1
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Escure G, Fournier E, Saade C, Issa LHB, Arib I, Tilmont R, Gazeau N, Thiam BM, Chovet M, Delforge M, Gower N, Fléchon L, Cavalieri D, Chauvet P, Nudel M, Goursaud L, Berthon C, Quesnel B, Facon T, Preudhomme C, Duployez N, Manier S. Small myeloid subclones are present at diagnosis of multiple myeloma in patients who develop secondary myelodysplastic syndromes. Haematologica 2024; 109:1289-1292. [PMID: 37855058 PMCID: PMC10985426 DOI: 10.3324/haematol.2023.284050] [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: 08/08/2023] [Accepted: 10/11/2023] [Indexed: 10/20/2023] Open
Abstract
Not available.
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Affiliation(s)
| | - Elise Fournier
- Department of Biology Pathology, Lille University Hospital, Lille
| | - Cynthia Saade
- Department of Hematology, Lille University Hospital, Lille
| | | | - Inès Arib
- Department of Hematology, Lille University Hospital, Lille
| | - Rémi Tilmont
- Department of Hematology, Lille University Hospital, Lille
| | - Nicolas Gazeau
- Department of Hematology, Lille University Hospital, Lille
| | - Binta M Thiam
- Department of Hematology, Lille University Hospital, Lille
| | - Morgane Chovet
- Department of Hematology, Lille University Hospital, Lille
| | | | - Nicolas Gower
- Department of Hematology, Lille University Hospital, Lille
| | - Léa Fléchon
- Canther Unit, INSERM UMR-S1277, CNRS UMR9020, ONCOLille, Lille University
| | | | - Paul Chauvet
- Department of Hematology, Lille University Hospital, Lille
| | - Morgane Nudel
- Department of Hematology, Lille University Hospital, Lille
| | - Laure Goursaud
- Department of Hematology, Lille University Hospital, Lille
| | - Céline Berthon
- Department of Hematology, Lille University Hospital, Lille
| | - Bruno Quesnel
- Department of Hematology, Lille University Hospital, Lille, France; Canther Unit, INSERM UMR-S1277, CNRS UMR9020, ONCOLille, Lille University
| | - Thierry Facon
- Department of Hematology, Lille University Hospital, Lille
| | - Claude Preudhomme
- Department of Hematology, Lille University Hospital, Lille, France; Canther Unit, INSERM UMR-S1277, CNRS UMR9020, ONCOLille, Lille University
| | - Nicolas Duployez
- Department of Biology Pathology, Lille University Hospital, Lille, France; Canther Unit, INSERM UMR-S1277, CNRS UMR9020, ONCOLille, Lille University
| | - Salomon Manier
- Department of Hematology, Lille University Hospital, Lille, France; Canther Unit, INSERM UMR-S1277, CNRS UMR9020, ONCOLille, Lille University.
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2
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Rudolphi-Solero T, Triviño-Ibáñez EM, González-Jiménez AD, Ramos-Font C, Ríos-Tamayo R, Rebollo-Aguirre AC, Sánchez-Sánchez R. Diagnostic relevance of 2-[ 18 F]-FDG PET/CT in patients recently diagnosed with monoclonal gammopathy of undetermined significance. Hematol Oncol 2023; 41:434-441. [PMID: 36222822 DOI: 10.1002/hon.3085] [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: 07/04/2022] [Revised: 09/23/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022]
Abstract
2-[18 F]-FDG PET/CT is a useful diagnostic technique to assess bone and soft tissue disease in multiple myeloma (MM) but is not recommended by the International Myeloma Working Group for the evaluation of monoclonal gammopathy of undetermined significance (MGUS). The objective of this study was to evaluate the role of 2-[18 F]-FDG PET/CT in the management of these patients. An observational retrospective study was conducted on 338 patients with MGUS who underwent 2-[18 F]-FDG PET/CT. The mean age was 70.80 ± 11.84 years, and 69.2% of patients had cardiovascular risk factors. Patients were classified according to their progression risk (Mayo Clinic). The mean post-diagnosis follow-up was 8.35 ± 14.46 months. Pathological findings were recorded in 49 patients: 30 with myeloma bone lesions (15 in the initial study and 15 in follow-up) and 19 with other neoplastic (n = 13) or pathologically significant findings (n = 6). Body mass index, monoclonal component rate (MCR) > 1 g/dL and ≥1 risk factors for MM were significant in univariate logistic regression analyses. The MCR emerged as the main predictor of a positive 2-[18 F]-FDG PET/CT in adjusted multivariate regression analysis, with an area under the receiver operating characteristic curve of 0.785 and cutoff for optimal sensitivity/specificity of 1.0 ng/mL (71.4% sensitivity, 71.2% specificity). 2-[18 F]-FDG PET/CT results correctly classify patients with MGUS and could improve the detection of bone lesions over existing techniques, with the additional possibility of detecting neoplastic processes. The best parameter to predict a positive 2-[18 F]-FDG PET/CT was the MCR.
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Affiliation(s)
- Teodoro Rudolphi-Solero
- Servicio de Medicina Nuclear, Complejo Hospitalario de Jaén, Jaén, Spain
- Instituto de Investigación Biosanitaria ibs-GRANADA, Granada, Spain
| | - Eva María Triviño-Ibáñez
- Instituto de Investigación Biosanitaria ibs-GRANADA, Granada, Spain
- Servicio de Medicina Nuclear, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | | | - Carlos Ramos-Font
- Instituto de Investigación Biosanitaria ibs-GRANADA, Granada, Spain
- Servicio de Medicina Nuclear, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Rafael Ríos-Tamayo
- Servicio de Hematología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | | | - Rocío Sánchez-Sánchez
- Instituto de Investigación Biosanitaria ibs-GRANADA, Granada, Spain
- Servicio de Medicina Nuclear, Hospital Universitario Virgen de las Nieves, Granada, Spain
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3
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Jelloul FZ, Quesada AE, Yang RK, Li S, Wang W, Xu J, Tang G, Yin CC, Fang H, El Hussein S, Khoury J, Bassett RL, Garcia-Manero G, Manasanch EE, Orlowski RZ, Qazilbash MH, Patel KP, Medeiros LJ, Lin P. Clinicopathologic Features of Therapy-Related Myeloid Neoplasms in Patients with Myeloma in the Era of Novel Therapies. Mod Pathol 2023; 36:100166. [PMID: 36990279 DOI: 10.1016/j.modpat.2023.100166] [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: 09/26/2022] [Revised: 02/27/2023] [Accepted: 03/20/2023] [Indexed: 03/29/2023]
Abstract
The development of therapy-related myeloid neoplasms (t-MN) is a rare complication that can occur in myeloma patients treated primarily with novel therapies. To better understand t-MNs in this context, we reviewed 66 such patients and compared them with a control group of patients who developed t-MN after cytotoxic therapies for other malignancies. The study group included 50 men and 16 women, with a median age of 68 years (range, 48-86 years). Therapies included proteasome inhibitors, immunomodulatory agents, and high-dose melphalan-based autologous stem cell transplantation (HDM-ASCT) in 64 (97%), 65 (98.5%), and 64 (97%) patients, respectively; 29 (43.9%) patients were exposed to other cytotoxic drugs besides HDM. The latency interval from therapy to t-MN was 4.9 years (range, 0.6-21.9 years). Patients who received HDM-ASCT in addition to other cytotoxic therapies had a longer latency period to t-MN compared with patients who only received HDM-ASCT (6.1 vs 4.7 years, P = .009). Notably, 11 patients developed t-MN within 2 years. Therapy-related myelodysplastic syndrome was the most common type of neoplasm (n = 60), followed by therapy-related acute myeloid leukemia (n = 4) and myelodysplastic syndrome/myeloproliferative neoplasm (n = 2). The most common cytogenetic aberrations included complex karyotypes (48.5%), del7q/-7 (43.9%), and/or del5q/-5 (40.9%). The most frequent molecular alteration was TP53 mutation, in 43 (67.2%) patients and the sole mutation in 20 patients. Other mutations included DNMT3A, 26.6%; TET2, 14.1%; RUNX1, 10.9%; ASXL1, 7.8%; and U2AF1, 7.8%. Other mutations in less than 5% of cases included SRSF2, EZH2, STAG2, NRAS, SETBP, SF3B1, SF3A1, and ASXL2. After a median follow-up of 15.3 months, 18 patients were alive and 48 died. The median overall survival after the diagnosis of t-MN in the study group was 18.4 months. Although the overall features are comparable to the control group, the short interval to t-MN (<2 years) underscores the unique vulnerable status of myeloma patients.
