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Shi L, Yan W, Xu J, Li L, Cui J, Liu Y, Du C, Yu T, Zhang S, Sui W, Deng S, Xu Y, Zou D, Wang H, Qiu L, An G. Immunophenotypic profile defines cytogenetic stability and unveils distinct prognoses in patients with newly-diagnosed multiple myeloma (NDMM). Ann Hematol 2024; 103:1305-1315. [PMID: 38049586 DOI: 10.1007/s00277-023-05573-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/28/2023] [Indexed: 12/06/2023]
Abstract
Prognostic significance of multiple immune antigens in multiple myeloma has been well established. However, a level of uncertainty remains regarding the intrinsic relationship between immunophenotypes and cytogenetic stability and precise risk stratification. To address these unresolved issues, we conducted a study involving 1389 patients enrolled in the National Longitudinal Cohort of Hematological Diseases in China (NCT04645199). Our results revealed that the correlation between antigen expression and cytogenetics is more prominent than cytopenia or organ dysfunction. Most immune antigens, apart from CD38, CD138, and CD81, exhibit significant associations with the incidence of at least one cytogenetic abnormality. In turn, we identified CD138-low/CD27-neg as specific adverse immunophenotypic profile, which remaining independent impact on progression-free survival (HR, 1.49; P = 0.007) and overall survival (HR, 1.77; P < 0.001) even in the context of cytogenetics. Importantly, CD138-low/CD27-neg profile was also associated with inferior survival after first relapse (P < 0.001). Moreover, the antigen expression profiles were not strictly similar when comparing diagnosis and relapse; in particular, the CD138-low/CD27-neg pattern was notably increased after disease progression (19.1 to 29.1%; P = 0.005). Overall, our study demonstrates that diverse immune profiles are strongly associated with cytogenetic stability, and a specific immunophenotype (CD138-low/CD27-neg) could effectively predict prognoses across different disease stages.
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Affiliation(s)
- Lihui Shi
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China
- Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Wenqiang Yan
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China
- Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Jingyu Xu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China
- Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Lingna Li
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China
- Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Jian Cui
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China
- Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Yuntong Liu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China
- Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Chenxing Du
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China
- Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Tengteng Yu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China
- Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Shuaishuai Zhang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China
- Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Weiwei Sui
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China
- Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Shuhui Deng
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China
- Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Yan Xu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China
- Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Dehui Zou
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China
- Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Huijun Wang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China
- Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Lugui Qiu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China.
- Tianjin Institutes of Health Science, Tianjin, 301600, China.
| | - Gang An
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China.
- Tianjin Institutes of Health Science, Tianjin, 301600, China.
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Notarfranchi L, Segreto R, Vescovini R, Dalla Palma AB, Marchica V, Burroughs-Garcia J, Toscani D, Todaro G, Raimondi V, Iannozzi NT, Bonomini S, Sammarelli G, Craviotto L, Pedrazzoni M, Storti P, Giuliani N. The impact of CD56 expression in smoldering myeloma patients on early progression. Hematol Oncol 2023; 41:587-589. [PMID: 36441875 DOI: 10.1002/hon.3104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Laura Notarfranchi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Hematology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Roberta Segreto
- Hematology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Rosanna Vescovini
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | | | | | - Denise Toscani
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Giannalisa Todaro
- Hematology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Vincenzo Raimondi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Sabrina Bonomini
- Hematology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | | | - Luisa Craviotto
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Hematology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Mario Pedrazzoni
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Paola Storti
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Nicola Giuliani
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Hematology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
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3
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Geng C, Zhou H, Wang H, Li Y, Leng Y, Zhang Z, Jian Y, Yang G, Chen W. Newly diagnosed multiple myeloma patients with CD56 expression benefit more from autologous stem cell transplantation. BMC Cancer 2022; 22:1349. [PMID: 36564753 PMCID: PMC9783713 DOI: 10.1186/s12885-022-10382-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 11/29/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Several studies showed that lack of CD56 expression was a poor prognostic factor for patients with newly diagnosed multiple myeloma (NDMM). However, other studies were not able to confirm the prognostic value of CD56 in NDMM. This study aimed to evaluate the prognostic value of CD56 expression for patients with NDMM who received autologous stem cell transplantation (ASCT). METHODS We retrospectively analyzed 370 patients with NDMM under 66 years old and the propensity score matching technique was used to reduce the bias between two groups. RESULTS CD56 expression was observed in 250 (67.6%) patients, and only half of transplant-eligible patients received ASCT for financial and adverse effects concerns after induction therapy. 54.8% (137/250) CD56 positive patients received ASCT; and 47.5% (57/120) CD56 negative patients received ASCT. Univariate and multivariate analyses showed that ASCT was correlated with longer overall survival (OS) (p < 0.001) and progression-free survival (PFS) (p < 0.001) for CD56 positive patients. However, ASCT had no impact on OS and PFS in univariate and multivariate analysis (p > 0.05). In the propensity score matching analysis, 186 CD56 positive patients were identified, 93 patients had received ASCT and 93 patients had no ASCT. Among 120 CD56 negative patients, 80 patients, 40 in each group, were identified. Among 186 matched CD56 positive patients, patients with ASCT had longer OS (87.6 vs.56.1 months, p = 0.049) and PFS (36.7 vs.30.9 months, p = 0.040). However, ASCT had no impact on OS and PFS for matched CD56 negative patients (p > 0.05). CONCLUSIONS These results demonstrated that ASCT may improve OS and PFS of CD56 positive patients and had no impact on survival of CD56 negative patients.
