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Malek E, Wang GM, Tatsuoka C, Cullen J, Madabhushi A, Driscoll JJ. Machine Learning Approach for Rapid, Accurate Point-of-Care Prediction of M-Spike Values in Multiple Myeloma. JCO Clin Cancer Inform 2023; 7:e2300078. [PMID: 37738540 DOI: 10.1200/cci.23.00078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/18/2023] [Accepted: 07/20/2023] [Indexed: 09/24/2023] Open
Abstract
PURPOSE The gold standard for monitoring response status in patients with multiple myeloma (MM) is serum and urine protein electrophoresis which quantify M-spike proteins; however, the turnaround time for results is 3-7 days which delays treatment decisions. We hypothesized that machine learning (ML) could integrate readily available clinical and laboratory data to rapidly and accurately predict patient M-spike values. METHODS A retrospective chart review was performed using the deidentified, electronic medical records of 171 patients with MM. RESULTS Random forest (RF) analysis identified the weighted value of each independent variable (N = 43) integrated into the ML algorithm. Pearson and Spearman coefficients indicated that the ML-predicted M-spike values correlated highly with laboratory-measured serum protein electrophoresis values. Feature selected RF modeling revealed that only two variables-the first lagged M-spike and serum total protein-accurately predicted the M-spike. CONCLUSION Taken together, our results demonstrate the feasibility and prognostic potential of ML tools that integrate electronic data to longitudinally monitor disease burden. ML tools support the seamless, secure exchange of patient information to expedite and personalize clinical decision making and overcome geographic, financial, and social barriers that currently limit the access of underserved populations to cancer care specialists so that the benefits of medical progress are not limited to selected groups.
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Affiliation(s)
- Ehsan Malek
- Adult Hematologic Malignancies & Stem Cell Transplant Section, Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, OH
- University Hospitals Cleveland Medical Center, Cleveland, OH
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH
| | - Gi-Ming Wang
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, School of Medicine, Cleveland, OH
| | - Curtis Tatsuoka
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, School of Medicine, Cleveland, OH
- Cancer Epidemiology and Prevention, University of Pittsburgh Medical Center, Hillman Cancer Center, Pittsburgh, PA
| | - Jennifer Cullen
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, School of Medicine, Cleveland, OH
| | - Anant Madabhushi
- Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, GA
- Atlanta Veterans Administration Medical Center, Atlanta, GA
| | - James J Driscoll
- Adult Hematologic Malignancies & Stem Cell Transplant Section, Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, OH
- University Hospitals Cleveland Medical Center, Cleveland, OH
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH
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Goldman-Mazur S, Visram A, Kapoor P, Dispenzieri A, Lacy MQ, Gertz MA, Buadi FK, Hayman SR, Dingli D, Kourelis T, Gonsalves W, Warsame R, Muchtar E, Leung N, Binder M, Fonder A, Hobbs M, Hwa YL, Kyle RA, Rajkumar SV, Kumar SK. Outcomes after biochemical or clinical progression in patients with multiple myeloma. Blood Adv 2023; 7:909-917. [PMID: 35413102 PMCID: PMC10025108 DOI: 10.1182/bloodadvances.2022007082] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/28/2022] [Accepted: 03/30/2022] [Indexed: 11/20/2022] Open
Abstract
Almost all patients with multiple myeloma (MM) eventually relapse, either asymptomatically or with end-organ damage. However, it remains unclear whether initiating therapy at the time of biochemical progression (BP) improves the outcomes compared with initiating therapy at the clinical progression (CP) stage. Here, we retrospectively assessed 1347 patients with relapsed MM. Most progressions were BP (60.4%); 39.6% had CP. The most prevalent symptoms at relapse were new or evolving bone disease (80.9%), anemia (38.0%), and renal failure (12.7%). Patients with BP had longer median time from second-line treatment to the next treatment compared with patients who had CP (17.0 vs 9.6 months; P < .001) as well as longer median overall survival from first relapse (59.4 vs 26.2 months; P < .001). Male sex (odds ratio [OR], 1.49; 95% confidence interval [CI], 1.02-2.18; P = .04), plasma cell labeling index ≥2% (OR, 1.58; 95% CI, 1.02-2.45; P = .04), and extramedullary disease at diagnosis (OR, 1.84; 95% CI, 1.08-3.13; P = .03) were associated with higher risk of CP, whereas very good partial remission or better had decreased risk of CP (OR, 0.62; 95% CI, 0.43-0.91; P = .02). To conclude, patients with CP have inferior postprogression outcomes compared with patients who have BP. Patients with deeper response to first-line therapy are less likely to develop CP. The presence of a specific CRAB (C, hypercalcemia; R, renal failure; A, anemia; B, bone disease) symptom at diagnosis predicts for the development of similar CRAB symptoms at relapse.
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Affiliation(s)
| | - Alissa Visram
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN
- Division of Hematology, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Prashant Kapoor
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN
| | | | - Martha Q. Lacy
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN
| | - Morie A. Gertz
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN
| | | | | | - David Dingli
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN
| | | | | | - Rahma Warsame
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN
| | - Eli Muchtar
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN
| | - Nelson Leung
- Division of Nephrology, Mayo Clinic Rochester, Rochester, MN
| | - Moritz Binder
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN
| | - Amie Fonder
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN
| | - Miriam Hobbs
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN
| | - Yi Lisa Hwa
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN
| | - Robert A. Kyle
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN
| | | | - Shaji K. Kumar
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN
- Correspondence: Shaji K. Kumar, Division of Hematology, Mayo Clinic Rochester, 200 First St SW, Rochester, MN 55905;
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Jung SH, Min CK, Lee JH, Mun YC, Bang SM, Yoon DH, Lee HS, Kim K, Lee JJ. Optimal timing of treatment at relapse after autologous stem cell transplantation in patients with multiple myeloma: a study of the Korean Multiple Myeloma Working Party (KMM-1909). Bone Marrow Transplant 2022; 57:1797-1802. [PMID: 36138069 DOI: 10.1038/s41409-022-01818-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 08/18/2022] [Accepted: 08/22/2022] [Indexed: 11/09/2022]
Abstract
The effectiveness of early treatment for biochemical relapse of multiple myeloma (MM) is unclear. To clarify this issue, this retrospective study was performed to evaluate the survival outcomes of 315 patients with relapsed MM after upfront autologous stem cell transplantation (ASCT). Over a median follow-up of 66.6 months (range, 15.1-195.5 months), 48.2% of patients showed biochemical relapse, 41.3% showed clinical relapse, and 10.5% showed significant biochemical relapse. Progression-free survival (PFS) and overall survival (OS) were inferior for patients with clinical relapse compared to the other patients. Multivariate analysis showed that clinical relapse was an independent prognostic factor for OS. In patients with biochemical relapse, there was no significant difference in survival between patients treated while asymptomatic and those treated once clinical symptoms had appeared. Relapse type after upfront ASCT was a significant prognostic factor in patients with MM. In addition, no survival benefit of early treatment at biochemical relapse was observed, but a triplet regimen may be beneficial for MM patients with biochemical relapse.
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Affiliation(s)
- Sung-Hoon Jung
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Republic of Korea
| | - Chang-Ki Min
- Seoul St. Mary's Hematology Hospital, Catholic University of Korea, Seoul, Republic of Korea
| | - Jae Hoon Lee
- Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Yeung-Chul Mun
- Ewha Womans University School of Medicine, Seoul, Republic of Korea
| | - Soo-Mee Bang
- Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Dok Hyun Yoon
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ho Sup Lee
- Kosin University Gospel Hospital, Busan, Republic of Korea
| | - Kihyun Kim
- Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea.
| | - Je-Jung Lee
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Republic of Korea.