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Affiliation(s)
- Fatima Zahra Jelloul
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Andres E Quesada
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Richard K Yang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Shaoying Li
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Wei Wang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jie Xu
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Guilin Tang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - C Cameron Yin
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hong Fang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Siba El Hussein
- Department of Pathology, University of Rochester Medical Center, Rochester, New York
| | - Joseph Khoury
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Roland L Bassett
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Elizabet E Manasanch
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Robert Z Orlowski
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Muzaffar H Qazilbash
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Keyur P Patel
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Pei Lin
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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4
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Kaur J, Valisekka SS, Hameed M, Bandi PS, Varma S, Onwughalu CJ, Ibrahim H, Mongia H. Monoclonal Gammopathy of Undetermined Significance: A Comprehensive Review. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2023; 23:e195-e212. [PMID: 36966041 DOI: 10.1016/j.clml.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 02/24/2023]
Abstract
Monoclonal Gammopathy of Undetermined Significance (MGUS) is an asymptomatic premalignant plasma cell dyscrasia with a predominate rise of the IgG immunoglobulin fraction without end-organ damage, often diagnosed incidentally. Despite its progression into various subsequent forms of hematological malignancies, MGUS remains underdiagnosed. A literature search was conducted using the Medline, Cochrane, Embase, and Google Scholar databases, including articles published until December 2022. Keywords used encompassed "Monoclonal Gammopathy of Undetermined Significance," "Plasma Cell dyscrasia," "Monoclonal gammopathy of renal significance," and "IgM Monoclonal gammopathy of Undetermined Significance," This study aimed to conduct a critical review to update knowledge regarding the pathophysiology, risk factors, clinical features, diagnostic protocols, complications, and current and novel treatments for MGUS. We recommend a multidisciplinary approach to manage MGUS due to the complexity of the illness's etiology, diagnosis, and therapy. This comprehensive review also highlights future prospects, such as developing screening protocols for at-risk populations, prevention of disease progression by early diagnosis through genome-wide association studies, and management using Daratumumab and NSAIDs.
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Affiliation(s)
- Jasneet Kaur
- Internal Medicine, Nassau University Medical Center, East Meadow, New York, USA..
| | | | - Maha Hameed
- Internal Medicine, Florida State University/Sarasota Memorial Hospital, Sarasota, Florida, USA.
| | | | | | | | - Hany Ibrahim
- Ain Shams University, Faculty of Medicine, Cairo, Egypt.
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5
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DeStefano CB, Gibson SJ, Sperling AS, Richardson PG, Ghobrial I, Mo CC. The emerging importance and evolving understanding of clonal hematopoiesis in multiple myeloma. Semin Oncol 2022; 49:19-26. [DOI: 10.1053/j.seminoncol.2022.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 01/09/2022] [Indexed: 12/19/2022]
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6
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Aksenova AY, Zhuk AS, Lada AG, Zotova IV, Stepchenkova EI, Kostroma II, Gritsaev SV, Pavlov YI. Genome Instability in Multiple Myeloma: Facts and Factors. Cancers (Basel) 2021; 13:5949. [PMID: 34885058 PMCID: PMC8656811 DOI: 10.3390/cancers13235949] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/20/2021] [Accepted: 11/22/2021] [Indexed: 02/06/2023] Open
Abstract
Multiple myeloma (MM) is a malignant neoplasm of terminally differentiated immunoglobulin-producing B lymphocytes called plasma cells. MM is the second most common hematologic malignancy, and it poses a heavy economic and social burden because it remains incurable and confers a profound disability to patients. Despite current progress in MM treatment, the disease invariably recurs, even after the transplantation of autologous hematopoietic stem cells (ASCT). Biological processes leading to a pathological myeloma clone and the mechanisms of further evolution of the disease are far from complete understanding. Genetically, MM is a complex disease that demonstrates a high level of heterogeneity. Myeloma genomes carry numerous genetic changes, including structural genome variations and chromosomal gains and losses, and these changes occur in combinations with point mutations affecting various cellular pathways, including genome maintenance. MM genome instability in its extreme is manifested in mutation kataegis and complex genomic rearrangements: chromothripsis, templated insertions, and chromoplexy. Chemotherapeutic agents used to treat MM add another level of complexity because many of them exacerbate genome instability. Genome abnormalities are driver events and deciphering their mechanisms will help understand the causes of MM and play a pivotal role in developing new therapies.
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Affiliation(s)
- Anna Y. Aksenova
- Laboratory of Amyloid Biology, St. Petersburg State University, 199034 St. Petersburg, Russia
| | - Anna S. Zhuk
- International Laboratory “Computer Technologies”, ITMO University, 197101 St. Petersburg, Russia;
| | - Artem G. Lada
- Department of Microbiology and Molecular Genetics, University of California, Davis, CA 95616, USA;
| | - Irina V. Zotova
- Department of Genetics and Biotechnology, St. Petersburg State University, 199034 St. Petersburg, Russia; (I.V.Z.); (E.I.S.)
- Vavilov Institute of General Genetics, St. Petersburg Branch, Russian Academy of Sciences, 199034 St. Petersburg, Russia
| | - Elena I. Stepchenkova
- Department of Genetics and Biotechnology, St. Petersburg State University, 199034 St. Petersburg, Russia; (I.V.Z.); (E.I.S.)
- Vavilov Institute of General Genetics, St. Petersburg Branch, Russian Academy of Sciences, 199034 St. Petersburg, Russia
| | - Ivan I. Kostroma
- Russian Research Institute of Hematology and Transfusiology, 191024 St. Petersburg, Russia; (I.I.K.); (S.V.G.)
| | - Sergey V. Gritsaev
- Russian Research Institute of Hematology and Transfusiology, 191024 St. Petersburg, Russia; (I.I.K.); (S.V.G.)
| | - Youri I. Pavlov
- Eppley Institute for Research in Cancer, Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE 68198, USA
- Departments of Biochemistry and Molecular Biology, Microbiology and Pathology, Genetics Cell Biology and Anatomy, University of Nebraska Medical Center, Omaha, NE 68198, USA
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7
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Obiorah IE, Patel BA, Groarke EM, Wang W, Trick M, Ombrello AK, Ferrada MA, Wu Z, Gutierrez-Rodrigues F, Lotter J, Wilson L, Hoffmann P, Cardona DO, Patel N, Dulau-Florea A, Kastner DL, Grayson PC, Beck DB, Young NS, Calvo KR. Benign and malignant hematologic manifestations in patients with VEXAS syndrome due to somatic mutations in UBA1. Blood Adv 2021; 5:3203-3215. [PMID: 34427584 PMCID: PMC8405186 DOI: 10.1182/bloodadvances.2021004976] [Citation(s) in RCA: 113] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/04/2021] [Indexed: 11/20/2022] Open
Abstract
Somatic mutations in UBA1 involving hematopoietic stem and myeloid cells have been reported in patients with the newly defined VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome. Here, we report clinical hematologic manifestations and unique bone marrow (BM) features in 16 patients with VEXAS. All patients were male and had a history of severe autoinflammatory and rheumatologic manifestations and a somatic UBA1 mutation (p.Met41). Ten patients had hematologic disorders: myelodysplastic syndrome (MDS; 6 of 16), multiple myeloma (2 of 16), monoclonal gammopathy of undetermined significance (2 of 16), and monoclonal B-cell lymphocytosis (2 of 16), and a few of those patients had 2 co-existing clonal processes. Although macrocytic anemia (100%) and lymphopenia (80%) were prevalent in all patients with VEXAS, thrombocytopenia and neutropenia were more common in patients with progression to MDS. All BMs in VEXAS patients had prominent cytoplasmic vacuoles in myeloid and erythroid precursors. In addition, most BMs were hypercellular with myeloid hyperplasia, erythroid hypoplasia, and varying degrees of dysplasia. All patients diagnosed with MDS were lower risk (low blast count, very good to intermediate cytogenetics) according to standard prognostic scoring with no known progression to leukemia. In addition, 10 of 16 patients had thrombotic events, including venous thromboembolism and arterial stroke. Although VEXAS presents symptomatically as a rheumatologic disease, morbidity and mortality are associated with progression to hematologic disease. Given the increased risk of developing MDS and multiple myeloma, surveillance for disease progression is important.