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Affiliation(s)
- Chuanying Geng
- grid.24696.3f0000 0004 0369 153XDepartment of Hematology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020 China
| | - Huixing Zhou
- grid.24696.3f0000 0004 0369 153XDepartment of Hematology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020 China
| | - Huijuan Wang
- grid.24696.3f0000 0004 0369 153XDepartment of Hematology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020 China
| | - Yanchen Li
- grid.24696.3f0000 0004 0369 153XDepartment of Hematology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020 China
| | - Yun Leng
- grid.24696.3f0000 0004 0369 153XDepartment of Hematology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020 China
| | - Zhiyao Zhang
- grid.24696.3f0000 0004 0369 153XDepartment of Hematology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020 China
| | - Yuan Jian
- grid.24696.3f0000 0004 0369 153XDepartment of Hematology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020 China
| | - Guangzhong Yang
- grid.24696.3f0000 0004 0369 153XDepartment of Hematology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020 China
| | - Wenming Chen
- grid.24696.3f0000 0004 0369 153XDepartment of Hematology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020 China
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Li L, Li X, Shang A, Zhao Y, Jin L, Zhao M, Shen W. Prognostic significance of CD56 antigen in newly diagnosed multiple myeloma: A real-world retrospective study. Medicine (Baltimore) 2022; 101:e30988. [PMID: 36221376 PMCID: PMC9542762 DOI: 10.1097/md.0000000000030988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The prognostic value of plasma cell CD56 expression of patients with multiple myeloma (MM) has been reported in many studies, but the results are controversial. This study aimed to examine the prognostic significance of CD56 in MM patients. Eighty seven patients with newly diagnosed MM were enrolled in this study, and their clinical characteristics, immunophenotypes, and cytogenetics were retrospectively analyzed to explore the prognostic significance of CD56 expression. Multiparameter flow cytometry was used to detect MM in bone marrow samples from all patients. Patients were divided into 2 groups based on whether they expressed CD56: CD56 + group and CD56 - group. After 4 cycles of chemotherapy, the overall response rate of the CD56 - patients was lower than that of the CD56 + patients (60.0% vs 81.1%, P = .036). Survival analysis showed that the median progression-free survival (PFS) was 10 months for the CD56 - group and 27 months for the CD56 + group (P = .007). The median overall survival (OS) of patients for the CD56 - group was 25 months versus not reached in the CD56 + group (P = .010). In addition, among the high-risk patients detected by fluorescence in situ hybridization (FISH), the median PFS was 4 months for the CD56 - group and 16 months for the CD56 + group (P = .012). The median OS of the CD56 + group and CD56 - group was 36 months and 15 months, respectively, with statistically significant differences (P = .017). Our study confirmed that CD56 - patients with MM had a worse prognosis than that of CD56 + patients with MM. Among the patients with ≥ 2 high-risk cytogenetics, the existence of the CD56 negativity can further identify MM patients with poor PFS and OS.
