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Dampmann M, Flossdorf S, Keyl J, Reinhardt HC, Hanoun C. Single-Center Experience of Patients with Plasma Cell Leukemia in the Era of New Therapeutics. Acta Haematol 2024:1-8. [PMID: 38763126 DOI: 10.1159/000539223] [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: 01/28/2024] [Accepted: 05/03/2024] [Indexed: 05/21/2024]
Abstract
INTRODUCTION Plasma cell leukemia (PCL) can occur de novo as primary PCL (pPCL), or in patients with prior diagnosis of multiple myeloma (MM) as secondary PCL (sPCL). In 2021, the diagnostic criteria have been revised, establishing a new cut-off of ≥5% plasma cells in the peripheral blood. Lacking specific clinical trials, PCL is treated similarly to MM; however, outcome for patients with PCL remains poor. Here, we report outcomes for patients with pPCL and sPCL in the era of novel agents. METHODS We performed a retrospective analysis and identified 19 patients (11 pPCL, 8 sPCL) who have been treated for PCL between 2010 and 2022 at University Hospital Essen. RESULTS Patients with pPCL had a median overall survival (OS) of 37.8 months (95% CI: [15.4; 52.3] months) from diagnosis, with a median time to next treatment (TTNT) of 18.4 (2.0; 22.9) months. All patients were treated with a proteasome-inhibitor (PI)-based induction therapy, and the majority was consolidated with an autologous stem cell transplantation (SCT). Five of these patients received a tandem transplantation. Patients with sPCL had a median OS of only 1.5 months after diagnosis of PCL. Only 1 patient achieved a remission with daratumumab and subsequent allogenic SCT. CONCLUSION With our study, we add evidence for a PI-based induction therapy followed by a consolidating autologous SCT for patients with pPCL and give further evidence that a tandem transplant concept might be beneficial. The diagnosis of sPCL remains devastating and needs new therapeutic approaches.
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Affiliation(s)
- Maria Dampmann
- Department of Hematology and Stem Cell Transplantation, University Hospital Essen, University Duisburg-Essen, Essen, Germany
- Institute of Cell Biology (Cancer Research), Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Sarah Flossdorf
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Essen, Germany
| | - Julius Keyl
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
| | - Hans Christian Reinhardt
- Department of Hematology and Stem Cell Transplantation, University Hospital Essen, University Duisburg-Essen, Essen, Germany
- National Center for Tumor Diseases (NCT-West), Campus University Hospital Essen, Essen, Germany
- German Cancer Consortium (Partner Site Essen), Essen, Germany
| | - Christine Hanoun
- Department of Hematology and Stem Cell Transplantation, University Hospital Essen, University Duisburg-Essen, Essen, Germany
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2
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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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3
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Baloch SS, Khan SR, Tariq M, Wasio A, Ali AA, Shahzadi M, Moosajee M, Anwar S, Raza A, Uddin S. Multiple myeloma and its rare paraneoplastic manifestations simmering under the surface. Pathol Res Pract 2023; 248:154689. [PMID: 37478520 DOI: 10.1016/j.prp.2023.154689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 07/23/2023]
Abstract
Paraneoplastic syndromes are complex clinical manifestations that occur because of the underlying malignancy in which the malignant cells produce hormones, cytokines, peptides or antibodies that causes symptoms and may affect multiple organ systems. These paraneoplastic conditions may be associated with different solid and hematological malignancies. Multiple Myeloma (MM) accounts for 10-15 % of hematological malignancies and 1-2 % of all malignancies. It is associated with some atypical clinical and laboratory paraneoplastic manifestations. Although there is a low incidence of these paraneoplastic, significant knowledge of these manifestations may assist in making a differential diagnosis in cases of doubt. The clinical presentation may vary and be evident even before or after the diagnosis of malignancy. These include vascular, neurological, dermatological, physiological, and other atypical conditions. Furthermore, these rare paraneoplastic manifestations need more valid, relevant scientific information, as most information about these conditions is derived from case reports. After the literature search, we have reported the paraneoplastic manifestations associated with multiple myeloma, published in the English literature, and the cognate management in this review article. To our knowledge, this is the first review article discussing various paraneoplastic manifestations of multiple myeloma.
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Affiliation(s)
| | - Saqib Raza Khan
- Department of Medical Oncology, Aga Khan University Hospital, Karachi, Pakistan.
| | - Muhammad Tariq
- Department of Medical Oncology, Khyber Teaching Hospital, Peshawar, Pakistan
| | - Abdul Wasio
- Department of Medicine, Carney Hospital, Massachusetts, USA
| | - Ayesha Arshad Ali
- Department of Medical Oncology, Aga Khan University Hospital, Karachi, Pakistan
| | - Mehwish Shahzadi
- Department of Medical Oncology, Aga Khan University Hospital, Karachi, Pakistan
| | - Munira Moosajee
- Department of Medical Oncology, Aga Khan University Hospital, Karachi, Pakistan
| | - Shaheena Anwar
- Department of Biosciences, Salim Habib University, Karachi, Pakistan
| | - Afsheen Raza
- Department of Biomedical Sciences, College of Health Sciences, Abu Dhabi University, the United Arab Emirates
| | - Shahab Uddin
- Translational Research Institute, Dermatology Institute, Academic Health System, Hamad Medical Corporation, Doha, the State of Qatar; Laboratory Animal Research Center, Qatar University, Doha, the State of Qatar.
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Jurczyszyn A, Olszewska-Szopa M, Vesole DH. The Current State of Knowledge About Evolution of Multiple Myeloma to Plasma Cell Leukemia. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2023; 23:188-193. [PMID: 36593169 DOI: 10.1016/j.clml.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 11/20/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022]
Abstract
Plasma cell leukemia is a rare form of multiple myeloma (MM). In contrast to de novo primary plasma cell leukemia (pPCL), which is very uncommon presentation of MM, there is increasing frequency of transformation to secondary plasma cell leukemia (sPCL) with increasing survival of patients (MM). The molecular basis of sPCL remains poorly understood sPCL is particularly aggressive and is associated with an extremely poor prognosis, constituting a major unmet medical need. High-quality data in sPCL regarding presentation, treatment and outcomes is limited. Herein we review the current state of knowledge on sPCL diagnostics, molecular biology, clinical characteristics, prognosis and reported treatment outcomes and the emergence of the new therapeutic strategies.
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Affiliation(s)
- Artur Jurczyszyn
- Hematology Department, Jagiellonian University Medical College, Cracow, Poland.
| | - Magdalena Olszewska-Szopa
- Department of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - David H Vesole
- Department of Medicine, John Theurer Cancer Center at Hackensack Meridian School of Medicine, Hackensack, NJ
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Wiedemann Á, Szita VR, Horváth R, Szederjesi A, Sebő A, Tóth AD, Masszi T, Varga G. Soluble B-cell maturation antigen as a monitoring marker for multiple myeloma. Pathol Oncol Res 2023; 29:1611171. [PMID: 37188125 PMCID: PMC10178067 DOI: 10.3389/pore.2023.1611171] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 04/18/2023] [Indexed: 05/17/2023]
Abstract
Objective: Response to treatment in multiple myeloma (MM) is routinely measured by serum and urine M-protein and free light chain (FLC), as described by the International Myeloma Working Group (IMWG) consensus statement. A non-negligible subgroup of patients however present without measurable biomarkers, others become oligo or non-secretory during recurrent relapses. The aim of our research was to evaluate soluble B-cell maturation antigen (sBCMA) as a monitoring marker measured concurrent with the standard monitoring in MM patients at diagnosis, at relapse and during follow up, in order to establish its potential usefulness in oligo and non-secretory disease. Method: sBCMA levels were measured in 149 patients treated for plasma cell dyscrasia (3 monoclonal gammopathy of unknown significance, 5 smoldering myeloma, 7 plasmacytoma, 8 AL amyloidosis and 126 MM) and 16 control subjects using a commercial ELISA kit. In 43 newly diagnosed patients sBCMA levels were measured at multiple timepoints during treatment, and compared to conventional IMWG response and progression free survival (PFS). Results: sBCMA levels among control subjects were significantly lower than among newly diagnosed or relapsed MM patients [20.8 (14.7-38.7) ng/mL vs. 676 (89.5-1,650) and 264 (20.7-1,603) ng/mL, respectively]. Significant correlations were found between sBCMA and the degree of bone marrow plasma cell infiltration. Out of the 37 newly diagnosed patients who have reached partial response or better per IMWG criteria, 33 (89%) have had at least a 50% drop in sBCMA level by therapy week 4. Cohorts made similarly to IMWG response criteria-achieving a 50% or 90% drop in sBCMA levels compared to level at diagnosis-had statistically significant differences in PFS. Conclusion: Our results confirmed that sBCMA levels are prognostic at important decision points in myeloma, and the percentage of BCMA change is predictive for PFS. This highlights the great potential use of sBCMA in oligo- and non-secretory myeloma.
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Primary plasma cell leukemia: consensus definition by the International Myeloma Working Group according to peripheral blood plasma cell percentage. Blood Cancer J 2021; 11:192. [PMID: 34857730 PMCID: PMC8640034 DOI: 10.1038/s41408-021-00587-0] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/10/2021] [Accepted: 11/15/2021] [Indexed: 11/08/2022] Open
Abstract
Primary plasma cell leukemia (PCL) has a consistently ominous prognosis, even after progress in the last decades. PCL deserves a prompt identification to start the most effective treatment for this ultra-high-risk disease. The aim of this position paper is to revisit the diagnosis of PCL according to the presence of circulating plasma cells in patients otherwise meeting diagnostic criteria of multiple myeloma. We could identify two retrospective series where the question about what number of circulating plasma cells in peripheral blood should be used for defining PCL. The presence of ≥5% circulating plasma cells in patients with MM had a similar adverse prognostic impact as the previously defined PCL. Therefore, PCL should be defined by the presence of 5% or more circulating plasma cells in peripheral blood smears in patients otherwise diagnosed with symptomatic multiple myeloma.