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Napodano C, Pocino K, Gulli F, Rossi E, Rapaccini GL, Marino M, Basile U. Mono/polyclonal free light chains as challenging biomarkers for immunological abnormalities. Adv Clin Chem 2022; 108:155-209. [PMID: 35659060 DOI: 10.1016/bs.acc.2021.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Free light chain (FLC) kappa (k) and lambda (λ) consist of low molecular weight proteins produced in excess during immunoglobulin synthesis and secreted into the circulation. In patients with normal renal function, over 99% of FLCs are filtered and reabsorbed. Thus, the presence of FLCs in the serum is directly related to plasma cell activity and the balance between production and renal clearance. FLCs are bioactive molecules that may exist as monoclonal (m) and polyclonal (p) FLCs. These have been detected in several body fluids and may be key indicators of ongoing damage and/or illness. International guidelines now recommend mFLC for screening, diagnosis and monitoring multiple myeloma and other plasma cell dyscrasias. In current clinical practice, FLCs in urine indicate cast nephropathy and other renal injury, whereas their presence in cerebrospinal fluid is important for identifying central nervous system inflammatory diseases such as multiple sclerosis. Increased pFLCs have also been detected in various conditions characterized by B cell activation, i.e., chronic inflammation, autoimmune disease and HCV infection. Monitoring the coronavirus (COVID-19) pandemic by analysis of salivary FLCs presents a significant opportunity in clinical immunology worthy of scientific pursuit.
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Affiliation(s)
- Cecilia Napodano
- Dipartimento di Scienze Mediche e Chirurgiche, UOC Gastroenterologia Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Krizia Pocino
- Dipartimento di Scienze Mediche e Chirurgiche, UOC Gastroenterologia Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesca Gulli
- Laboratorio di Patologia Clinica, Ospedale Madre Giuseppina Vannini, Rome, Italy
| | - Elena Rossi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gian Ludovico Rapaccini
- Dipartimento di Scienze Mediche e Chirurgiche, UOC Gastroenterologia Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mariapaola Marino
- Dipartimento di Medicina e Chirurgia Traslazionale, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Umberto Basile
- Dipartimento di Scienze di laboratorio e Infettivologiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
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5
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The Current Role of the Heavy/Light Chain Assay in the Diagnosis, Prognosis and Monitoring of Multiple Myeloma: An Evidence-Based Approach. Diagnostics (Basel) 2021; 11:diagnostics11112020. [PMID: 34829367 PMCID: PMC8620453 DOI: 10.3390/diagnostics11112020] [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: 09/30/2021] [Revised: 10/27/2021] [Accepted: 10/27/2021] [Indexed: 11/17/2022] Open
Abstract
Despite tremendous progress being made in recent years, multiple myeloma (MM) remains a challenging disease. The laboratory plays a critical role in the overall management of patients. The diagnosis, prognosis, clinical monitoring and evaluation of the response are key moments in the clinical care process. Conventional laboratory methods have been and continue to be the basis of laboratory testing in monoclonal gammopathies, along with the serum free light chain test. However, more accurate methods are needed to achieve new and more stringent clinical goals. The heavy/light chain assay is a relatively new test which can overcome some of the limitations of the conventional methods for the evaluation of intact immunoglobulin MM patients. Here, we report an update of the evidence accumulated in recent years on this method regarding its use in MM.
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Early detection of treatment failure and early rescue intervention in multiple myeloma: time for new approaches. Blood Adv 2021; 5:1340-1343. [PMID: 33656540 DOI: 10.1182/bloodadvances.2020003996] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/02/2021] [Indexed: 12/20/2022] Open
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7
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Caro J, Al Hadidi S, Usmani S, Yee AJ, Raje N, Davies FE. How to Treat High-Risk Myeloma at Diagnosis and Relapse. Am Soc Clin Oncol Educ Book 2021; 41:291-309. [PMID: 34010042 DOI: 10.1200/edbk_320105] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Survival in multiple myeloma has improved greatly during the past 2 decades, but this change has primarily benefited patients who have standard-risk disease. Patients with high-risk disease remain a challenge to diagnose and treat. To improve their clinical outcomes, it is imperative to develop tools to readily identify them and to provide them with the most effective available treatments. The most widely used stratification system, the revised International Staging System, incorporates serum β-2 microglobulin, albumin, lactate dehydrogenase, and high-risk chromosomal abnormalities [del(17p), t(4;14), and t(14;16)]. Recent updates have included mutational status and chromosome 1q abnormalities. Plasma cell leukemia, extramedullary disease, circulating plasma cells, renal failure, and frailty are also associated with poor outcome. The treatment approach for a newly diagnosed patient with high-risk multiple myeloma should include induction therapy, autologous stem cell transplantation if appropriate, and maintenance therapy. Triplet therapy with a proteasome inhibitor, immunomodulatory drug, and steroid, with or without an anti-CD38 antibody, should be considered for induction, along with a proteasome inhibitor and/or immunomodulatory drug for maintenance. Aiming for a deep and sustained response is important. Similar principles apply at relapse, with close monitoring of response, especially extramedullary disease and active management of side effects, so that patients can continue therapy and benefit from treatment. Immune-based therapies, including autologous CAR T-cell-based therapies and bispecific antibodies, show promising activity in relapsed disease and are being actively explored in earlier disease settings. As the prognosis for high-risk disease remains poor, the future goal for this patient group is to develop specific clinical trials to explore novel approaches and therapies efficiently.
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Affiliation(s)
- Jessica Caro
- Perlmutter Cancer Center, NYU Langone Health, New York, NY
| | - Samer Al Hadidi
- Department of Hematology and Oncology, Baylor College of Medicine, Houston, TX
| | - Saad Usmani
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute/Atrium Health, Charlotte, NC
| | - Andrew J Yee
- Center for Multiple Myeloma, Massachusetts General Hospital, Boston, MA
| | - Noopur Raje
- Center for Multiple Myeloma, Massachusetts General Hospital, Boston, MA
| | - Faith E Davies
- Perlmutter Cancer Center, NYU Langone Health, New York, NY
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8
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Hanafi HHW, Husin A, Yaacob NM, Abdullah AD. Relapsed/Progressive Disease and Its Prognostic Factors among Multiple Myeloma Patients Receiving Novel Agent Treatment in North East Peninsular Malaysia: A Single Centre Experience. Malays J Med Sci 2020; 27:62-77. [PMID: 33154703 PMCID: PMC7605841 DOI: 10.21315/mjms2020.27.5.7] [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: 03/11/2020] [Accepted: 08/10/2020] [Indexed: 11/25/2022] Open
Abstract
Background Some multiple myeloma (MM) patients still relapse/progress despite novel agent therapy and relapse/progression in MM is therefore a vital area of ongoing research in the novel treatment era. This retrospective cohort study aimed to evaluate the time to relapse/progression (TTP) among MM patients who received novel agents and to determine the associated prognostic factors. Methods This study included 89 MM patients treated at Hospital Universiti Sains Malaysia. We analysed the TTP and the type of relapse/progression (biochemical versus clinical), and a Cox proportional hazard model was used to identify the significant prognostic factors. Results Sixty-four percent of patients had biochemical relapse/progression. The overall median TTP among MM patients who received the novel agent(s) was 29.33 months (95% CI: 21.36–37.29). The type of paraprotein at diagnosis (P = 0.026, P = 0.228), International Staging System (ISS) score (P = 0.036, P = 0.067) and autologous stem cell transplant (ASCT) (P = 0.002) were prognostic factors for relapse/progression by simple Cox regression, but ASCT was the only significant predictor detected by multiple Cox regression (P = 0.003). Conclusion Our study reflects the importance of paraprotein monitoring to detect early features of relapse/progression. ASCT is the most prognostic factor that may lengthen the TTP.