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Affiliation(s)
- Liping Li
- Department of Oncology and Hematology, The Second Hospital of Jilin University, Nanguan District, Changchun City, Jilin, China
| | - Xiaofeng Li
- Department of Oncology and Hematology, The Second Hospital of Jilin University, Nanguan District, Changchun City, Jilin, China
| | - An Shang
- Department of Oncology and Hematology, The Second Hospital of Jilin University, Nanguan District, Changchun City, Jilin, China
| | - Yan Zhao
- Department of Oncology and Hematology, The Second Hospital of Jilin University, Nanguan District, Changchun City, Jilin, China
| | - Lifang Jin
- Department of Oncology and Hematology, The Second Hospital of Jilin University, Nanguan District, Changchun City, Jilin, China
| | - Meng Zhao
- Department of Oncology and Hematology, The Second Hospital of Jilin University, Nanguan District, Changchun City, Jilin, China
| | - Weizhang Shen
- Department of Oncology and Hematology, The Second Hospital of Jilin University, Nanguan District, Changchun City, Jilin, China
- *Correspondence: Weizhang Shen, Department of Oncology and Hematology, The Second Hospital of Jilin University, No 218, Lane Ziqiang, Nanguan District, Changchun City, Jilin Province, 130041, China (e-mail: )
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5
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[Update on biology of primary plasma cell leukemia]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2022; 43:603-607. [PMID: 36709141 PMCID: PMC9395563 DOI: 10.3760/cma.j.issn.0253-2727.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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6
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Cottini F, Rodriguez J, Hughes T, Sharma N, Guo L, Lozanski G, Liu B, Cocucci E, Yang Y, Benson D. Redefining CD56 as a biomarker and therapeutic target in Multiple Myeloma. Mol Cancer Res 2022; 20:1083-1095. [PMID: 35380709 DOI: 10.1158/1541-7786.mcr-21-0828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 02/11/2022] [Accepted: 03/29/2022] [Indexed: 11/16/2022]
Abstract
Multiple myeloma (MM) cells aberrantly express surface antigens compared to normal plasma cells. Among others, CD56 is present at variable levels in approximately 70% of MM patients; however very little is known about CD56 role in MM. We demonstrated that MM patients with more than 10 percent of CD56-expressing clonal MM cells have inferior clinical outcomes. By gain-of and loss-of function models, we revealed that CD56 promotes MM cell growth, survival, and adhesion to stromal cells. These protumoral effects are induced by the activation of the RSK2/CREB1 signaling pathway, with increased mRNA and protein levels of the anti-apoptotic genes BCL2 and MCL1. Consequently, the genomic and pharmacological inhibition of RSK2 or CREB1 specifically induced MM cell death in CD56-expressing MM cells. Finally, we observed that CD56 signaling decreases CRBN expression, reducing responses to lenalidomide. RSK2 or CREB1 inhibition increased CRBN levels and were synergic with lenalidomide in inducing cell death, especially in CD56-expressing MM cells. In conclusion, our findings demonstrate that CD56 promotes MM cell growth, and pave the way to novel therapies based on targeting CD56, along with the use of CD56 as a predictive biomarker for MM therapies. Implications: Multiple myeloma (MM) is an incurable, genetically heterogeneous disease, without available tailored therapeutic approaches. CD56 signaling promotes MM growth and adhesion, by activating CREB1 target genes, MCL1 and BCL2. Inhibition of CREB1 alone or in combination with lenalidomide is an unexplored synthetic lethal approach in CD56-expressing MM patients.