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LncRNAs LY86-AS1 and VIM-AS1 Distinguish Plasma Cell Leukemia Patients from Multiple Myeloma Patients. Biomedicines 2021; 9:biomedicines9111637. [PMID: 34829867 PMCID: PMC8615960 DOI: 10.3390/biomedicines9111637] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/24/2021] [Accepted: 11/04/2021] [Indexed: 12/13/2022] Open
Abstract
Long non-coding RNAs (lncRNAs) are functional RNAs longer than 200 nucleotides. Due to modern genomic techniques, the involvement of lncRNAs in tumorigenesis has been revealed; however, information concerning lncRNA interplay in multiple myeloma (MM) and plasma cell leukemia (PCL) is virtually absent. Herein, we aimed to identify the lncRNAs involved in MM to PCL progression. We investigated representative datasets of MM and PCL patients using next-generation sequencing. In total, 13 deregulated lncRNAs (p < 0.00025) were identified; four of them were chosen for further validation in an independent set of MM and PCL patients by RT-qPCR. The obtained results proved the significant downregulation of lymphocyte antigen antisense RNA 1 (LY86-AS1) and VIM antisense RNA 1 (VIM-AS1) in PCL compared to MM. Importantly, these two lncRNAs could be involved in the progression of MM into PCL; thus, they could serve as promising novel biomarkers of MM progression.
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Bezdekova R, Jelinek T, Kralova R, Stork M, Polackova P, Vsianska P, Brozova L, Jarkovsky J, Almasi M, Boichuk I, Knechtova Z, Penka M, Pour L, Sevcikova S, Hajek R, Rihova L. Necessity of flow cytometry assessment of circulating plasma cells and its connection with clinical characteristics of primary and secondary plasma cell leukaemia. Br J Haematol 2021; 195:95-107. [PMID: 34500493 PMCID: PMC9292932 DOI: 10.1111/bjh.17713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/30/2021] [Indexed: 01/23/2023]
Abstract
Plasma cell leukaemia (PCL) is a rare and very aggressive plasma cell disorder. Preventing a dismal outcome of PCL requires early diagnosis with appropriate analytical tools. Therefore, the investigation of 33 patients with primary and secondary PCL was done when the quantity of circulating plasma cells (PCs) using flow cytometry (FC) and morphology assessment was evaluated. The phenotypic profile of the PCs was also analysed to determine if there is an association with clinical outcomes and to evaluate the prognostic value of analysed markers. Our results revealed that FC is an excellent method for identifying circulating PCs as a significantly higher number was identified by FC than by morphology (26·7% vs. 13·5%, P = 0·02). None of secondary PCL cases expressed CD19 or CD20. A low level of expression with similar positivity of CD27, CD28, CD81 and CD117 was found in both PCL groups. A decrease of CD44 expression was detected only in secondary PCL. Expression of CD56 was present in more than half of PCL cases as well as cytoplasmic nestin. A decreased level of platelets, Eastern Cooperative Oncology Group score of 2-3 and lack of CD20+ PC were associated with a higher risk of death. FC could be incorporated in PCL diagnostics not only to determine the number of circulating PCs, but also to assess their phenotype profile and this information should be useful in patients' diagnosis and possible prognosis.
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Affiliation(s)
- Renata Bezdekova
- Department of Clinical Hematology, University Hospital Brno, Brno, Czech Republic.,Babak Myeloma Group, Department of Pathophysiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Tomas Jelinek
- Department of Hematooncology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Romana Kralova
- Department of Clinical Hematology, University Hospital Brno, Brno, Czech Republic.,Babak Myeloma Group, Department of Pathophysiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Martin Stork
- Department of Internal Medicine - Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - Petra Polackova
- Department of Clinical Hematology, University Hospital Brno, Brno, Czech Republic
| | - Pavla Vsianska
- Department of Clinical Hematology, University Hospital Brno, Brno, Czech Republic.,Babak Myeloma Group, Department of Pathophysiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Lucie Brozova
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jiri Jarkovsky
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Martina Almasi
- Department of Clinical Hematology, University Hospital Brno, Brno, Czech Republic.,Babak Myeloma Group, Department of Pathophysiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Ivanna Boichuk
- Department of Internal Medicine - Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - Zdenka Knechtova
- Department of Internal Medicine - Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - Miroslav Penka
- Department of Clinical Hematology, University Hospital Brno, Brno, Czech Republic
| | - Ludek Pour
- Department of Internal Medicine - Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - Sabina Sevcikova
- Department of Clinical Hematology, University Hospital Brno, Brno, Czech Republic.,Babak Myeloma Group, Department of Pathophysiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Roman Hajek
- Department of Hematooncology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Lucie Rihova
- Department of Clinical Hematology, University Hospital Brno, Brno, Czech Republic.,Babak Myeloma Group, Department of Pathophysiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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Li C, Cao W, Que Y, Wang Q, Xiao Y, Gu C, Wang D, Wang J, Jiang L, Xu H, Xu J, Zhou X, Hong Z, Wang N, Huang L, Zhang S, Chen L, Mao X, Xiao M, Zhang W, Meng L, Cao Y, Zhang T, Li J, Zhou J. A phase I study of anti-BCMA CAR T cell therapy in relapsed/refractory multiple myeloma and plasma cell leukemia. Clin Transl Med 2021; 11:e346. [PMID: 33784005 PMCID: PMC7943908 DOI: 10.1002/ctm2.346] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 02/10/2021] [Accepted: 02/17/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Relapsed/refractory (R/R) multiple myeloma (MM) patients and primary plasma cell leukemia (PCL) have an unfavorable prognosis and no effective treatment. This study was designed to assess the safety and preliminary efficacy of a novel anti-B-cell maturation antigen (BCMA) chimeric antigen receptor (CAR) T cell in R/R MM and PCL. METHODS Between February 22, 2017, and June 25, 2018, 28 R/R and two R/R primary PCL patients received a median dose of 11.2 × 106 CAR+ cells/kg. The subjects were refractory to a proteasome inhibitor and/or an immunomodulatory agent. Fludarabine and cyclophosphamide were given as lymphodepletion chemotherapy. RESULTS Results for these 30 consecutive patients who received an anti-BCMA CAR T cell infusion are reported. The patients had received a median of four prior lines of therapy. A total of 44 different types of adverse events were recorded, and hematologic toxic effects were the most common events of any grade during treatment. Hematologic toxic effects were also the most common events of grade 3 or higher. A total of 29 patients (96.7%) had cytokine release syndrome, which was of grade 1 or 2 in 24 patients (80%) and grade 3 in five patients (16.7%). Neurologic toxic effects only occurred in one patient (3.3%) and were of grade 1. The objective response rate was 90%, and the complete response rate was 43.3%. With a median follow-up of 12.6 months, the median progression-free survival (PFS) and overall survival were 5.2 months and 14.0 months. One of the two primary PCL achieved a complete response with a PFS of 307 days. The other patients achieved a very good partial response with a PFS of 117 days. CONCLUSIONS Anti-BCMA CAR T cell treatment is safe and highly active in R/R multiple myeloma.
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Affiliation(s)
- Chunrui Li
- Department of Hematology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
- Immunotherapy Research Center for Hematologic Diseases of Hubei ProvinceWuhanHubeiChina
| | - Wenyue Cao
- Department of Hematology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
- Immunotherapy Research Center for Hematologic Diseases of Hubei ProvinceWuhanHubeiChina
| | - Yimei Que
- Department of Hematology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
- Immunotherapy Research Center for Hematologic Diseases of Hubei ProvinceWuhanHubeiChina
| | | | - Yi Xiao
- Department of Hematology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
- Immunotherapy Research Center for Hematologic Diseases of Hubei ProvinceWuhanHubeiChina
| | - Chaojiang Gu
- College of Life Science and HealthWuhan University of Science and TechnologyWuhanHubeiChina
- Wuhan Bio‐Raid Biotechnology Co., Ltd.WuhanHubeiChina
| | - Di Wang
- Department of Hematology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
- Immunotherapy Research Center for Hematologic Diseases of Hubei ProvinceWuhanHubeiChina
| | - Jue Wang
- Department of Hematology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
- Immunotherapy Research Center for Hematologic Diseases of Hubei ProvinceWuhanHubeiChina
| | - Lijun Jiang
- Department of Hematology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
- Immunotherapy Research Center for Hematologic Diseases of Hubei ProvinceWuhanHubeiChina
| | - Hao Xu
- Department of Hematology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
- Immunotherapy Research Center for Hematologic Diseases of Hubei ProvinceWuhanHubeiChina
| | - Jinhuan Xu
- Department of Hematology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
- Immunotherapy Research Center for Hematologic Diseases of Hubei ProvinceWuhanHubeiChina
| | - Xiaoxi Zhou
- Department of Hematology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
- Immunotherapy Research Center for Hematologic Diseases of Hubei ProvinceWuhanHubeiChina
| | - Zhenya Hong
- Department of Hematology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
- Immunotherapy Research Center for Hematologic Diseases of Hubei ProvinceWuhanHubeiChina
| | - Na Wang
- Department of Hematology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
- Immunotherapy Research Center for Hematologic Diseases of Hubei ProvinceWuhanHubeiChina
| | - Liang Huang
- Department of Hematology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
- Immunotherapy Research Center for Hematologic Diseases of Hubei ProvinceWuhanHubeiChina
| | - Shangkun Zhang
- College of Life Science and HealthWuhan University of Science and TechnologyWuhanHubeiChina
- Wuhan Bio‐Raid Biotechnology Co., Ltd.WuhanHubeiChina
| | - Liting Chen
- Department of Hematology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
- Immunotherapy Research Center for Hematologic Diseases of Hubei ProvinceWuhanHubeiChina
| | - Xia Mao
- Department of Hematology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
- Immunotherapy Research Center for Hematologic Diseases of Hubei ProvinceWuhanHubeiChina
| | - Min Xiao
- Department of Hematology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
- Immunotherapy Research Center for Hematologic Diseases of Hubei ProvinceWuhanHubeiChina
| | - Wei Zhang
- Department of Hematology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
- Immunotherapy Research Center for Hematologic Diseases of Hubei ProvinceWuhanHubeiChina
| | - Li Meng
- Department of Hematology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
- Immunotherapy Research Center for Hematologic Diseases of Hubei ProvinceWuhanHubeiChina
| | - Yang Cao
- Department of Hematology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
- Immunotherapy Research Center for Hematologic Diseases of Hubei ProvinceWuhanHubeiChina
| | - Tongcun Zhang
- College of Life Science and HealthWuhan University of Science and TechnologyWuhanHubeiChina
- Wuhan Bio‐Raid Biotechnology Co., Ltd.WuhanHubeiChina
| | - Jian Li
- Department of HematologyPeking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Jianfeng Zhou
- Department of Hematology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
- Immunotherapy Research Center for Hematologic Diseases of Hubei ProvinceWuhanHubeiChina
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11
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Reinert CP, Krieg E, Esser M, Nikolaou K, Bösmüller H, Horger M. Role of computed tomography texture analysis using dual-energy-based bone marrow imaging for multiple myeloma characterization: comparison with histology and established serologic parameters. Eur Radiol 2020; 31:2357-2367. [PMID: 33011876 PMCID: PMC7979667 DOI: 10.1007/s00330-020-07320-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 08/02/2020] [Accepted: 09/17/2020] [Indexed: 11/05/2022]
Abstract
Objective To identify textural features on dual-energy CT (DECT)–based bone marrow images in myeloma which correlate with serum markers of myeloma activity and the degree of medullary involvement. Methods A total of 110 patients (63.0 ± 11.0 years, 51 female) who underwent unenhanced whole-body DECT between September 2015 and February 2019 were retrospectively included, which was approved by our institutional ethics committee with a waiver of the informed consent requirement. All patients had current hematologic laboratory tests. Using DECT post-processing, non-calcium bone marrow images were reconstructed. The vertebral bodies T10–L5 were segmented for quantification of textural features, which were compared with serologic parameters and myeloma stages by the Mann-Whitney U test. In a subgroup of 56/110 patients with current bone marrow biopsies, textural features were correlated with the degree of bone marrow infiltration. Results First-order features were higher in patients with advanced stage of myeloma (p < .02), whereas the 2nd-order “gray-level co-occurrence matrix (GLCM) cluster prominence” was lower (p < .04). In patients with elevated serum-free light chains (SFLC) or kappa/lambda SFLC ratio above 1.56, the “entropy” and 2nd-order GLCM features were lower (p < .03). The degree of bone marrow infiltration correlated with 1st-order features (e.g., “uniformity”; rP = 0.49; p < .0001), whereas “entropy” and 2nd-order GLCM features were negatively correlated (e.g., “difference entropy”; rP = − 0.54; p < .0001). Conclusions CT textural features applied on non-calcium bone marrow images correlate well with myeloma-related serologic parameters and histology showing a more uniform tissue structure and higher attenuation with increasing medullary infiltration and could therefore be used as additional imaging biomarkers for non-invasive assessment of medullary involvement. Key Points • Texture analysis applied on dual-energy reconstructed non-calcium bone marrow images provides information about marrow structure and attenuation. • Myeloma-related serologic parameters and the degree of myeloma cell infiltration correlate with 1st- and 2nd-order features which could be useful as additional imaging biomarkers for non-invasive assessment of medullary involvement. Electronic supplementary material The online version of this article (10.1007/s00330-020-07320-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christian Philipp Reinert
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.