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Affiliation(s)
- Hany Haqimi Wan Hanafi
- Haematopoietic Stem Cell Transplant Unit, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.,Department of Internal Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Azlan Husin
- Haematopoietic Stem Cell Transplant Unit, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.,Department of Internal Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Najib Majdi Yaacob
- Unit of Biostatistics and Research Methodology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Abu Dzarr Abdullah
- Haematopoietic Stem Cell Transplant Unit, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.,Department of Internal Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
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9
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Latifoltojar A, Boyd K, Riddell A, Kaiser M, Messiou C. Characterising spatial heterogeneity of multiple myeloma in high resolution by whole body magnetic resonance imaging: Towards macro-phenotype driven patient management. Magn Reson Imaging 2020; 75:60-64. [PMID: 33075451 DOI: 10.1016/j.mri.2020.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/24/2020] [Accepted: 10/14/2020] [Indexed: 11/17/2022]
Abstract
Diagnosis of patients suspected of multiple myeloma requires a combination of serological and biochemical tests, bone marrow aspirate (BMA) and/or bone marrow trephine (BMT) biopsies as well as complementary information provided by whole-body cross-sectional imaging studies. However, given the heterogeneous nature of multiple myeloma, discrepancies can arise between disease burden on trephine and extent of disease within the marrow on whole-body magnetic resonance imaging (WB-MRI). Here, for the first time, we report on a series of symptomatic multiple myeloma patients for whom there was substantial discordance between disease burden on trephine and WB-MRI.
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Affiliation(s)
- Arash Latifoltojar
- The Royal Marsden Hospital, Downs road, Sutton, Surrey SM2 5PT, United Kingdom
| | - Kevin Boyd
- The Royal Marsden Hospital, Downs road, Sutton, Surrey SM2 5PT, United Kingdom
| | - Angela Riddell
- The Royal Marsden Hospital, Downs road, Sutton, Surrey SM2 5PT, United Kingdom
| | - Martin Kaiser
- The Royal Marsden Hospital, Downs road, Sutton, Surrey SM2 5PT, United Kingdom; The Institute of Cancer Research, 15 Cotswold road, Sutton, Surrey SM2 5NG, United Kingdom
| | - Christina Messiou
- The Royal Marsden Hospital, Downs road, Sutton, Surrey SM2 5PT, United Kingdom; The Institute of Cancer Research, 15 Cotswold road, Sutton, Surrey SM2 5NG, United Kingdom.
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10
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Offidani M, Boccadoro M, Di Raimondo F, Petrucci MT, Tosi P, Cavo M. Expert Panel Consensus Statement for Proper Evaluation of First Relapse in Multiple Myeloma. Curr Hematol Malig Rep 2020; 14:187-196. [PMID: 31077067 DOI: 10.1007/s11899-019-00507-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE OF REVIEW A working group of six expert physicians convened to assess the spectrum of multiple myeloma relapse presentations, discussed the features that can define the disease as aggressive and not aggressive, and established whether this information could help in selecting treatment together with the characteristics of disease and of patients and type of prior therapy. RECENT FINDINGS The working group agreed that relapse should be distinguished between biochemical and clinical according to IMWG. Moreover, the expert panel defined "aggressive disease" as a clinical condition that requires therapy able to induce a rapid and as deep as possible response to release symptoms and to avoid impending danger of new events. According to this definition, relapse was considered aggressive if it presents with at least one of the following features: doubling of M protein rate over 2 months, renal insufficiency, hypercalcemia, extramedullary disease, elevated LDH, high plasma cell proliferative index, presence of plasma cells in peripheral blood, or skeletal-related complications. Moreover, the panel agreed that this classification can be useful to choose therapy in first relapse together with other patient, disease, and prior therapy characteristics. So, this item was included in a new therapeutic algorithm. The treatment choice in MM at relapse is wider than in the past with the availability of many new therapeutic regimens leading to increased diversity of approaches and relevant risk of inappropriate treatment decisions. A practical classification of relapses into aggressive or non-aggressive, included in a decisional algorithm on MM management at first relapse, could help to make the appropriate treatment decisions.
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Affiliation(s)
- M Offidani
- Clinica di Ematologia, A.O.U. Ospedali Riuniti di Ancona, via Conca, 71, 60126, Ancona, Italy.
| | - M Boccadoro
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - F Di Raimondo
- Division of Hematology, AOU Policlinico-OVE, University of Catania, Catania, Italy
| | - M T Petrucci
- Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Rome, Italy
| | - P Tosi
- Hematology Unit, Infermi Hospital Rimini, Rimini, Italy
| | - M Cavo
- Institute of Hematology Seragnoli, DIMES, University of Bologna, Bologna, Italy
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11
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Early Relapse After Autologous Transplant Is Associated With Very Poor Survival and Identifies an Ultra-High-Risk Group of Patients With Myeloma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 20:445-452. [DOI: 10.1016/j.clml.2019.10.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/20/2019] [Accepted: 10/15/2019] [Indexed: 01/01/2023]
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12
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Bennett KM, Storrar N, Johnson P, Fernandes PM. Progressive multifocal leukoencephalopathy (PML) following autologous peripheral blood stem cell transplantation for multiple myeloma. Clin Case Rep 2020; 8:938-943. [PMID: 32577238 PMCID: PMC7303860 DOI: 10.1002/ccr3.2612] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/19/2019] [Accepted: 10/29/2019] [Indexed: 11/11/2022] Open
Abstract
PML should be considered in patients with neurological symptoms following MM and in those who are immunosuppressed. Symptoms are diverse and often rapidly progressing. Prompt referral and early involvement of the multidisciplinary team are crucial.
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Affiliation(s)
- Karina M. Bennett
- Department of NeurologyNHS LothianWestern General HospitalEdinburghUK
| | - Neill Storrar
- Department of HaematologyNHS LothianWestern General HospitalEdinburghUK
| | - Peter Johnson
- Department of HaematologyNHS LothianWestern General HospitalEdinburghUK
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13
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Markovic U, Leotta V, Tibullo D, Giubbolini R, Romano A, Del Fabro V, Parrinello NL, Cannizzaro MT, Di Raimondo F, Conticello C. Serum free light chains and multiple myeloma: Is it time to extend their application? Clin Case Rep 2020; 8:617-624. [PMID: 32274022 PMCID: PMC7141730 DOI: 10.1002/ccr3.2636] [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: 09/30/2019] [Revised: 11/14/2019] [Accepted: 12/01/2019] [Indexed: 02/06/2023] Open
Abstract
In nonsecretory, oligo-secretory, and light chain multiple myeloma patients, serial sFLC evaluation could precede biochemical and clinical disease progression, even in extramedullary relapse, thus initiating early treatment with novel anti-MM agents.