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Affiliation(s)
- Francesca Cottini
- Division of Hematology, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Jose Rodriguez
- Division of Hematology, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Tiffany Hughes
- Division of Hematology, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Nidhi Sharma
- Division of Hematology, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Ling Guo
- Department of Pathology, OhioHealth, Columbus, Ohio
| | - Gerard Lozanski
- Department of Pathology, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Bei Liu
- Division of Hematology, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Emanuele Cocucci
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
- The Ohio State University, College of Pharmacy, Columbus, Ohio
| | - Yiping Yang
- Division of Hematology, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Don Benson
- Division of Hematology, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
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7
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Zhang L, Huang Y, Lin Y, Zhang A, Zou R, Xu H, Wang S. Prognostic significance of CD56 expression in patients with multiple myeloma: a meta-analysis. Hematology 2022; 27:122-131. [PMID: 35068378 DOI: 10.1080/16078454.2021.2019365] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Lijuan Zhang
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, People’s Republic of China
- Department of Hematology, The First Affiliated Hospital of Xiamen University, Xiamen, People’s Republic of China
| | - Yun Huang
- Department of Hematology, The First Affiliated Hospital of Xiamen University, Xiamen, People’s Republic of China
| | - Yun Lin
- Department of Hematology, The First Affiliated Hospital of Xiamen University, Xiamen, People’s Republic of China
| | - Aili Zhang
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, People’s Republic of China
- Department of Hematology, The First Affiliated Hospital of Xiamen University, Xiamen, People’s Republic of China
| | - Rong Zou
- Department of Hematology, The First Affiliated Hospital of Xiamen University, Xiamen, People’s Republic of China
| | - Huiying Xu
- Department of Hematology, The First Affiliated Hospital of Xiamen University, Xiamen, People’s Republic of China
| | - Sili Wang
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, People’s Republic of China
- Department of Hematology, The First Affiliated Hospital of Xiamen University, Xiamen, People’s Republic of China
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8
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Iltar U, Ataş Ü, Vural E, Alhan FN, Yücel OK, Salim O, Undar L. Outcomes of stem cell mobilization and engraftment in patients with multiple myeloma according to CD56 expression status. Transfus Apher Sci 2022; 61:103351. [PMID: 35022157 DOI: 10.1016/j.transci.2022.103351] [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: 11/12/2021] [Revised: 12/31/2021] [Accepted: 01/05/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND The molecular mechanism underlying the mobilization and engraftment of CD34+ cells is poorly understood. The most relevant factors in the regulation of stem cell release and engraftment include chemokines, adhesion molecules, and chemokine receptors. Previously, it was suggested that the absence of CD56 expression could be used as a predictive factor for mobilization failure at the time of diagnosis. Here, we investigated the effect of CD56 expression status on both mobilization and engraftment processes. Additionally, other factors affecting mobilization and engraftment efficacy were investigated. METHODS Data from 79 multiple myeloma patients undergoing autologous stem cell transplantation between 2015 and 2020 were analyzed for peripheral stem cell mobilization and posttransplant neutrophil and platelet engraftment according to CD56 expression on myeloma cells. RESULTS No difference in either the median number of CD34+ cells collected or time to engraftment was found between the CD56+ and CD56- groups. The age of the patients (p = 0.025) and peak number of circulating CD34+ cells in peripheral blood (p = 0.005) were important predictors for a higher number of collected CD34+ cells. The average time to recovery of leukocytes and platelets after transplantation was markedly correlated with the number of transplanted stem cells and peak number of circulating CD34+ cells in peripheral blood, respectively (p = 0.049 and p = 0.003). CONCLUSIONS Our results indicated no effect of CD56 expression status on the mobilization and engraftment of PBSCs. Our results also support the notion that the peak number of circulating CD34+ cells in peripheral blood is clinically important for rapid platelet engraftment following HPC transplantation.
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Affiliation(s)
- Utku Iltar
- Akdeniz University, Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Antalya, Turkey.
| | - Ünal Ataş
- Akdeniz University, Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Antalya, Turkey
| | - Ece Vural
- Akdeniz University, Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Antalya, Turkey
| | - Fadime Nurcan Alhan
- Akdeniz University, Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Antalya, Turkey
| | - Orhan Kemal Yücel
- Akdeniz University, Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Antalya, Turkey
| | - Ozan Salim
- Akdeniz University, Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Antalya, Turkey
| | - Levent Undar
- Akdeniz University, Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Antalya, Turkey
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9
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Bezdekova R, Jelinek T, Kralova R, Stork M, Polackova P, Vsianska P, Brozova L, Jarkovsky J, Almasi M, Boichuk I, Knechtova Z, Penka M, Pour L, Sevcikova S, Hajek R, Rihova L. Necessity of flow cytometry assessment of circulating plasma cells and its connection with clinical characteristics of primary and secondary plasma cell leukaemia. Br J Haematol 2021; 195:95-107. [PMID: 34500493 PMCID: PMC9292932 DOI: 10.1111/bjh.17713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/30/2021] [Indexed: 01/23/2023]
Abstract
Plasma cell leukaemia (PCL) is a rare and very aggressive plasma cell disorder. Preventing a dismal outcome of PCL requires early diagnosis with appropriate analytical tools. Therefore, the investigation of 33 patients with primary and secondary PCL was done when the quantity of circulating plasma cells (PCs) using flow cytometry (FC) and morphology assessment was evaluated. The phenotypic profile of the PCs was also analysed to determine if there is an association with clinical outcomes and to evaluate the prognostic value of analysed markers. Our results revealed that FC is an excellent method for identifying circulating PCs as a significantly higher number was identified by FC than by morphology (26·7% vs. 13·5%, P = 0·02). None of secondary PCL cases expressed CD19 or CD20. A low level of expression with similar positivity of CD27, CD28, CD81 and CD117 was found in both PCL groups. A decrease of CD44 expression was detected only in secondary PCL. Expression of CD56 was present in more than half of PCL cases as well as cytoplasmic nestin. A decreased level of platelets, Eastern Cooperative Oncology Group score of 2-3 and lack of CD20+ PC were associated with a higher risk of death. FC could be incorporated in PCL diagnostics not only to determine the number of circulating PCs, but also to assess their phenotype profile and this information should be useful in patients' diagnosis and possible prognosis.