| | - Eva Krieg
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Michael Esser
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.,Cluster of Excellence iFIT (EXC 2180) "Image Guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen, Germany.,German Cancer Consortium (DKTK), Partner Site Tübingen, Tübingen, Germany
| | - Hans Bösmüller
- Institute of Pathology and Neuropathology, University Hospital Tübingen, Liebermeisterstraße 8, 72076, Tübingen, Germany
| | - Marius Horger
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
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12
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Reinert CP, Krieg EM, Bösmüller H, Horger M. Mid-term response assessment in multiple myeloma using a texture analysis approach on dual energy-CT-derived bone marrow images - A proof of principle study. Eur J Radiol 2020; 131:109214. [PMID: 32835853 DOI: 10.1016/j.ejrad.2020.109214] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 07/29/2020] [Accepted: 08/03/2020] [Indexed: 01/23/2023]
Abstract
PURPOSE To identify textural features on dual-energy CT (DECT)-generated virtual non calcium (VNC) bone marrow images in a small group of patients with multiple myeloma undergoing systemic treatment which could potentially help for mid-term response assessment. METHODS 44 patients (59.1 ± 11.2 yr.) with multiple myeloma who underwent unenhanced whole-body reduced-dose DECT before and after systemic therapy were evaluated. All patients had current hematologic laboratory tests including serum levels of immunoglobulins, albumin, and total proteins. Using DECT post-processing, bone marrow images of the axial skeleton were reconstructed. The vertebral bodies T10-L5 were segmented for quantification of 1st order (n = 18) and 2nd order Gray Level Co-occurrence Matrix (GLCM) textural features (n = 23) based on an open-source radiomics library (Pyradiomics), which were then compared with the hematologic response category to treatment. Five patients underwent only active surveillance at intervals after previous successful therapy. RESULTS According to hematologic diagnosis, 29 patients were classified as complete response (CR), 10 as partial response (PR) and 5 as stable disease (SD). We observed a significant drop of the 1st order textural features "10th percentile" (p = 0.009), "median" (p = 0.01), and "minimum" (p < 0.0001) after treatment, whereas the 1st order feature "range" (p = 0.0004) and the 2nd order GLCM feature "difference variance" (p = 0.007) significantly increased in patients experiencing CR. A similar trend, however, without statistical significance, could be observed in patients achieving PR after treatment. 2nd order GLCM feature "difference variance" proved to be a significant discriminator (p = 0.01) between patients with CR and PR (sensitivity 0.93, specificity 0.70) for a cut-off value of -0.28. In patients classified CR, both the mean serum protein and the beta-2 microglobulin decreased after treatment, whereas the serum albumin increased (p < 0.01). The same trend without significance could be observed in patients classified PR. CONCLUSIONS Changes in textural features applied on VNC bone marrow images in the pre- and posttreatment settings correlate well with myeloma-specific hematologic parameters and provide complementary information for the assessment of the late effects of treatment on the bone marrow.
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Affiliation(s)
- Christian Philipp Reinert
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany.
| | - Eva-Maria Krieg
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
| | - Hans Bösmüller
- Institute of Pathology and Neuropathology, University Hospital Tübingen, Liebermeisterstraße 8, 72076 Tübingen, Germany
| | - Marius Horger
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
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13
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Kasinathan G. Primary plasma cell leukaemia in a 39-year-old man. BMJ Case Rep 2020; 13:13/7/e235543. [PMID: 32709663 PMCID: PMC7380833 DOI: 10.1136/bcr-2020-235543] [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: 11/07/2022] Open
Abstract
Plasma cell leukaemia (PCL) is an aggressive haematological malignancy which is classified into primary (pPCL) and secondary PCL. A 39-year-old Indian man presented to the Department of Hematology with a 2-week history of fever and lethargy. Clinically, he was pale and febrile. Haemogram revealed bicytopenia with leucocytosis. The peripheral blood film portrayed rouleax formation with 45% of circulating plasma cells. Serum protein electrophoresis and immunofixation revealed IgG lambda paraproteinaemia of 48 g/L. Bone marrow aspirate, flow cytometry and trephine were consistent with IgG lambda pPCL. He was treated with six cycles of bortezomib, thalidomide and dexamethasone combination chemotherapy followed by high-dose melphalan conditioning and autologous stem cell transplant. Currently, he is in complete remission for the past 18 months and is on oral lenalidomide maintenance therapy. Prognosis is often dismal in pPCL with the median overall survival below 1 year if treatment is delayed.
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14
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Suska A, Vesole DH, Castillo JJ, Kumar SK, Parameswaran H, Mateos MV, Facon T, Gozzetti A, Mikala G, Szostek M, Mikhael J, Hajek R, Terpos E, Jurczyszyn A. Plasma Cell Leukemia - Facts and Controversies: More Questions than Answers? Clin Hematol Int 2020; 2:133-142. [PMID: 34595454 PMCID: PMC8432408 DOI: 10.2991/chi.k.200706.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/01/2020] [Indexed: 11/18/2022] Open
Abstract
Plasma cell leukemia (PCL) is an aggressive hematological malignancy characterized by an uncontrolled clonal proliferation of plasma cells (PCs) in the bone marrow and peripheral blood. PCL has been defined by an absolute number of circulating PCs exceeding 2.0 × 109/L and/or >20% PCs in the total leucocyte count. It is classified as primary PCL, which develops de novo, and secondary PCL, occurring at the late and advanced stages of multiple myeloma (MM). Primary and secondary PCL are clinically and biologically two distinct entities. After the diagnosis, treatment should be immediate and should include a proteasome inhibitor and immunomodulator-based combination regimens as induction, followed by stem cell transplantation (SCT) in transplant-eligible individuals who have cleared the peripheral blood of circulating PCs. Due to the rarity of the condition, there have been very few clinical trials. Furthermore, virtually all of the myeloma trials exclude patients with active PCL. The evaluation of response has been defined by the International Myeloma Working Group and consists of both acute leukemia and MM criteria. With conventional chemotherapy, the prognosis of primary PCL has been ominous, with reported overall survival (OS) ranging from 6.8 to 12.6 months. The use of novel agents and autologous SCT appears to be associated with deeper response and an improved survival, although it still remains low. The PCL prognostic index provides a simple score to risk-stratify PCL. The prognosis of secondary PCL is extremely poor, with OS of only 1 month.
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Affiliation(s)
- Anna Suska
- Department of Hematology, Jagiellonian University Medical College, Kopernika 17, Krakow 31-501, Poland
| | - David H Vesole
- The John Theurer Cancer Center at Hackensack UMC, Hackensack, NJ, USA
| | - Jorge J Castillo
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Shaji K Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Maria V Mateos
- Complejo Asistencial Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (CAUSA/IBSAL), Salamanca, Spain
| | - Thierry Facon
- Service des Maladies du Sang, Hôpital Claude Huriez, Lille, France
| | | | - Gabor Mikala
- Department of Hematology and Stem Cell Transplantation, South-Pest Central Hospital, Natl. Inst. Hematol. Infectol, Budapest, Hungary
| | - Marta Szostek
- Department of Hematology, Jagiellonian University Medical College, Kopernika 17, Krakow 31-501, Poland
| | - Joseph Mikhael
- Translational Genomics Research Institute, City of Hope Cancer Center, Phoenix, Arizona, USA
| | - Roman Hajek
- University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Artur Jurczyszyn
- Department of Hematology, Jagiellonian University Medical College, Kopernika 17, Krakow 31-501, Poland
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15
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Abstract
Plasma cell leukemia (PCL) is a rare and aggressive variant of myeloma and has a poor prognosis. It needs prompt recognition in order to institute timely treatment. Given its relatively low incidence, it is an evolving area of research as well. This case report describes a patient with PCL in the setting of a previously treated myeloma. The report also reviews the clinicopathologic, cytogenetic, and immunophenotypic characteristics of PCL and its management.