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Affiliation(s)
- Uros Markovic
- UOC di Ematologia con Trapianto di Midollo OsseoAOU "Policlinico‐Vittorio Emanuele”CataniaItaly
| | - Valerio Leotta
- UOC di Ematologia con Trapianto di Midollo OsseoAOU "Policlinico‐Vittorio Emanuele”CataniaItaly
| | - Daniele Tibullo
- Department of Biomedical and Biotechnological SciencesUniversity of CataniaCataniaItaly
| | - Rachele Giubbolini
- UOC di Ematologia con Trapianto di Midollo OsseoAOU "Policlinico‐Vittorio Emanuele”CataniaItaly
- Division of Hematology Largo del PozzoAOU PoliclinicoModenaItaly
| | - Alessandra Romano
- UOC di Ematologia con Trapianto di Midollo OsseoAOU "Policlinico‐Vittorio Emanuele”CataniaItaly
| | - Vittorio Del Fabro
- UOC di Ematologia con Trapianto di Midollo OsseoAOU "Policlinico‐Vittorio Emanuele”CataniaItaly
| | | | | | - Francesco Di Raimondo
- UOC di Ematologia con Trapianto di Midollo OsseoAOU "Policlinico‐Vittorio Emanuele”CataniaItaly
| | - Concetta Conticello
- UOC di Ematologia con Trapianto di Midollo OsseoAOU "Policlinico‐Vittorio Emanuele”CataniaItaly
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14
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Hassoun H, Bayer R, Devlin S, Gentile T, Becker M, O'Dweyer K, Lesser M, Landau H, Chung D, Giralt S. A phase II clinical trial of lenalidomide intensification in patients with serologic/asymptomatic progression of multiple myeloma while on lenalidomide maintenance: a tri-state transplant consortium study. Leuk Lymphoma 2020; 61:488-490. [PMID: 31957517 DOI: 10.1080/10428194.2019.1672058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Hani Hassoun
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ruthee Bayer
- Northwell Health Cancer Institute, Long Island Jewish Medical Center, North Shore University Hospital, the Monter Cancer Center, Lake Success, NY, USA
| | - Sean Devlin
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Theresa Gentile
- Upstate University Hospital, Professor of Medicine, Syracuse, NY, USA
| | - Michael Becker
- Adult Bone Marrow Transplant Service, Division of Hematologic Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kristen O'Dweyer
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - Martin Lesser
- University of Rochester Medical Center, Wilmot Cancer Institute, Rochester, NY, USA
| | - Heather Landau
- Biostatistics Unit, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - David Chung
- Adult BMT Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, USA
| | - Sergio Giralt
- Adult BMT Service, Melvin Berlin Family Chair in Myeloma Research, Weill Cornell Medical College, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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15
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Tate JR. The Paraprotein - an Enduring Biomarker. Clin Biochem Rev 2019; 40:5-22. [PMID: 30828116 PMCID: PMC6370287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The 'paraprotein', also known as M-protein, monoclonal protein and monoclonal component, has stood the test of time as the key biomarker in monoclonal gammopathies. It continues to reinvent itself as new electrophoretic and immunoassay methods are developed that are analytically more sensitive. Use of the serum free light chain immunoassay in particular has led to new clinical discoveries and improvements in the diagnosis and monitoring of patients with plasma cell dyscrasia and other monoclonal gammopathies. In addition, minimal residual disease can be detected using mass spectrometry and flow cytometry methods.
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Affiliation(s)
- Jillian R Tate
- Chemical Pathology, Pathology Queensland, Royal Brisbane and Women's Hospital, Herston, Qld 4029, Australia
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16
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Katodritou E, Kyrtsonis MC, Delimpasi S, Kyriakou D, Symeonidis A, Spanoudakis E, Vasilopoulos G, Anagnostopoulos A, Kioumi A, Zikos P, Aktypi A, Briasoulis E, Megalakaki A, Repousis P, Adamopoulos I, Gogos D, Kotsopoulou M, Pappa V, Papadaki E, Fotiou D, Nikolaou E, Giannopoulou E, Hatzimichael E, Giannakoulas N, Douka V, Kokoviadou K, Timotheatou D, Terpos E. Real-world data on Len/Dex combination at second-line therapy of multiple myeloma: treatment at biochemical relapse is a significant prognostic factor for progression-free survival. Ann Hematol 2018; 97:1671-1682. [PMID: 29756171 PMCID: PMC6097756 DOI: 10.1007/s00277-018-3361-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 05/02/2018] [Indexed: 11/26/2022]
Abstract
We evaluated progression-free survival (PFS) rate of patients treated with lenalidomide/dexamethasone (Len/Dex), the efficacy of the combination, and the prognostic significance of treatment at biochemical vs. clinical relapse on PFS in 207 consecutive myeloma patients treated with Len/Dex in second line, according to routine clinical practice in Greece. First-line treatment included bortezomib-based (63.3%) or immunomodulatory drug-based (34.8%) therapies; 25% of patients underwent autologous stem cell transplantation. Overall response rate was 73.4% (17.8% complete response and 23.7% very good partial response); median time to best response was 6.7 months. Overall, median PFS and 12-month PFS rate was 19.2 months and 67.6%, respectively. 67.5% of patients had biochemical relapse and 32.5% had clinical relapse prior to initiation of Len/Dex. Median PFS was 24 months for patients treated at biochemical relapse vs. 13.2 months for those treated at clinical relapse (HR:0.63, p = 0.006) and the difference remained significant after adjustment for other prognostic factors. Type of relapse was the strongest prognostic factor for PFS in multivariate analysis. These real-world data confirm the efficacy of Len/Dex combination at first relapse; more importantly, it is demonstrated for the first time outside a clinical trial setting that starting therapy with Len/Dex at biochemical, rather than at clinical relapse, is a significant prognostic factor for PFS, inducing a 37% reduction of the probability of disease progression or death.
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Affiliation(s)
- Eirini Katodritou
- Department of Hematology, Theagenion Cancer Hospital, Thessaloniki, Greece.
| | - Marie-Christine Kyrtsonis
- First Department of Propaedeutic Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Sosana Delimpasi
- Department of Hematology and Bone Marrow Transplantation Unit, Evangelismos Hospital, Athens, Greece
| | - Despoina Kyriakou
- Department of Transfusion Medicine, School of Medicine, University of Thessaly, Larissa, Greece
| | - Argiris Symeonidis
- Department of Internal Medicine, Division of Hematology, University of Patras Medical School, Patras, Greece
| | - Emmanouil Spanoudakis
- Department of Hematology, Dimokrition University of Alexandroupolis, Alexandroupolis, Greece
| | - Georgios Vasilopoulos
- Department of Hematology, School of Medicine, University of Thessaly, Larissa, Greece
| | - Achilles Anagnostopoulos
- Department of Hematology and Bone Marrow Transplantation Unit, George Papanicolaou Hospital, Thessaloniki, Greece
| | - Anna Kioumi
- Department of Hematology, Papageorgiou General Hospital, Thessaloniki, Greece
| | | | | | - Evangelos Briasoulis
- Department of Hematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | | | | | | | | | | | | | | | | | - Eftychia Nikolaou
- First Department of Propaedeutic Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Eleftheria Hatzimichael
- Department of Hematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Nikolaos Giannakoulas
- Department of Hematology, School of Medicine, University of Thessaly, Larissa, Greece
| | - Vassiliki Douka
- Department of Hematology and Bone Marrow Transplantation Unit, George Papanicolaou Hospital, Thessaloniki, Greece
| | - Kyriaki Kokoviadou
- Department of Hematology, Papageorgiou General Hospital, Thessaloniki, Greece
| | | | - Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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17
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Chim CS, Kumar SK, Orlowski RZ, Cook G, Richardson PG, Gertz MA, Giralt S, Mateos MV, Leleu X, Anderson KC. Management of relapsed and refractory multiple myeloma: novel agents, antibodies, immunotherapies and beyond. Leukemia 2018; 32:252-262. [PMID: 29257139 PMCID: PMC5808071 DOI: 10.1038/leu.2017.329] [Citation(s) in RCA: 213] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 10/09/2017] [Accepted: 11/06/2017] [Indexed: 02/06/2023]
Abstract
Despite enormous advances, management of multiple myeloma (MM) remains challenging. Multiple factors impact the decision to treat or which regimen to use at MM relapse/progression. Recent major randomized controlled trials (RCTs) showed widely varying progression-free survivals (PFS), ranging from a median of 4 months (MM-003) to 23.6 months (ASPIRE). Based on these RCTs, next-generation proteasome inhibitors (carfilzomib and ixazomib), next-generation immunomodulatory agent (pomalidomide), and monoclonal antibodies (elotuzumab and daratumumab) were approved for relapsed and refractory MM. Daratumumab, targeting CD38, has multiple mechanisms of action including modulation of the immunosuppressive bone marrow micro-environment. In addition to the remarkable single agent activity in refractory MM, daratumumab produced deep responses and superior PFS in MM when combined with lenalidomide/dexamethasone, or bortezomib/dexamethasone. Other anti-CD38 antibodies, such as isatuximab and MOR202, are undergoing assessment. Elotuzumab, targeting SLAMF7, yielded superior response rates and PFS when combined with lenalidomide/dexamethasone. New combinations of these next generation novel agents and/or antibodies are undergoing clinical trials. Venetoclax, an oral BH3 mimetic inhibiting BCL2, showed single agent activity in MM with t(11;14), and is being studied in combination with bortezomib/dexamethasone. Selinexor, an Exportin-1 inhibitor, yielded promising results in quad- or penta-refractory MM including patients resistant to daratumumab. Pembrolizumab, an anti-PD1 check-point inhibitor, is being tested in combination with lenalidomide/dexamethasone or pomalidomide/dexamethasone. Chimeric antigen receptor-T cells targeting B-cell maturation antigen have yielded deep responses in RRMM. Finally, salvage autologous stem cell transplantation (ASCT) remains an important treatment in MM relapsing/progressing after a first ASCT. Herein, the clinical trial data of these agents are summarized, cautious interpretation of RCTs highlighted, and algorithm for salvage treatment of relapse/refractory MM proposed.