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Affiliation(s)
- Renata Bezdekova
- Department of Clinical Hematology, University Hospital Brno, Brno, Czech Republic.,Babak Myeloma Group, Department of Pathophysiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Tomas Jelinek
- Department of Hematooncology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Romana Kralova
- Department of Clinical Hematology, University Hospital Brno, Brno, Czech Republic.,Babak Myeloma Group, Department of Pathophysiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Martin Stork
- Department of Internal Medicine - Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - Petra Polackova
- Department of Clinical Hematology, University Hospital Brno, Brno, Czech Republic
| | - Pavla Vsianska
- Department of Clinical Hematology, University Hospital Brno, Brno, Czech Republic.,Babak Myeloma Group, Department of Pathophysiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Lucie Brozova
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jiri Jarkovsky
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Martina Almasi
- Department of Clinical Hematology, University Hospital Brno, Brno, Czech Republic.,Babak Myeloma Group, Department of Pathophysiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Ivanna Boichuk
- Department of Internal Medicine - Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - Zdenka Knechtova
- Department of Internal Medicine - Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - Miroslav Penka
- Department of Clinical Hematology, University Hospital Brno, Brno, Czech Republic
| | - Ludek Pour
- Department of Internal Medicine - Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - Sabina Sevcikova
- Department of Clinical Hematology, University Hospital Brno, Brno, Czech Republic.,Babak Myeloma Group, Department of Pathophysiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Roman Hajek
- Department of Hematooncology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Lucie Rihova
- Department of Clinical Hematology, University Hospital Brno, Brno, Czech Republic.,Babak Myeloma Group, Department of Pathophysiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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10
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Immunophenotypic Characterization and Ploidy Analysis of Neoplastic Plasma Cells by Multiparametric Flow Cytometry. Indian J Hematol Blood Transfus 2021; 38:473-480. [DOI: 10.1007/s12288-021-01477-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 05/04/2021] [Indexed: 11/26/2022] Open
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11
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Koumpis E, Tassi I, Malea T, Papathanasiou K, Papakonstantinou I, Serpanou A, Tsolas E, Kapsali E, Vassilakopoulos TP, Papoudou-Bai A, Hatzimichael E. CD56 expression in multiple myeloma: Correlation with poor prognostic markers but no effect on outcome. Pathol Res Pract 2021; 225:153567. [PMID: 34352440 DOI: 10.1016/j.prp.2021.153567] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 07/25/2021] [Accepted: 07/26/2021] [Indexed: 11/17/2022]
Abstract
CD56 or neural cell adhesion molecule (NCAM) is a membrane glycoprotein expressed on neural cells, muscle tissues and myeloma cells. Expression of CD56 has been studied in patients with multiple myeloma (MM) with controversial results. The scope of this study was to examine the expression of CD56 in MM patients at diagnosis and investigate its association with clinicopathologic parameters. We retrospectively collected and analyzed data from 109 patients with MM diagnosed over the last decade (January 2010 to June 2020). Expression of CD56 was assessed by immunohistochemistry in bone marrow biopsies and investigated its association with a variety of clinicopathological parameters. For the statistical analysis χ2 test and Mann-Whitney U tests were used to compare categorical and continuous variables in CD56+ and CD56- patients, respectively. Statistical analysis was performed using SPSS 21.0 for Windows (SPSS, Chicago, IL). Based on the expression of CD56 the patient population was divided to CD56+ patients and CD56- patients; Sixty-eight patients were CD56 + and 41 patients were CD56-. Absence of CD56 expression was associated with unfavorable prognostic parameters such as elevated lactate dehydrogenase (LDH) and β2-microglobulin levels, advanced stage according to the International Staging System (ISS) and clonal bone marrow plasma cell infiltration ≥ 60%, but no effect on outcome, while the expression of CD56 was associated with well differentiated neoplastic plasma cells. Our study confirmed that lack of CD56 expression is a possible marker of poor prognosis in patients with MM. The detection of CD56 expression by either immunohistochemistry or flow cytometry is simple and cheap, and it could be incorporated in future prognostic or predictive scores. Prospective studies are needed in order to evaluate the role of expression of CD56 as a predictive biomarker in the era of novel regimens.