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Affiliation(s)
- Ifeyinwa Emmanuela Obiorah
- Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute
- Hematology Section, Department of Laboratory Medicine, Clinical Center
| | | | - Emma M Groarke
- Hematology Branch, National Heart, Lung, and Blood Institute
| | - Weixin Wang
- Hematology Section, Department of Laboratory Medicine, Clinical Center
| | - Megan Trick
- Hematology Section, Department of Laboratory Medicine, Clinical Center
| | - Amanda K Ombrello
- Metabolic, Cardiovascular, and Inflammatory Disease Genomics Branch, National Human Genome Research Institute, and
| | - Marcela A Ferrada
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD
| | - Zhijie Wu
- Hematology Branch, National Heart, Lung, and Blood Institute
| | | | - Jennifer Lotter
- Hematology Branch, National Heart, Lung, and Blood Institute
| | - Lorena Wilson
- Metabolic, Cardiovascular, and Inflammatory Disease Genomics Branch, National Human Genome Research Institute, and
| | - Patrycja Hoffmann
- Metabolic, Cardiovascular, and Inflammatory Disease Genomics Branch, National Human Genome Research Institute, and
| | - Daniela Ospina Cardona
- Metabolic, Cardiovascular, and Inflammatory Disease Genomics Branch, National Human Genome Research Institute, and
| | - Nisha Patel
- Hematology Section, Department of Laboratory Medicine, Clinical Center
| | | | - Daniel L Kastner
- Metabolic, Cardiovascular, and Inflammatory Disease Genomics Branch, National Human Genome Research Institute, and
| | - Peter C Grayson
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD
| | - David B Beck
- Metabolic, Cardiovascular, and Inflammatory Disease Genomics Branch, National Human Genome Research Institute, and
| | - Neal S Young
- Hematology Branch, National Heart, Lung, and Blood Institute
| | - Katherine R Calvo
- Hematology Section, Department of Laboratory Medicine, Clinical Center
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8
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Absence of a common founder mutation in patients with cooccurring myelodysplastic syndrome and plasma cell disorder. Blood 2021; 137:1260-1263. [PMID: 33120432 DOI: 10.1182/blood.2020007555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 10/03/2020] [Indexed: 02/07/2023] Open
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9
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Affiliation(s)
- Nelson Leung
- From the Divisions of Nephrology and Hypertension and of Hematology (N.L.) and the Department of Laboratory Medicine and Pathology (S.H.N.), Mayo Clinic, Rochester, MN; and Department of Nephrology and Centre d'Investigation Clinique INSERM 1402, Centre de Référence Amylose AL et Autres Maladies par Dépôt d'Immunoglobulines Monoclonales, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, and Centre National de la Recherche Scientifique UMR7276, Université de Limoges, Limoges - all in France (F.B.)
| | - Frank Bridoux
- From the Divisions of Nephrology and Hypertension and of Hematology (N.L.) and the Department of Laboratory Medicine and Pathology (S.H.N.), Mayo Clinic, Rochester, MN; and Department of Nephrology and Centre d'Investigation Clinique INSERM 1402, Centre de Référence Amylose AL et Autres Maladies par Dépôt d'Immunoglobulines Monoclonales, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, and Centre National de la Recherche Scientifique UMR7276, Université de Limoges, Limoges - all in France (F.B.)
| | - Samih H Nasr
- From the Divisions of Nephrology and Hypertension and of Hematology (N.L.) and the Department of Laboratory Medicine and Pathology (S.H.N.), Mayo Clinic, Rochester, MN; and Department of Nephrology and Centre d'Investigation Clinique INSERM 1402, Centre de Référence Amylose AL et Autres Maladies par Dépôt d'Immunoglobulines Monoclonales, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, and Centre National de la Recherche Scientifique UMR7276, Université de Limoges, Limoges - all in France (F.B.)
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10
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Characteristics and outcomes of therapy-related myeloid neoplasms following autologous stem cell transplantation for multiple myeloma. Blood Cancer J 2021; 11:63. [PMID: 33741897 PMCID: PMC7979889 DOI: 10.1038/s41408-021-00454-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/23/2021] [Accepted: 03/04/2021] [Indexed: 12/14/2022] Open
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11
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Bacchiarri F, Sammartano V, Santoni A, Raspadori D, Zappone E, Defina M, Ciofini S, Sicuranza A, Bocchia M, Gozzetti A. First reported case of secondary mixed phenotype acute leukemia after multiple myeloma. AMERICAN JOURNAL OF BLOOD RESEARCH 2021; 11:123-131. [PMID: 33796400 PMCID: PMC8010609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 02/15/2021] [Indexed: 06/12/2023]
Abstract
In recent years the outcome of patients with multiple myeloma (MM) has significantly improved, due to new drugs. However, some agents, i.e. the alkylating drug melphalan, can be associated with an increased incidence of secondary malignancies. Myelodysplastic syndromes and acute myeloid leukemia are reported in the literature, and rarely acute lymphoblastic leukemia. Here we describe a unique case of a 56-years old female patient affected by MM since 2015 in complete remission after autologous stem cell transplant and in lenalidomide maintenance, who developed 2 years later mixed phenotype acute leukemia (MPAL). The patient, refractory to both lymphoblastic and myeloid acute leukemia regimens, achieved complete remission with bi-specific anti-CD19/anti-CD3 monoclonal antibody blinatumomab and with hypomethylating agent azacytidine plus the BCL-2 inhibitor venetoclax. She then underwent hematopoietic stem cell transplantation from HLA-identical sibling donor and she is still in complete remission after 9 months. To the best of our knowledge, there are no cases in the literature describing MPAL after autologous transplant for MM. Our patient was treated with blinatumomab and venetoclax and achieved complete remission 9 months from allogeneic transplant. The mechanism underlying the development of MPAL is not completely understood and therapies are still lacking. In this context the combination of blinatumomab, azacytidine and venetoclax successfully used in this patient may provide food for thought for further studies in this rare setting of patients.
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Affiliation(s)
- Francesca Bacchiarri
- Hematology Unit, University of Siena, Azienda Ospedaliera Universitaria Senese Siena, Italy
| | - Vincenzo Sammartano
- Hematology Unit, University of Siena, Azienda Ospedaliera Universitaria Senese Siena, Italy
| | - Adele Santoni
- Hematology Unit, University of Siena, Azienda Ospedaliera Universitaria Senese Siena, Italy
| | - Donatella Raspadori
- Hematology Unit, University of Siena, Azienda Ospedaliera Universitaria Senese Siena, Italy
| | - Elisabetta Zappone
- Hematology Unit, University of Siena, Azienda Ospedaliera Universitaria Senese Siena, Italy
| | - Marzia Defina
- Hematology Unit, University of Siena, Azienda Ospedaliera Universitaria Senese Siena, Italy
| | - Sara Ciofini
- Hematology Unit, University of Siena, Azienda Ospedaliera Universitaria Senese Siena, Italy
| | - Anna Sicuranza
- Hematology Unit, University of Siena, Azienda Ospedaliera Universitaria Senese Siena, Italy
| | - Monica Bocchia
- Hematology Unit, University of Siena, Azienda Ospedaliera Universitaria Senese Siena, Italy
| | - Alessandro Gozzetti
- Hematology Unit, University of Siena, Azienda Ospedaliera Universitaria Senese Siena, Italy
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12
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Biological and clinical significance of dysplastic hematopoiesis in patients with newly diagnosed multiple myeloma. Blood 2021; 135:2375-2387. [PMID: 32299093 DOI: 10.1182/blood.2019003382] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 03/15/2020] [Indexed: 02/07/2023] Open
Abstract
Risk of developing myelodysplastic syndrome (MDS) is significantly increased in both multiple myeloma (MM) and monoclonal gammopathy of undetermined significance, suggesting that it is therapy independent. However, the incidence and sequelae of dysplastic hematopoiesis at diagnosis are unknown. Here, we used multidimensional flow cytometry (MFC) to prospectively screen for the presence of MDS-associated phenotypic alterations (MDS-PA) in the bone marrow of 285 patients with MM enrolled in the PETHEMA/GEM2012MENOS65 trial (#NCT01916252). We investigated the clinical significance of monocytic MDS-PA in a larger series of 1252 patients enrolled in 4 PETHEMA/GEM protocols. At diagnosis, 33 (11.6%) of 285 cases displayed MDS-PA. Bulk and single-cell-targeted sequencing of MDS recurrently mutated genes in CD34+ progenitors (and dysplastic lineages) from 67 patients revealed clonal hematopoiesis in 13 (50%) of 26 cases with MDS-PA vs 9 (22%) of 41 without MDS-PA; TET2 and NRAS were the most frequently mutated genes. Dynamics of MDS-PA at diagnosis and after autologous transplant were evaluated in 86 of 285 patients and showed that in most cases (69 of 86 [80%]), MDS-PA either persisted or remained absent in patients with or without MDS-PA at diagnosis, respectively. Noteworthy, MDS-associated mutations infrequently emerged after high-dose therapy. Based on MFC profiling, patients with MDS-PA have altered hematopoiesis and T regulatory cell distribution in the tumor microenvironment. Importantly, the presence of monocytic MDS-PA at diagnosis anticipated greater risk of hematologic toxicity and was independently associated with inferior progression-free survival (hazard ratio, 1.5; P = .02) and overall survival (hazard ratio, 1.7; P = .01). This study reveals the biological and clinical significance of dysplastic hematopoiesis in newly diagnosed MM, which can be screened with moderate sensitivity using cost-effective MFC.