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Affiliation(s)
- C S Chim
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Hong Kong
| | - S K Kumar
- Department of Medicine, Mayo Clinic at Rochester, Rochester, MN, USA
| | - R Z Orlowski
- Department of Lymphoma/Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - G Cook
- Haematology & Myeloma Studies, Section of Experimental Haematology, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - P G Richardson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - M A Gertz
- Department of Medicine, Mayo Clinic at Rochester, Rochester, MN, USA
| | - S Giralt
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - M V Mateos
- Department of Haematology, University Hospital of Salamanca, Salamanca, Spain
| | - X Leleu
- Hopital La Mileterie, part of the Academic Hospital of Poitiers (CHU), France
| | - K C Anderson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
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18
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Muta T, Miyamoto T, Kamimura T, Kanda Y, Nohgawa M, Ueda Y, Iwato K, Sasaki O, Mori T, Uchida N, Iida S, Fukuda T, Atsuta Y, Sunami K. Significance of Salvage Autologous Stem Cell Transplantation for Relapsed Multiple Myeloma: A Nationwide Retrospective Study in Japan. Acta Haematol 2018; 139:35-44. [PMID: 29339642 DOI: 10.1159/000484652] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 10/24/2017] [Indexed: 12/20/2022]
Abstract
Autologous stem cell transplantation (ASCT) has been employed for patients with relapsed multiple myeloma (MM) after up-front ASCT. The present retrospective study aimed to examine the survival benefit from salvage ASCT. Among 446 patients with relapsed MM after up-front single ASCT, 70 patients received salvage ASCT, the employment of which reduced the risk of mortality after relapse (p = 0.041). Using the parameters before initial ASCT, the advantage of salvage ASCT compared to standard therapy was confirmed in the subgroup with an international staging system stage of I or II (p = 0.040), good performance status (PS; p = 0.043), or no/mild renal comorbidity (p = 0.029). The advantage of salvage ASCT was also confirmed in the subgroup excluding those with early relapse within 7 months after initial ASCT (p = 0.026). Among patients who received salvage ASCT, a favorable prognosis is apparent for those with a time to relapse after initial ASCT of longer than 24 months. The overall survival after salvage ASCT was favorable excluding patients with the following factors: early relapse, poor PS, moderate/severe renal comorbidity, and progressive disease (p < 0.001). In conclusion, our results reinforced the evidence for encouraging salvage ASCT for eligible patients.
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Affiliation(s)
- Tsuyoshi Muta
- Department of Hematology/Oncology, Japan Community Health Care Organization (JCHO), Kyushu Hospital, Kita-Kyushu, Japan
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19
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Greil C, Ihorst G, Gaiser F, Salzer U, Bisse E, Kastritis E, Ludwig H, Wäsch R, Engelhardt M. The serum heavy/light chain immunoassay: A valuable tool for sensitive paraprotein assessment, risk, and disease monitoring in monoclonal gammopathies. Eur J Haematol 2017; 99:449-458. [PMID: 28886228 DOI: 10.1111/ejh.12958] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The heavy/light chain (HLC)-immunoassay quantifies light chain types of each immunoglobulin class in patients with monoclonal gammopathies. METHODS We assessed 147 consecutive patients with different forms and stages of plasma cell dyscrasias (PCD) who received standard tests (serum and urine protein electrophoresis [SPEP, UPEP], immunofixation [IFE], serum-free light chain [SFLC]), and HLC-immunoassay. Patients with multiple myeloma (MM, n = 102), smoldering MM (SMM, n = 5), monoclonal gammopathy of undetermined significance (MGUS, n = 28), and Waldenström's macroglobulinemia (WM, n = 12) were included. RESULTS We verified a significant correlation between HLC- and standard monoclonal protein (mp)-parameters, and HLC-increases with higher disease stage and unfavorable remission status. In patients with difficult to quantify mp, more abnormal HLC- than SPEP-, immunoglobulin-, or SFLC-results were found. In WM, a pathological HLC κ/λ-ratio and M-component were observed in 95% and 58%, respectively. In 21/28 MGUS and 5/5 SMM patients, HLC κ/λ-ratios were abnormal. Testing different HLC cutoffs, patients with extreme HLC values showed impaired progression-free survival (PFS). CONCLUSIONS Despite the fact that different PCD patients were included, the assessment of the HLC-immunoassay in MGUS, SMM, MM, and WM, our comparison with standard mp-assays, and relevant PFS differences may excite future applications, which should be confirmed in prospective multicenter trials.
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Affiliation(s)
- Christine Greil
- Department of Medicine I, Hematology, Oncology & Stem Cell Transplantation, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Gabriele Ihorst
- Faculty of Medicine, Clinical Trials Unit, University of Freiburg, Freiburg, Germany
| | - Felix Gaiser
- Department of Medicine I, Hematology, Oncology & Stem Cell Transplantation, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Ulrich Salzer
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Emanuel Bisse
- Central Laboratory, Medical Center, University of Freiburg, Freiburg, Germany
| | | | - Heinz Ludwig
- Zentrum für Onkologie, Wihelminenkrebsforschungsinstitut, Beethovengasse, Österreich
| | - Ralph Wäsch
- Department of Medicine I, Hematology, Oncology & Stem Cell Transplantation, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Monika Engelhardt
- Department of Medicine I, Hematology, Oncology & Stem Cell Transplantation, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany
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20
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Jenner EL, Evans JAR, Harding SJ. Serum Free Light Chain (FLC) Analysis: A Guiding Light in Monoclonal Gammopathy Management. J Appl Lab Med 2017; 2:98-106. [PMID: 33636952 DOI: 10.1373/jalm.2016.021352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 03/31/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND Monoclonal free light chains (FLCs) were first reported by Dr. Henry Bence Jones over 150 years ago in the urine of patients with multiple myeloma. Now established as important tumor markers, they aid not only in the diagnosis of monoclonal gammopathies but also in their clinical management by indicating the response to treatment and persistence of residual disease. CONTENT A particular focus over the past 15 years has been on the replacement of urine with serum analysis for monoclonal FLC measurement. Because of the limited sensitivity and practical constraints of urine assessment, a combination of serum electrophoresis and serum FLC analysis has been adopted by many laboratories as a first-line screen for patients with a suspected monoclonal gammopathy. Early myeloma diagnosis may translate into improved clinical outcomes, and a new study, iStopMM, is underway to ascertain the benefit of population-wide screening protocols for early detection of the disease in its asymptomatic phase. Laboratory algorithms that include measurement of both monoclonal intact immunoglobulins and FLCs are important for assessing possible changes in myelomic clones in response to treatment, and recent data from Intergroupe Francophone du Myelome trials validate serum FLC as a clinically relevant disease biomarker. Whether sensitive serum techniques such as FLC analysis can be used to guide the use of more invasive procedures for detection of minimal residual disease is the subject of emerging studies. SUMMARY Here we review the current and evolving utility of serum FLC measurements for the management of patients with monoclonal gammopathies.