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Affiliation(s)
- Epameinondas Koumpis
- Department of Haematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Iliana Tassi
- Department of Haematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Theodora Malea
- Department of Haematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Konstantina Papathanasiou
- Department of Haematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Ioannis Papakonstantinou
- Department of Haematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Anastasia Serpanou
- Department of Haematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Evangelos Tsolas
- Department of Haematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Eleni Kapsali
- Department of Haematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Theodoros P Vassilakopoulos
- Department of Haematology and Bone Marrow Transplantation, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandra Papoudou-Bai
- Department of Pathology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Eleftheria Hatzimichael
- Department of Haematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece.
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12
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Göçer M, Kurtoğlu E. Is absence of CD56 a predictive factor for peripheral blood stem cell mobilization failure in patients with multiple myeloma? J Clin Apher 2020; 36:332-339. [PMID: 33333593 DOI: 10.1002/jca.21864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/22/2020] [Accepted: 12/06/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND CD56 is believed to play a major role in MM pathogenesis with a 70% to 80% expression rate in malignant plasma cells at the time of diagnosis. Our objective in this study was to investigate the relationship between the characteristics of CD56 expression in bone marrow aspiration material at the time of diagnosis and the success of stem cell mobilization in patients diagnosed with MM. METHODS This monocenter study included 94 patients who were diagnosed with MM and had a stem cell mobilization procedure for autologous hematopoietic stem cell transplantation. The primary endpoint of the study was to compare the mobilization success between the groups with and without CD56 expression. The secondary endpoint was to identify other factors affecting mobilization failure outside CD56. RESULTS At the time of diagnosis, 49 (52.1%) patients had CD56 expression and 45 (47.9%) did not. Mobilization failed in 11 (11.7%) patients. Age, gender, ISS stage and the number of premobilization treatment regimens were not found predictive of mobilization failure. CD56 negativity was 42.2% in the group that had mobilization success and 90.9% in the group that had mobilization failure (P = .001). CONCLUSIONS The fact that CD56 residing on the membrane enables interaction between bone marrow cells and ECM and functions as a signal molecule increases sensitivity to the chemotherapy and G-CSF that are used for mobilization. We found that absence of CD56 can be used as a predictive factor for mobilization failure at the time of diagnosis.