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Affiliation(s)
| | - Gabor Varadi
- Hematology and Oncology, Albert Einstein Medical Center, Philadelphia, USA
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16
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Yu T, Xu Y, An G, Tai YT, Ho M, Li Z, Deng S, Zou D, Yu Z, Hao M, Anderson KC, Qiu L. Primary Plasma Cell Leukemia: Real-World Retrospective Study of 46 Patients From a Single-Center Study in China. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 20:e652-e659. [PMID: 32624447 DOI: 10.1016/j.clml.2020.05.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Primary plasma cell leukemia (PPCL) is a rare and aggressive plasma cell disorder. The use of novel agents, together with autologous stem cell transplantation, has improved survival outcome in PPCL. However, the prognosis is still very poor, and the optimal treatment remains an unmet clinical need. PATIENTS AND METHODS We studied the efficacy and prognostic impact of novel agents in 46 patients with PPCL patients at the Blood Diseases Hospital in China. We examined the impact of clinical and laboratory features, as well as therapies (bortezomib- and/or immunomodulatory drug-based therapies, chemotherapy) on survival and extent of clinical response, including progression-free survival and overall survival (OS). Progression-free survival and OS were assessed by the Kaplan-Meier method, and survival distributions were compared by log-rank test. RESULTS In our cohort of 46 PPCL patients, the median age at the time of diagnosis was 54 years. Overall response rate was 54% (25/46). The median (95% confidence interval) progression-free survival time was 6 (0-12.5) months, and OS time was 14 (4.6-23.4) months. The OS time was significantly longer in patients treated with bortezomib-based versus non-bortezomib-based therapies (median [95% confidence interval], 19 [9-28.9] vs. 5 [4-24] months; P = .019). CONCLUSION This large single-center study of PPCL supports the use of bortezomib-based therapies as frontline treatment in PPCL patients.
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Affiliation(s)
- Tengteng Yu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Hematological Disorders, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China; Jerome Lipper Multiple Myeloma Center, LeBow Institute for Myeloma Therapeutics, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Yan Xu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Hematological Disorders, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China; Jerome Lipper Multiple Myeloma Center, LeBow Institute for Myeloma Therapeutics, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Gang An
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Hematological Disorders, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Yu-Tzu Tai
- Jerome Lipper Multiple Myeloma Center, LeBow Institute for Myeloma Therapeutics, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Matthew Ho
- UCD School of Medicine, College of Health and Agricultural Science and UCD Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland
| | - Zengjun Li
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Hematological Disorders, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China; Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Shuhui Deng
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Hematological Disorders, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Dehui Zou
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Hematological Disorders, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Zhen Yu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Hematological Disorders, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Mu Hao
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Hematological Disorders, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Kenneth C Anderson
- Jerome Lipper Multiple Myeloma Center, LeBow Institute for Myeloma Therapeutics, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.
| | - Lugui Qiu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Hematological Disorders, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China.
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17
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Wålinder G, Samuelsson J, Näsman P, Hansson M, Juliusson G, Forsberg K, Svensson R, Linder O, Carlson K, Kristinsson SY, Mellqvist UH, Hveding Blimark C, Turesson I, Nahi H. Outcome and characteristics of non‐measurable myeloma: A cohort study with population‐based data from the Swedish Myeloma Registry. Eur J Haematol 2020; 104:376-382. [DOI: 10.1111/ejh.13351] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/05/2019] [Accepted: 11/06/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Göran Wålinder
- Department of Medicine Karolinska Institutet Stockholm Sweden
- Department of Hematology Karolinska University Hospital Huddinge Huddinge Sweden
| | - Jan Samuelsson
- Department of Hematology Linkoping University Hospital Linköping Sweden
| | - Per Näsman
- Center for Safety Research KTH Royal Institute of Technology Stockholm Sweden
| | - Markus Hansson
- Hematology Lund University Lund Sweden
- Department of Hematology Skåne University Hospital Lund‐Malmö Sweden
| | | | - Karin Forsberg
- Department of Hematology Norrlands University Hospital Umeå Sweden
| | - Ronald Svensson
- Department of Hematology Linkoping University Hospital Linköping Sweden
| | - Olle Linder
- Department of Hematology Örebro University Hospital Örebro Sweden
| | - Kristina Carlson
- Department of Hematology Uppsala University Hospital Uppsala Sweden
| | | | | | | | - Ingemar Turesson
- Hematology Lund University Lund Sweden
- Department of Hematology Skåne University Hospital Lund‐Malmö Sweden
| | - Hareth Nahi
- Department of Medicine Karolinska Institutet Stockholm Sweden
- Department of Hematology Karolinska University Hospital Huddinge Huddinge Sweden
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18
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Atkin C, Reddy-Kolanu V, Drayson MT, Sapey E, Richter AG. The prevalence and significance of monoclonal gammopathy of undetermined significance in acute medical admissions. Br J Haematol 2020; 189:1127-1135. [PMID: 31999849 DOI: 10.1111/bjh.16487] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 12/23/2019] [Indexed: 12/31/2022]
Abstract
Monoclonal gammopathy of undetermined significance (MGUS) affects 3·2% of adults aged >50 years. MGUS carries a life-long risk of progression to multiple myeloma and causes complications including infection and renal impairment; common causes of hospital admission. This study aimed to assess MGUS prevalence in emergency medical hospital admissions. Patients were recruited from unselected emergency medical admissions in a hospital in the United Kingdom. Serum protein electrophoresis was performed, with immunofixation of abnormal results. Reason for admission and routine test results were recorded. After education about MGUS and myeloma, patients chose whether they wished to be informed of new diagnoses. A total of 660 patients were tested and 35 had a paraprotein suggestive of MGUS. The overall rate of MGUS was 5·3%. MGUS prevalence in those aged >50 years was 6·94%, higher than the previously published rate of 3·2% (P < 0·0005). There were higher rates in those with chronic kidney disease (13·75% vs. 4·14%, P = 0·002), heart failure (14% vs. 4·59%, P = 0·012), anaemia (8·96% vs. 3·41%, P = 0·003) or leucocytosis (9·33% vs. 3·04%, P = 0·002). In all, 96% of patients wished to be informed of their screening results. The prevalence of MGUS in emergency hospital admissions is higher than expected based on previous population-based rates. This may suggest a selected population for screening.
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Affiliation(s)
- Catherine Atkin
- Birmingham Acute Care Research, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | | | - Mark T Drayson
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Elizabeth Sapey
- Birmingham Acute Care Research, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Alex G Richter
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
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19
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Manthri S, Zafar R, Cornell RF, Chakraborty K. Rare case of non-producer variant of plasma cell dyscrasias with circulating plasma cells. BMJ Case Rep 2019; 12:12/11/e231314. [PMID: 31767606 DOI: 10.1136/bcr-2019-231314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Non-producing variant of plasma cell disorders with circulating plasma cells is an aggressive variant of plasma cell dyscrasias with relatively poor outcomes. A 75-year-old man was admitted due to anaemia (90 g/L) and thrombocytopenia (9×109/L). Comprehensive metabolic panel showed creatinine of 1.34 mg/dL, total protein of 6 g/dL, and corrected calcium was normal. Peripheral smear review showed 8% circulating atypical plasmacytoid cells. Bone marrow biopsy (BMB) confirmed plasma cell myeloma involving 90%-95% of bone marrow cellularity. Serum protein electrophoresis showed no monoclonal protein. Due to aggressive biology of non-producer variant and outcomes based on circulating plasma cells, he was started on VD-PACE (bortezomib, dexamethasone, cisplatin, doxorubicin, cyclophosphamide and etoposide) chemotherapy. BMB after cycle 1 chemotherapy showed no morphologic, immunophenotypic, or flow cytometric features of a plasma cell neoplasm. Given excellent treatment response cycle 2 was changed to VRD (bortezomib, lenalidomide and dexamethasone). Following two cycles of VRD, he underwent autologous haematopoietic cell transplantation. Day 80 BMB suggested stringent complete response.
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Affiliation(s)
- Sukesh Manthri
- Division of Hematology/Oncology, Department of Internal Medicine, East Tennessee State University, Johnson City, Tennessee, USA
| | - Rabia Zafar
- Pathology, East Tennessee State University, Johnson City, Tennessee, USA
| | - Robert Frank Cornell
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Kanishka Chakraborty
- Division of Hematology/Oncology, Department of Internal Medicine, East Tennessee State University, Johnson City, Tennessee, USA
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20
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Mendoza H, Tormey CA, Siddon AJ. Use of B-Cell Gene Rearrangement Studies to Establish Clonality in Non-producer Non-secretory Multiple Myeloma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 20:e18-e21. [PMID: 31711890 DOI: 10.1016/j.clml.2019.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 10/15/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Hadrian Mendoza
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT
| | - Christopher A Tormey
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT; Pathology and Laboratory Medicine Service, VA Connecticut Healthcare System, West Haven, CT
| | - Alexa J Siddon
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT; Department of Pathology, Yale School of Medicine, New Haven, CT; Pathology and Laboratory Medicine Service, VA Connecticut Healthcare System, West Haven, CT.
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21
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Nandakumar B, Kumar SK, Dispenzieri A, Buadi FK, Dingli D, Lacy MQ, Hayman SR, Kapoor P, Leung N, Fonder A, Hobbs M, Hwa YL, Muchtar E, Warsame R, Kourelis TV, Russell S, Lust JA, Lin Y, Go RS, Siddiqui M, Zeldenrust S, Kyle RA, Gertz MA, Rajkumar SV, Gonsalves WI. Cytogenetic Features and Clinical Outcomes of Patients With Non-secretory Multiple Myeloma in the Era of Novel Agent Induction Therapy. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 20:53-56. [PMID: 31685378 DOI: 10.1016/j.clml.2019.09.624] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 09/12/2019] [Accepted: 09/29/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Non-secretory multiple myeloma (NSMM) is a rare subtype of multiple myeloma (MM) characterized by the absence of monoclonal protein in the serum and/or urine. We look at the clinical and cytogenetic features of NSMM in this study. PATIENTS AND METHODS This study evaluates a cohort of 30 patients with newly diagnosed NSMM seen at the Mayo Clinic, Rochester, MN, between 2008 and 2018 and treated with novel agent induction therapies. Survival outcomes were estimated using the Kaplan-Meier method and compared using the log-rank test. RESULTS These patients with NSMM appear to have a large disease burden at diagnosis with a median bone marrow plasma cell percentage of 70% and more than one-half of all patients having Multiple Myeloma International Staging System Stage III disease. There was a higher preponderance for t(11;14) primary cytogenetic abnormality in this NSMM cohort, accounting for more than 50% of the cohort. Finally, the overall survival of this cohort appears to be slightly worse than a matched-control group of newly diagnosed patients with MM with secretory disease. CONCLUSIONS Future multi-institution studies confirming these above findings on this rare entity are warranted.