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21
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Analytical Criticalities Associated to Different Immunological Methods for Serum Free Light Chain Detection in Plasma Cell Dyscrasias: A Description of Particular Clinical Cases. Int J Mol Sci 2017; 18:ijms18040804. [PMID: 28417905 PMCID: PMC5412388 DOI: 10.3390/ijms18040804] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 04/03/2017] [Accepted: 04/05/2017] [Indexed: 11/17/2022] Open
Abstract
Current criteria for differential diagnosis of multiple myeloma (MM), Monoclonal gammopathy of undetermined significance (MGUS), and smoldering multiple myeloma (SMM) are included in the 2003 guidelines by the International Myeloma Working Group (IMWG). An updated version was then published in 2014, highlighting the importance of serum free light chain (sFLC) detection, as well as the κ/λ ratio as excellent indicators of clonality. At present, two commercial assays for sFLC quantification are available: the Freelite™ assay and the N-Latex assay. The first was developed by The Binding Site based on a mixture of polyclonal antibodies directed against a variety of FLC epitopes. It may be run on a wide range of nephelometers, as well as on turbidimeters. The second method was developed by Siemens and runs exclusively on Siemens instruments. It employs a probe mixture of mouse monoclonal antibodies. The aim of our study was to evaluate sFLC measurement and calculated κ/λ ratio in 85 patients with monoclonal gammopathies (MGs) in order to compare methods. We demonstrated that there is only a moderate concordance between the two FLC assays. In particular, in one case, we observed no qualitative alterations of the serum protein pattern, and in the absence of a Freelite™ assay, sFLC measurement would not have been possible to highlight the increase of λ FLC.
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22
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Özkurt ZN, Sucak GT, Akı ŞZ, Yağcı M, Haznedar R. Early Prognostic Value of Monitoring Serum Free Light Chain in Patients with Multiple Myeloma Undergoing Autologous Stem Cell Transplantation. Cancer Invest 2017; 35:195-201. [PMID: 28112977 DOI: 10.1080/07357907.2016.1270958] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We hypothesized the levels of free light chains obtained before and after autologous stem cell transplantation can be useful in predicting transplantation outcome. We analyzed 70 multiple myeloma patients. Abnormal free light chain ratios before stem cell transplantation were found to be associated early progression, although without any impact on overall survival. At day +30, the normalization of levels of involved free light chain related with early progression. According to these results almost one-third reduction of free light chain levels can predict favorable prognosis after autologous stem cell transplantation.
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Affiliation(s)
- Zübeyde Nur Özkurt
- a Department of Hematology , Gazi University School of Medicine , Ankara , Turkey
| | - Gülsan Türköz Sucak
- a Department of Hematology , Gazi University School of Medicine , Ankara , Turkey
| | - Şahika Zeynep Akı
- a Department of Hematology , Gazi University School of Medicine , Ankara , Turkey
| | - Münci Yağcı
- a Department of Hematology , Gazi University School of Medicine , Ankara , Turkey
| | - Rauf Haznedar
- a Department of Hematology , Gazi University School of Medicine , Ankara , Turkey
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Gonsalves WI, Rajkumar SV, Gertz MA, Dispenzieri A, Lacy MQ, Buadi FK, Dingli D, Go RS, Leung N, Kapoor P, Hayman SR, Lust JA, Russell SJ, Zeldenrust SR, Hwa YL, Kourelis TV, Kyle RA, Kumar SK. Clinical course and outcomes of patients with multiple myeloma who relapse after autologous stem cell therapy. Bone Marrow Transplant 2016; 51:1156-8. [DOI: 10.1038/bmt.2016.91] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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24
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Paolini L. Quantification of β region IgA paraproteins – should we include immunochemical “heavy/light chain” measurements? Counterpoint. ACTA ACUST UNITED AC 2016; 54:1059-64. [DOI: 10.1515/cclm-2015-0692] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 12/13/2015] [Indexed: 11/15/2022]
Abstract
AbstractSerum protein electrophoresis (SPE), serum immunofixation (s-IFE), free light chain measurement (FLC) and nephelometric measurements of total immunoglobulin in serum (IgTot) are some of the laboratory tests required for the management of plasma cell proliferative disorders. The monoclonal protein is usually visible on SPE as a spike (M-spike) in the γ region and the derived densitogram is used to quantify it relative to serum total protein concentration. IgA M-protein, however, often migrates in the β region on SPE and its quantification can be masked by other serum proteins that migrate in this region. The immunoassay Hevylite™ (heavy/light chain, HLC) seems to solve this problem: it quantifies the involved/uninvolved isotype, calculating the ratio IgAκ/IgAλ, considered indicative of clonal proliferation. However, this test seems redundant in the case of artifacts on SPE such as obvious hemolysis or lipemia, or if the IgA M-spike is clearly visible in the β region. In conclusion whereas the IgA HLC assay does not represent an alternative to SPE and s-IFE in the diagnostic patient workup, it may prove to be an alternative to SPE, s-IFE and total IgA quantification in risk stratification and evaluation of response to therapy in patients affected by MM and other monoclonal plasma proliferative disorders.
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25
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Protein electrophoresis and serum free light chains in the diagnosis and monitoring of plasma cell disorders: laboratory testing and current controversies. ACTA ACUST UNITED AC 2016; 54:899-905. [DOI: 10.1515/cclm-2016-0268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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26
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Caldini A, Nozzoli C, Terreni A, Staderini M, Berardi M, Biagioli T, Brogi M, Bosi A. New patterns of relapse in multiple myeloma: a case of “light chain escape” in which FLC predicted relapse earlier than urine and serum immunofixation. ACTA ACUST UNITED AC 2016; 54:991-5. [DOI: 10.1515/cclm-2015-0689] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 10/15/2015] [Indexed: 11/15/2022]
Abstract
AbstractMultiple myeloma (MM) is characterized, in about 80% of cases, by the production of monoclonal intact immunoglobulin and more than 95% of them have elevated concentrations of involved (i.e. of the same class of intact immunoglobulin) free light chain (FLC). The introduction of novel therapeutic strategies has changed the natural history of the disease, leading to new manifestations of relapse. Light chain escape (LCE) is a pattern of relapse in which the FLC increase is not accompanied by a concomitant raise of the original monoclonal component (MC). Here we present a case of a 55-year-old man with an IgG kappa MM stage III diagnosed in September 2007. At presentation an IgG kappa MC and urine Bence Jones protein (BJP) kappa were present. Bone marrow biopsy (BMB) showed the presence of 80% monotypic kappa plasma cells (PCs). The patient received bortezomib, thalidomide, dexamethasone before undergoing a double autologous stem cell transplantation (ASCT) in October 2008 and April 2009. In May 2011 he relapsed showing the same pattern of presentation and treatment with lenalidomide and dexamethasone was started. ln May 2013 serum and urine immunofixation and FLC became negative. In September 2014, an increase of kappa FLC was observed, while serum and urine immunofixations remained negative until January 2015, when urine immunofixation became positive. Eventually, in February 2015, serum immunofixation revealed the presence of a free kappa MC. After a new BMB showing 80% of monotypic kappa PCs, a LCE relapse was diagnosed and the patient started the treatment with bendamustine, bortezomib and dexamethasone. In the present case, the increase of kappa FLC has indicated relapse 4 and 5 months earlier than urine and serum IFE, respectively. Our observation confirms that it is advisable to routinely perform FLC or BJP during follow up of MM patients undergoing ASCT and/or treatment with biological drugs to ensure that LCE is not missed.
