) with novel agents did not improve their overall response rate (ORR) or complete response (CR) compared with those who received conventional therapy (ORR: 87.2 vs. 79.5%, P = 0.336; CR: 23.4 vs. 12.8%, P = 0.215). This effect translated into a similar PFS (39.6 vs. 30.0 months; P = 0.450) and OS (107.6 vs. 75.7 months; P = 0.175). In summary, MM t(11;14) patients did not benefit from the introduction of novel agents as much as SR patients did, indicating that other therapies are needed to improve their outcomes.
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Affiliation(s)
- Borja Puertas
- University Hospital of Salamanca/IBSAL/Cancer Research Center-IBMCC (USAL-CSIC), CIBERONC, Salamanca, Spain
| | - Verónica González-Calle
- University Hospital of Salamanca/IBSAL/Cancer Research Center-IBMCC (USAL-CSIC), CIBERONC, Salamanca, Spain
| | - Eduardo Sobejano-Fuertes
- Department of Hematology, University Hospital Dr. José Molina Orosa, Lanzarote, Canary Islands, Palmas, Spain
| | | | - Beatriz Rey-Bua
- University Hospital of Salamanca/IBSAL/Cancer Research Center-IBMCC (USAL-CSIC), CIBERONC, Salamanca, Spain
| | - Irene Padilla
- Department of Hematology, University Hospital of León, León, Spain
| | - Ramón García-Sanz
- University Hospital of Salamanca/IBSAL/Cancer Research Center-IBMCC (USAL-CSIC), CIBERONC, Salamanca, Spain
| | - Noemi Puig
- University Hospital of Salamanca/IBSAL/Cancer Research Center-IBMCC (USAL-CSIC), CIBERONC, Salamanca, Spain
| | - Norma C Gutiérrez
- University Hospital of Salamanca/IBSAL/Cancer Research Center-IBMCC (USAL-CSIC), CIBERONC, Salamanca, Spain
| | - María-Victoria Mateos
- University Hospital of Salamanca/IBSAL/Cancer Research Center-IBMCC (USAL-CSIC), CIBERONC, Salamanca, Spain.
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Egan PA, O'Connor SJM, Deighan WI, McConville CE, Elder PT, Curly Morris TCM, Alexander HD. IgD multiple myeloma: biology, diagnosis, and treatment. Leuk Lymphoma 2022; 63:3433-3437. [PMID: 36263946 DOI: 10.1080/10428194.2022.2126280] [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: 01/28/2022] [Accepted: 09/09/2022] [Indexed: 11/06/2022]
Abstract
IgD multiple myeloma is uncommon. Patients generally present at a younger age and have shorter progression free and overall survivals (OSs). Its rarity has inhibited development of a specific risk stratification system or informed best treatment protocols. We present interphase fluorescence in situ hybridization results from a group of 29 cases. These showed evidence of a decreased male to female ratio, decreased OS in patients aged 70 and over, better outcomes in those with kappa light chain restriction, and CD56 positive patients had longer survivals than those lacking CD56. We discuss the biology of IgD multiple myeloma, the need for prospective studies, and challenges for improvements in diagnosis and treatment. We suggest an International Register to accelerate development of best practice guidelines for diagnosis, risk stratification, and treatment.
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Affiliation(s)
- Philip A Egan
- Ulster University Faculty of Life and Health Sciences, Northern Ireland Centre for Stratified Medicine, Derry, UK
| | - Sheila J M O'Connor
- St James's Institute of Oncology, Haematological Malignancy Diagnostic Service, Leeds, UK
| | - W Ian Deighan
- Department of Clinical Chemistry, Altnagelvin Area Hospital, Derry, UK
| | - Conal E McConville
- Department of Haematology, Altnagelvin Area Hospital, North West Cancer Centre, Derry, UK
| | - Patrick T Elder
- Department of Haematology, Altnagelvin Area Hospital, North West Cancer Centre, Derry, UK
| | - T C M Curly Morris
- Queen's University Belfast Faculty of Medicine Health and Life Sciences, Patrick G Johnston Centre for Cancer Research, Belfast, UK
| | - H Denis Alexander
- Ulster University Faculty of Life and Health Sciences, Northern Ireland Centre for Stratified Medicine, Derry, UK
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6
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Jian Y, Zhang Z, Zhou H, Yang G, Geng C, Wang H, Gao W, Chen W. CD20 expression: A risk stratification factor for newly diagnosed multiple myeloma with t(11;14). Front Oncol 2022; 12:1061438. [PMID: 36531062 PMCID: PMC9752036 DOI: 10.3389/fonc.2022.1061438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/16/2022] [Indexed: 01/17/2024] Open
Abstract
OBJECTIVE Translocation (11;14) is one of the most frequent recurrent cytogenetic abnormalities in multiple myeloma (MM), while its clinical prognostic value remains controversial. CD20 expression is uncommon in MM while strongly associated with t(11;14). This study aimed to investigate whether CD20 could provide further prognostic value in MM patients harboring t(11;14). METHODS CD20 expression detected by flow cytometry was retrospectively analyzed in 211 newly diagnosed MM patients with t(11;14). The clinical characteristics and outcomes were analyzed between CD20 positive and negative patients. RESULTS CD20 expression was found in 34.6% (73/211) newly diagnosed MM (NDMM) patients with t(11;14), associated with lower serum creatine levels and lower incidence of plasmacytoma. Based on similar treatment regimens, CD20 positive patients had a comparable overall response rate to CD20 negative patients, whereas had a lower CR/sCR (complete response/stringent complete response) rate than the latter (31.4% vs. 46.4%, P =0.045). Nevertheless, CD20 positive patients had a longer tendency of progression-free survival (PFS) (59.0 vs. 29.0 months, P =0.163) and significantly longer overall survival (OS) (99.0 vs. 56.0 months, P=0.003) than CD20 negative patients. Further investigation among CD20 expression proportion showed that strong expression of CD20 (>80% of bone marrow plasma cells) exhibited the longest OS (median not reached, P =0.011). However, the favorable impact of CD20 expression on survival was eliminated with the contaminant presence of cytogenetic abnormalities besides t(11;14). Autologous stem cell transplantation (ASCT) could improve the prognosis of CD20 negative t(11;14) patients. Multivariate analysis confirmed that CD20 expression was an independent favorable indicator for longer OS in t(11;14) MM patients. CONCLUSION CD20 expression is a favorable prognostic factor in NDMM with t(11;14) and could provide further risk-stratification value in this heterogeneous disease subgroup.
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Affiliation(s)
| | | | | | | | | | | | | | - Wenming Chen
- Department of Hematology, Myeloma Research Center of Beijing, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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7
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Wang J, Yang S, Liao P, Zeng L, Ling W, Wan L, Weng J, Zhong L. Incidence and effect of secondary cardiac amyloidosis on outcomes of patients with t(11;14) multiple myeloma. Front Cardiovasc Med 2022; 9:994384. [PMID: 36119749 PMCID: PMC9479066 DOI: 10.3389/fcvm.2022.994384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 08/16/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe t(11;14)(q13;32) is a common chromosome translocation in multiple myeloma (MM), but its prognostic value remains controversial. Immunoglobulin light chain amyloidosis is commonly secondary to multiple myeloma, which can rapidly cause heart failure and high mortality. We aimed to investigate the prevalence of secondary cardiac amyloidosis in MM patients with t(11;14) and to evaluate its impact on survival outcomes.MethodsWe retrospectively identified 52 MM patients with t(11;14) in our center between October 2015 and April 2022. The associations between cardiac amyloidosis and clinical and biological parameters were statistically analyzed, and the impacts of concomitant of cardiac amyloidosis on survival and prognosis of MM patients with t(11;14) were also assessed.ResultsConcomitant presence of cardiac amyloidosis was observed in 15 (28.8%) of all cases. Patients with cardiac amyloidosis had significantly higher NT-proBNP (p = 0.002) and higher hs-cTnT (p < 0.001), while the patients without cardiac amyloidosis had higher percentage of bone marrow plasma cells (p = 0.027), higher incidence of hemoglobin <80 g/L (p = 0.021) and bone destruction (p < 0.001). The median overall survival (OS) for all patients was 33.4 months after a median follow-up of 23.8 months. The amyloidosis group showed a significantly shorter OS than the non-amyloidosis group (15.3 vs. 41.8 months, p < 0.001). Besides, patients harboring NT-proBNP >1,800 pg/ml (p < 0.001) or hs-cTnT ≧40 pg/ml (p = 0.001) or light chain (LC) only isotype (p = 0.033) had a significantly shorter mean OS compared with patients with lower NT-proBNP or hs-cTnT or other M-protein isotype. Univariate analyses showed that NT-proBNP >1,800 pg/ml, hs-cTnT ≧40 pg/ml, LC only isotype, and concomitant presence of cardiac amyloidosis were independently associated with shorter OS, while NT-proBNP >1,800 pg/ml still retained the prognostic value for OS in multivariate analyses.ConclusionThe t(11;14) MM patients with coexisting cardiac amyloidosis may represent a distinct clinical entity that confers a poor outcome. These findings may have important clinical and biological implications.
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Affiliation(s)
- Jinghua Wang
- Department of Hematology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shuo Yang
- Department of Hematology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Pengjun Liao
- Department of Hematology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Lingji Zeng
- Department of Hematology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wei Ling
- Department of Hematology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Li Wan
- Department of Endocrinology & Metabolism, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jianyu Weng
- Department of Hematology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- *Correspondence: Liye Zhong
| | - Liye Zhong
- Department of Hematology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Jianyu Weng
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Nafría Jiménez B, Oliveros Conejero R. IgE multiple myeloma: detection and follow-up. ADVANCES IN LABORATORY MEDICINE 2022; 3:79-90. [PMID: 37359442 PMCID: PMC10197376 DOI: 10.1515/almed-2021-0087] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/12/2021] [Indexed: 06/28/2023]
Abstract
Objectives We report a new case of immunoglobulin E multiple myeloma (IgE), a very rare isotype that accounts for <0.1% of cases of this monoclonal gammopathy. To ensure the adequate detection, quantification and identification of the monoclonal component, it is crucial that protein assays are performed. We provide some clues related to clinical laboratory results, which will facilitate an adequate management of the disease. Case presentation A 45-year-old patient with a five-week history of pain at the level of the elbow, who was diagnosed with IgE-Kappa multiple myeloma based on laboratory, radiological, and bone marrow findings. The patient received induction chemotherapy prior to hematopoietic stem-cell transplantation and is currently on follow-up. Conclusions Protein assays performed in the clinical laboratory, including protein electrophoresis and immunofixation, allowed for the detection of an IgE-Kappa monoclonal component prior to the appearance of the typical CRAB symptoms (hypercalcemia, renal involvement, anemia, and bone pain) of multiple myeloma (MM). The detection of IgE-Kappa facilitated early diagnosis and management.
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Affiliation(s)
- Beatriz Nafría Jiménez
- Department of Clinical Biochemistry, Hospital Universitario Donostia, San Sebastián, Spain
- Servicio de Análisis Clínicos, Hospital Universitario Donostia, San Sebastián, Spain
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Papadhimitriou SI, Terpos E, Liapis K, Pavlidis D, Marinakis T, Kastritis E, Dimopoulos MA, Tsitsilonis OE, Kostopoulos IV. The Cytogenetic Profile of Primary and Secondary Plasma Cell Leukemia: Etiopathogenetic Perspectives, Prognostic Impact and Clinical Relevance to Newly Diagnosed Multiple Myeloma with Differential Circulating Clonal Plasma Cells. Biomedicines 2022; 10:biomedicines10020209. [PMID: 35203419 PMCID: PMC8869452 DOI: 10.3390/biomedicines10020209] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/08/2022] [Accepted: 01/10/2022] [Indexed: 12/21/2022] Open
Abstract
Plasma cell leukemia (PCL) is a rare and aggressive plasma cell dyscrasia that may appear as de-novo leukemia (pPCL) or on the basis of a pre-existing multiple myeloma (MM), called secondary plasma cell leukemia (sPCL). In this prospective study, we have applied a broad panel of FISH probes in 965 newly diagnosed MM (NDMM) and 44 PCL cases of both types to reveal the particular cytogenetic differences among the three plasma cell dyscrasias. In order to evaluate the frequency and patterns of clonal evolution, the same FISH panel was applied both at diagnosis and at the time of first relapse for 81 relapsed MM patients and both at MM diagnosis and during sPCL transformation for the 19 sPCL cases described here. pPCL was characterized by frequent MYC translocations and t(11;14) with a 11q13 breakpoint centered on the MYEOV gene, not commonly seen in MM. sPCL had a higher number of FISH abnormalities and was strongly associated with the presence of del(17p13), either acquired at the initial MM stage or as a newly acquired lesion upon leukemogenesis in the context of the apparent clonal evolution observed in sPCL. In clinical terms, sPCL showed a shorter overall survival than pPCL with either standard or high-risk (t(4;14) and/or t(14;16) and/or del(17p13) and/or ≥3 concomitant aberrations) abnormalities (median 5 months vs. 21 and 11 months respectively, p < 0.001), suggesting a prognostic stratification based on cytogenetic background. These observations proved relevant in the NDMM setting, where higher levels of circulating plasma cells (CPCs) were strongly associated with high-risk cytogenetics (median frequency of CPCs: 0.11% of peripheral blood nucleated cells for high-risk vs. 0.007% for standard-risk NDMM, p < 0.0001). Most importantly, the combined evaluation of CPCs (higher or lower than a cut-off of 0.03%), together with patients’ cytogenetic status, could be used for an improved prognostic stratification of NDMM patients.