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Affiliation(s)
- Mesut Göçer
- Department of Internal Medicine, Division of Hematology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Erdal Kurtoğlu
- Department of Internal Medicine, Division of Hematology, Antalya Training and Research Hospital, Antalya, Turkey
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13
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Hu JJ, Nie SM, Gao Y, Yan XS, Huang JX, Li TL, Liu SS, Mao CX, Zhou JJ, Xu YJ, Wang W, Meng FJ, Feng XQ. [The correlations and prognostic value of neutrophil to lymphocyte ratio, immunophenotype and cytogenetic abnormalities in patients with newly diagnosed multiple myeloma]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2020; 40:1044-1046. [PMID: 32023739 PMCID: PMC7342691 DOI: 10.3760/cma.j.issn.0253-2727.2019.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- J J Hu
- Department of Hematology, the Affiliated Hospital of Qingdao University, Qingdao 266000, China
| | - S M Nie
- Department of Hematology, the Affiliated Hospital of Qingdao University, Qingdao 266000, China
| | - Y Gao
- Department of Hematology, the Affiliated Hospital of Qingdao University, Qingdao 266000, China
| | - X S Yan
- Department of Hematology, the Affiliated Hospital of Qingdao University, Qingdao 266000, China
| | - J X Huang
- Department of Hematology, the Affiliated Hospital of Qingdao University, Qingdao 266000, China
| | - T L Li
- Department of Hematology, the Affiliated Hospital of Qingdao University, Qingdao 266000, China
| | - S S Liu
- Department of Hematology, the Affiliated Hospital of Qingdao University, Qingdao 266000, China
| | - C X Mao
- Department of Hematology, the Affiliated Hospital of Qingdao University, Qingdao 266000, China
| | - J J Zhou
- Department of Hematology, the Affiliated Hospital of Qingdao University, Qingdao 266000, China
| | - Y J Xu
- Department of Hematology, the Affiliated Hospital of Qingdao University, Qingdao 266000, China
| | - W Wang
- Department of Hematology, the Affiliated Hospital of Qingdao University, Qingdao 266000, China
| | - F J Meng
- Department of Hematology, the Affiliated Hospital of Qingdao University, Qingdao 266000, China
| | - X Q Feng
- Department of Hematology, the Affiliated Hospital of Qingdao University, Qingdao 266000, China
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14
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Wang H, Zhou X, Zhu JW, Ye JN, Guo HF, Sun C. Association of CD117 and HLA-DR expression with shorter overall survival and/or progression-free survival in patients with multiple myeloma treated with bortezomib and thalidomide combination treatment without transplantation. Oncol Lett 2018; 16:5655-5666. [PMID: 30344721 PMCID: PMC6176261 DOI: 10.3892/ol.2018.9365] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 06/27/2018] [Indexed: 12/14/2022] Open
Abstract
Certain immunophenotypes in multiple myeloma (MM), including CD56 and CD117, have been reported to be associated with overall survival (OS). However, previous reports have ignored the impact of different treatment regimens and the long-term prognostic value of immunophenotyping in MM when treated with novel agents, including thalidomide and bortezomib, in the absence of transplantation for autologous stem cell transplantation and allo-hematopoietic stem cell transplantation. To further understand the long-term prognostic value of immunophenotyping in MM, when treated with bortezomib combined with thalidomide-based regimens without transplantation, 80 patients who were newly diagnosed between January 2007 and December 2015, were analyzed retrospectively. In contrast to previous studies, no significant survival time difference was observed between CD56+/CD117+ and CD56-/CD117- groups. Multivariate analysis suggested that human leukocyte antigen-antigen D-related (HLA-DR)+ was independently associated with shorter OS and progression-free survival (PFS), while CD117+ was an independent prognostic factor for decreased PFS. In addition, the myeloma prognostic index (MPI), defined by HLA-DR+, age ≥65 years and international staging system stage III, was suitable for risk stratification of patients treated with novel agents for OS and PFS. The results of the current study suggested that HLA-DR+ patients had a shorter OS and PFS and CD117+ patients had shorter PFS. HLA-DR+ or CD117+ was sufficient to affect survival. Evaluating these markers may reveal valuable prognostic factors for MM in patients receiving bortezomib combined with thalidomide-based regimens without autologous stem cell transplantation and allo-hematopoietic stem cell transplantation). MPI may describe an accessible tool to predict the prognosis of patients with MM.