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13
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[Gamma heavy chain disease associated with aggressive B lymphoma in the context of myelodysplastic syndrome]. Rev Med Interne 2020; 42:355-358. [PMID: 33229056 DOI: 10.1016/j.revmed.2020.10.381] [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: 07/28/2020] [Revised: 10/09/2020] [Accepted: 10/28/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Heavy chain disease is a rare entity characterized by the production of incomplete immunoglobulin heavy chain without associated light chain. It is a B-cell lymphoproliferation, categorized according to the immunoglobulin involved. It is often associated with lymphomas but also with autoimmune diseases. OBSERVATION We report the case of a 70-year-old patient who presented a gamma-type heavy chain disease, associated with a diffuse large B-cell lymphoma in the context of myelodysplastic syndrome. CONCLUSION This is the first case of diffuse large B-cell lymphoma associated gamma heavy chain disease described in the context of myelodysplastic syndrome.
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Giri S, Barth P, Costa LJ, Olszewski AJ. Second primary malignancy among older adults with multiple myeloma receiving first-line lenalidomide-based therapy: A population-based analysis. J Geriatr Oncol 2020; 12:256-261. [PMID: 32684352 DOI: 10.1016/j.jgo.2020.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 06/08/2020] [Accepted: 07/06/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Clinical trials have suggested that patients with myeloma treated with lenalidomide may have an increased risk of second primary malignancies (SPM). Whether such risks are of significant relevance in the real-world clinical practice, particularly among older patients receiving first-line lenalidomide based therapy, remains unclear. METHODS Using Surveillance Epidemiology and End Results-Medicare database, we identified adults ≥ 65 years with plasma cell myeloma diagnosed in 2007-2015 who received at least one oral anti-myeloma agent. We defined first-line lenalidomide-containing therapy as use within 90 days of diagnosis. SPM was defined as a malignancy reported to a cancer registry > 90 days after myeloma diagnosis. We computed cumulative incidence of SPM (with death being a competing event) and compared SPM rates between patients treated with or without first-line lenalidomide using a Fine-Gray's model, adjusting for age, sex, race, ethnicity, prior malignancy, and histologic subtype. RESULTS Of 9850 Medicare beneficiaries, 4009 (41%) received first-line lenalidomide. During median follow up of 5.0 years, 423 patients (4.3%) developed SPM, including 361 solid tumors (85%) and 61 hematologic malignancies (14%). The cumulative incidence of any SPM at 5 years was similar among those who received first-line lenalidomide and those who did not (5.3% vs 4.4%; sub-hazard ratio, SHR 1.06, P = .53). Consistent results were seen in the risk of solid tumor (4.7% vs 3.6%; SHR 1.13, P = .24) or hematologic malignancy (4.7 vs 3.6%, SHR 0.73; P = .72). CONCLUSION First-line lenalidomide therapy among older adults with myeloma was not associated with a significantly increased risk of any SPM.
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Affiliation(s)
- Smith Giri
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, United States of America; Division of Hematology/Oncology, University of Alabama at Birmingham, Birmingham, AL, United States of America.
| | - Peter Barth
- Alpert Medical School of Brown University, Providence, RI, United States of America; Division of Hematology-Oncology, Lifespan Cancer Institute, Providence, RI, United States of America
| | - Luciano J Costa
- Division of Hematology/Oncology, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Adam J Olszewski
- Alpert Medical School of Brown University, Providence, RI, United States of America; Division of Hematology-Oncology, Lifespan Cancer Institute, Providence, RI, United States of America
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Epstein MM, Saphirak C, Zhou Y, LeBlanc C, Rosmarin AG, Ash A, Singh S, Fisher K, Birmann BM, Gurwitz JH. Identifying monoclonal gammopathy of undetermined significance in electronic health data. Pharmacoepidemiol Drug Saf 2020; 29:69-76. [PMID: 31736189 PMCID: PMC7365702 DOI: 10.1002/pds.4912] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 09/17/2019] [Accepted: 09/26/2019] [Indexed: 01/08/2023]
Abstract
PURPOSE Monoclonal gammopathy of undetermined significance (MGUS) is a prevalent yet largely asymptomatic precursor to multiple myeloma. Patients with MGUS must undergo regular surveillance and testing, with few known predictors of progression. We developed an algorithm to identify MGUS patients in electronic health data to facilitate large-scale, population-based studies of this premalignant condition. METHODS We developed a four-step algorithm using electronic health record and health claims data from men and women aged 50 years or older receiving care from a large, multispecialty medical group between 2007 and 2015. The case definition required patients to have at least two MGUS ICD-9 diagnosis codes within 12 months, at least one serum and/or urine protein electrophoresis and one immunofixation test, and at least one in-office hematology/oncology visit. Medical charts for selected cases were abstracted then adjudicated independently by two physicians. We assessed algorithm validity by positive predictive value (PPV). RESULTS We identified 833 people with at least two MGUS diagnosis codes; 429 (52%) met all four algorithm criteria. We randomly selected 252 charts for review, including 206 from patients meeting all four algorithm criteria. The PPV for the 206 algorithm-identified charts was 76% (95% CI, 70%-82%). Among the 49 cases deemed to be false positives (24%), 33 were judged to have multiple myeloma or another lymphoproliferative condition, such as lymphoma. CONCLUSIONS We developed a simple algorithm that identified MGUS cases in electronic health data with reasonable accuracy. Inclusion of additional steps to eliminate cases with malignant disease may improve algorithm performance.
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Affiliation(s)
- Mara Meyer Epstein
- The Meyers Primary Care Institute, a joint venture of Reliant Medical Group, Fallon Health, and the University of Massachusetts Medical School, Worcester, MA, USA
- Division of Geriatric Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Cassandra Saphirak
- The Meyers Primary Care Institute, a joint venture of Reliant Medical Group, Fallon Health, and the University of Massachusetts Medical School, Worcester, MA, USA
| | - Yanhua Zhou
- The Meyers Primary Care Institute, a joint venture of Reliant Medical Group, Fallon Health, and the University of Massachusetts Medical School, Worcester, MA, USA
| | | | | | - Arlene Ash
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Sonal Singh
- The Meyers Primary Care Institute, a joint venture of Reliant Medical Group, Fallon Health, and the University of Massachusetts Medical School, Worcester, MA, USA
- Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA, USA
| | - Kimberly Fisher
- The Meyers Primary Care Institute, a joint venture of Reliant Medical Group, Fallon Health, and the University of Massachusetts Medical School, Worcester, MA, USA
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Brenda M Birmann
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Jerry H Gurwitz
- The Meyers Primary Care Institute, a joint venture of Reliant Medical Group, Fallon Health, and the University of Massachusetts Medical School, Worcester, MA, USA
- Division of Geriatric Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
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Jin J, Luo S, Ye X, Huang J. BCOR mutation and TLS-ERG expression in acute myeloid leukemia with monoclonal immunoglobulinemia. Onco Targets Ther 2019; 12:7123-7127. [PMID: 31564896 PMCID: PMC6730603 DOI: 10.2147/ott.s218805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 08/08/2019] [Indexed: 11/23/2022] Open
Abstract
Acute myeloid leukemia (AML) originates from the abnormal clonal proliferation of myeloblasts. Immunoglobulin is secreted by B cells. AML with monoclonal antibody often indicates a poor prognosis. Here we report a case of BCOR mutation and TLS-ERG expression in AML with monoclonal immunoglobulinemia. After chemotherapy, the patient achieved bone marrow complete remission. BCOR mutation and TLS-ERG fusion gene in patient's bone marrow were not detected, at the same time, peripheral blood monoclonal immunoglobulin also disappeared. BCOR mutation or TLS-ERG fusion gene expression is associated with poor prognosis, AML with monoclonal immunoglobulin may have the same prognostic significance.