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27
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Lopez A, Mateos MV, Oriol A, Valero M, Martínez J, Lorenzo JI, Perez M, Martinez R, de Paz R, Granell M, De Arriba F, Blanchard MJ, Peñalver FJ, Bello JL, Martin ML, Bargay J, Blade J, Lahuerta JJ, San Miguel JF, de la Rubia J. Patterns of relapse and outcome of elderly multiple myeloma patients treated as front-line therapy with novel agents combinations. Leuk Res Rep 2015; 4:64-9. [PMID: 26500850 PMCID: PMC4588395 DOI: 10.1016/j.lrr.2015.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 08/06/2015] [Accepted: 09/11/2015] [Indexed: 11/12/2022] Open
Abstract
We report the characteristics of relapse, treatment response, and outcomes of 145 elderly patients with multiple myeloma in first relapse after front-line treatment with VMP or VTP. Reappearance of CRAB symptoms (113 patients) and more aggressive forms of disease (32 patients) were the most common patterns of relapse. After second-line therapy, 75 (51.7%) patients achieved at partial response and 16 (11%) complete response (CR). Overall survival was longer among patients receiving VMP as front-line induction (21.4 vs. 14.4 months, P=0.037), in patients achieving CR (28.3 vs. 14.8 months; P=0.04), and in patients without aggressive relapse (28.6 vs. 7.6 months; P=0.0007).
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Affiliation(s)
- Aurelio Lopez
- Hematology, Hospital Arnau de Vilanova, Valencia, Spain
| | | | - Albert Oriol
- Hematology, Hospital Germans Trias i Pujol, Barcelona, Spain
| | - Marta Valero
- Hematology, Hospital Arnau de Vilanova, Valencia, Spain
| | | | | | | | - Rafael Martinez
- Hematology, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - Raquel de Paz
- Hematology, Hospital Universitario La Paz, Madrid, Spain
| | - Miguel Granell
- Hematology, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | | | - Jose Luis Bello
- Hematology, Complejo Universitario, Santiago de Compostela, Spain
| | | | - Joan Bargay
- Hematology, Hospital Sont Llatzer, Palma de Mallorca, Spain
| | - Joan Blade
- Hematology, IDIBAPS, Hospital Clinic de Barcelona, Barcelona, Spain
| | | | | | - Javier de la Rubia
- Hematology Service, University Hospital Doctor Peset, Avda. Gaspar Aguilar, 90, 46017 Valencia, Spain ; Universidad Católica "San Vicente Mártir", Valencia, Spain
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28
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García-Sanz R, Oriol A, Moreno MJ, de la Rubia J, Payer AR, Hernández MT, Palomera L, Teruel AI, Blanchard MJ, Gironella M, Ribas P, Bargay J, Abellá E, Granell M, Ocio EM, Ribera JM, San Miguel JF, Mateos MV. Zoledronic acid as compared with observation in multiple myeloma patients at biochemical relapse: results of the randomized AZABACHE Spanish trial. Haematologica 2015; 100:1207-13. [PMID: 26069291 DOI: 10.3324/haematol.2015.128439] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 05/29/2015] [Indexed: 11/09/2022] Open
Abstract
This study analyzed the anti-myeloma effect of zoledronic acid monotherapy by investigating patients at the time of asymptomatic biochemical relapse. One hundred patients were randomized to receive either zoledronic acid (4 mg iv/4 weeks, 12 doses) (n=51) or not (n=49). Experimental and control groups were well balanced for disease and prognostic features. Zoledronic acid did not show an antitumor effect according to changes in M-component. However, there were fewer symptomatic progressions in the experimental group than in the control group (34 versus 41, respectively; P=0.05) resulting in a median time to symptoms of 16 versus 10 months (P=0.161). The median time to next therapy was also slightly longer for the treated group than the untreated, control group (13.4 versus 10.1 months), although the difference was not statistically significant (P=0.360). The pattern of relapses was different for treated versus control patients: progressive bone disease (8 versus 20), anemia (24 versus 18), renal dysfunction (1 versus 2), and plasmacytomas (1 versus 1, respectively). This concurred with fewer skeletal-related events in the treated group than in the control group (2 versus 14), with a projected 4-year event proportion of 6% versus 40% (P<0.001). In summary, zoledronic acid monotherapy does not show an antitumor effect on biochemical relapses in multiple myeloma, but does reduce the risk of progression with symptomatic bone disease and skeletal complications. This trial was registered in the ClinicalTrials.gov database with code NCT01087008.
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Affiliation(s)
| | - Albert Oriol
- ICO - Hospital Germans Trias i Pujol, Fundació Josep Carreras, Spain
| | | | - Javier de la Rubia
- Hospital Universitario La Fe and Universidad Católica de Valencia, Spain
| | | | | | | | - Ana I Teruel
- Hospital Clínico Universitario de Valencia, Spain
| | | | | | - Paz Ribas
- Hospital Universitario Dr. Peset de Valencia, Spain
| | - Joan Bargay
- Hospital Son Llàtzer de Palma de Mallorca, Spain
| | | | - Miquel Granell
- Hospital de la Santa Creu i Sant Pau de Barcelona, Spain
| | - Enrique M Ocio
- Hospital Universitario de Salamanca-IBSAL, IBMCC (USAL-CSIC), Spain
| | - Josep M Ribera
- ICO - Hospital Germans Trias i Pujol, Fundació Josep Carreras, Spain
| | | | - María V Mateos
- Hospital Universitario de Salamanca-IBSAL, IBMCC (USAL-CSIC), Spain
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29
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Li W, Zhou JZ, Chang HR, Dai LJ, Zhu ZL, Feng YF, Gong FR, Wu DP. Comparison of SPE, IFE, and FLC in Monitoring Patients with Multiple Myeloma After Autologous Stem Cell Transplantation. Cell Biochem Biophys 2015; 73:643-7. [DOI: 10.1007/s12013-015-0655-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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30
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Shah N, Callander N, Ganguly S, Gul Z, Hamadani M, Costa L, Sengsayadeth S, Abidi M, Hari P, Mohty M, Chen YB, Koreth J, Landau H, Lazarus H, Leather H, Majhail N, Nath R, Osman K, Perales MA, Schriber J, Shaughnessy P, Vesole D, Vij R, Wingard J, Giralt S, Savani BN. Hematopoietic Stem Cell Transplantation for Multiple Myeloma: Guidelines from the American Society for Blood and Marrow Transplantation. Biol Blood Marrow Transplant 2015; 21:1155-66. [PMID: 25769794 DOI: 10.1016/j.bbmt.2015.03.002] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 03/04/2015] [Indexed: 01/28/2023]
Abstract
Therapeutic strategies for multiple myeloma (MM) have changed dramatically over the past decade. Thus, the role of hematopoietic stem cell transplantation (HCT) must be considered in the context of this evolution. In this evidence-based review, we have critically analyzed the data from the most recent clinical trials to better understand how to incorporate HCT and when HCT is indicated. We have provided our recommendations based on strength of evidence with the knowledge that ongoing clinical trials make this a dynamic field. Within this document, we discuss the decision to proceed with autologous HCT, factors to consider before proceeding to HCT, the role of tandem autologous HCT, post-HCT maintenance therapy, and the role of allogeneic HCT for patients with MM.