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Affiliation(s)
- Stefanos I. Papadhimitriou
- Department of Laboratory Hematology, Athens Regional General Hospital “Georgios Gennimatas”, 11527 Athens, Greece; (S.I.P.); (D.P.)
| | - Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.T.); (E.K.); (M.-A.D.)
| | - Konstantinos Liapis
- Department of Haematology, University Hospital of Alexandroupolis, Democritus University of Thrace Medical School, 68100 Alexandroupolis, Greece;
| | - Dimitrios Pavlidis
- Department of Laboratory Hematology, Athens Regional General Hospital “Georgios Gennimatas”, 11527 Athens, Greece; (S.I.P.); (D.P.)
| | - Theodoros Marinakis
- Department of Clinical Hematology, Athens Regional General Hospital “Georgios Gennimatas”, 11527 Athens, Greece;
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.T.); (E.K.); (M.-A.D.)
| | - Meletios-Athanasios Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.T.); (E.K.); (M.-A.D.)
| | - Ourania E. Tsitsilonis
- Department of Biology, School of Sciences, National and Kapodistrian University of Athens, Panepistimiopolis, Ilissia, 15784 Athens, Greece;
| | - Ioannis V. Kostopoulos
- Department of Laboratory Hematology, Athens Regional General Hospital “Georgios Gennimatas”, 11527 Athens, Greece; (S.I.P.); (D.P.)
- Department of Biology, School of Sciences, National and Kapodistrian University of Athens, Panepistimiopolis, Ilissia, 15784 Athens, Greece;
- Correspondence: or ; Tel.: +30-210-727-4929; Fax: +30-210-727-4635
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10
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Effect of t (11;14) Abnormality on Outcomes of Patients With Newly Diagnosed Multiple Myeloma in the Connect MM Registry. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2021; 22:149-157. [PMID: 34588149 DOI: 10.1016/j.clml.2021.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 08/09/2021] [Accepted: 08/24/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND The t (11;14) (q13;32) translocation [t (11;14)] is present in ∼20% of patients with newly diagnosed multiple myeloma (NDMM), but studies examining its prognostic ability have yielded divergent results, and data are lacking on outcomes from first-line therapy. PATIENTS AND METHODS Data from the Connect MM Registry, a large US, multicenter, prospective observational cohort study of patients with NDMM were used to examine the effect of t (11;14) status on first-line therapy outcomes in the Overall population (n = 1574) and race groups (African American [AA] vs. non-African American [NAA]). RESULTS Baseline characteristics were generally similar between patients with (n = 378) and without (n = 1196) t (11;14). Prevalence of t (11;14) was similar by race (AA, 27%; NAA, 24%). In the overall population, regardless of first-line therapy, t (11;14) status did not affect progression-free survival (hazard ratio, 1.02; P = 0.7675) or overall survival (hazard ratio, 0.99; P = .9417). AA patients with t (11;14) had higher likelihood of death (Nominal Cox regression P = .0298) vs. patients without t (11;14). CONCLUSIONS Acknowledging observational study and inferential limitations, this exploratory analysis of a predominantly community-based population suggests that t (11;14) is a neutral prognostic factor in the general MM population but may be a negative factor for overall survival in AA patients.
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11
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Kitadate A, Terao T, Narita K, Ikeda S, Takahashi Y, Tsushima T, Miura D, Takeuchi M, Takahashi N, Matsue K. Multiple myeloma with t(11;14)-associated immature phenotype has lower CD38 expression and higher BCL2 dependence. Cancer Sci 2021; 112:3645-3654. [PMID: 34288263 PMCID: PMC8409299 DOI: 10.1111/cas.15073] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/02/2021] [Accepted: 07/14/2021] [Indexed: 11/29/2022] Open
Abstract
CD38 expression on myeloma cells is a critical factor affecting the early response to the anti-CD38 antibody daratumumab. However, factors affecting CD38 expression in untreated multiple myeloma are not fully elucidated. In this study, we found that CD38 expression was significantly lower in myeloma patients with the translocation t(11;14)-associated immature plasma cell phenotype, and particularly in those expressing B-cell-associated genes such as PAX5 and CD79A. CD138, a representative marker of plasmacytic differentiation, was also significantly lower in these patients, suggesting that CD38 expression may be associated with the differentiation and maturation stages of myeloma cells. Furthermore, the BCL2/BCL2L1 ratio, a response marker of the BCL2 inhibitor venetoclax, was significantly higher in patients with the immature phenotype expressing B-cell-associated genes. The BCL2/BCL2L1 ratio and CD38 expression were significantly negatively correlated. We also confirmed that patients with translocation t(11;14) expressing B-cell-associated genes were indeed less sensitive to daratumumab-mediated direct cytotoxicity but highly sensitive to venetoclax treatment in ex vivo assays. Moreover, all-trans-retinoic acid, which enhances CD38 expression and induces cell differentiation in myeloma cells, reduced B-cell marker expression and the BCL2/BCL2L1 ratio in myeloma cell lines, leading to reduced efficacy of venetoclax. Venetoclax specifically induces cell death in myeloma with t(11;14), although why patients with translocation t(11;14) show BCL2 dependence is unclear. These results suggest that BCL2 dependence, as well as CD38 expression, are deeply associated with the differentiation and maturation stages of myeloma cells. This study highlights the importance of examining t(11;14) and considering cell maturity in myeloma treatment strategies.
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Affiliation(s)
- Akihiro Kitadate
- Division of Hematology/Oncology, Department of Medicine, Kameda Medical Center, Kamogawa, Japan.,Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, Akita, Japan
| | - Toshiki Terao
- Division of Hematology/Oncology, Department of Medicine, Kameda Medical Center, Kamogawa, Japan
| | - Kentaro Narita
- Division of Hematology/Oncology, Department of Medicine, Kameda Medical Center, Kamogawa, Japan
| | - Sho Ikeda
- Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, Akita, Japan
| | - Yuto Takahashi
- Department of Life Science, Akita University Graduate School of Engineering Science, Akita, Japan
| | - Takafumi Tsushima
- Division of Hematology/Oncology, Department of Medicine, Kameda Medical Center, Kamogawa, Japan
| | - Daisuke Miura
- Division of Hematology/Oncology, Department of Medicine, Kameda Medical Center, Kamogawa, Japan
| | - Masami Takeuchi
- Division of Hematology/Oncology, Department of Medicine, Kameda Medical Center, Kamogawa, Japan
| | - Naoto Takahashi
- Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, Akita, Japan
| | - Kosei Matsue
- Division of Hematology/Oncology, Department of Medicine, Kameda Medical Center, Kamogawa, Japan
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Hassan H, Szalat R. Genetic Predictors of Mortality in Patients with Multiple Myeloma. APPLICATION OF CLINICAL GENETICS 2021; 14:241-254. [PMID: 33953598 PMCID: PMC8092627 DOI: 10.2147/tacg.s262866] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/31/2021] [Indexed: 12/19/2022]
Abstract
Multiple myeloma (MM) is a heterogeneous disease featured by clonal plasma cell proliferation and genomic instability. The advent of next-generation sequencing allowed unraveling the complex genomic landscape of the disease. Several recurrent genomic aberrations including immunoglobulin genes translocations, copy number abnormalities, complex chromosomal events, transcriptomic and epigenomic deregulation, and mutations define various molecular subgroups with distinct outcomes. In this review, we describe the recurrent genomic events identified in MM impacting patients’ outcome and survival. These genomic aberrations constitute new markers that could be incorporated into a prognostication model to eventually guide therapy at every stage of the disease.
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Affiliation(s)
- Hamza Hassan
- Department of Hematology and Medical Oncology, Boston University Medical Center, Boston, MA, USA
| | - Raphael Szalat
- Department of Hematology and Medical Oncology, Boston University Medical Center, Boston, MA, USA.,Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
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13
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Abu Zaanona MI, Patel P. Plasma cell leukaemia with t(11;14) not responsive to venetoclax. BMJ Case Rep 2021; 14:14/1/e238641. [PMID: 33495184 PMCID: PMC7839868 DOI: 10.1136/bcr-2020-238641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
A 70-year-old man with medical history of IgG kappa multiple myeloma, initially diagnosed in 2017, underwent induction therapy with carfilzomib, lenalidomide and dexamethasone followed by autologous haematopoietic stem cell transplantation. Nine months following transplant, disease relapsed in the form of plasma cell leukaemia. Fluorescent in situ hybridisation of malignant plasma cells revealed t(11;14). A combination therapy including venetoclax was used based on efficacy data for Bcl-2 inhibitor venetoclax from available early-phase clinical trials in patients with relapsed multiple myeloma with t(11;14) and other published case studies. Unfortunately, the disease was primary refractory, and after further ineffective therapies, the patient did not have a successful outcome.
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Affiliation(s)
| | - Priyank Patel
- Department of Hematology & Oncology, Carle Foundation Hospital, Urbana, Illinois, USA
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Zeissig MN, Zannettino ACW, Vandyke K. Tumour Dissemination in Multiple Myeloma Disease Progression and Relapse: A Potential Therapeutic Target in High-Risk Myeloma. Cancers (Basel) 2020; 12:cancers12123643. [PMID: 33291672 PMCID: PMC7761917 DOI: 10.3390/cancers12123643] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/02/2020] [Accepted: 12/02/2020] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Like in solid cancers, the process of dissemination is a critical feature of disease progression in the blood cancer multiple myeloma. At diagnosis, myeloma patients have cancer that has spread throughout the bone marrow, with patients with more disseminatory myeloma having worse outcomes for their disease. In this review, we discuss the current understanding of the mechanisms that underpin the dissemination process in multiple myeloma. Furthermore, we discuss the potential for the use of therapies that target the dissemination process as a novel means of improving outcomes for multiple myeloma patients. Abstract Multiple myeloma (MM) is a plasma cell (PC) malignancy characterised by the presence of MM PCs at multiple sites throughout the bone marrow. Increased numbers of peripheral blood MM PCs are associated with rapid disease progression, shorter time to relapse and are a feature of advanced disease. In this review, the current understanding of the process of MM PC dissemination and the extrinsic and intrinsic factors potentially driving it are addressed through analysis of patient-derived MM PCs and MM cell lines as well as mouse models of homing and dissemination. In addition, we discuss how patient cytogenetic subgroups that present with highly disseminated disease, such as t(4;14), t(14;16) and t(14;20), suggest that intrinsic properties of MM PC influence their ability to disseminate. Finally, we discuss the possibility of using therapeutic targeting of tumour dissemination to slow disease progression and prevent overt relapse.
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Affiliation(s)
- Mara N. Zeissig
- Myeloma Research Laboratory, Faculty of Health and Medical Sciences, Adelaide Medical School, The University of Australia, Adelaide 5005, Australia; (M.N.Z.); (A.C.W.Z.)
- Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide 5000, Australia
| | - Andrew C. W. Zannettino
- Myeloma Research Laboratory, Faculty of Health and Medical Sciences, Adelaide Medical School, The University of Australia, Adelaide 5005, Australia; (M.N.Z.); (A.C.W.Z.)
- Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide 5000, Australia
- Central Adelaide Local Health Network, Adelaide 5000, Australia
- Centre for Cancer Biology, University of South Australia, Adelaide 5000, Australia
| | - Kate Vandyke
- Myeloma Research Laboratory, Faculty of Health and Medical Sciences, Adelaide Medical School, The University of Australia, Adelaide 5005, Australia; (M.N.Z.); (A.C.W.Z.)
- Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide 5000, Australia
- Correspondence: ; Tel.: +61-8-8128-4694
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15
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Gao W, Du J, Liu J, Zhou H, Zhang Z, Jian Y, Yang G, Wang G, Tian Y, Li Y, Wu Y, Fu W, Li J, Chen W. What Multiple Myeloma With t(11;14) Should Be Classified Into in Novel Agent Era: Standard or Intermediate Risk? Front Oncol 2020; 10:538126. [PMID: 33194599 PMCID: PMC7649769 DOI: 10.3389/fonc.2020.538126] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/20/2020] [Indexed: 11/20/2022] Open
Abstract
Objective To investigate the prognostic value of t(11;14) for de novo multiple myeloma (MM) patients in novel agent era. Methods A total of 455 patients with fluorescence in situ hybridization (FISH), before treatments from three hospitals in China, were included in the study. All patients received autologous stem cell transplantation (ASCT) after induction therapy as consolidation. High risk (HR) cytogenetics were defined as t(4;14), t(14;16), and/or del 17p. Results A total of 152 patients were in the HR group. Of patients without HR cytogenetics, 55 were in the t(11;14) group, and 248 were in the standard risk (SR) group without t(11;14). Gain in 1q21 was observed in 38.9% patients with t(11;14). There were no differences in median progression free survival (PFS) and overall survival (OS), respectively, between patients in the t(11;14) group and those in the SR group. Patients in the t(11;14) group had the longer median PFS and OS, respectively, compared with those in the HR group. Regardless of coexisting with 1q21 gain or not, patients in the t(11;14) group still had similar median PFS and OS compared to those in the SR group. Finally, multivariate analysis indicated that including 1q21 gain and bone marrow plasma cell with CD20 expression, no variables were found to predict the outcome of the t(11;14) group in our cohort. Conclusions These results confirm that outcomes of t(11;14) MM are similar to standard risk patients when they receive novel agent induction therapy consolidated by ASCT. Gain of 1q21 coexists with t(11;14) frequently. In addition, both bone marrow plasma cell with CD20 expression and 1q21 gain have no impact on median PFS or OS for patients with t(11;14).
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Affiliation(s)
- Wen Gao
- Department of Hematology, Myeloma Research Center of Beijing, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Juan Du
- Department of Hematology, The Myeloma & Lymphoma Center, Changzheng Hospital, The Second Military Medical University, Shanghai, China
| | - Junru Liu
- Department of Hematology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Huixing Zhou
- Department of Hematology, Myeloma Research Center of Beijing, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Zhiyao Zhang
- Department of Hematology, Myeloma Research Center of Beijing, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yuan Jian
- Department of Hematology, Myeloma Research Center of Beijing, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Guangzhong Yang
- Department of Hematology, Myeloma Research Center of Beijing, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Guorong Wang
- Department of Hematology, Myeloma Research Center of Beijing, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Ying Tian
- Department of Hematology, Myeloma Research Center of Beijing, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yanchen Li
- Department of Hematology, Myeloma Research Center of Beijing, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yin Wu
- Department of Hematology, Myeloma Research Center of Beijing, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Weijun Fu
- Department of Hematology, The Myeloma & Lymphoma Center, Changzheng Hospital, The Second Military Medical University, Shanghai, China
| | - Juan Li
- Department of Hematology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wenming Chen
- Department of Hematology, Myeloma Research Center of Beijing, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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16
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Clinical features and survival outcomes in IgD myeloma: a study by Asia Myeloma Network (AMN). Leukemia 2020; 35:1797-1802. [PMID: 33082513 PMCID: PMC8179848 DOI: 10.1038/s41375-020-01060-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/21/2020] [Accepted: 10/05/2020] [Indexed: 12/12/2022]
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17
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Lemieux C, Johnston LJ, Lowsky R, Muffly LS, Craig JK, Shiraz P, Rezvani A, Frank MJ, Weng WK, Meyer E, Shizuru J, Arai S, Negrin R, Miklos DB, Sidana S. Outcomes with Autologous or Allogeneic Stem Cell Transplantation in Patients with Plasma Cell Leukemia in the Era of Novel Agents. Biol Blood Marrow Transplant 2020; 26:e328-e332. [PMID: 32961371 DOI: 10.1016/j.bbmt.2020.08.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/30/2020] [Accepted: 08/31/2020] [Indexed: 12/19/2022]
Abstract
Plasma cell leukemia (PCL) is a rare and very aggressive plasma cell disorder. The optimal treatment approach, including whether to pursue an autologous (auto) or allogeneic (allo) stem cell transplantation (SCT) is not clear, given the lack of clinical trial-based evidence. This single-center retrospective study describes the outcomes of 16 patients with PCL (n = 14 with primary PCL) who underwent either autoSCT (n = 9) or alloSCT (n = 7) for PCL in the era of novel agents, between 2007 and 2019. The median age of the cohort was 58 years. High-risk cytogenetics were found in 50% of the patients. All patients received a proteasome inhibitor and/or immunomodulatory drug-based regimen before transplantation. At the time of transplantation, 10 patients (62%) obtained at least a very good partial response (VGPR). The response after autoSCT (3 months) was at least a VGPR in 6 patients (67%; complete response [CR] in 5). All patients undergoing alloSCT achieved a CR at 3 months. Maintenance therapy was provided to 5 patients (56%) after autoSCT. The median progression-free survival after transplantation was 6 months in the autoSCT group, compared with 18 months in the alloSCT group (P = .09), and median overall survival (OS) after transplantation in the 2 groups was 19 months and 40 months, respectively (P = .41). The median OS from diagnosis was 27 months and 49 months, respectively (P = .50). Of the 11 deaths, 10 patients (91%) died of relapsed disease. AlloSCT was not observed to offer any significant survival advantage over autoSCT in PCL, in agreement with recent reports, and relapse remains the primary cause of death in these patients.
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Affiliation(s)
- Christopher Lemieux
- Stanford Cancer Institute, Stanford University Medical Center, Stanford, California
| | - Laura J Johnston
- Stanford Cancer Institute, Stanford University Medical Center, Stanford, California
| | - Robert Lowsky
- Stanford Cancer Institute, Stanford University Medical Center, Stanford, California
| | - Lori S Muffly
- Stanford Cancer Institute, Stanford University Medical Center, Stanford, California
| | - Juliana K Craig
- Stanford Cancer Institute, Stanford University Medical Center, Stanford, California
| | - Parveen Shiraz
- Stanford Cancer Institute, Stanford University Medical Center, Stanford, California
| | - Andrew Rezvani
- Stanford Cancer Institute, Stanford University Medical Center, Stanford, California
| | - Matthew J Frank
- Stanford Cancer Institute, Stanford University Medical Center, Stanford, California
| | - Wen-Kai Weng
- Stanford Cancer Institute, Stanford University Medical Center, Stanford, California
| | - Everett Meyer
- Stanford Cancer Institute, Stanford University Medical Center, Stanford, California
| | - Judith Shizuru
- Stanford Cancer Institute, Stanford University Medical Center, Stanford, California
| | - Sally Arai
- Stanford Cancer Institute, Stanford University Medical Center, Stanford, California
| | - Robert Negrin
- Stanford Cancer Institute, Stanford University Medical Center, Stanford, California
| | - David B Miklos
- Stanford Cancer Institute, Stanford University Medical Center, Stanford, California
| | - Surbhi Sidana
- Stanford Cancer Institute, Stanford University Medical Center, Stanford, California.
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18
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Biologic Implications of t(11;14) in Multiple Myeloma Explained With a Case of Refractory Disease Sensitive to Venetoclax. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 20:e556-e559. [PMID: 32653454 DOI: 10.1016/j.clml.2020.05.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/13/2020] [Accepted: 05/19/2020] [Indexed: 02/06/2023]
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19
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Mao XH, Zhuang JL, Zhao DD, Li XQ, Du X, Hao M, Xu Y, Yan YT, Liu JH, Fan HS, Sui WW, Deng SH, Li CW, Zhao JW, Yi SH, Du CX, Zou DH, Li ZJ, Zhao YZ, Zhan FH, Tai YT, Fang BJ, Song YP, Wang JX, Anderson KC, Qiu LG, An G. IgH translocation with undefined partners is associated with superior outcome in multiple myeloma patients. Eur J Haematol 2020; 105:326-334. [PMID: 32421883 DOI: 10.1111/ejh.13440] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND In multiple myeloma (MM), impact of specific chromosomal translocations involving IgH (14q21 locus, including t(4;14), t(11;14), and t(14;16)) has been explored extensively. However, over 15% MM patients harboring IgH translocation with undefined partners have long been ignored. METHODS A prospective non-randomized cohort study with a total of 715 newly-diagnosed MM cases was conducted, 13.6% of whom were t(14;undefined) positive. The whole cohort was divided into four groups: no IgH split (47.7%); t(14;undefined) (13.6%); t(11;14) (17.6%); and t(4;14) or t(14;16) group (21.1%). RESULTS Median OS for the four groups was 84.2, not reached (NR), 58.7, and 44.2 months, respectively, with P values for t(14;undefined) vs no IgH split, t(11;14), and t(4;14)/t(14;16) groups of 0.197, 0.022, and 0.001, respectively. In bortezomib-based group, the survival advantage gained by t(14;undefined) group was much more significant compared to t(11;14) and t(4;14)/t(14;16) groups. Importantly, t(14;undefined) turned out to be an independent predictive factor for longer OS of MM patients in multivariate analysis, especially in the context of bortezomib treatment. Similar results were also observed in the PUMCH external validation cohort. CONCLUSION Collectively, our data confirmed and externally validated the favorable prognosis of the t(14;undefined) groups, especially in the era of novel agents.
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Affiliation(s)
- Xue-Han Mao
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Jun-Ling Zhuang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Duo-Duo Zhao
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiao-Qing Li
- Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Xin Du
- Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Mu Hao
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Yan Xu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Yu-Ting Yan
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Jia-Hui Liu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Hui-Shou Fan
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Wei-Wei Sui
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Shu-Hui Deng
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Cheng-Wen Li
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Jia-Wei Zhao
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Shu-Hua Yi
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Chen-Xing Du
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - De-Hui Zou
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Zeng-Jun Li
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Yao-Zhong Zhao
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Feng-Huang Zhan
- Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Yu-Tzu Tai
- LeBow Institute for Myeloma Therapeutics and Jerome Lipper Center for Multiple Myeloma Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Bai-Jun Fang
- Department of Hematology, Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, China
| | - Yong-Ping Song
- Department of Hematology, Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, China
| | - Jian-Xiang Wang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Kenneth C Anderson
- LeBow Institute for Myeloma Therapeutics and Jerome Lipper Center for Multiple Myeloma Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Lu-Gui Qiu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Gang An
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
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Inamdar AA, Loo A, Mikhail N, Lee P. Secondary Plasma Cell Leukemia in a Recurrent Multiple Myeloma: Rare Case Scenario. Cureus 2020; 12:e8456. [PMID: 32642366 PMCID: PMC7336714 DOI: 10.7759/cureus.8456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Plasma cell leukemia (PCL) is an aggressive hematological condition characterized by the presence of plasma cells in the peripheral smear. It presents as de novo or may arise from multiple myeloma (MM), and hence is diagnosed as primary or secondary PCL, respectively. We report a case of 79-year-old patient diagnosed with MM two years prior to the admission to our institution with prior treatment with bortezomib, lenalidomide and dexamethasone (VRD) and daratumumab, pomalidomide and dexamethasone. Morphologic examination and flow cytometry studies performed on the peripheral smear demonstrated 45%-55% small to medium atypical plasma cells showing a kappa restriction and dim CD138 expression on flow cytometry analysis. The patient was started on brentuximab vedotin, etoposide, cytoxan and dexamethasone, which resulted in near complete elimination of the atypical plasma cells from the peripheral smear one week after the completion of two cycles. He received three cycles of brentuximab vedotin with a gradual decrease in serum free light chain. However, he eventually developed lethargy, weakness and seizures. The involvement of the central nervous system (CNS) by MM was confirmed with MRI, flow cytometry and cytology of cerebrospinal fluid. The treatment with whole brain radiation and ibrutinib was initiated. Our case report highlights the rare case of aggressive clinical course of MM leading to the development of plasmacytoma of kidney, secondary PCL and eventually spreading to the CNS.