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Affiliation(s)
- Jingxia Jin
- Department of Hematology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang 322000, People's Republic of China
| | - Shuna Luo
- Department of Hematology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang 322000, People's Republic of China
| | - XingNong Ye
- Department of Hematology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang 322000, People's Republic of China
| | - Jian Huang
- Department of Hematology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang 322000, People's Republic of China
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17
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Therapy-related myeloid neoplasms after treatment for plasma-cell disorders. Best Pract Res Clin Haematol 2019; 32:54-64. [DOI: 10.1016/j.beha.2019.02.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 02/07/2019] [Indexed: 01/01/2023]
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18
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González-Calle V, Mateos MV. Monoclonal gammopathies of unknown significance and smoldering myeloma: Assessment and management of the elderly patients. Eur J Intern Med 2018; 58:57-63. [PMID: 29907380 DOI: 10.1016/j.ejim.2018.05.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 05/09/2018] [Accepted: 05/23/2018] [Indexed: 11/16/2022]
Abstract
Monoclonal gammopathy of unknown significance (MGUS) is the most frequent plasma cell disorder that commonly affects elderly patients. Although it is an asymptomatic condition, as well as smoldering myeloma (SMM), the risk of progression to multiple myeloma requiring therapy or other B-cell disorders varies greatly for individual patients, remaining low for MGUS (1% per year), while higher and not uniform for SMM patients (10% per year). This scenario implies some special considerations regarding assessment and follow-up, especially in the elderly. In this review, we provide the updated diagnostic criteria of monoclonal gammopathies proposed by the International Myeloma Working Group (IMGW); the current recommendations for the assessment of asymptomatic plasma cell disorders, with some concerns about the need of geriatric evaluation in the elderly population, the importance of distinguishing myeloma-related symptomatology from signs or symptoms caused by multiple chronic conditions typically found in the elderly. Finally, the identification of predictor markers of progression has enabled a proposal of risk-adapted follow-up strategies in MGUS and SMM that should be implemented in clinical practice. Although the standard of care is observation for MGUS and SMM patients as well, a recent randomized trial targeting high-risk SMM showed the clinical benefit of early intervention. The change of the treatment paradigm is also very promising and feasible for elderly patients, as long as a comprehensive geriatric assessment is conducted to optimize early treatment and reach maximum benefit with minimum toxicity, in other words, to ensure a better quality of life for these patients.
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Affiliation(s)
- Verónica González-Calle
- Complejo Asistencial Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain.
| | - María Victoria Mateos
- Complejo Asistencial Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain.
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19
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Barth P, Castillo JJ, Olszewski AJ. Outcomes of secondary solid tumor malignancies among patients with myeloma: A population‐based study. Cancer 2018; 125:550-558. [DOI: 10.1002/cncr.31853] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 09/30/2018] [Accepted: 10/18/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Peter Barth
- Department of Medicine, Warren Alpert Medical School Brown University Providence Rhode Island
- Division of Hematology‐Oncology Rhode Island Hospital Providence Rhode Island
| | - Jorge J. Castillo
- Division of Hematologic Malignancies, Dana‐Farber Cancer Institute Boston Massachusetts
- Department of Medicine Harvard Medical School Boston Massachusetts
| | - Adam J. Olszewski
- Department of Medicine, Warren Alpert Medical School Brown University Providence Rhode Island
- Division of Hematology‐Oncology Rhode Island Hospital Providence Rhode Island
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20
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Costa LJ, Godby KN, Chhabra S, Cornell RF, Hari P, Bhatia S. Second primary malignancy after multiple myeloma-population trends and cause-specific mortality. Br J Haematol 2018; 182:513-520. [DOI: 10.1111/bjh.15426] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 04/22/2018] [Accepted: 05/01/2018] [Indexed: 12/27/2022]
Affiliation(s)
- Luciano J. Costa
- Division of Hematology and Oncology; Department of Medicine; University of Alabama at Birmingham; Birmingham AL USA
| | - Kelly N. Godby
- Division of Hematology and Oncology; Department of Medicine; University of Alabama at Birmingham; Birmingham AL USA
| | - Saurabh Chhabra
- Division of Hematology and Oncology; Department of Medicine; Medical College of Wisconsin; Milwaukee WI USA
| | - Robert Frank Cornell
- Division of Hematology and Oncology; Department of Medicine; Vanderbilt University; Nashville TN USA
| | - Parameswaran Hari
- Division of Hematology and Oncology; Department of Medicine; Medical College of Wisconsin; Milwaukee WI USA
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship; University of Alabama at Birmingham; Birmingham AL USA
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21
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Mittal N, Gupta R, Rahman K, Gupta T, Nityanand S. Co-existence of myeloid neoplasm and monoclonal gammopathy; case series and review of literature. Hematol Oncol Stem Cell Ther 2017; 11:183-186. [PMID: 29222965 DOI: 10.1016/j.hemonc.2017.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 09/04/2017] [Accepted: 11/18/2017] [Indexed: 10/18/2022] Open
Affiliation(s)
- Navkirti Mittal
- Department of Hematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, U.P., India.
| | - Ruchi Gupta
- Department of Hematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, U.P., India.
| | - Khaliqur Rahman
- Department of Hematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, U.P., India.
| | - Tanvi Gupta
- Department of Hematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, U.P., India.
| | - Soniya Nityanand
- Department of Hematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, U.P., India.
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22
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Muchtar E, Kumar SK, Magen H, Gertz MA. Diagnosis and management of smoldering multiple myeloma: the razor's edge between clonality and cancer. Leuk Lymphoma 2017; 59:288-299. [PMID: 28592156 DOI: 10.1080/10428194.2017.1334124] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Smoldering multiple myeloma (SMM) is a rare plasma cell disorder, and as the disease is asymptomatic, diagnosis is often incidental. SMM is characterized by increased marrow infiltration by clonal plasma cells and/or elevated serum M-protein in the absence of a myeloma-defining event (MDE). In recent years, SMM has gained increased attention owing to a broadening of the criteria for MDE, which include apart from the CRAB criteria, three additional parameters. Survival advantage may be offered by early treatment in the high-risk subset, based on a single trial. In this review, we assess the risk factors and models for progression to multiple myeloma. A review of our diagnostic and management approaches to SMM is presented.