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Affiliation(s)
| | | | | | | | - David Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | | | - Nelson Leung
- Division of Hematology, Mayo Clinic, Rochester, MN; Department of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Amie Fonder
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Miriam Hobbs
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Yi Lisa Hwa
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Eli Muchtar
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | | | - John A Lust
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Ronald S Go
- Division of Hematology, Mayo Clinic, Rochester, MN
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22
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Ngu S, Asti D, Valecha G, Thumallapally N, Pant M, Bershadskiy A. Primary plasma cell leukemia: A case report and review of the literature. Clin Case Rep 2019; 7:1702-1708. [PMID: 31534731 PMCID: PMC6745387 DOI: 10.1002/ccr3.2339] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 04/29/2019] [Accepted: 05/29/2019] [Indexed: 01/25/2023] Open
Abstract
Due to the rarity and fulminant nature of the condition, there are limited data driving dialogue for optimal treatment strategies for plasma cell leukemia (PCL). Additionally, the current diagnostic definition of PCL has not been prospectively studied which may result in delays to initiating early aggressive treatment due to underdiagnosis.
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Affiliation(s)
- Sam Ngu
- Staten Island University HospitalStaten IslandNew York
| | - Divya Asti
- Staten Island University HospitalStaten IslandNew York
| | | | | | - Manisha Pant
- Staten Island University HospitalStaten IslandNew York
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Badr-El-Dine M, Abdelzaher E, Eid M, Elshennawy R. Petrous apex non-secretory plasma cell myeloma with aberrant cytokeratin expression. J Histotechnol 2019; 43:47-50. [PMID: 31424328 DOI: 10.1080/01478885.2019.1650998] [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: 10/26/2022]
Abstract
Multiple myeloma is a monoclonal proliferation of plasma cells with common involvement of vertebrae, ribs and skull vault. However, involvement of skull base is relatively uncommon and myeloma manifesting initially as a petrous apex mass is distinctly rare. We report a rare case of non-secretory multiple myeloma in a 52-year-old Egyptian male presenting primarily as a right petrous apex mass with abducens nerve palsy. Additionally, neoplastic cells aberrantly expressed cytokeratin. Although rare, plasma cell myeloma should be considered in the differential diagnosis of petrous apex masses.
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Affiliation(s)
- Mohamed Badr-El-Dine
- Otorhinolaryngology Department, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Eman Abdelzaher
- Pathology Department, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Mohamed Eid
- Diagnostic Radiology Department, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Rawda Elshennawy
- Pathology Department, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
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Smith N, Kimberger K, Parrish C, Currie S, Butterworth S, Alty J. Multiple myeloma with multiple neurological presentations. Pract Neurol 2019; 19:511-517. [PMID: 31273077 DOI: 10.1136/practneurol-2019-002205] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2019] [Indexed: 11/04/2022]
Abstract
Multiple myeloma is a haematological malignancy with clonal plasma cell proliferation and production of monoclonal immunoglobulins. Its neurological complications are relatively common, caused by both the disease and the treatment. Neurologists should therefore be familiar with its neurological manifestations and complications. We describe a 40-year-old woman who presented with lower cranial neuropathies mimicking variant Guillain-Barré syndrome, with normal brain and spinal cord imaging and cerebrospinal fluid (CSF) albuminocytological dissociation, and subsequently diagnosed with IgD myeloma. She relapsed repeatedly with differing neurological presentations: numb chin syndrome and twice with impaired vision, first from cerebral venous sinus thrombosis and later from leptomeningeal infiltration of the optic chiasm. We discuss the neurological complications of myeloma, emphasising the need to consider it in a wide variety of neurological presentations and repeatedly to reassess its associated neurological diagnoses. We also highlight the complexity of myeloma treatment.
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Affiliation(s)
- Nicholas Smith
- Department of Neurology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Katja Kimberger
- Department of Haematology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Stuart Currie
- Department of Neuroradiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Jane Alty
- Department of Neurology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Yang Y, Han X, Zheng G, Cai Z. Comparison of two serum free light chain assays for the diagnosis of primary plasma cell malignant proliferative disease. Health Sci Rep 2019; 2:e113. [PMID: 31049418 PMCID: PMC6482328 DOI: 10.1002/hsr2.113] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 12/01/2018] [Accepted: 12/25/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND AIMS The serum free light chain assay (sFLC) is well established for aiding in the diagnosis, prognosis, and monitoring of plasma cell proliferative disorders. There are currently two commercially available sFLC immunoassays, Freelite, based on polyclonal antibody technology, and N Latex FLC, based on monoclonal antibodies. This study aimed to compare the analytical and clinical performance of these two assays in a Chinese population. METHODS This study included 74 consecutive patients who were newly diagnosed with monoclonal gammopathies (MGs) including multiple myeloma (MM), AL amyloidosis, and light chain deposition disease (LCDD) between January 2014 and May 2015 at the First Affiliated Hospital of Zhejiang University. Alongside serum and urine electrophoresis analysis, the serum samples were retrospectively tested with both sFLC assays according to the manufacturers' instructions. RESULTS The two sFLC assays showed a moderate correlation for κFLC (Passing-Bablok slope = 0.645, coefficient of determination (R 2) = 0.83, and Spearman coefficient = 0.904). However, for λFLC, a poor correlation was found (Passing-Bablok slope = 0.690, R 2 = 0.39, and Spearman coefficient = 0.852). The concordance rate of κFLC, λFLC, and κ/λ FLC ratio were 83.78%, 75.68%, and 86.49%, respectively. The clinical sensitivity of the κ/λ ratios were 83.8% for the Freelite assay and 75.7% for the N Latex FLC assay. CONCLUSION Although the concordance and the clinical sensitivity of the two assays appeared comparable, a number of discrepancies were observed. There is a low correlation between the two assays in clinical practice, suggesting that the assays are not equivalent and, thus, current IMWG guidelines, based on Freelite, cannot be cross-applied to N Latex FLC.
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Affiliation(s)
- Yang Yang
- Bone Marrow Transplantation Center, The First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Xiaoyan Han
- Bone Marrow Transplantation Center, The First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Gaofeng Zheng
- Bone Marrow Transplantation Center, The First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Zhen Cai
- Bone Marrow Transplantation Center, The First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
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26
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Jain AG, Faisal-Uddin M, Khan AK, Wazir M, Shen Q, Manoucheri M. Plasma cell leukemia - one in a million: A case report. World J Clin Oncol 2019; 10:161-165. [PMID: 30949445 PMCID: PMC6441660 DOI: 10.5306/wjco.v10.i3.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/30/2019] [Accepted: 02/27/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Plasma cell leukemia (PCL) is diagnosed by the presence of an absolute plasma cell count of > 2 × 109/L or 20% plasma cells in the peripheral blood. Because the incidence of PCL is relatively low, our case report study presents a rare opportunity to describe the clinical and pathological characteristics of this leukemia, as well as different modalities of treatment and outcomes of primary PCL (pPCL).
CASE SUMMARY A 56-year-old male with a history of hypertension complained of pain in the left flank area which started four months prior to admission. On admission, his vital signs were stable, and physical examination was completely benign. Laboratory evaluation showed hemoglobin of 5.1 g/dL, white blood cell count of 6.6 cells per cubic millimeter with 16% atypical lymphocytes, and platelet count of 51000 per microliter. Peripheral smear showed more than 10%-15% of plasma cells (Figure 1), and flow cytometry of peripheral blood confirmed PCL with 24% plasma cells CD138+. Bone marrow biopsy demonstrated 80% plasma cells (38+, 138+, 117+, 10-, 19-, 20-, 56-) with 90% cellularity. The Oncology team was consulted, and VCD therapy was started. After completing therapy at 1, 4, 8, and 11 d, the patient was discharged home. The patient was being considered for a bone marrow transplant evaluation within two months of discharge.
CONCLUSION PCL is a rare and aggressive form of leukemia with a poor prognosis. Multi-center studies and clinical trials should be conducted to develop accurate criteria for the initial diagnosis and prompt treatment of this disease.
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Affiliation(s)
- Akriti G Jain
- Internal Medicine, Florida Hospital, Orlando, FL 32804, United States
| | | | - Abdul K Khan
- Internal Medicine, Florida Hospital, Orlando, FL 32804, United States
| | - Mohammed Wazir
- Internal Medicine, Florida Hospital, Orlando, FL 32804, United States
| | - Qi Shen
- Central Florida Pathology Associates, Florida Hospital, Orlando, FL 32804, United States
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Primary Plasma Cell Leukemia: A Retrospective Study of a Rare Disease From Tertiary Cancer Centre From India. Indian J Hematol Blood Transfus 2019; 35:649-654. [PMID: 31741616 DOI: 10.1007/s12288-019-01114-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 03/11/2019] [Indexed: 12/25/2022] Open
Abstract
Plasma cell leukemia (PCL) is an aggressive rare leukemic variant of multiple myeloma (MM). We aim to present 4 years data on clinical profile and treatment outcomes of Primary PCL (PPCL) patients treated at tertiary care cancer centre from Northern India. To analyse response and safety profile of a PPCL with or without stem cell transplantation. Retrospectively reviewed and analysed PPCL patient's data at our centre from January-2013 to June-2017. Total 11 PPCL patients diagnosed among 240 MM patients during study period. Eight were males. Only 10 patients were started on treatment. Four (n = 4/10) patients underwent stem cell transplantation. Overall response rate was 70% (n = 7). Eleven culture positive bacterial infections (bloodstream = 2, urinary tract = 3; pulmonary = 6) were recorded. Four patients had fungal infections. One patient had Herpes Zoster infection. Relapse rate of entire cohort was 50% (n = 5). Median PFS and OS of entire cohort was 11 months (95% confidence interval 6.3-15.6) and 21 months (95% C.I. 1-49.8) respectively. The estimated PFS and OS at 1 year of transplanted versus nontransplanted patients were 71% + 24% versus 0% (P = 0.96) and 71% + 24% versus 15% + 19% (P = 0.234) respectively. Treatment with PIs + IMAs followed by transplants (single/double) might improve depth and duration of remission and OS. Patients should be treated with indefinite maintenance therapy to control disease.
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Light-chain plasma cell myeloma caused by 14q32/IGH translocation and loss of the other allele. Int J Hematol 2019; 109:572-577. [PMID: 30887274 DOI: 10.1007/s12185-019-02629-7] [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: 01/14/2019] [Revised: 03/09/2019] [Accepted: 03/11/2019] [Indexed: 10/27/2022]
Abstract
Light-chain plasma cell myeloma (LC-PCM) is a PCM subtype in which only immunoglobulin light-chain is secreted. However, the absence of immunoglobulin heavy-chain (IGH) production in this condition has not been fully elucidated. To address this issue, we retrospectively analyzed patients at our center with LC-PCM and found a group who had only split signals of IGH gene derived from 14q32/IGH translocations by fluorescence in situ hybridization (FISH). Six patients were identified with only split signals of the IGH gene derived from 14q32/IGH translocations. Five of these patients were newly diagnosed, while one had IgG-λ PCM at presentation, which transformed to λ LC-PCM after treatment. The translocation partners were identified in four patients: two cases of (11;14)(q13;q32) and two cases of (4;14)(p16;q32). The development of LC-PCM appears to be explained by the application of allelic exclusion in these patients, such that 14q32/IGH translocation in one allele contributes to the pathogenesis of PCM and the subsequent loss of the other allele is responsible for the loss of IGH production. These findings suggest that a FISH pattern of IGH with "split and loss" may constitute a unique subgroup of LC-PCM.