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Affiliation(s)
| | - Abraham Loo
- Pathology and Laboratory Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
| | - Nagy Mikhail
- Pathology, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
| | - Patrick Lee
- Hematology Oncology, Monmouth Medical Center, Long Branch, USA
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21
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Secretory status of monoclonal immunoglobulin is related to the outcome of patients with myeloma: a retrospective study. Blood Adv 2020; 3:751-760. [PMID: 30833275 DOI: 10.1182/bloodadvances.2018019851] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 01/16/2019] [Indexed: 12/28/2022] Open
Abstract
The treatment of multiple myeloma (MM) with proteasome inhibitor (PI) bortezomib has significantly improved the survival of patients with MM. The 26S proteasome inhibitor targets the unfolded protein response (UPR) by inhibiting proteasome degradation of ubiquitinated paraprotein, subsequently leading to the lethal accumulation of paraprotein within the endoplasmic reticulum. According to secretory status of monoclonal immunoglobulin, newly diagnosed MM (NDMM) is divided into measurable and unmeasurable disease, which includes oligosecretory, nonsecretory, and nonproducer myeloma. The present study analyzed the clinical characteristics of 822 patients with NDMM who had either measurable or unmeasurable diseases and received bortezomib- or thalidomide-based therapies. Our results showed that the median progression-free survival (PFS) and overall survival (OS) of patients with MM was significantly longer in patients with measurable disease than those in oligosecretory, nonsecretory, and nonproducer MM (PFS: 27, 18, 19, and 2.0 months, respectively [P < .001]; OS: 51, 30, 22, and 2.0 months, respectively [P < .001]). Within the unmeasurable group, patients with nonproducer myeloma showed the shortest PFS and OS. Importantly, compared with thalidomide treatment, bortezomib significantly improved the PFS and OS of patients with MM with measurable disease (PFS: 25 and 33 months [P = .022], respectively; OS: 41 and 58 months [P < .001], respectively), but not those with unmeasurable disease (PFS: 18 and 16 months [P = .617], respectively; OS: 22 and 27 months [P = .743], respectively). Our results indicate that bortezomib-based therapy performed no better than thalidomide-based treatment in patients with unmeasurable MM. The results need to be confirmed in other patient cohorts, preferably in the context of a prospective trial.
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Kupsh A, Arnall J, Voorhees P. A successful case of venetoclax-based therapy in relapsed/refractory secondary plasma cell leukemia. J Oncol Pharm Pract 2019; 26:1274-1278. [DOI: 10.1177/1078155219895072] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Secondary plasma cell leukemia (sPCL) patients typically are either refractory to conventional therapies or have short remissions to drug regimens used in multiple myeloma (MM), which highlights sPCL’s aggressive nature and association with advanced stage disease. t(11,14) is correlated with increased BCL-2 expression, which makes it a cytogenic marker of interest for use of the BCL-2 inhibitor venetoclax. Little data of venetoclax’s use has been published in plasma cell leukemia. We present a case of a refractory/relapsed sPCL patient displaying t(11,14) who achieved a very good partial response (VGPR) from venetoclax therapy in combination with dexamethasone and bortezomib. Case report Our case describes a 67-year-old male initially diagnosed with IgG kappa MM in 2013, which transformed into non-secretory secondary plasma cell leukemia. Over a two-year period, despite responses to various therapies, the patient continued to experience relapses and exhausted options of novel agents seen in MM treatment. The patient was started on venetoclax in combination with bortezomib and oral dexamethasone. Management and outcome Due to the patient’s disease transformation into a non-secretory form of sPCL, PET/CT scans were relied upon to monitor disease progression. The PET/CT scan after three months of venetoclax combination treatment showed a very good partial response to therapy, with near resolution of metabolically active osseous disease. Discussion The success of venetoclax-based therapy in achieving a very good partial response suggests its utility in relapsed/refractory sPCL patients, who have exhausted various combinations of drug regimens used in treatment of MM and have historically poor survival outcomes.
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Affiliation(s)
- Allison Kupsh
- Hematology/Oncology Pharmacy Division, University of Washington Medicine, Seattle, WA, USA
| | - Justin Arnall
- Hematology/Oncology Pharmacy Division, Levine Cancer Institute, Charlotte, NC, USA
| | - Peter Voorhees
- Plasma Cell Disorders, Levine Cancer Institute, Charlotte, NC, USA
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Setiadi AF, Sheikine Y. CD138-negative plasma cell myeloma: a diagnostic challenge and a unique entity. BMJ Case Rep 2019; 12:12/11/e232233. [PMID: 31791993 DOI: 10.1136/bcr-2019-232233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Plasma cell neoplasms may exhibit variations in morphology and immunophenotype, which can mimic mature B-cell lymphoproliferative disorders and pose diagnostic challenges. This case illustrates a rare entity of plasma cell myeloma, where the entire plasma cell population exhibited lymphoid morphology, negativity for CD138, positivity for CD20 and cyclin D1, and positive fluorescence in situ hybridisation for t(11;14) and del(17 p), mimicking a mature B-cell lymphoproliferative disorder, in particular mantle cell lymphoma. In this case, a careful analysis of flow cytometry gating strategies and use of other ancillary tests were keys for correct diagnosis. In addition to the diagnostic implications due to its rarity, CD138-negative plasma cell myeloma may represent a unique entity, which is associated with 'stem cell'-like clonogenic properties, more aggressive clinical behaviour and resistance to chemotherapy.
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Affiliation(s)
- Audi Francesca Setiadi
- Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada .,Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Yuri Sheikine
- Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.,Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
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24
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Gran C, Uttervall K, Borg Bruchfeld J, Wallblom A, Alici E, Gahrton G, Nahi H. Translocation (11;14) in newly diagnosed multiple myeloma, time to reclassify this standard risk chromosomal aberration? Eur J Haematol 2019; 103:588-596. [PMID: 31487754 DOI: 10.1111/ejh.13325] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/25/2019] [Accepted: 08/26/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The most common translocation in multiple myeloma (MM) is t(11;14)(q13;q32), and its importance as prognostic factor has been controversial. The aim was to analyze its prognostic value. METHOD In this retrospective study of 469 newly diagnosed myeloma patients, outcomes in patients with (11;14) and standard risk (t(11;14)SR) or high risk (t(11;14)HR) cytogenetics were compared to outcomes of patients without t(11;14) and SR (non-t(11;14)SR) or HR (non-t(11;14)HR), respectively. RESULTS Overall progression-free survival (PFS) was shorter in t(11;14)SR than non-t(11;14)SR (median 28.9 vs 35.3 months); however, the difference was not significant (P = .2). Overall survival (OS) did not differ significantly between the groups. In the subgroup of patients that did not receive high-dose treatment, PFS was shorter for t(11;14)SR compared to non-t(11;14)SR, 10.6 vs 24.6 months (P = .01). Although OS were shorter for t(11,14)SR compared to non-t(11;14)SR (5-year OS 41.7% vs 63.8%), the difference was not significant (P = .1). In HDT patients, no significant difference was observed for OS or PFS between those with or without t(11;14). CONCLUSION This study shows that t(11;14) is associated with poorer outcome in MM, particularly in non-high-dose-treated SR patients. It should be considered an intermediate or high-risk marker in these patients.
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Affiliation(s)
- Charlotte Gran
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Clinical Chemistry, Karolinska University Hospital, Stockholm, Sweden
| | - Katarina Uttervall
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Hematology Center, Karolinska University Hospital, Stockholm, Sweden
| | - Johanna Borg Bruchfeld
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Hematology Center, Karolinska University Hospital, Stockholm, Sweden
| | - Ann Wallblom
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Evren Alici
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Gösta Gahrton
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Hareth Nahi
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Hematology Center, Karolinska University Hospital, Stockholm, Sweden
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25
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Clinical characteristics and prognosis of immunoglobulin D myeloma in the novel agent era. Ann Hematol 2019; 98:963-970. [DOI: 10.1007/s00277-018-3582-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 12/11/2018] [Indexed: 01/26/2023]
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26
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Sanoja-Flores L, Flores-Montero J, Garcés JJ, Paiva B, Puig N, García-Mateo A, García-Sánchez O, Corral-Mateos A, Burgos L, Blanco E, Hernández-Martín J, Pontes R, Díez-Campelo M, Millacoy P, Rodríguez-Otero P, Prosper F, Merino J, Vidriales MB, García-Sanz R, Romero A, Palomera L, Ríos-Tamayo R, Pérez-Andrés M, Blanco JF, González M, van Dongen JJM, Durie B, Mateos MV, San-Miguel J, Orfao A. Next generation flow for minimally-invasive blood characterization of MGUS and multiple myeloma at diagnosis based on circulating tumor plasma cells (CTPC). Blood Cancer J 2018; 8:117. [PMID: 30455467 PMCID: PMC6242818 DOI: 10.1038/s41408-018-0153-9] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 10/22/2018] [Accepted: 10/29/2018] [Indexed: 12/26/2022] Open
Abstract
Here, we investigated for the first time the frequency and number of circulating tumor plasma cells (CTPC) in peripheral blood (PB) of newly diagnosed patients with localized and systemic plasma cell neoplasms (PCN) using next-generation flow cytometry (NGF) and correlated our findings with the distinct diagnostic and prognostic categories of the disease. Overall, 508 samples from 264 newly diagnosed PCN patients, were studied. CTPC were detected in PB of all active multiple myeloma (MM; 100%), and smoldering MM (SMM) patients (100%), and in more than half (59%) monoclonal gammopathy of undetermined significance (MGUS) cases (p <0.0001); in contrast, CTPC were present in a small fraction of solitary plasmacytoma patients (18%). Higher numbers of CTPC in PB were associated with higher levels of BM infiltration and more adverse prognostic features, together with shorter time to progression from MGUS to MM (p <0.0001) and a shorter survival in MM patients with active disease requiring treatment (p ≤ 0.03). In summary, the presence of CTPC in PB as assessed by NGF at diagnosis, emerges as a hallmark of disseminated PCN, higher numbers of PB CTPC being strongly associated with a malignant disease behavior and a poorer outcome of both MGUS and MM.