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Affiliation(s)
- Eli Muchtar
- a Division of Hematology , Mayo Clinic , Rochester , MN , USA
| | - Shaji K Kumar
- a Division of Hematology , Mayo Clinic , Rochester , MN , USA
| | - Hila Magen
- b Institute of Hematology, Davidoff cancer center, Beilinson Hospital, Rabin Medical Center, Petah-Tikva and Sackler School of Medicine , Tel-Aviv University , Tel-Aviv , Israel
| | - Morie A Gertz
- a Division of Hematology , Mayo Clinic , Rochester , MN , USA
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23
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Le Clech L, Sakka M, Meskar A, Kerspern H, Eveillard JR, Berthou C, Buors C, Lippert E, Guillerm G, Quintin-Roué I, Carré JL, Ianotto JC. The presence of monoclonal gammopathy in Ph-negative myeloproliferative neoplasms is associated with a detrimental effect on outcomes. Leuk Lymphoma 2017; 58:2582-2587. [DOI: 10.1080/10428194.2017.1312380] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Lenaïg Le Clech
- Service d’Hématologie, Institut de Cancéro-Hématologie, CHRU de Brest, Brest, France
| | - Mehdi Sakka
- Laboratoire de Biochimie, CHRU de Brest, Brest, France
| | - Ahmed Meskar
- Laboratoire de Biochimie, CHRU de Brest, Brest, France
| | | | | | - Christian Berthou
- Service d’Hématologie, Institut de Cancéro-Hématologie, CHRU de Brest, Brest, France
| | | | - Eric Lippert
- Laboratoire d’Hématologie, CHRU de Brest, Brest, France
| | - Gaelle Guillerm
- Service d’Hématologie, Institut de Cancéro-Hématologie, CHRU de Brest, Brest, France
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24
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Musto P, Anderson K, Attal M, Richardson P, Badros A, Hou J, Comenzo R, Du J, Durie B, San Miguel J, Einsele H, Chen W, Garderet L, Pietrantuono G, Hillengass J, Kyle R, Moreau P, Lahuerta J, Landgren O, Ludwig H, Larocca A, Mahindra A, Cavo M, Mazumder A, McCarthy P, Nouel A, Rajkumar S, Reiman A, Riva E, Sezer O, Terpos E, Turesson I, Usmani S, Weiss B, Palumbo A. Second primary malignancies in multiple myeloma: an overview and IMWG consensus. Ann Oncol 2017; 28:228-245. [DOI: 10.1093/annonc/mdw606] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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25
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Guo TJ, Huang XJ, Wen L, Lu J. Two Secondary Primary Malignancies after Bortezomib Therapy for Multiple Myeloma: A Single-center Experience. Chin Med J (Engl) 2017; 130:239-241. [PMID: 28091419 PMCID: PMC5282684 DOI: 10.4103/0366-6999.198017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Tian-Jiao Guo
- Department of Hematology, Peking University People's Hospital and Peking University Institute of Hematology, Beijing 100044, China,Department of Hematology, Fu Xing Hospital, Capital Medical University, Beijing 100038, China
| | - Xiao-Jun Huang
- Department of Hematology, Peking University People's Hospital and Peking University Institute of Hematology, Beijing 100044, China
| | - Lei Wen
- Department of Hematology, Peking University People's Hospital and Peking University Institute of Hematology, Beijing 100044, China
| | - Jin Lu
- Department of Hematology, Peking University People's Hospital and Peking University Institute of Hematology, Beijing 100044, China,Address for correspondence: Prof. Jin Lu, Department of Hematology, Peking University People's Hospital and Peking University Institute of Hematology, No. 11 Xizhimen South Street, Xicheng District, Beijing 100044, China E-Mail:
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Snowden JA, Greenfield DM, Bird JM, Boland E, Bowcock S, Fisher A, Low E, Morris M, Yong K, Pratt G. Guidelines for screening and management of late and long-term consequences of myeloma and its treatment. Br J Haematol 2017; 176:888-907. [PMID: 28107574 DOI: 10.1111/bjh.14514] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
A growing population of long-term survivors of myeloma is now accumulating the 'late effects' not only of myeloma itself, but also of several lines of treatment given throughout the course of the disease. It is thus important to recognise the cumulative burden of the disease and treatment-related toxicity in both the stable and active phases of myeloma, some of which is unlikely to be detected by routine monitoring. We summarise here the evidence for the key late effects in long-term survivors of myeloma, including physical and psychosocial consequences (in Parts 1 and 2 respectively), and recommend the use of late-effects screening protocols in detection and intervention. The early recognition of late effects and effective management strategies should lead to an improvement in the management of myeloma patients, although evidence in this area is currently limited and further research is warranted.
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Affiliation(s)
- John A Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Diana M Greenfield
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.,Department of Oncology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Jennifer M Bird
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Elaine Boland
- Palliative Medicine, Queen's Centre for Oncology and Haematology, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | - Stella Bowcock
- King's College Hospital NHS Foundation Trust, London, UK
| | | | | | | | - Kwee Yong
- University College London, London, UK
| | - Guy Pratt
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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28
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Nolte F, Mossner M, Jann JC, Nowak D, Boch T, Müller NZ, Hofmann WK, Metzgeroth G. Concomitant MDS with isolated 5q deletion and MGUS: case report and review of molecular aspects. Eur J Haematol 2016; 98:302-310. [PMID: 27862375 DOI: 10.1111/ejh.12827] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2016] [Indexed: 12/23/2022]
Abstract
Patients with monoclonal gammopathy of undetermined significance (MGUS) have a higher risk for the development of concomitant primary cancers such as multiple myeloma (MM) and myelodysplastic syndrome (MDS). We report the case of patient initially suffering from MGUS of the IgG lambda subtype for more than 10 yr, which evolved to MM and MDS with deletion (5q) with severe pancytopenia. Due to pancytopenia, he received dose-reduced treatment with lenalidomide and dexamethasone. He achieved an ongoing transfusion independency after about 1 month of treatment. Bone marrow taken 14 months after start of treatment showed a complete cytogenetic response of the del(5q) clone and a plasma cell infiltration below 5%. In contrast to the development of MM in MGUS patients, the subsequent occurrence of MDS after diagnosis of MGUS is infrequent. Moreover, the biological association of MDS with MGUS is not sufficiently understood, but the non-treatment-related occurrence supports the pathogenetic role of pre-existing alterations of stem cells. Here, we summarize data on concomitant MDS and MGUS/MM with particular emphasis on molecular aspects.
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Affiliation(s)
- Florian Nolte
- Medical faculty Mannheim of the University of Heidelberg, Mannheim, Germany.,Department of Internal Medicine, Hematology and Oncology, St. Hedwig Hospital, Berlin, Germany
| | - Maximilian Mossner
- Medical faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | | | - Daniel Nowak
- Medical faculty Mannheim of the University of Heidelberg, Mannheim, Germany.,Department of Hematology and Oncology, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Tobias Boch
- Medical faculty Mannheim of the University of Heidelberg, Mannheim, Germany.,Department of Hematology and Oncology, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Nadine Zoe Müller
- Medical faculty Mannheim of the University of Heidelberg, Mannheim, Germany.,Department of Hematology and Oncology, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Wolf-Karsten Hofmann
- Medical faculty Mannheim of the University of Heidelberg, Mannheim, Germany.,Department of Hematology and Oncology, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Georgia Metzgeroth
- Medical faculty Mannheim of the University of Heidelberg, Mannheim, Germany.,Department of Hematology and Oncology, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
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29
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Castillo JJ, Gertz MA. Secondary malignancies in patients with multiple myeloma, Waldenström macroglobulinemia and monoclonal gammopathy of undetermined significance. Leuk Lymphoma 2016; 58:773-780. [DOI: 10.1080/10428194.2016.1217527] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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30
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Simultaneous Manifestation of Chronic Myelomonocytic Leukemia and Multiple Myeloma during Treatment by Prednisolone and Eltrombopag for Immune-Mediated Thrombocytopenic Purpura. Case Rep Hematol 2016; 2016:4342820. [PMID: 27597907 PMCID: PMC5002293 DOI: 10.1155/2016/4342820] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 06/09/2016] [Accepted: 07/10/2016] [Indexed: 11/17/2022] Open
Abstract
An 80-year-old man was admitted to our hospital because of severe thrombocytopenia. He was diagnosed with idiopathic thrombocytopenia, and prednisolone together with eltrombopag was started, leading to significant improvement of platelet counts. Four years later, there was a prominent increase of peripheral blood monocytes, which was accompanied by recurrence of thrombocytopenia. Bone marrow aspirates and serum electrophoresis revealed coexistence of chronic myelomonocytic leukemia (CMML) and multiple myeloma (MM). The patient received lenalidomide plus dexamethasone therapy but died due to exacerbation of the disorder. It was supposed that thrombocytopenia was secondarily caused by CMML and MM developed at a later period.
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Mahindra A, Raval G, Mehta P, Brazauskas R, Zhang MJ, Zhong X, Bird JM, Freytes CO, Hale GA, Herzig R, Holmberg LA, Kamble RT, Kumar S, Lazarus HM, Majhail NS, Marks DI, Moreb JS, Olsson R, Saber W, Savani BN, Schiller GJ, Tay J, Vogl DT, Waller EK, Wiernik PH, Wirk B, Lonial S, Krishnan AY, Dispenzieri A, Brandenburg NA, Gale RP, Hari PN. New cancers after autotransplantations for multiple myeloma. Biol Blood Marrow Transplant 2015; 21:738-45. [PMID: 25555448 PMCID: PMC4359647 DOI: 10.1016/j.bbmt.2014.12.028] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 12/23/2014] [Indexed: 11/23/2022]
Abstract
We describe baseline incidence and risk factors for new cancers in 4161 persons receiving autotransplants for multiple myeloma in the United States from 1990 to 2010. Observed incidence of invasive new cancers was compared with expected incidence relative to the US population. The cohort represented 13,387 person-years at-risk. In total, 163 new cancers were observed, for a crude incidence rate of 1.2 new cancers per 100 person-years and cumulative incidences of 2.6% (95% confidence interval [CI], 2.09 to 3.17), 4.2% (95% CI, 3.49 to 5.00), and 6.1% (95% CI, 5.08 to 7.24) at 3, 5, and 7 years, respectively. The incidence of new cancers in the autotransplantation cohort was similar to age-, race-, and gender-adjusted comparison subjects with an observed/expected (O/E) ratio of 1.00 (99% CI, .81 to 1.22). However, acute myeloid leukemia and melanoma were observed at higher than expected rates with O/E ratios of 5.19 (99% CI, 1.67 to 12.04; P = .0004), and 3.58 (99% CI, 1.82 to 6.29; P < .0001), respectively. Obesity, older age, and male gender were associated with increased risks of new cancers in multivariate analyses. This large data set provides a baseline for comparison and defines the histologic type specific risk for new cancers in patients with MM receiving postautotransplantation therapies, such as maintenance.