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29
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Singh S, Rath A, Yadav S. Primary Plasma Cell Leukaemia: Case report and review of the literature. Sultan Qaboos Univ Med J 2019; 18:e397-e401. [PMID: 30607287 DOI: 10.18295/squmj.2018.18.03.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 04/04/2018] [Accepted: 05/24/2018] [Indexed: 11/16/2022] Open
Abstract
Plasma cell leukaemia (PCL) is one of the most aggressive and rarest forms of plasma cell dyscrasia. However, the diagnostic criteria for this condition have not yet been revised and there is no specific treatment to significantly improve the course of the disease. We report a 69-year-old male who presented to the Lok Nayak Hospital, New Delhi, India, in 2017 with dyspnoea and chest pain. A peripheral blood smear showed an absolute plasma cell count of 2.16 × 109/L. A bone marrow examination showed 61% atypical plasma cells exhibiting kappa light chain restriction. Biochemical investigations were consistent with a diagnosis of primary PCL with renal involvement. Bortezomib-based chemotherapy was initiated, which resulted in an improvement in the patient's haematological and biochemical parameters. This case report includes a comprehensive review of the clinical and diagnostic features, pathobiology and treatment of PCL.
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Affiliation(s)
- Sarika Singh
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Ashutosh Rath
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Surekha Yadav
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
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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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Kang J, Hong JY, Yoon DH, Kim S, Lee KM, Park JS, Park CJ, Min WK, Seo EJ, Jang S, Suh C. Efficacy and Survival Outcome Associated with the Use of Novel Agents and Autologous Stem Cell Transplantation in Cases of Immunoglobulin D Multiple Myeloma in Korea. Acta Haematol 2018; 139:185-192. [PMID: 29635247 DOI: 10.1159/000486664] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 12/22/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Immunoglobulin D multiple myeloma (IgD MM) is characterized by a poor prognosis. Data are lacking on the survival benefits associated with the use of novel agents followed by autologous stem cell transplantation (ASCT) in IgD MM patients. We evaluated the clinical outcomes of induction treatment with novel agents followed by ASCT. METHODS This was a single-center, retrospective study of 22 IgD MM patients who underwent ASCT between 1995 and 2016. Of these, 10 (45.4%) received novel agents and 12 (54.6%) received nonnovel agents. Clinical features and survival outcomes were examined. RESULTS Median overall survival (OS) was 37.7 months in the 22 patients. Those in the novel-agents group received bortezomib or thalidomide-based regimens, whereas 91.7% of the nonnovel-agents group received a vincristine-based regimen. The median progression-free survival and OS in the novel-agent/nonnovel-agent groups were 8.3/7.4 and 38.6/12.5 months, respectively. The median OS of patients receiving maintenance therapy was not reached. CONCLUSION This study showed improved survival outcomes compared to our previous study (37.7 vs. 12 months), suggesting that the use of a novel agent as induction and maintenance therapy may be beneficial in patients with IgD MM who undergo ASCT.
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Affiliation(s)
- Jihoon Kang
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Division of Hematology/Oncology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jung Yong Hong
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dok Hyun Yoon
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Shin Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kyoung Min Lee
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jung Sun Park
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chan-Jeoung Park
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Won-Ki Min
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Eul-Ju Seo
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seongsoo Jang
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Cheolwon Suh
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Real-world data on prognosis and outcome of primary plasma cell leukemia in the era of novel agents: a multicenter national study by the Greek Myeloma Study Group. Blood Cancer J 2018. [PMID: 29523783 PMCID: PMC5849880 DOI: 10.1038/s41408-018-0059-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
We have studied the efficacy and the prognostic impact of novel agents in 50 primary plasma cell leukemia (pPCL) patients registered in our database. Eighty percent of patients were treated upfront with novel agent-based combinations; 40% underwent autologous stem cell transplantation (ASCT). Objective response rate was 76; 38% achieved at least very good partial response (≥vgPR) and this correlated significantly with bortezomib-based therapy plus ASCT. At the time of evaluation, 40 patients had died. Early mortality rate (≤1 month) was 6%. Median progression-free survival (PFS) and overall survival (OS) were 12 months and 18 months respectively, both significantly longer in patients treated with bortezomib-based therapy + ASCT vs. others (PFS: 18 vs. 9 months; p = 0.004, OS: 48 vs. 14 months; p = 0.007). Bortezomib-based therapy + ASCT predicted for OS in univariate analysis. In multivariate analysis, achievement of ≥vgPR and LDH ≥ 300 U/L were significant predictors for OS. These real-world data, based on one of the largest reported national multicenter series of pPCL patients treated mostly with novel agents support that, among the currently approved induction therapies, bortezomib-based regimens are highly effective and reduce the rate of early mortality whereas in combination with ASCT consolidation they prolong OS.
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Non-Secretory Myeloma: Ready for a new Definition? Mediterr J Hematol Infect Dis 2017; 9:e2017053. [PMID: 28894562 PMCID: PMC5584772 DOI: 10.4084/mjhid.2017.053] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 07/28/2017] [Indexed: 12/24/2022] Open
Abstract
Non-secretory myeloma is a rare myeloma subtype whose diagnosis, until a few years ago, was established by demonstration of monoclonal plasma cells ≥10% in the bone marrow and by negative results on serum and urine electrophoresis and immunofixation studies. However, this type of myeloma could be misdiagnosed if the workup does not include an accurate study of serum free light chain test since some of the patients diagnosed as non-secretory could be light chain only with small amounts monoclonal proteinuria. Due to this limit in classification, all the information available today, generally coming from retrospective studies including patients studied completely and incompletely, could be misleading. A new definition is, thus, needed to distinguish between the true non-secretory, with a possible better prognosis, and the other forms of oligo-secretory myeloma with a prognosis more similar to the secretory form of myeloma. With all the data of the literature, the availability of laboratory and radiological tools, times are mature to depict a new definition of nonsecretory myeloma that deserves a peculiar work up and different response evaluation and, may be, a different therapeutic approach.
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Al Hadidi S, Katato K, Bachuwa G. Immunoglobulin D Multiple Myeloma Presenting as Spontaneous Fracture. Case Rep Oncol 2017; 10:272-275. [PMID: 28512409 PMCID: PMC5422729 DOI: 10.1159/000466687] [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] [Received: 02/28/2017] [Accepted: 02/28/2017] [Indexed: 11/19/2022] Open
Abstract
Immunoglobulin D multiple myeloma is a rare type of multiple myeloma that usually presents as bone pain, fatigue, or weight loss. We report a case of immunoglobulin D multiple myeloma in a 53-year-old Caucasian male patient with previous medical history of anaplastic oligodendroglioma status post-surgical resection who was evaluated for back pain while mowing the lawn. His physical examination showed tenderness over the lower thoracic vertebrae with no sensory or motor impairment. Initial lab investigations showed normocytic anemia and hypercalcemia with low parathyroid hormone. Magnetic resonance imaging of thoracic spine with and without contrast showed acute pathological fracture of the T12 vertebral body with enhancing soft tissue which extended into the left ventral epidural space and left T11-T12 neural foramen. Serum protein electrophoresis showed abnormal protein band in the gamma globulin. Free light chain assay showed serum free kappa which was elevated at 3,090.0 mg/L (reference range 3.3-19.4 mg/L). Immunoglobulin D was elevated at 566.0 mg/dL (reference range <15.3 mg/dL). The patient was successfully treated with standard chemotherapy and autologous peripheral blood stem cell transplant with complete remission 3 years after starting treatment. Advancement in the treatment of immunoglobulin D multiple myeloma urge clinicians to offer their patients new treatment options especially as of the earlier presentation of this subtype of multiple myeloma and the previous reports of worse prognosis.
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Affiliation(s)
- Samer Al Hadidi
- aMichigan State University, Flint, MI, USA.,bHurley Medical Center, Flint, MI, USA
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35
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Dupuis MM, Tuchman SA. Non-secretory multiple myeloma: from biology to clinical management. Onco Targets Ther 2016; 9:7583-7590. [PMID: 28008276 PMCID: PMC5171196 DOI: 10.2147/ott.s122241] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Multiple myeloma (MM) is the second most common hematologic malignancy in the US. It is typically characterized by production of large amounts of defective immunoglobulin (Ig). Diagnosing MM and monitoring treatment response, including eventual relapse, are largely based on sequential measurements of Ig. However, a small subset of MM called non-secretory multiple myeloma (NSMM) produces no detectable Ig. This subset of true NSMM has become even smaller over time, as the advent of the serum free light chain assay has resulted in the majority of NSMM patients being recategorized as light-chain MM – that is, MM cells that produce only the light-chain component of Ig. True forms of NSMM, meaning MM that secretes no monoclonal proteins whatsoever, constitute a distinct entity that is reviewed; definition of NSMM using current detection methods, discuss the biology underpinning NSMM development, and share recommendations for how NSMM should be managed clinically with respect to detection, treatment, and monitoring.
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Affiliation(s)
| | - Sascha A Tuchman
- Division of Hematology/Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Mina R, D’Agostino M, Cerrato C, Gay F, Palumbo A. Plasma cell leukemia: update on biology and therapy. Leuk Lymphoma 2016; 58:1538-1547. [DOI: 10.1080/10428194.2016.1250263] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Roberto Mina
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Mattia D’Agostino
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Chiara Cerrato
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Francesca Gay
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Antonio Palumbo
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
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37
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Grover S, Selhi PK, Sood N, Sandhu JS, Kaur H. Non-Secretory Myeloma, Diagnosed on Renal Biopsy as Cast Nephropathy. J Clin Diagn Res 2016; 10:ED04-5. [PMID: 27504298 DOI: 10.7860/jcdr/2016/19060.7925] [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: 01/24/2016] [Accepted: 03/28/2016] [Indexed: 11/24/2022]
Abstract
Multiple myeloma is a disorder of plasma cells which can involve kidneys in the form of cast nephropathy. Neoplastic plasma cells produce either complete immunoglobulins or fragments of immunoglobulins leading to a monoclonal spike in the serum and/or Bence Jones proteinuria. Very few patients present as non-secretory myeloma when no immunoglobulins (M spike) are produced or only light chains are secreted which can only be detected in urine. Acute renal failure due to cast nephropathy can rarely be the first presentation of multiple myeloma. We here in report a case in which primary diagnosis of multiple myeloma was made on renal biopsy due to its characteristic histomorphology. The diagnosis was later on supported by presence of neoplastic plasma cells in the aspirate and biopsy of bone marrow.