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Affiliation(s)
- L Sanoja-Flores
- Cancer Research Center (IBMCC-CSIC/USAL-IBSAL); Cytometry Service (NUCLEUS) and Department of Medicine, University of Salamanca (USAL), Salamanca, Spain
- Centro de Investigación Biomédica en Red de Cáncer: CIBER-ONC number CB16/12/00400, Instituto Carlos III, Madrid, Spain
| | - J Flores-Montero
- Cancer Research Center (IBMCC-CSIC/USAL-IBSAL); Cytometry Service (NUCLEUS) and Department of Medicine, University of Salamanca (USAL), Salamanca, Spain
- Centro de Investigación Biomédica en Red de Cáncer: CIBER-ONC number CB16/12/00400, Instituto Carlos III, Madrid, Spain
| | - J J Garcés
- Clinica Universidad de Navarra (UNAV), Applied Medical Research Center (CIMA), IDISNA. CIBER-ONC number CB16/12/00369 and CB16/12/00489, Pamplona, Spain
| | - B Paiva
- Clinica Universidad de Navarra (UNAV), Applied Medical Research Center (CIMA), IDISNA. CIBER-ONC number CB16/12/00369 and CB16/12/00489, Pamplona, Spain
| | - N Puig
- Department of Hematology, University Hospital of Salamanca (HUSA), IBSAL; IBMCC (USAL-CSIC). CIBER-ONC number CB16/12/00233, Salamanca, Spain
| | - A García-Mateo
- Department of Hematology, Health Care Center of Segovia (CAS), Segovia, Spain
| | - O García-Sánchez
- Department of Hematology, University Hospital of Salamanca (HUSA), IBSAL; IBMCC (USAL-CSIC). CIBER-ONC number CB16/12/00233, Salamanca, Spain
| | - A Corral-Mateos
- Cancer Research Center (IBMCC-CSIC/USAL-IBSAL); Cytometry Service (NUCLEUS) and Department of Medicine, University of Salamanca (USAL), Salamanca, Spain
- Centro de Investigación Biomédica en Red de Cáncer: CIBER-ONC number CB16/12/00400, Instituto Carlos III, Madrid, Spain
| | - L Burgos
- Clinica Universidad de Navarra (UNAV), Applied Medical Research Center (CIMA), IDISNA. CIBER-ONC number CB16/12/00369 and CB16/12/00489, Pamplona, Spain
| | - E Blanco
- Cancer Research Center (IBMCC-CSIC/USAL-IBSAL); Cytometry Service (NUCLEUS) and Department of Medicine, University of Salamanca (USAL), Salamanca, Spain
- Centro de Investigación Biomédica en Red de Cáncer: CIBER-ONC number CB16/12/00400, Instituto Carlos III, Madrid, Spain
| | - J Hernández-Martín
- Department of Hematology, Health Care Center of Segovia (CAS), Segovia, Spain
| | - R Pontes
- Faculty of Medicine, Federal University of Rio de Janeiro and Institute of Pediatrics and Childhood Care, Rio de Janeiro, Brazil
| | - M Díez-Campelo
- Department of Hematology, University Hospital of Salamanca (HUSA), IBSAL; IBMCC (USAL-CSIC). CIBER-ONC number CB16/12/00233, Salamanca, Spain
| | - P Millacoy
- Department of Hematology, Hospital Center of Navarra (CHN), Pamplona, Spain
| | - P Rodríguez-Otero
- Clinica Universidad de Navarra (UNAV), Applied Medical Research Center (CIMA), IDISNA. CIBER-ONC number CB16/12/00369 and CB16/12/00489, Pamplona, Spain
| | - F Prosper
- Clinica Universidad de Navarra (UNAV), Applied Medical Research Center (CIMA), IDISNA. CIBER-ONC number CB16/12/00369 and CB16/12/00489, Pamplona, Spain
| | - J Merino
- Clinica Universidad de Navarra (UNAV), Applied Medical Research Center (CIMA), IDISNA. CIBER-ONC number CB16/12/00369 and CB16/12/00489, Pamplona, Spain
| | - M B Vidriales
- Department of Hematology, University Hospital of Salamanca (HUSA), IBSAL; IBMCC (USAL-CSIC). CIBER-ONC number CB16/12/00233, Salamanca, Spain
| | - R García-Sanz
- Department of Hematology, University Hospital of Salamanca (HUSA), IBSAL; IBMCC (USAL-CSIC). CIBER-ONC number CB16/12/00233, Salamanca, Spain
| | - A Romero
- Primary Care Center Miguel Armijo, Sanidad de Castilla y León (SACYL), Salamanca, Spain
| | - L Palomera
- Department of Hematology, University Hospital Lozano Blesa (HULB), Zaragoza, Spain
| | - R Ríos-Tamayo
- Department of Hematology, Virgen de las Nieves Hospital (HVN), Granada, Spain
| | - M Pérez-Andrés
- Cancer Research Center (IBMCC-CSIC/USAL-IBSAL); Cytometry Service (NUCLEUS) and Department of Medicine, University of Salamanca (USAL), Salamanca, Spain
- Centro de Investigación Biomédica en Red de Cáncer: CIBER-ONC number CB16/12/00400, Instituto Carlos III, Madrid, Spain
| | - J F Blanco
- Department of Orthopedics, University Hospital of Salamanca, IBSAL; IBMCC (USAL-CSIC), Salamanca, Spain
| | - M González
- Department of Hematology, University Hospital of Salamanca (HUSA), IBSAL; IBMCC (USAL-CSIC). CIBER-ONC number CB16/12/00233, Salamanca, Spain
| | - J J M van Dongen
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - B Durie
- Cedars-Sinai Samuel Oschin Cancer Center, Los Angeles, CA, USA
| | - M V Mateos
- Department of Hematology, University Hospital of Salamanca (HUSA), IBSAL; IBMCC (USAL-CSIC). CIBER-ONC number CB16/12/00233, Salamanca, Spain
| | - J San-Miguel
- Clinica Universidad de Navarra (UNAV), Applied Medical Research Center (CIMA), IDISNA. CIBER-ONC number CB16/12/00369 and CB16/12/00489, Pamplona, Spain
| | - A Orfao
- Cancer Research Center (IBMCC-CSIC/USAL-IBSAL); Cytometry Service (NUCLEUS) and Department of Medicine, University of Salamanca (USAL), Salamanca, Spain.
- Centro de Investigación Biomédica en Red de Cáncer: CIBER-ONC number CB16/12/00400, Instituto Carlos III, Madrid, Spain.
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Sundaramoorthy P, Gasparetto C, Kang Y. The combination of a sphingosine kinase 2 inhibitor (ABC294640) and a Bcl-2 inhibitor (ABT-199) displays synergistic anti-myeloma effects in myeloma cells without a t(11;14) translocation. Cancer Med 2018; 7:3257-3268. [PMID: 29761903 PMCID: PMC6051232 DOI: 10.1002/cam4.1543] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 04/06/2018] [Accepted: 04/09/2018] [Indexed: 12/31/2022] Open
Abstract
Multiple myeloma (MM) remains an incurable disease in need of the development of novel therapeutic agents and drug combinations. ABT‐199 is a specific Bcl‐2 inhibitor in clinical trials for MM; however, its activity as a single agent was limited to myeloma patients with the t(11;14) translocation who acquire resistance due to co‐expression of Mcl‐1 and Bcl‐xL. These limitations preclude its use in a broader patient population. We have recently found that a sphingosine kinase 2‐specific inhibitor (ABC294640) induces apoptosis in primary human CD138+ cells and MM cell lines. ABC294640 is currently in phase I/II clinical trials for myeloma (clinicaltrials.gov: #NCT01410981). Interestingly, ABC294640 down‐regulates c‐Myc and Mcl‐1, but does not have any effects on Bcl‐2. We first evaluated the combinatorial anti‐myeloma effect of ABC294640 and ABT‐199 in vitro in 7 MM cell lines, all of which harbor no t(11;14) translocation. Combination index calculation demonstrated a synergistic anti‐myeloma effect of the combination of ABC294640 and ABT‐199. This synergistic anti‐myeloma effect was maintained even in the presence of bone marrow (BM) stromal cells. The combination of ABC294640 and ABT‐199 led to enhanced cleavage of PARP and caspase‐3/9 and increased Annexin‐V expression, consistent with the induction of apoptosis by the combination treatment. In addition, the combination of ABC294640 and ABT‐199 resulted in the down‐regulation of the anti‐apoptotic proteins Mcl‐1, Bcl‐2, and Bcl‐xL and the cleavage of Bax and Bid. The combination induced both the mitochondrial mediated‐ and caspase‐mediated apoptosis pathways. Finally, the combination of ABC294640 and ABT‐199 resulted in augmented anti‐myeloma effect in vivo in a mouse xenograft model. These findings demonstrate that the co‐administration of ABC294640 and ABT‐199 exhibits synergistic anti‐myeloma activity in vitro and in vivo, providing justification for a clinical study of this novel combination in patients with relapsed/refractory multiple myeloma.
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Affiliation(s)
- Pasupathi Sundaramoorthy
- Division of Hematological Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Cristina Gasparetto
- Division of Hematological Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Yubin Kang
- Division of Hematological Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
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Singh N, Pasricha S, Agrawal N, Gandhi JS, Panaych A, Mehta A, Ahmed R, Bhurani D. Diagnostic Dilemmas in Aggressive Large B Cell Neoplasms with Enigmatic Immunohistochemical Profile: How Far Should We Investigate? Indian J Hematol Blood Transfus 2018; 34:194-196. [PMID: 29398833 DOI: 10.1007/s12288-017-0839-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 06/07/2017] [Indexed: 10/19/2022] Open
Affiliation(s)
- Neha Singh
- Department of Laboratory Medicine, Rajiv Gandhi Cancer Institute and Research Center, Rohini, Delhi, India
| | - Sunil Pasricha
- Department of Laboratory Medicine, Rajiv Gandhi Cancer Institute and Research Center, Rohini, Delhi, India
| | - Narendra Agrawal
- Department of Hemato-Oncology, Rajiv Gandhi Cancer Institute and Research Center, Rohini, Delhi, India
| | - Jatin S Gandhi
- Department of Laboratory Medicine, Rajiv Gandhi Cancer Institute and Research Center, Rohini, Delhi, India
| | - Ajit Panaych
- Department of Laboratory Medicine, Rajiv Gandhi Cancer Institute and Research Center, Rohini, Delhi, India
| | - Anurag Mehta
- Department of Laboratory Medicine, Rajiv Gandhi Cancer Institute and Research Center, Rohini, Delhi, India
| | - Rayaz Ahmed
- Department of Hemato-Oncology, Rajiv Gandhi Cancer Institute and Research Center, Rohini, Delhi, India
| | - Dinesh Bhurani
- Department of Hemato-Oncology, Rajiv Gandhi Cancer Institute and Research Center, Rohini, Delhi, India
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30
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Ferry JA. There Are No Magic Bullets in Hematopathology: Even Immunostains for CD20 and CD3 Can Get You Into Trouble. Adv Anat Pathol 2018; 25:14-23. [PMID: 28914619 DOI: 10.1097/pap.0000000000000174] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Immunohistochemistry is a powerful tool for the diagnosis and subclassification of hematolymphoid neoplasms. However, the expression of certain markers is not always as expected, and unusual patterns of staining can lead to misdiagnosis. CD20 and CD3 are our most commonly used markers for identification of B cells and T cells, respectively, and they almost always yield reliable, specific staining. This discussion focuses on diagnostic pitfalls related to the use of immunohistochemistry for CD20 and CD3 in hematopathology, and specifically on diagnostic challenges that arise when (1) CD20 is not expressed in B-cell lymphomas, when (2) CD20 is expressed in plasma cell neoplasms and T-cell lymphomas, and when (3) CD3 is expressed in B-cell lymphomas and Hodgkin lymphoma.
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Clinical implications of cytogenetic heterogeneity in multiple myeloma patients with TP53 deletion. Mod Pathol 2017; 30:1378-1386. [PMID: 28664940 PMCID: PMC5628266 DOI: 10.1038/modpathol.2017.63] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 05/09/2016] [Accepted: 05/10/2017] [Indexed: 12/28/2022]
Abstract
TP53 deletion (ΔTP53) in myeloma is known to be a high-risk finding associated with poorer prognosis. The prognostic impact of underlying cytogenetic heterogeneity in patients with myeloma associated with ΔTP53 is unknown. We studied 90 patients with myeloma associated with ΔTP53 identified by interphase fluorescence in situ hybridization and assessed the impact of karyotype and coexisting alterations of IGH, RB1, and CKS1B. There were 54 men and 36 women with a median age of 59 years (range 38-84); 14 patients had a normal karyotype (NK/ΔTP53), 73 had a complex karyotype (CK/ΔTP53), and 3 had a non-complex abnormal karyotype. Patients with CK/ΔTP53 showed a significantly poorer overall survival compared with patients with NK/ΔTP53 (P=0.0243). Furthermore, in the CK/ΔTP53 group, patients with IGH rearrangement other than t(11;14)(q13;q32)/CCND1-IGH, designated as adverse-IGH, had an even worse outcome (P=0.0045). In contrast, RB1 deletion, CKS1B gain, ploidy, additional chromosome 17 abnormalities, or ΔTP53 clone size did not impact prognosis. Stem cell transplant did not improve overall survival in either the NK/ΔTP53 or CK/ΔTP53 (P=0.8810 and P=0.1006) groups, but tandem stem cell transplant did improve the overall survival of patients with CK/ΔTP53 (P=0.0067). Multivariate analysis confirmed in this cohort that complex karyotype (hazard ratio 1.976, 95% CI 1.022-3.821, P=0.043), adverse-IGH (hazard ratio 3.126, 95% CI 1.192-8.196, P=0.020), and tandem stem cell transplant independently correlate with overall survival (hazard ratio 0.281, 95% CI 0.091-0.866, P=0.027). We conclude that comprehensive genetic assessment adds to TP53 status in the risk stratification of myeloma patients.