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Affiliation(s)
| | | | - Paulette Mehta
- University of Arkansas for Medical Sciences, Little Rock, Arkansas; Central Arkansas Veterans Healthcare System, Little Rock, Arkansas
| | - Ruta Brazauskas
- Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mei-Jie Zhang
- Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Xiaobo Zhong
- Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jennifer M Bird
- University Hospitals Bristol NHS Trust, Bristol, United Kingdom
| | - César O Freytes
- South Texas Veterans Health Care System and University of Texas Health Science Center San Antonio, San Antonio, Texas
| | | | - Roger Herzig
- James Brown Cancer Center, University of Louisville Hospital, Louisville, Kentucky
| | | | - Rammurti T Kamble
- Baylor College of Medicine Center for Cell and Gene Therapy, Houston, Texas
| | | | - Hillard M Lazarus
- Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, Ohio
| | | | - David I Marks
- University Hospitals Bristol NHS Trust, Bristol, United Kingdom
| | - Jan S Moreb
- Shands HealthCare and University of Florida, Gainesville, Florida
| | - Richard Olsson
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden
| | - Wael Saber
- Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Bipin N Savani
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Jason Tay
- University of Ottawa, Ottawa, Ontario, Canada
| | - Dan T Vogl
- Abramson Cancer Center University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
| | - Edmund K Waller
- Winship Cancer Institute, Emory University Hospital, Atlanta, Georgia
| | | | - Baldeep Wirk
- Stony Brook University Medical Center, Stony Brook, New York
| | - Sagar Lonial
- Winship Cancer Institute, Emory University Hospital, Atlanta, Georgia
| | | | | | | | | | - Parameswaran N Hari
- Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin.
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32
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Barceló F, Cerdà JJ, Gutiérrez A, Jimenez-Marco T, Durán MA, Novo A, Ros T, Sampol A, Portugal J. Characterization of monoclonal gammopathy of undetermined significance by calorimetric analysis of blood serum proteome. PLoS One 2015; 10:e0120316. [PMID: 25794164 PMCID: PMC4368597 DOI: 10.1371/journal.pone.0120316] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 02/07/2015] [Indexed: 01/11/2023] Open
Abstract
Monoclonal gammopathy of undetermined significance (MGUS) is a premalignant proliferative disorder that may progress to multiple myeloma, a malignant plasma cell neoplasia. We evaluated differential scanning calorimetry (DSC) as an experimental tool for differentiating serum samples of MGUS patients from healthy individuals. DSC thermograms can be used for monitoring changes in the serum proteome associated with MGUS. MGUS patients showed great variability in serum thermogram characteristics, which depended on the IgG, IgA or IgM isotypes and/or the κ or λ light chains. Thermogram feature parameters distinguished patients with MGUS from healthy people. Serum samples, named as non-MGUS, were also collected from patients with subjacent immunological pathologies who were discarded of having MGUS through serum immunofixation. They were used to verify the sensitivity of DSC for discriminating MGUS from related blood dyscrasias. Only some DSC thermogram feature parameters differentiated, to a lesser extent, between MGUS and non-MGUS individuals. We contemplate DSC as a tool for early diagnosis and monitoring of MGUS.
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Affiliation(s)
- Francisca Barceló
- Grupo de Investigación Clínica y Translacional, Instituto Universitario de Investigación en Ciencias de la Salud, Universidad de las Islas Baleares, Palma de Mallorca, Spain
- * E-mail:
| | - Joan J. Cerdà
- Instituto de Física Interdisciplinar y Sistemas Complejos, Universidad de las Islas Baleares-Consejo Superior de Investigaciones Científicas, Palma de Mallorca, Spain
| | - Antonio Gutiérrez
- Biología Clínica Hematológica, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Teresa Jimenez-Marco
- Fundación Banco de Sangre y Tejidos de las Islas Baleares, e Instituto Universitario de Investigación en Ciencias de la Salud-Universidad de las Islas Baleares, Palma de Mallorca, Spain
| | - M. Antonia Durán
- Biología Clínica Hematológica, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Andrés Novo
- Biología Clínica Hematológica, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Teresa Ros
- Biología Clínica Hematológica, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Antonia Sampol
- Servicio de Hematología y Hemoterapia, Instituto de Investigación Sanitaria de Palma, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - José Portugal
- Instituto de Biologia Molecular de Barcelona, Consejo Superior de Investigaciones Científicas, Barcelona, Spain
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Matthes T, McKee T, Dunand-Sauthier I, Manfroi B, Park S, Passweg J, Huard B. Myelopoiesis dysregulation associated to sustained APRIL production in multiple myeloma-infiltrated bone marrow. Leukemia 2015; 29:1901-8. [DOI: 10.1038/leu.2015.68] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 02/24/2015] [Accepted: 02/25/2015] [Indexed: 12/22/2022]
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Gertz MA, Terpos E, Dispenzieri A, Kumar S, Shah RA, Orlowski R, Kastritis E, Dimopoulos MA, Shah J. Therapy-related myelodysplastic syndrome/acute leukemia after multiple myeloma in the era of novel agents. Leuk Lymphoma 2014; 56:1723-6. [PMID: 25284489 DOI: 10.3109/10428194.2014.970543] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Survival for patients with multiple myeloma has increased. Both melphalan and lenalidomide are associated with subsequent development of myelodysplasia. We reviewed the cases of all patients with multiple myeloma who had subsequent development of myelodysplastic syndrome (MDS) or acute non-lymphoblastic leukemia (ANLL) during a 12-year period in three centers. Of 55 patients identified, two received only lenalidomide before myelodysplasia developed. The median time between the diagnoses of multiple myeloma and MDS/ANLL was 52.7 months. Median survival after the diagnosis of MDS or ANLL was 6.7 months. Treatment of MDS comprised allogeneic stem cell transplant in eight patients (median survival, 219 days; one patient alive at 624 days) and a hypomethylating agent in 21 patients (response of stable or better in five patients). Myelodysplasia remains a devastating complication of therapy for multiple myeloma, with short survival and poor response rates to available modalities.
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Monoclonal Gammopathy of Undetermined Significance and Smoldering Multiple Myeloma. Hematol Oncol Clin North Am 2014; 28:775-90. [DOI: 10.1016/j.hoc.2014.06.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Ailawadhi S, Swaika A, Razavi P, Yang D, Chanan-Khan A. Variable risk of second primary malignancy in multiple myeloma patients of different ethnic subgroups. Blood Cancer J 2014; 4:e243. [PMID: 25192415 PMCID: PMC4183772 DOI: 10.1038/bcj.2014.63] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 07/10/2014] [Accepted: 07/24/2014] [Indexed: 12/31/2022] Open
Abstract
Second primary malignancies (SPMs) among multiple myeloma (MM) patients have been reported with an estimated incidence varying from 1 to 15%. We have previously reported that significant disparity exists in MM survival across patients of different ethnicities. We undertook a Surveillance Epidemiology and End Results-based analysis to describe the incidence of SPMs among MM patients of different ethnicities, to explore the variable impact that SPMs might have on MM outcomes of patients across racial subgroups. We found that the risk of developing SPMs among MM patients is variable depending on the patient's ethnic background. This warrants further exploration of the impact of SPMs on outcomes of MM patients across different racial subgroups, especially in the form of prospective data collection and analyses.