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Affiliation(s)
- Sumit Grover
- Assistant Professor, Department of Pathology, Dayanand Medical College and Hospital , Ludhiana, Punjab, India
| | - Pavneet Kaur Selhi
- Professor, Department of Pathology, Dayanand Medical College and Hospital , Ludhiana, Punjab, India
| | - Neena Sood
- Professor and Head, Department of Pathology, Dayanand Medical College and Hospital , Ludhiana, Punjab, India
| | - Jasvinder Singh Sandhu
- Professor and Head, Department of Nephrology, Dayanand Medical College and Hospital , Ludhiana, Punjab, India
| | - Harpreet Kaur
- Professor, Department of Pathology, Dayanand Medical College and Hospital , Ludhiana, Punjab, India
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38
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Ali A, Paul Y, Nwabudike SM, Ogbonna O, Grantham M, Taddesse-Heath L. Plasma Cell Leukemia Presenting as a Chest Wall Mass: A Case Report. Case Rep Oncol 2016; 9:338-43. [PMID: 27462235 PMCID: PMC4939667 DOI: 10.1159/000447353] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 06/02/2016] [Indexed: 11/19/2022] Open
Abstract
Plasma cell leukemia (PCL) is an uncommon neoplasm of plasma cells, with an aggressive clinical course and poor outcome, even with current standard of care. It can occur either de novo (primary PCL) or as a progression of multiple myeloma (MM). This disease has unique diagnostic criteria but certain genetic markers and clinical features may overlap with MM. Due to the low prevalence of PCL, guidelines on its management are extrapolated from the management of MM and based on small retrospective studies and cases reports/series. We present an interesting case of PCL in a middle-aged African-American male, who was diagnosed incidentally after chest wall imaging for an unrelated complaint. The diagnostic approach, management and outcomes of PCL are discussed.
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Affiliation(s)
- Ahmed Ali
- Division of Hematology and Oncology, Howard University Hospital, Washington, D.C., USA
| | - Yonette Paul
- Department of Internal Medicine, Howard University Hospital, Washington, D.C., USA
| | | | - Onyekachi Ogbonna
- Division of Hematology and Oncology, Howard University Hospital, Washington, D.C., USA
| | - Mica Grantham
- Department of Pathology, Howard University Hospital, Washington, D.C., USA
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Wang GR, Sun WJ, Chen WM, Huang ZX, Zhang JJ, An N, Shen M, Li X. Immunoglobulin D Multiple Myeloma: Disease Profile, Therapeutic Response, and Survival. Acta Haematol 2016; 136:140-6. [PMID: 27409804 DOI: 10.1159/000446599] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 04/14/2016] [Indexed: 01/02/2023]
Abstract
OBJECTIVES The long-term clinical characteristics, response to therapy, and survival in patients with immunoglobulin D (IgD) multiple myeloma (MM) were investigated. METHODS A retrospective study was conducted that included 68 patients treated in the last 10 years, 37 of whom received bortezomib only (bortezomib group), 13 of whom received bortezomib and underwent autologous hematopoietic stem cell transplantation (bortezomib + ASCT group), and 18 of whom received conditional chemotherapy (non-bortezomib group). RESULTS The ratio of males to females was 44:24, and the median age was 56.5 years. The overall response rate of each group was 91.9, 77.8, and 100%, respectively. The median overall survival (OS) and progression-free survival (PFS) were 24 and 15.5 months, respectively, among the 68 patients. The median OS of each group was 23, 21.5, and 27 months, respectively. The median PFS of each group was 18, 12, and 24 months, respectively. The 3- and 5-year OS were 64 and 45%, respectively, and the 3- and 5-year PFS were 39 and 13%, respectively, among the 68 patients. Cox regression showed that the percentage of bone marrow plasmacytosis was significantly associated with OS (p = 0.038). CONCLUSIONS The survival of IgD patients is shorter than that of other MM patients. Treatment strategies with bortezomib followed by stem cell transplantation may boost the response rate and improve survival.
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Affiliation(s)
- Guo-Rong Wang
- Department of Hematology and Oncology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Cifola I, Lionetti M, Pinatel E, Todoerti K, Mangano E, Pietrelli A, Fabris S, Mosca L, Simeon V, Petrucci MT, Morabito F, Offidani M, Di Raimondo F, Falcone A, Caravita T, Battaglia C, De Bellis G, Palumbo A, Musto P, Neri A. Whole-exome sequencing of primary plasma cell leukemia discloses heterogeneous mutational patterns. Oncotarget 2016; 6:17543-58. [PMID: 26046463 PMCID: PMC4627327 DOI: 10.18632/oncotarget.4028] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 05/11/2015] [Indexed: 02/04/2023] Open
Abstract
Primary plasma cell leukemia (pPCL) is a rare and aggressive form of plasma cell dyscrasia and may represent a valid model for high-risk multiple myeloma (MM). To provide novel information concerning the mutational profile of this disease, we performed the whole-exome sequencing of a prospective series of 12 pPCL cases included in a Phase II multicenter clinical trial and previously characterized at clinical and molecular levels. We identified 1, 928 coding somatic non-silent variants on 1, 643 genes, with a mean of 166 variants per sample, and only few variants and genes recurrent in two or more samples. An excess of C > T transitions and the presence of two main mutational signatures (related to APOBEC over-activity and aging) occurring in different translocation groups were observed. We identified 14 candidate cancer driver genes, mainly involved in cell-matrix adhesion, cell cycle, genome stability, RNA metabolism and protein folding. Furthermore, integration of mutation data with copy number alteration profiles evidenced biallelically disrupted genes with potential tumor suppressor functions. Globally, cadherin/Wnt signaling, extracellular matrix and cell cycle checkpoint resulted the most affected functional pathways. Sequencing results were finally combined with gene expression data to better elucidate the biological relevance of mutated genes. This study represents the first whole-exome sequencing screen of pPCL and evidenced a remarkable genetic heterogeneity of mutational patterns. This may provide a contribution to the comprehension of the pathogenetic mechanisms associated with this aggressive form of PC dyscrasia and potentially with high-risk MM.
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Affiliation(s)
- Ingrid Cifola
- Institute for Biomedical Technologies, National Research Council, Milan, Italy
| | - Marta Lionetti
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Hematology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Eva Pinatel
- Institute for Biomedical Technologies, National Research Council, Milan, Italy
| | - Katia Todoerti
- Laboratory of Pre-Clinical and Translational Research, IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero in Vulture (PZ), Italy
| | - Eleonora Mangano
- Institute for Biomedical Technologies, National Research Council, Milan, Italy
| | | | - Sonia Fabris
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Hematology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Laura Mosca
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Hematology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Vittorio Simeon
- Laboratory of Pre-Clinical and Translational Research, IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero in Vulture (PZ), Italy
| | - Maria Teresa Petrucci
- Hematology, Department of Cellular Biotechnologies and Hematology, La Sapienza University, Rome, Italy
| | | | - Massimo Offidani
- Hematologic Clinic, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - Francesco Di Raimondo
- Department of Biomedical Sciences, Division of Hematology, Ospedale Ferrarotto, University of Catania, Catania, Italy
| | - Antonietta Falcone
- Hematology Unit, IRCCS "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Italy
| | - Tommaso Caravita
- Department of Hematology, Ospedale S. Eugenio, Tor Vergata University, Rome, Italy
| | - Cristina Battaglia
- Institute for Biomedical Technologies, National Research Council, Milan, Italy.,Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | - Gianluca De Bellis
- Institute for Biomedical Technologies, National Research Council, Milan, Italy
| | - Antonio Palumbo
- Division of Hematology, University of Torino, A.O.U. San Giovanni Battista, Torino, Italy
| | - Pellegrino Musto
- Scientific Direction, IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero in Vulture (PZ), Italy
| | - Antonino Neri
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Hematology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Braga CG, Rodrigues AR, Alves M, Portela C, Pinto L, Marques H. Plasma cell leukaemia. Porto Biomed J 2016; 1:49-51. [PMID: 32258549 DOI: 10.1016/j.pbj.2016.04.001] [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: 02/03/2015] [Accepted: 09/08/2015] [Indexed: 10/21/2022] Open
Abstract
Plasma cell leukaemia (PCL) is a rare and aggressive disease. Diagnosis is made when there are >2000/#mL circulating plasma cells in peripheral blood or plasmacytosis >20% of total leukocyte count. We report a case of a 51-year old man with generalized bone pain and constitutional symptoms. Blood peripheral smear revealed leukocytosis with 39% plasma cells. Bone marrow biopsy showed plasma cell invasion, which confirmed the diagnosis of PCL. Additionally, the patient had markers of advanced disease. Chemotherapy with vincristine, adriamycin and dexamethasone was started. Despite an initial favourable response, the patient died 2 months later due to an infectious complication. PCL has no established treatment and has a dismal prognosis, requiring the achievement of better data to improve the disease course.
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Affiliation(s)
| | | | - Marina Alves
- Serviço de Medicina Interna, Hospital de Braga, Braga, Portugal
| | | | - Luísa Pinto
- Serviço de Medicina Interna, Hospital de Braga, Braga, Portugal
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Erturk K, Tastekin D, Gundogdu G, Tas F, Vatansever S. Is it solitary plasmacytoma or nonsecretory myeloma? A must-be-solved dilemma? Biomed Pharmacother 2016; 77:27-9. [PMID: 26796261 DOI: 10.1016/j.biopha.2015.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 11/23/2015] [Indexed: 11/17/2022] Open
Abstract
Presentation of multiple myeloma with bone lesions is common. It is vital that differentiation between nonsecretory multiple myeloma and plasmocytoma be done and that each disorder be treated accordingly. In this paper, we present a patient with nonsecretory multiple myeloma, who suffered from distal humerus fracture with severe bone destruction, renal failure, hypercalcemia and anemia.