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32
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Lakshman A, Alhaj Moustafa M, Rajkumar SV, Dispenzieri A, Gertz MA, Buadi FK, Lacy MQ, Dingli D, Fonder AL, Hayman SR, Hobbs MA, Gonsalves WI, Hwa YL, Kapoor P, Leung N, Go RS, Lin Y, Kourelis TV, Lust JA, Russell SJ, Zeldenrust SR, Kyle RA, Kumar SK. Natural history of t(11;14) multiple myeloma. Leukemia 2017; 32:131-138. [DOI: 10.1038/leu.2017.204] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 06/07/2017] [Accepted: 06/19/2017] [Indexed: 12/19/2022]
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Hanbali A, Hassanein M, Rasheed W, Aljurf M, Alsharif F. The Evolution of Prognostic Factors in Multiple Myeloma. Adv Hematol 2017; 2017:4812637. [PMID: 28321258 PMCID: PMC5339490 DOI: 10.1155/2017/4812637] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 01/22/2017] [Accepted: 02/05/2017] [Indexed: 12/23/2022] Open
Abstract
Multiple myeloma (MM) is a heterogeneous hematologic malignancy involving the proliferation of plasma cells derived by different genetic events contributing to the development, progression, and prognosis of this disease. Despite improvement in treatment strategies of MM over the last decade, the disease remains incurable. All efforts are currently focused on understanding the prognostic markers of the disease hoping to incorporate the new therapeutic modalities to convert the disease into curable one. We present this comprehensive review to summarize the current standard prognostic markers used in MM along with novel techniques that are still in development and highlight their implications in current clinical practice.
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Affiliation(s)
- Amr Hanbali
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mona Hassanein
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Walid Rasheed
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mahmoud Aljurf
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Fahad Alsharif
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Leiba M, Duek A, Amariglio N, Avigdor A, Benyamini N, Hardan I, Zilbershats I, Ganzel C, Shevetz O, Novikov I, Cohen Y, Ishoev G, Rozic G, Nagler A, Trakhtenbrot L. Translocation t(11;14) in newly diagnosed patients with multiple myeloma: Is it always favorable? Genes Chromosomes Cancer 2016; 55:710-8. [DOI: 10.1002/gcc.22372] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 05/02/2016] [Accepted: 05/03/2016] [Indexed: 12/20/2022] Open
Affiliation(s)
- Merav Leiba
- Division of Hematology and Bone Marrow Transplantation; and the Cancer Research Center, The Chaim Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University; Tel Aviv Israel
| | - Adrian Duek
- Division of Hematology and Bone Marrow Transplantation; and the Cancer Research Center, The Chaim Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University; Tel Aviv Israel
| | - Ninette Amariglio
- Division of Hematology and Bone Marrow Transplantation; and the Cancer Research Center, The Chaim Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University; Tel Aviv Israel
| | - Abraham Avigdor
- Division of Hematology and Bone Marrow Transplantation; and the Cancer Research Center, The Chaim Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University; Tel Aviv Israel
| | - Noam Benyamini
- Department of Hematology and Bone Marrow Transplantation; Rambam Health Care Campus; Haifa Israel
| | - Izhar Hardan
- Department of Hematology; Meir Medical Center; Kfar Saba Israel
| | | | - Chezi Ganzel
- Department of Hematology; Shaare Zedek Medical Center; Jerusalem Israel
| | - Olga Shevetz
- Department of Hematology; Kaplan Medical Center; Rehovot Israel
| | - Ilya Novikov
- Biostatistical Unit; Gertner Institute of Epidemiology and Health Policy Research; Ramat Gan Israel
| | - Yossi Cohen
- Department of Hematology; Laniyado Hospital; Netanya Israel
| | - Galina Ishoev
- Division of Hematology and Bone Marrow Transplantation; and the Cancer Research Center, The Chaim Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University; Tel Aviv Israel
| | - Gabriela Rozic
- Division of Hematology and Bone Marrow Transplantation; and the Cancer Research Center, The Chaim Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University; Tel Aviv Israel
| | - Arnon Nagler
- Division of Hematology and Bone Marrow Transplantation; and the Cancer Research Center, The Chaim Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University; Tel Aviv Israel
| | - Luba Trakhtenbrot
- Division of Hematology and Bone Marrow Transplantation; and the Cancer Research Center, The Chaim Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University; Tel Aviv Israel
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35
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Lisenko K, Schönland S, Hegenbart U, Wallenwein K, Braun U, Mai EK, Hillengass J, Goldschmidt H, Jauch A, Ho AD, Raab M, Hundemer M. Potential therapeutic targets in plasma cell disorders: A flow cytometry study. CYTOMETRY PART B-CLINICAL CYTOMETRY 2016; 92:145-152. [DOI: 10.1002/cyto.b.21351] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 12/03/2015] [Accepted: 12/08/2015] [Indexed: 02/05/2023]
Affiliation(s)
- Katharina Lisenko
- Department of Internal Medicine V; University of Heidelberg; Heidelberg Germany
| | - Stefan Schönland
- Department of Internal Medicine V; University of Heidelberg; Heidelberg Germany
| | - Ute Hegenbart
- Department of Internal Medicine V; University of Heidelberg; Heidelberg Germany
| | - Katrin Wallenwein
- Department of Internal Medicine V; University of Heidelberg; Heidelberg Germany
| | - Ute Braun
- Department of Internal Medicine V; University of Heidelberg; Heidelberg Germany
| | - Elias K. Mai
- Department of Internal Medicine V; University of Heidelberg; Heidelberg Germany
| | - Jens Hillengass
- Department of Internal Medicine V; University of Heidelberg; Heidelberg Germany
| | - Hartmut Goldschmidt
- Department of Internal Medicine V; University of Heidelberg; Heidelberg Germany
- National Center for Tumor Diseases, University of Heidelberg; Heidelberg Germany
| | - Anna Jauch
- Institute of Human Genetics, University of Heidelberg; Heidelberg Germany
| | - Anthony D. Ho
- Department of Internal Medicine V; University of Heidelberg; Heidelberg Germany
| | - Marc Raab
- Department of Internal Medicine V; University of Heidelberg; Heidelberg Germany
| | - Michael Hundemer
- Department of Internal Medicine V; University of Heidelberg; Heidelberg Germany
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Feng X, Deng S, An G, Qin X, Sui W, Zou D, Qiu L, Xu Y. [Clinical characteristics and survival of newly diagnosed multiple myeloma patients under 40 years old from single center and literature review]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2015; 36:933-6. [PMID: 26632466 PMCID: PMC7342414 DOI: 10.3760/cma.j.issn.0253-2727.2015.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
目的 探讨国内极年轻多发性骨髓瘤(MM)患者临床表现及预后。 方法 回顾性分析单中心35例40岁以下初治MM患者的临床表现及生存情况,并与已发表的西方国家数据进行比较。 结果 40岁以下MM患者占同时期初治MM患者的4.6%,与国外数据相比,该部分患者国际分期系统Ⅲ期比例较高,有更高比例的IgD型、贫血、血小板减少及17p13缺失。中位随访17(1~89)个月,35例患者的中位无进展生存(PFS)及总生存(OS)时间分别为13和33个月,截止至随访结束有17例患者死亡,其中8例死于疾病诊断后1年内。单因素分析结果显示,髓外浸润(P=0.031),17p13缺失(P=0.015)及肾功能受损(P=0.000)是影响PFS的不良因素,而17p13缺失(P=0.015)及肾功能受损(P=0.001)是影响OS的不良因素。多因素分析结果显示,肾功能损伤是影响预后的不良因素(PFS:HR=3.953,95%可信区间1.263~12.371,P=0.018; OS:HR=5.769,95%可信区间1.602~20.771,P=0.007)。 结论 国内40岁以下MM患者的临床特征及生存情况与西方国家患者有所不同,因此在临床诊疗过程中应特别重视该亚群患者。
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Affiliation(s)
- Xiaoyan Feng
- Department of Lymphoma and Myeloma, Institute of Hematology & Blood Diseases Hospital, Tianjin 300020, China
| | - Shuhui Deng
- Department of Lymphoma and Myeloma, Institute of Hematology & Blood Diseases Hospital, Tianjin 300020, China
| | - Gang An
- Department of Lymphoma and Myeloma, Institute of Hematology & Blood Diseases Hospital, Tianjin 300020, China
| | - Xiaoqi Qin
- Department of Lymphoma and Myeloma, Institute of Hematology & Blood Diseases Hospital, Tianjin 300020, China
| | - Weiwei Sui
- Department of Lymphoma and Myeloma, Institute of Hematology & Blood Diseases Hospital, Tianjin 300020, China
| | - Dehui Zou
- Department of Lymphoma and Myeloma, Institute of Hematology & Blood Diseases Hospital, Tianjin 300020, China
| | - Lugui Qiu
- Department of Lymphoma and Myeloma, Institute of Hematology & Blood Diseases Hospital, Tianjin 300020, China
| | - Yan Xu
- Department of Lymphoma and Myeloma, Institute of Hematology & Blood Diseases Hospital, Tianjin 300020, China
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18F-FDG PET/CT, 99mTc-MIBI, and MRI in the prediction of outcome of patients with multiple myeloma: a comparative study. Clin Nucl Med 2015; 40:303-8. [PMID: 25608167 DOI: 10.1097/rlu.0000000000000696] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE The aim of this study was to compare the relative contribution of 18F-FDG PET/CT, 99mTc-MIBI, and MRI in predicting progression-free survival (PFS) and overall survival (OS) in multiple myeloma (MM) patients. PATIENTS AND METHODS Thirty-three newly diagnosed MM patients had been evaluated in a previous study by 18F-FDG PET/CT, 99mTc-MIBI, and spine and pelvis MRI reporting focal lesions and diffuse bone marrow involvement. Twenty-seven patients were then subjected to a mean follow-up period of 58 months, whereas 6 patients were lost. RESULTS 18F-FDG PET/CT, 99mTc-MIBI, and MRI were positive in 26, 24, and 22 patients, respectively, showing diffuse bone marrow involvement in 12, 21, and 17 patients and a total of 185, 56, and 39 focal lesions, respectively. At follow-up, 18 patients showed complete or partial remission, whereas 9 patients developed progressive disease, 7 of which died of myeloma. Univariate and subsequent multivariate analysis showed that F-FDG PET/CT focal uptake and Tc-MIBI focal and diffuse uptake predicted PFS (P = 0.0006), whereas 18F-FDG PET/CT focal uptake and 99mTc-MIBI focal uptake predicted OS (P = 0.0010). Although MRI diffuse pattern predicted PFS at univariate analysis (P = 0.0376), it was not retained in the model at multivariate analysis. Receiver operating characteristic curve analysis showed that the number of focal lesions best discriminating for PFS and OS prediction was 4 and 11 for 18F-FDG PET/CT and 2 in both cases for 99mTc-MIBI, respectively. By Kaplan-Meier analysis and log-rank testing, PFS and OS at follow-up were significantly better in patients showing a number of focal lesions at F-FDG PET/CT or Tc-MIBI lower than the respective cutoff (P = 0.03, P = 0.004, and P < 0.0001, respectively). Finally, PFS was significantly better in patients showing absent/faint diffuse Tc-MIBI uptake than in those having moderate/intense diffuse uptake (P = 0.0012). CONCLUSIONS 18F-FDG PET/CT and 99mTc-MIBI may be useful in predicting PFS and OS in myeloma patients.