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Affiliation(s)
- S Ailawadhi
- Division of Hematology/Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - A Swaika
- Division of Hematology/Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - P Razavi
- Division of Hematology/Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - D Yang
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - A Chanan-Khan
- Division of Hematology/Oncology, Mayo Clinic, Jacksonville, FL, USA
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Myelodysplastic syndrome with 5q deletion following IgM monoclonal gammopathy, showing gene mutation MYD88 L265P. Blood Cells Mol Dis 2014; 54:51-2. [PMID: 25159121 DOI: 10.1016/j.bcmd.2014.07.022] [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: 05/02/2014] [Accepted: 07/29/2014] [Indexed: 11/22/2022]
Abstract
Patients affected by monoclonal gammopathy of undetermined significance (MGUS) very rarely develop a myelodysplastic syndrome (MDS). However, it was also demonstrated that MGUS patients had a significantly increased risk of developing MDS compared to the general population. We report a case of 5q-syndrome following a MGUS IgMk with mutation of MYD88 L256P. To our knowledge, this is the first case of del(5q) MDS following MGUS IgMk with the MYD88 L256P mutation in which there is coexistence of the markers of the two clonal diseases, but as an expression of distinct pathological features.
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38
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van de Donk NWCJ, Palumbo A, Johnsen HE, Engelhardt M, Gay F, Gregersen H, Hajek R, Kleber M, Ludwig H, Morgan G, Musto P, Plesner T, Sezer O, Terpos E, Waage A, Zweegman S, Einsele H, Sonneveld P, Lokhorst HM. The clinical relevance and management of monoclonal gammopathy of undetermined significance and related disorders: recommendations from the European Myeloma Network. Haematologica 2014; 99:984-96. [PMID: 24658815 PMCID: PMC4040895 DOI: 10.3324/haematol.2013.100552] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 03/14/2014] [Indexed: 12/18/2022] Open
Abstract
Monoclonal gammopathy of undetermined significance is one of the most common pre-malignant disorders. IgG and IgA monoclonal gammopathy of undetermined significance are precursor conditions of multiple myeloma; light-chain monoclonal gammopathy of undetermined significance of light-chain multiple myeloma; and IgM monoclonal gammopathy of undetermined significance of Waldenström's macroglobulinemia and other lymphoproliferative disorders. Clonal burden, as determined by bone marrow plasma cell percentage or M-protein level, as well as biological characteristics, including heavy chain isotype and light chain production, are helpful in predicting risk of progression of monoclonal gammopathy of undetermined significance to symptomatic disease. Furthermore, alterations in the bone marrow microenvironment of monoclonal gammopathy of undetermined significance patients result in an increased risk of venous and arterial thrombosis, infections, osteoporosis, and bone fractures. In addition, the small clone may occasionally be responsible for severe organ damage through the production of a monoclonal protein that has autoantibody activity or deposits in tissues. These disorders are rare and often require therapy directed at eradication of the underlying plasma cell or lymphoplasmacytic clone. In this review, we provide an overview of the clinical relevance of monoclonal gammopathy of undetermined significance. We also give general recommendations of how to diagnose and manage patients with monoclonal gammopathy of undetermined significance.
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Affiliation(s)
| | - Antonio Palumbo
- Divisione di Ematologia dell'Università di Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Turin, Italy
| | - Hans Erik Johnsen
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark
| | - Monika Engelhardt
- Department of Hematology and Oncology, University of Freiburg Medical Center, Germany
| | - Francesca Gay
- Divisione di Ematologia dell'Università di Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Turin, Italy
| | - Henrik Gregersen
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark
| | - Roman Hajek
- Department of Haemato-oncology, University Hospital Ostrava and Faculty of Medicine, Czech Republic
| | - Martina Kleber
- Department of Hematology and Oncology, University of Freiburg Medical Center, Germany
| | - Heinz Ludwig
- Department of Medicine I, Wilhelminenspital Wien, Austria
| | - Gareth Morgan
- Institute of Cancer Research, Royal Marsden Hospital, London, UK
| | - Pellegrino Musto
- Scientific Direction, Centro di Riferimento Oncologico della Basilicata, Istituto di Ricovero e Cura a Carattere Scientifico, Rionero in Vulture, Italy
| | | | - Orhan Sezer
- Department of Hematology, Memorial Hospital, Istanbul, Turkey
| | - Evangelos Terpos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Greece
| | - Anders Waage
- Department of Hematology, St. Olavs Hospital, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sonja Zweegman
- Department of Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - Hermann Einsele
- Universitätsklinik Würzburg, Medizinische Klinik und Poliklinik II, Würzburg, Germany
| | - Pieter Sonneveld
- Department of Hematology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Henk M Lokhorst
- Department of Hematology, University Medical Center Utrecht, The Netherlands
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Yoshida Y, Oguma S, Ohno H, Nakabo Y, Katsurada T, Kawahara M, Kawabata H. Co-occurrence of monoclonal gammopathy and myelodysplasia: a retrospective study of fourteen cases. Int J Hematol 2014; 99:721-5. [DOI: 10.1007/s12185-014-1570-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 03/12/2014] [Accepted: 03/13/2014] [Indexed: 12/01/2022]
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40
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Matarraz S, Paiva B, Díez-Campelo M, Bárrena S, Jara-Acevedo M, Gutiérrez ML, Sayagués JM, Sánchez ML, Bárcena P, Garrastazul MP, Berruezo MJ, Duran JM, Cerveró C, García-Erce JA, Florensa L, Méndez GD, Gutierrez O, Del Cañizo MC, van Dongen JJM, San Miguel JF, Orfao A. Immunophenotypic alterations of bone marrow myeloid cell compartments in multiple myeloma patients predict for myelodysplasia-associated cytogenetic alterations. Leukemia 2014; 28:1747-50. [PMID: 24625552 DOI: 10.1038/leu.2014.103] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- S Matarraz
- Department of Medicine, Centro de Investigación del Cáncer (IBMCC, University of Salamanca-CSIC) and IBSAL, Salamanca, Spain
| | - B Paiva
- Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada (CIMA), Pamplona, Spain
| | - M Díez-Campelo
- Department of Hematology, University Hospital, IBSAL and University of Salamanca, Salamanca, Spain
| | - S Bárrena
- Department of Medicine, Centro de Investigación del Cáncer (IBMCC, University of Salamanca-CSIC) and IBSAL, Salamanca, Spain
| | - M Jara-Acevedo
- Department of Medicine, Centro de Investigación del Cáncer (IBMCC, University of Salamanca-CSIC) and IBSAL, Salamanca, Spain
| | - M L Gutiérrez
- Department of Medicine, Centro de Investigación del Cáncer (IBMCC, University of Salamanca-CSIC) and IBSAL, Salamanca, Spain
| | - J M Sayagués
- Department of Medicine, Centro de Investigación del Cáncer (IBMCC, University of Salamanca-CSIC) and IBSAL, Salamanca, Spain
| | - M-L Sánchez
- Department of Medicine, Centro de Investigación del Cáncer (IBMCC, University of Salamanca-CSIC) and IBSAL, Salamanca, Spain
| | - P Bárcena
- Department of Medicine, Centro de Investigación del Cáncer (IBMCC, University of Salamanca-CSIC) and IBSAL, Salamanca, Spain
| | - M P Garrastazul
- Department of Hematology, Hospital Punta Europa, Algeciras, Spain
| | - M J Berruezo
- Department of Hematology, Hospital Punta Europa, Algeciras, Spain
| | - J M Duran
- Department of Hematology, Hospital La Línea, Cádiz, Spain
| | - C Cerveró
- Department of Hematology, Hospital Virgen de la Luz, Cuenca, Spain
| | | | - L Florensa
- Department of Hematology, Hospital del Mar, Barcelona, Spain
| | - G D Méndez
- Department of Hematology, Hospital de Jerez, Cádiz, Spain
| | - O Gutierrez
- Department of Hematology, Rio Hortega Hospital, Valladolid, Spain
| | - M C Del Cañizo
- Department of Hematology, University Hospital, IBSAL and University of Salamanca, Salamanca, Spain
| | - J J M van Dongen
- Department of Immunology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - J F San Miguel
- Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada (CIMA), Pamplona, Spain
| | - A Orfao
- Department of Medicine, Centro de Investigación del Cáncer (IBMCC, University of Salamanca-CSIC) and IBSAL, Salamanca, Spain
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41
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Update on second primary malignancies in multiple myeloma: a focused review. Leukemia 2014; 28:1423-6. [DOI: 10.1038/leu.2014.22] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 10/30/2013] [Accepted: 11/05/2013] [Indexed: 01/14/2023]
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