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Affiliation(s)
- Kayhan Erturk
- Department of Medical Oncology, Institute of Oncology, Istanbul University Capa, 34093 Istanbul, Turkey.
| | - Didem Tastekin
- Department of Medical Oncology, Institute of Oncology, Istanbul University Capa, 34093 Istanbul, Turkey
| | - Gokcen Gundogdu
- Department of Pathology, Istanbul University, Capa, 34093 Istanbul, Turkey
| | - Faruk Tas
- Department of Medical Oncology, Institute of Oncology, Istanbul University Capa, 34093 Istanbul, Turkey
| | - Sezai Vatansever
- Department of Medical Oncology, Institute of Oncology, Istanbul University Capa, 34093 Istanbul, Turkey
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Jacobs RW, Saliba RM, Sasaki K, Farhan S, Armas A, Shah ND, Bashir Q, Qureshi S, Rondon G, Hosing C, Popat U, Parmar S, Shah JJ, Wang M, Weber DM, Thomas SK, Orlowski RZ, Champlin RE, Qazilbash MH. Outcome of Patients With Nonsecretory Multiple Myeloma After Autologous Hematopoietic Stem Cell Transplantation. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2016; 16:36-42. [DOI: 10.1016/j.clml.2015.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 11/05/2015] [Accepted: 11/11/2015] [Indexed: 12/29/2022]
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Iriuchishima H, Ozaki S, Konishi J, Matsumoto M, Murayama K, Nakamura F, Yamamoto G, Handa H, Saitoh T, Nagura E, Shimizu K, Nojima Y, Murakami H. Primary Plasma Cell Leukemia in the Era of Novel Agents: A Multicenter Study of the Japanese Society of Myeloma. Acta Haematol 2015; 135:113-21. [PMID: 26505781 DOI: 10.1159/000439424] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 08/16/2015] [Indexed: 11/19/2022]
Abstract
We investigated the treatment and outcome of Japanese patients with primary plasma cell leukemia (pPCL) in the era of novel agents and analyzed the risk factors affecting survival. Among 3,318 patients with symptomatic multiple myeloma (MM), 38 patients were diagnosed with pPCL. The median overall survival (OS) of the pPCL patients was 2.85 years, which was significantly extended compared with that in previous reports. The proportion of patients treated with novel agents was 61%. The OS of the patients treated with novel agents was significantly extended compared with that of patients treated without novel agents according to the generalized Wilcoxon test (2.85 vs. 1.16 years, p = 0.049). This statistical finding suggests that treatment with novel agents could have prevented early death in the patients with pPCL. Age was the only statistically significant prognostic factor associated with an inferior OS (hazard ratio 4.57). Five patients received maintenance therapy with novel agents, and their OS tended to be longer than that of the other patients without maintenance (4.45 vs. 2.85 years). Unlike MM, OS for pPCL has not been improved significantly over the last decade, especially in elderly patients. Therefore, it is important to establish the treatment strategy, particularly after induction treatment.
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Affiliation(s)
- Hirono Iriuchishima
- Department of Medicine and Clinical Science, Gunma University Graduate School of Medicine, Maebashi, Japan
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Nonsecretory Multiple Myeloma and AL Amyloidosis Presenting with Nephrotic Range Proteinuria. Case Rep Nephrol 2015; 2015:635974. [PMID: 26090243 PMCID: PMC4454745 DOI: 10.1155/2015/635974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 05/12/2015] [Accepted: 05/13/2015] [Indexed: 11/24/2022] Open
Abstract
Nonsecretory multiple myeloma (NSMM) is the absence of a detectable monoclonal protein in serum and urine of a multiple myeloma (MM) patient and immunoglobulin light chain (AL) amyloidosis is a significantly rare complication. A case of NSMM with AL amyloidosis and nephrotic range proteinuria is presented. Sharing clinical, therapeutic, and prognostic characteristics with MM, real challenge may be during initial diagnosis of NSMM and assessment of treatment response. In elderly patients with unexplained renal dysfunction, MM should be in the differential diagnosis and the absence of a monoclonal protein should not rule out MM but should remind us of the possibility of NSMM.
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47
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Modi J, Kamal J, Eter A, El-Sayegh S, El-Charabaty E. Immunoglobulin D Multiple Myeloma With Rapidly Progressing Renal Failure. J Clin Med Res 2015; 7:653-5. [PMID: 26124916 PMCID: PMC4471757 DOI: 10.14740/jocmr2210w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2015] [Indexed: 12/30/2022] Open
Abstract
Immunoglobulin D (IgD) multiple myeloma (MM) is a very rare form of myeloma affecting less than 2% of all myeloma patients. It has a multiorgan involvement with renal failure being the key feature. We present here a case of IgD MM in a 62-year-old white male, smoker with past medical history of hypertension, who presented to emergency department with complaints of lower abdominal pain, constipation and decreased urination. Physical exam was unremarkable. Laboratory investigation showed S.Cr 5.99 mg/dL, hemoglobin 8.7 g/dL and corrected S.Ca 10.6 mg/dL. Urine dipstick showed 100 protein and TP/Cr ratio was 23. Serology was positive for serum free lambda chain level of 8,947.6 mg/L as well with free κ/λ ratio < 0.01. The results of serum and urine electrophoresis and immunofixation were also supportive of diagnosis of IgD MM. IgD level was remarkably elevated (27,300 mg/L) too. CT scan of abdomen/pelvis was negative for obstructive uropathy. Skeletal survey showed a solitary lytic lesion in the iliac crest. His kidney function deteriorated next day requiring hemodialysis. The bone marrow biopsy was positive for plasma cell hypercellularity (70-80%) and flow cytometry showed 8% monoclonal IgD lambda plasma cells. The patient was started on bortezomib and dexamethasone and he underwent bone marrow transplant 6 months later. He is doing well hematologically now but he remains dialysis-dependent. IgD MM is a very rare disease affecting younger population with poor prognosis; patients often end up on hemodialysis despite better control of the hematological component.
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Affiliation(s)
- Jwalant Modi
- Department of Internal Medicine, Staten Island University Hospital, NY, USA
| | - Jeanne Kamal
- Department of Internal Medicine, Staten Island University Hospital, NY, USA
| | - Ahmad Eter
- Department of Internal Medicine, Staten Island University Hospital, NY, USA
| | - Suzanne El-Sayegh
- Department of Internal Medicine, Staten Island University Hospital, NY, USA
| | - Elie El-Charabaty
- Department of Internal Medicine, Staten Island University Hospital, NY, USA
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Plasma cell leukemia: Clinicopathologic, immunophenotypic and cytogenetic characteristics of 4 cases. Hematol Oncol Stem Cell Ther 2015; 8:71-7. [PMID: 25929729 DOI: 10.1016/j.hemonc.2015.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 03/28/2015] [Accepted: 04/04/2015] [Indexed: 12/19/2022] Open
Abstract
Plasma cell leukemia (PCL) is a rare hematologic malignancy with very poor outcome. It is defined by the presence of >2 × 10(9)/L plasma cells or >20% plasmacytosis of the differential white cell count in the peripheral blood. Primary PCL is first diagnosed in the leukemic phase, while secondary PCL corresponds to the leukemic transformation of a previously diagnosed multiple myeloma (MM). The incidence of PCL ranges between 2-4% of patients with MM and 0.9% of patients with acute leukemia. In this case series, we describe the clinicopathologic, immunophenotypic, and cytogenetic findings of four patients diagnosed with PCL within a ten-year period (2002-2012) at King Faisal Specialist Hospital and Research Centre (General Organization), Riyadh, Saudi Arabia.
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49
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Plasma cell morphology in multiple myeloma and related disorders. Morphologie 2015; 99:38-62. [PMID: 25899140 DOI: 10.1016/j.morpho.2015.02.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 02/23/2015] [Indexed: 12/28/2022]
Abstract
Normal and reactive plasma cells (PC) are easy to ascertain on human bone marrow films, due to their small mature-appearing nucleus and large cytoplasm, the latter usually deep blue after Giemsa staining. Cytoplasm is filled with long strands of rough endoplasmic reticulum and one large Golgi apparatus (paranuclear hof), demonstrating that PC are dedicated mainly to protein synthesis and excretion (immunoglobulin). Deregulation of the genome may induce clonal expansion of one PC that will lead to immunoglobulin overproduction and eventually to one among the so-called PC neoplasms. In multiple myeloma (MM), the number of PC is over 10% in most patients studied. Changes in the morphology of myeloma PC may be inconspicuous as compared to normal PC (30-50% patients). In other instances PC show one or several morphological changes. One is related to low amount of cytoplasm, defining lymphoplasmacytoid myeloma (10-15% patients). In other cases (40-50% patients), named immature myeloma cases, nuclear-cytoplasmic asynchrony is observed: presence of one nucleolus, finely dispersed chromatin and/or irregular nuclear contour contrast with a still large and blue (mature) cytoplasm. A peculiar morphological change, corresponding to the presence of very immature PC named plasmablasts, is observed in 10-15% cases. Several prognostic morphological classifications have been published, as mature myeloma is related to favorable outcome and immature myeloma, peculiarly plasmablastic myeloma, is related to dismal prognosis. However, such classifications are no longer included in current prognostic schemes. Changes related to the nucleus are very rare in monoclonal gammopathy of unknown significance (MGUS). In contrast, anomalies related to the cytoplasm of PC, including color (flaming cells), round inclusions (Mott cells, Russell bodies), Auer rod-like or crystalline inclusions, are reported in myeloma cases as well as in MGUS and at times in reactive disorders. They do not correspond to malignant changes of PC but are related to abnormal synthesis, trafficking, or excretion of the immunoglobulin that is stored in excess within the cytoplasm. Occurrence of crystalline inclusions within PC may be the first anomaly leading to the diagnosis of adult Fanconi syndrome. After a historical perspective, the authors report on the various morphological aspects of PC that may occur in multiple myeloma and related disorders, and discuss about their clinical and pathophysiological significance. Today, morphological identification and accurate determination of % PC within bone marrow remain ancillary criteria for the diagnosis of MM and help for the diagnosis of rare renal disorders.
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Jelinek T, Kryukov F, Rihova L, Hajek R. Plasma cell leukemia: from biology to treatment. Eur J Haematol 2015; 95:16-26. [DOI: 10.1111/ejh.12533] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2014] [Indexed: 12/15/2022]
Affiliation(s)
- Tomas Jelinek
- University Hospital Ostrava; Department of Haematooncology; Ostrava Czech Republic
| | - Fedor Kryukov
- University of Ostrava; Faculty of Medicine; Ostrava Czech Republic
| | - Lucie Rihova
- University Hospital Brno; Department of Clinical Haematology; Brno Czech Republic
| | - Roman Hajek
- University Hospital Ostrava; Department of Haematooncology; Ostrava Czech Republic
- University of Ostrava; Faculty of Medicine; Ostrava Czech Republic
- University Hospital Brno; Department of Clinical Haematology; Brno Czech Republic
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