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Sun Q, An G, Liu E, Li Z, Zhang H, Yang Q, Sun F, Ma Y, Xian M, Zhang P, Ru K. [The clinic and pathologic significance of plasma cell myeloma with CCND1]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2015; 36:775-9. [PMID: 26462780 PMCID: PMC7342711 DOI: 10.3760/cma.j.issn.0253-2727.2015.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To study the clinical and pathologic features of multiple myeloma(MM) with CCND1. METHODS Retrospectively analyzed the clinical and pathologic profiles of 158 patients with MM from 2010 to 2013. The clinical and morphologic features of bone marrow aspiration, biopsy and immunophenotypic analysis which was carried out by flow cytometry and immunohistochemistry were analyzed in all patients with MM respectively. CCND1 translocation was studied by FISH method in all cases. Classical cytogenetic studies of bone marrow were performed in 24 cases whose CCND1 was positive. RESULTS In the 158 patients with MM, CCND1 was detected in 31 patients (19.6%). In 31 patients, type IgA, IgD, IgG, IgM, light-chain only and nonsecretory MM were 4 cases,4 cases,11 cases,1 case, 6 cases and 5 cases respectively. A high incidence of CCND1 was observed in IgD and nonsecretory MM comparied with IgA and IgG respectively (P<0.05). but no statistical significance was reached between κ and λ type patients (P=0.627). The morphology of plasma cell in bone marrow biopsies were small Lymphocyte- Like 24 cases,mature plasma cell 6 cases and immature plasma cell 1 case. Immunophenotype of all 31 cases was CD38⁺CD138⁺CD19⁻CD45⁻, (CD56⁺ in 11 cases, CD20⁺ in 9 cases, CD117⁺ in 3 cases. MM with CCND1 showed a strong association with CD20 expression, the lack of CD56 expression. Immunohistochemistry showed positive for cyclinD1 in 22 cases. CONCLUSION A high incidence of CCND1 was detected in the IgD and nonsecretory MM, and correlated with Small Lymphocyte- Like, higher positive rate of CD20, cyclinD1 and the lack of CD56 expression. MM with CCND1 must be distinguished from LPL and other mature B cell lymphomas which have plasmacytoid differentiation.
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Affiliation(s)
- Qi Sun
- Institute of Hematology & Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China
| | - Gang An
- Institute of Hematology & Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China
| | - Enbin Liu
- Institute of Hematology & Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China
| | - Zhanqi Li
- Institute of Hematology & Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China
| | - Hongju Zhang
- Institute of Hematology & Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China
| | - Qingying Yang
- Institute of Hematology & Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China
| | - Fujun Sun
- Institute of Hematology & Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China
| | - Yue Ma
- Institute of Hematology & Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China
| | - Mu Xian
- Institute of Hematology & Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China
| | - Peihong Zhang
- Institute of Hematology & Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China
| | - Kun Ru
- Institute of Hematology & Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China
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Juárez Salcedo LM, López Rubio M, Gil Fernández JJ, Garcia-Suarez J, Magro E, Arranz E, Gutiérrez Jomarrón I, Marcellini Antonio S, Blasco A, Burgaleta C. Atypical IgM multiple myeloma with deletion of c-MAF. Int J Lab Hematol 2015; 37:686-9. [PMID: 25996654 DOI: 10.1111/ijlh.12385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 04/14/2015] [Indexed: 11/26/2022]
Abstract
IgM multiple myeloma (MM) is a rare subtype of myeloma that shares clinical and pathological features with Waldenström's macroglobulinaemia. These are two separate entities that differ both in therapy and prognosis. We report a 57-year-old male, who presented with anaemia, hypercalcaemia, acute renal failure and several vertebral fractures that clinically suggested a multiple myeloma. Further investigations revealed a serum monoclonal component of IgM lambda type and a bone marrow infiltrated by small, lymphoplasmocytic cells. IgM MM was finally diagnosed by means of both inmunophenotypic and immunohistochemistry techniques, stressing the importance of inmunophenotypic evaluation when clinical and morphological features are discordant. Fluorescence in situ hybridization (FISH) studies disclosed a particular combination of deletion 13q14, t(11;14) and monoallelic deletion C-MAF without t(14;16). The clinical evolution after a Bortezomib-containing polychemotherapy and autologous stem cell transplantation (ASCT) conditioned with busulphan and melphalan is also presented. This very uncommon case highlights the impact of immunophenotyping on the differential diagnosis between IgM MM and WM, to choose the best treatment and establish an appropriate outcome.
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Affiliation(s)
- L M Juárez Salcedo
- Division of Hematology, Hospital Universitario Príncipe de Asturias, Madrid, Spain
| | - M López Rubio
- Division of Hematology, Hospital Universitario Príncipe de Asturias, Madrid, Spain
| | - J J Gil Fernández
- Division of Hematology, Hospital Universitario Príncipe de Asturias, Madrid, Spain
| | - J Garcia-Suarez
- Division of Hematology, Hospital Universitario Príncipe de Asturias, Madrid, Spain
| | - E Magro
- Division of Hematology, Hospital Universitario Príncipe de Asturias, Madrid, Spain
| | - E Arranz
- Division of Cytogenetic, Hospital Universitario La Princesa, Madrid, Spain
| | - I Gutiérrez Jomarrón
- Division of Hematology, Hospital Universitario Príncipe de Asturias, Madrid, Spain
| | - S Marcellini Antonio
- Division of Hematology, Hospital Universitario Príncipe de Asturias, Madrid, Spain
| | - A Blasco
- Division of Pathological Anatomy, Hospital Universitario Príncipe de Asturias, Madrid, Spain
| | - C Burgaleta
- Division of Hematology, Hospital Universitario Príncipe de Asturias, Madrid, Spain.,Medicine Departament, Universidad de Alcalá de Henares, Madrid, Spain
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Bochtler T, Hegenbart U, Kunz C, Granzow M, Benner A, Seckinger A, Kimmich C, Goldschmidt H, Ho AD, Hose D, Jauch A, Schönland SO. Translocation t(11;14) Is Associated With Adverse Outcome in Patients With Newly Diagnosed AL Amyloidosis When Treated With Bortezomib-Based Regimens. J Clin Oncol 2015; 33:1371-8. [DOI: 10.1200/jco.2014.57.4947] [Citation(s) in RCA: 154] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Bortezomib has become a cornerstone in the treatment of AL amyloidosis. In this study, we addressed the prognostic impact of cytogenetic aberrations for bortezomib-treated patients. Patients and Methods We analyzed a consecutive series of 101 patients with AL amyloidosis treated with bortezomib-dexamethasone as first-line treatment by interphase fluorescence in situ hybridization (iFISH). Patients were ineligible for high-dose chemotherapy, which would put them at risk for cardiac or renal failure, and thus represented a poor-risk group. Results Presence of t(11;14), versus its absence, was associated with inferior hematologic event-free survival (median, 3.4 v 8.8 months, respectively; P = .002), overall survival (median, 8.7 v 40.7 months, respectively; P = .05), and remission rate (≥ very good partial remission; 23% v 47%, respectively; P = .02). In multivariable Cox regression models incorporating established hematologic and clinical risk factors, t(11;14) was an independent adverse prognostic marker for hematologic event-free survival (hazard ratio, 2.94; 95% CI, 1.37 to 6.25; P = .006) and overall survival (hazard ratio, 3.13; 95% CI, 1.16 to 8.33; P = .03), but not for remission (≥ very good partial remission). Markedly, the multiple myeloma high-risk iFISH aberrations t(4;14), t(14;16), del(17p), and gain of 1q21 conferred no adverse prognosis in this bortezomib-dexamethasone–treated group. After backward variable selection, the final multivariable model was validated in a consecutive series of 32 patients treated with bortezomib, dexamethasone, and cyclophosphamide. Conclusion iFISH results are important independent prognostic factors in AL amyloidosis. In contrast to our recently published results with melphalan and dexamethasone standard therapy, bortezomib is less beneficial to patients harboring t(11;14), whereas it effectively alleviates the poor prognosis inherent to high-risk aberrations. Given the discrepant response to different treatment modalities, iFISH may help to guide therapeutic choices in these poor-risk patients requiring rapid hematologic response.
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Affiliation(s)
- Tilmann Bochtler
- Tilmann Bochtler, Ute Hegenbart, Anja Seckinger, Christoph Kimmich, Hartmut Goldschmidt, Anthony D. Ho, Dirk Hose, and Stefan O. Schönland, Amyloidosis Center, University Hospital Heidelberg; Christina Kunz and Axel Benner, German Cancer Research Center; Martin Granzow and Anna Jauch, Institute of Human Genetics, University Heidelberg; and Hartmut Goldschmidt and Dirk Hose, National Center for Tumor Diseases, Heidelberg, Germany
| | - Ute Hegenbart
- Tilmann Bochtler, Ute Hegenbart, Anja Seckinger, Christoph Kimmich, Hartmut Goldschmidt, Anthony D. Ho, Dirk Hose, and Stefan O. Schönland, Amyloidosis Center, University Hospital Heidelberg; Christina Kunz and Axel Benner, German Cancer Research Center; Martin Granzow and Anna Jauch, Institute of Human Genetics, University Heidelberg; and Hartmut Goldschmidt and Dirk Hose, National Center for Tumor Diseases, Heidelberg, Germany
| | - Christina Kunz
- Tilmann Bochtler, Ute Hegenbart, Anja Seckinger, Christoph Kimmich, Hartmut Goldschmidt, Anthony D. Ho, Dirk Hose, and Stefan O. Schönland, Amyloidosis Center, University Hospital Heidelberg; Christina Kunz and Axel Benner, German Cancer Research Center; Martin Granzow and Anna Jauch, Institute of Human Genetics, University Heidelberg; and Hartmut Goldschmidt and Dirk Hose, National Center for Tumor Diseases, Heidelberg, Germany
| | - Martin Granzow
- Tilmann Bochtler, Ute Hegenbart, Anja Seckinger, Christoph Kimmich, Hartmut Goldschmidt, Anthony D. Ho, Dirk Hose, and Stefan O. Schönland, Amyloidosis Center, University Hospital Heidelberg; Christina Kunz and Axel Benner, German Cancer Research Center; Martin Granzow and Anna Jauch, Institute of Human Genetics, University Heidelberg; and Hartmut Goldschmidt and Dirk Hose, National Center for Tumor Diseases, Heidelberg, Germany
| | - Axel Benner
- Tilmann Bochtler, Ute Hegenbart, Anja Seckinger, Christoph Kimmich, Hartmut Goldschmidt, Anthony D. Ho, Dirk Hose, and Stefan O. Schönland, Amyloidosis Center, University Hospital Heidelberg; Christina Kunz and Axel Benner, German Cancer Research Center; Martin Granzow and Anna Jauch, Institute of Human Genetics, University Heidelberg; and Hartmut Goldschmidt and Dirk Hose, National Center for Tumor Diseases, Heidelberg, Germany
| | - Anja Seckinger
- Tilmann Bochtler, Ute Hegenbart, Anja Seckinger, Christoph Kimmich, Hartmut Goldschmidt, Anthony D. Ho, Dirk Hose, and Stefan O. Schönland, Amyloidosis Center, University Hospital Heidelberg; Christina Kunz and Axel Benner, German Cancer Research Center; Martin Granzow and Anna Jauch, Institute of Human Genetics, University Heidelberg; and Hartmut Goldschmidt and Dirk Hose, National Center for Tumor Diseases, Heidelberg, Germany
| | - Christoph Kimmich
- Tilmann Bochtler, Ute Hegenbart, Anja Seckinger, Christoph Kimmich, Hartmut Goldschmidt, Anthony D. Ho, Dirk Hose, and Stefan O. Schönland, Amyloidosis Center, University Hospital Heidelberg; Christina Kunz and Axel Benner, German Cancer Research Center; Martin Granzow and Anna Jauch, Institute of Human Genetics, University Heidelberg; and Hartmut Goldschmidt and Dirk Hose, National Center for Tumor Diseases, Heidelberg, Germany
| | - Hartmut Goldschmidt
- Tilmann Bochtler, Ute Hegenbart, Anja Seckinger, Christoph Kimmich, Hartmut Goldschmidt, Anthony D. Ho, Dirk Hose, and Stefan O. Schönland, Amyloidosis Center, University Hospital Heidelberg; Christina Kunz and Axel Benner, German Cancer Research Center; Martin Granzow and Anna Jauch, Institute of Human Genetics, University Heidelberg; and Hartmut Goldschmidt and Dirk Hose, National Center for Tumor Diseases, Heidelberg, Germany
| | - Anthony D. Ho
- Tilmann Bochtler, Ute Hegenbart, Anja Seckinger, Christoph Kimmich, Hartmut Goldschmidt, Anthony D. Ho, Dirk Hose, and Stefan O. Schönland, Amyloidosis Center, University Hospital Heidelberg; Christina Kunz and Axel Benner, German Cancer Research Center; Martin Granzow and Anna Jauch, Institute of Human Genetics, University Heidelberg; and Hartmut Goldschmidt and Dirk Hose, National Center for Tumor Diseases, Heidelberg, Germany
| | - Dirk Hose
- Tilmann Bochtler, Ute Hegenbart, Anja Seckinger, Christoph Kimmich, Hartmut Goldschmidt, Anthony D. Ho, Dirk Hose, and Stefan O. Schönland, Amyloidosis Center, University Hospital Heidelberg; Christina Kunz and Axel Benner, German Cancer Research Center; Martin Granzow and Anna Jauch, Institute of Human Genetics, University Heidelberg; and Hartmut Goldschmidt and Dirk Hose, National Center for Tumor Diseases, Heidelberg, Germany
| | - Anna Jauch
- Tilmann Bochtler, Ute Hegenbart, Anja Seckinger, Christoph Kimmich, Hartmut Goldschmidt, Anthony D. Ho, Dirk Hose, and Stefan O. Schönland, Amyloidosis Center, University Hospital Heidelberg; Christina Kunz and Axel Benner, German Cancer Research Center; Martin Granzow and Anna Jauch, Institute of Human Genetics, University Heidelberg; and Hartmut Goldschmidt and Dirk Hose, National Center for Tumor Diseases, Heidelberg, Germany
| | - Stefan O. Schönland
- Tilmann Bochtler, Ute Hegenbart, Anja Seckinger, Christoph Kimmich, Hartmut Goldschmidt, Anthony D. Ho, Dirk Hose, and Stefan O. Schönland, Amyloidosis Center, University Hospital Heidelberg; Christina Kunz and Axel Benner, German Cancer Research Center; Martin Granzow and Anna Jauch, Institute of Human Genetics, University Heidelberg; and Hartmut Goldschmidt and Dirk Hose, National Center for Tumor Diseases, Heidelberg, Germany
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Talley PJ, Chantry AD, Buckle CH. Genetics in myeloma: genetic technologies and their application to screening approaches in myeloma. Br Med Bull 2015; 113:15-30. [PMID: 25662536 DOI: 10.1093/bmb/ldu041] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Despite advances in the treatment of multiple myeloma (MM), it remains an incurable malignant disease. Myeloma genetics is intrinsically complex, but it offers an opportunity to categorize the disease and apply a personalized medicine approach. AREAS OF AGREEMENT Research into the genetics of myeloma is moving at a fast pace and is highlighting areas and patient cohorts likely to benefit from specific treatment. Targeting residual disease is likely to be crucial to improved clinical outcome. AREAS OF CONTROVERSY Patients in clinical trials are more likely to receive genetic diagnosis than non-trial patients, for whom access is ad hoc and dependent upon regional commissioning arrangements. AREAS TIMELY FOR DEVELOPING RESEARCH Relating genetics to potential treatment pathways will become crucial for improved myeloma outcomes. Universal access to standardized genetic testing will facilitate modern personalized treatments.