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Affiliation(s)
- Nina Shah
- MD Anderson Cancer Center, Houston, Texas.
| | - Natalie Callander
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | | | - Mehdi Hamadani
- Center for International Blood and Marrow Transplant Research and Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Luciano Costa
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - Parameswaran Hari
- Center for International Blood and Marrow Transplant Research and Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mohamad Mohty
- Hopital Saint-Antoine, APHP, Paris, France; Université Pierre & Marie Curie, Paris, France, INSERM, UMRs 938, Paris, France
| | - Yi-Bin Chen
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - John Koreth
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Heather Landau
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | | | - Rajneesh Nath
- University of Massachusetts, Worcester, Massachusetts
| | - Keren Osman
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Jeffrey Schriber
- Cancer Transplant Institute at Scottsdale Healthcare, Scottsdale, Arizona
| | | | - David Vesole
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, New Jersey
| | - Ravi Vij
- Washington University School of Medicine, St. Louis, Missouri
| | - John Wingard
- University of Florida College of Medicine, Gainesville, Florida
| | - Sergio Giralt
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Bipin N Savani
- Vanderbilt University Medical Center, Nashville, Tennesee
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31
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Holstein SA, Richardson PG, Laubach JP, McCarthy PL. Management of relapsed multiple myeloma after autologous stem cell transplant. Biol Blood Marrow Transplant 2015; 21:793-8. [PMID: 25652690 DOI: 10.1016/j.bbmt.2014.12.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 12/22/2014] [Indexed: 11/28/2022]
Abstract
Autologous stem cell transplantation (ASCT) remains a standard of care for multiple myeloma patients who are eligible to receive high-dose therapy, recognizing that the optimal timing and integration of this approach is now under study in a number of randomized trials. Despite the improved response rates with induction therapy consisting of immunomodulatory drugs and/or proteasome inhibitors, as well as the increasing use of post-ASCT maintenance therapy, most myeloma patients relapse and die of their disease. Here we discuss the options for managing post-ASCT relapse, including the role of various salvage regimens in the setting of relapsed and refractory myeloma, salvage ASCT, and salvage allogeneic SCT.
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Affiliation(s)
- Sarah A Holstein
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York
| | - Paul G Richardson
- Department of Hematologic Oncology, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Jacob P Laubach
- Department of Hematologic Oncology, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Philip L McCarthy
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York.
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32
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Patterns of Relapse or Progression After Bortezomib-Based Salvage Therapy in Patients With Relapsed/Refractory Multiple Myeloma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2014; 14:389-94. [DOI: 10.1016/j.clml.2014.02.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 02/11/2014] [Accepted: 02/11/2014] [Indexed: 11/22/2022]
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33
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Fernández de Larrea C, Delforge M, Davies F, Bladé J. Response evaluation and monitoring of multiple myeloma. Expert Rev Hematol 2014; 7:33-42. [PMID: 24483347 DOI: 10.1586/17474086.2014.876899] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Monitoring multiple myeloma (MM) is essential during the evaluation of response to each therapy line, after transplantation and at the time of relapse or progression in all patients. An initial complete workup, including appropriate protein studies in serum and urine is mandatory. The use of uniform criteria is particularly important in the context of clinical trials. Complete remission (CR) definition, the goal for the majority of patients, is now in constant evolution, with immunophenotypic and molecular minimal residual disease measurement in bone marrow as well as imaging techniques. Identification of relapse/progression with traditional and novel techniques for eventual prompt intervention with rescue treatment is a current issue of debate.
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Affiliation(s)
- Carlos Fernández de Larrea
- Department of Hematology, Amyloidosis and Myeloma Unit, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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34
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Fernández de Larrea C, Jiménez R, Rosiñol L, Giné E, Tovar N, Cibeira MT, Fernández-Avilés F, Martínez C, Rovira M, Bladé J. Pattern of relapse and progression after autologous SCT as upfront treatment for multiple myeloma. Bone Marrow Transplant 2013; 49:223-7. [PMID: 24076551 DOI: 10.1038/bmt.2013.150] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 07/11/2013] [Accepted: 08/13/2013] [Indexed: 12/11/2022]
Abstract
The achievement of CR is the crucial step for a prolonged PFS and OS after an autologous SCT in multiple myeloma (MM). Unfortunately, even with the use of new regimens and the current high CR rates, most, if not all, patients will ultimately relapse or progress. We analyzed the type of relapse or progression (asymptomatic vs symptomatic), clinical features including the presence of extramedullary involvement and time to next treatment in 211 patients who underwent melphalan-based autologous SCT over an 18-year period at our institution. After autologous SCT, serological or asymptomatic relapse/progression was observed in about one half of the patients. The treatment-free interval was significantly longer in patients relapsing from CR than in those progressing from PR (P=0.017). Patients with serological relapse/progression had a significantly longer OS than those relapsing from symptomatic disease (P=0.002). The relapse pattern was similar to the initial clinical presentation. Survival after relapse/progression was shorter in those patients with a 24-h urine M-protein excretion of at least 200 mg (P=0.048). Extramedullary involvement was frequent (24%), being the highest risk in patients with extramedullary involvement at diagnosis (P=0.001).
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Affiliation(s)
- C Fernández de Larrea
- Amyloidosis and Myeloma Unit, Department of Hematology, Servei d'Hematologia, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - R Jiménez
- Amyloidosis and Myeloma Unit, Department of Hematology, Servei d'Hematologia, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - L Rosiñol
- Amyloidosis and Myeloma Unit, Department of Hematology, Servei d'Hematologia, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - E Giné
- Amyloidosis and Myeloma Unit, Department of Hematology, Servei d'Hematologia, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - N Tovar
- Amyloidosis and Myeloma Unit, Department of Hematology, Servei d'Hematologia, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - M T Cibeira
- Amyloidosis and Myeloma Unit, Department of Hematology, Servei d'Hematologia, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - F Fernández-Avilés
- Amyloidosis and Myeloma Unit, Department of Hematology, Servei d'Hematologia, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - C Martínez
- Amyloidosis and Myeloma Unit, Department of Hematology, Servei d'Hematologia, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - M Rovira
- Amyloidosis and Myeloma Unit, Department of Hematology, Servei d'Hematologia, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - J Bladé
- Amyloidosis and Myeloma Unit, Department of Hematology, Servei d'Hematologia, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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35
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Jenner E. Serum free light chains in clinical laboratory diagnostics. Clin Chim Acta 2013; 427:15-20. [PMID: 23999048 DOI: 10.1016/j.cca.2013.08.018] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 08/22/2013] [Accepted: 08/23/2013] [Indexed: 02/08/2023]
Abstract
Monoclonal free light chains (FLCs) are important disease biomarkers in patients with plasma cell-proliferative disorders. The increasing evidence for clonal diversity and evolution in multiple myeloma highlights the importance of laboratory algorithms that measure both intact immunoglobulins and monoclonal FLCs, at diagnosis and when monitoring response to treatment. A particular focus in the field has been on the utility of serum FLC (sFLC) assays to replace urine electrophoresis for monoclonal FLC measurement. Due to the limited sensitivity and practical constraints of urine analysis, a serum-based algorithm of SPE and sFLC has been adopted by many laboratories as a first line screen in patients with suspected monoclonal gammopathies. This review will discuss the data supporting the use of this simple serum-based algorithm at initial diagnosis, including its utility for the rapid identification of monoclonal FLC in the setting of unexplained acute kidney injury, and provide a comprehensive review of the diagnostic sensitivity of sFLC in patients with multiple myeloma, AL amyloidosis and light chain deposition disease.
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Affiliation(s)
- Ellen Jenner
- The Binding Site Group Ltd., 8 Calthorpe Road, Edgbaston, Birmingham B15 1QT, UK.
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