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Affiliation(s)
- Polly J Talley
- Sheffield Diagnostic Genetics Service, Sheffield Children's NHS Foundation Trust, Western Bank, Sheffield S10 2TH, UK
| | - Andrew D Chantry
- Sheffield Myeloma Research Team (SMaRT), Department of Oncology, University of Sheffield Medical School, Beech Hill Road, Sheffield S10 2RX, UK
| | - Clive H Buckle
- Sheffield Myeloma Research Team (SMaRT), Department of Oncology, University of Sheffield Medical School, Beech Hill Road, Sheffield S10 2RX, UK
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t(14;16)-positive multiple myeloma shows negativity for CD56 expression and unfavorable outcome even in the era of novel drugs. Blood Cancer J 2015; 5:e285. [PMID: 25723856 PMCID: PMC4349263 DOI: 10.1038/bcj.2015.6] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Shin HJ, Kim K, Lee JJ, Song MK, Lee EY, Park SH, Kim SH, Jang MA, Kim SJ, Chung JS. The t(11;14)(q13;q32) translocation as a poor prognostic parameter for autologous stem cell transplantation in myeloma patients with extramedullary plasmacytoma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2014; 15:227-35. [PMID: 25812994 DOI: 10.1016/j.clml.2014.12.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 11/23/2014] [Accepted: 12/06/2014] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Fluorescence in-situ hybridization (FISH)-detected abnormalities, including del(17p), del(13q), and t(4;14), have been associated with inferior prognosis. However, there are few data about the prognostic significance of cytogenetic abnormalities for autologous stem cell transplantation (ASCT) in multiple myeloma (MM) patients with extramedullary plasmacytoma (EMP). PATIENTS AND METHODS Between April 2004 and December 2012, 290 MM patients underwent ASCT at 3 centers. FISH data for bone marrow samples obtained at diagnosis were available for 58 patients who had EMP at diagnosis or during treatment. RESULTS The t(11;14), t(4;14), del(13q), and 1q gain abnormalities were seen in 14.9%, 6.3%, 25.6%, and 42.9%, respectively. No t(14;16) or del(17p) cytogenetic abnormality was detected in the examined patients. Patients with t(11;14) had a lower response rate compared to patients with other cytogenetic abnormalities. EMP-specific relapse was higher in patients with t(11;14) than in patients with other cytogenetic abnormalities (42.9% vs. 10%-33.3%). Each of the 4 cytogenetic abnormalities predicted shorter median progression-free survival (6-12 months vs. 27-37 months) and shorter overall survival (16-22 months vs. 68 months or not reached) compared to no cytogenetic abnormality. The t(11;14) translocation was an important prognostic factor for both progression-free survival (hazard ratio, 25.154; P < .001) and overall survival (hazard ratio, 7.484; P = .024) in the multivariate analysis. CONCLUSION In the current study, t(11;14), t(4;14), del(13q), and 1q gain were associated with worse survival in MM patients with EMP. The role of t(11;14) as a prognostic parameter for ASCT in MM patients with EMP should be confirmed with a large, well-designed study.
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Affiliation(s)
- Ho-Jin Shin
- Division of Hematology-Oncology, Department of Internal Medicine, School of Medicine, Pusan National University, Medical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Kihyun Kim
- Department of Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea.
| | - Je-Jung Lee
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun
| | - Moo-Kon Song
- Division of Hematology-Oncology, Department of Internal Medicine, School of Medicine, Pusan National University, Medical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Eun Yup Lee
- Department of Laboratory Medicine, Pusan National University School of Medicine, Pusan National University Hospital, Busan, South Korea
| | - Sang Hyuk Park
- Department of Laboratory Medicine, Pusan National University School of Medicine, Pusan National University Hospital, Busan, South Korea
| | - Sun-Hee Kim
- Department of Laboratory Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea
| | - Mi-Ae Jang
- Department of Laboratory Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea
| | - Seok Jin Kim
- Department of Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea
| | - Joo Seop Chung
- Division of Hematology-Oncology, Department of Internal Medicine, School of Medicine, Pusan National University, Medical Research Institute, Pusan National University Hospital, Busan, South Korea
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An G, Wang H, Qin X, Shi L, Xu Y, Deng S, Sui W, Zhu G, Yao H, Yi S, Qin Y, Li F, Hao M, Ru K, Qi J, Cheng T, Wang J, Chang H, Qiu L. Polyclonal serum IgM level identifies a subgroup of multiple myeloma patients with low-risk clinicobiological features and superior survival. Leuk Res 2014; 38:666-72. [PMID: 24746293 DOI: 10.1016/j.leukres.2014.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 02/17/2014] [Accepted: 02/20/2014] [Indexed: 10/25/2022]
Abstract
Normal plasma cells (PCs) are either undetectable or outnumbered by the myelomatous PC compartment in bone marrow of multiple myeloma (MM). However, residual normal PCs have been detected in a minority of symptomatic MM patients with superior survival. The number of normal PCs is also an important factor to identify monoclonal gammopathy of undetermined significance (MGUS)-like MM. We speculate that the polyclonal serum IgM level in non-IgM myelomas may reflect the number of residual normal PCs. Here we investigated the prognostic relevance of polyclonal serum IgM level in a series of 485 newly diagnosed symptomatic MM (NDMM) patients. Our results showed that symptomatic MM patients with polyclonal IgM more than 0.5g/L displayed a favorable baseline clinical feature, together with a significantly lower frequency of high-risk cytogenetic abnormalities. This group of patients had a significantly prolonged progression-free survival (PFS) and overall survival (OS) regardless of thalidomide or bortezomib therapy. Furthermore, the superior outcome was independent of the depth of response. Our findings suggest that polyclonal IgM level is capable of identifying a group of symptomatic MM patients with distinct clinicobiological characteristics and favorable survival, similar with MGUS-like MM.
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Affiliation(s)
- Gang An
- State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Tianjin, People's Republic of China
| | - Huijun Wang
- State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Tianjin, People's Republic of China
| | - Xiaoqi Qin
- State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Tianjin, People's Republic of China
| | - Lihui Shi
- State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Tianjin, People's Republic of China
| | - Yan Xu
- State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Tianjin, People's Republic of China
| | - Shuhui Deng
- State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Tianjin, People's Republic of China
| | - Weiwei Sui
- State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Tianjin, People's Republic of China
| | - Guoqing Zhu
- State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Tianjin, People's Republic of China
| | - Hongjing Yao
- State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Tianjin, People's Republic of China
| | - Shuhua Yi
- State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Tianjin, People's Republic of China
| | - Yu Qin
- Department of Diagnostics, College of Basic Medical Science, Tianjin Medical University, Tianjin 300070, People's Republic of China
| | - Fei Li
- The First Affiliated Hospital of Nanchang University, 30006 Nanchang, Jiangxi, People's Republic of China
| | - Mu Hao
- State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Tianjin, People's Republic of China
| | - Kun Ru
- State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Tianjin, People's Republic of China
| | - Junyuan Qi
- State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Tianjin, People's Republic of China
| | - Tao Cheng
- State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Tianjin, People's Republic of China
| | - Jianxiang Wang
- State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Tianjin, People's Republic of China
| | - Hong Chang
- Department of Laboratory Hematology, University Health Network, University of Toronto, Canada
| | - Lugui Qiu
- State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Tianjin, People's Republic of China.
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New developments in the pathology of malignant lymphoma. A review of the literature published from August 2013 to December 2013. J Hematop 2014. [DOI: 10.1007/s12308-014-0199-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Zagouri F, Kastritis E, Symeonidis AS, Giannakoulas N, Katodritou E, Delimpasi S, Repousis P, Terpos E, Dimopoulos MA. Immunoglobulin D myeloma: clinical features and outcome in the era of novel agents. Eur J Haematol 2014; 92:308-12. [PMID: 24460646 DOI: 10.1111/ejh.12255] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2013] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Immunoglobulin D (IgD) multiple myeloma is an uncommon variant of the disease probably associated with poorer prognosis. However, data on IgD myeloma patients treated in the novel agent era are lacking. METHODS To assess the frequency and the specific characteristics and evaluate the outcome of patients with IgD myeloma, we analyzed the database of the Greek Myeloma Study Group. RESULTS Between January 2000 and December 2012, among the 1239 patients with symptomatic myeloma, 31 (2.5%) were diagnosed with IgD myeloma. The median age of patients with IgD myeloma was 65 yr (range 26-80 yr) versus 68 yr (range 23-96 yr) of all others, and 84% had lambda light chain (vs. 38% of the patients with other subtypes). Patients with IgD myeloma presented more often with features of high-risk disease, that is, with advanced ISS, high LDH, significant renal dysfunction, and large amounts of Bence Jones proteinuria. Response to primary therapy was similar to other patients, although there was a trend for better quality of responses in patients with IgD myeloma. The median survival of these patients was 51.5 months versus 50.7 months for patients of other subtypes. In a multivariate model to adjust for differences in prognostic features, IgD myeloma was not associated with a different prognosis. CONCLUSION The incidence of IgD myeloma is 2.5%. Although patients with IgD myeloma present more often with high-risk features, their outcome in the era of novel agents is similar to that of patients with other myeloma subtypes.
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Affiliation(s)
- Flora Zagouri
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Xu Z, Van Der Jagt R, Faught C, Beaulieu Bergeron M. A rare IgM multiple myeloma with aberrant PAX5 expression mimicking lymphoplasmacytic lymphoma. Ann Hematol 2013; 93:1251-2. [PMID: 24240978 DOI: 10.1007/s00277-013-1959-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 11/04/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Z Xu
- Department of Pathology and Laboratory Medicine, Division of Hematopathology, The Ottawa Hospital, 451 Smyth Road, Ottawa, ON, Canada, K1H 8M5,
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