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Affiliation(s)
- Huan Wang
- Department of Hematology, Affiliated Wuxi People's Hospital, Nanjing Medical University, Wuxi, Jiangsu 214023, P.R. China
| | - Xin Zhou
- Department of Hematology, Affiliated Wuxi People's Hospital, Nanjing Medical University, Wuxi, Jiangsu 214023, P.R. China
| | - Jian-Wei Zhu
- Department of Hematology, Affiliated Wuxi People's Hospital, Nanjing Medical University, Wuxi, Jiangsu 214023, P.R. China
| | - Jian-Nan Ye
- Department of Hematology, Affiliated Wuxi People's Hospital, Nanjing Medical University, Wuxi, Jiangsu 214023, P.R. China
| | - Hong-Feng Guo
- Department of Hematology, Affiliated Wuxi People's Hospital, Nanjing Medical University, Wuxi, Jiangsu 214023, P.R. China
| | - Chao Sun
- Department of Hematology, Affiliated Wuxi People's Hospital, Nanjing Medical University, Wuxi, Jiangsu 214023, P.R. China
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15
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Immunophenotypic and cytogenetic evolution patterns of the neoplastic plasma cells in multiple myeloma relapsed after stem cell transplant. J Hematop 2018. [DOI: 10.1007/s12308-018-0330-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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16
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Low expression of neural cell adhesion molecule, CD56, is associated with low efficacy of bortezomib plus dexamethasone therapy in multiple myeloma. PLoS One 2018; 13:e0196780. [PMID: 29738534 PMCID: PMC5940221 DOI: 10.1371/journal.pone.0196780] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 04/19/2018] [Indexed: 11/19/2022] Open
Abstract
Bortezomib (Btz) is an active agent used to treat multiple myeloma (MM). Not all patients who receive Btz-containing therapy show a favorable response. Interaction of cellular adhesion molecules with MM and bone marrow stromal cells is crucial for the survival of MM cells. However, little is known about the role of these molecules in the sensitivity of MM to Btz-containing therapy. Thus, we evaluated the correlation between the level of cellular adhesion molecules in MM cells and the efficacy of Btz plus dexamethasone (Bd) therapy. The expression of the neural cell adhesion molecule gene (NCAM, also known as CD56), ITGA4, CXCR4, and other genes were analyzed in 74 samples of primary MM cells collected from patients before they received Bd therapy. Of the eight genes tested, expression of NCAM was lower among patients who responded poorly to Bd therapy. In vitro expression of NCAM induced by transfection of MM cells enhanced their sensitivity to Btz treatment by causing accumulation of polyubiquitinated proteins. Our results indicate that expression of NCAM is associated with better response to Btz treatment and is a promising candidate biomarker for predicting response to therapies involving Btz.
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17
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Plasma Cell Immunophenotyping Improve Prognostic Stratification of Multiple Myeloma Patients. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2018. [DOI: 10.5812/ijcm.5350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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18
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Iriyama N, Miura K, Hatta Y, Kobayashi S, Uchino Y, Kurita D, Sakagami H, Takahashi H, Sakagami M, Kobayashi Y, Nakagawa M, Ohtake S, Iizuka Y, Takei M. Clinical effect of immunophenotyping on the prognosis of multiple myeloma patients treated with bortezomib. Oncol Lett 2017; 13:3803-3808. [PMID: 28521480 DOI: 10.3892/ol.2017.5920] [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] [Received: 03/28/2016] [Accepted: 01/19/2017] [Indexed: 11/06/2022] Open
Abstract
In the present study, the effect of immunophenotyping on the prognoses of patients with multiple myeloma (MM) treated with bortezomib plus dexamethasone was investigated. The study involved 46 patients with MM, and analyzed the prognostic significance of the expression of cluster of differentiation (CD)45, CD56 and mature plasma cell (MPC)-1, and other factors including the International Staging System (ISS) stage, age, gender, the immunoglobulin subtype and the treatment line number prior to bortezomib treatment. Although CD56 and MPC-1 expression did not appear to affect the time to next treatment (TNT) or overall survival rate (OS), the univariate analysis determined that CD45 positivity was an adverse prognostic factor for TNT and OS, and that being male was significantly associated with inferior TNT and OS. Multivariate analyses determined that CD45 expression was prognostically significant for TNT and OS. In conclusion, CD45 positivity is an adverse prognostic factor in MM patients treated with bortezomib. The data from the present study demonstrate the clinical importance of classifying MM cells immunophenotypically to determine the prognoses of patients.
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Affiliation(s)
- Noriyoshi Iriyama
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Katsuhiro Miura
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Yoshihiro Hatta
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Sumiko Kobayashi
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Yoshihito Uchino
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Daisuke Kurita
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Hitomi Sakagami
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Hiromichi Takahashi
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan.,Department of Clinical Laboratory, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Masashi Sakagami
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Yujin Kobayashi
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Masaru Nakagawa
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Shimon Ohtake
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Yoshikazu Iizuka
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Masami Takei
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan
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19
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Suzuki K, Yano S, Nishiwaki K, Sano K, Shimada T, Yahagi Y, Ogasawara Y, Sugiyama K, Takahara S, Saito T, Kasama K, Minami J, Yokoyama H, Kamiyama Y, Katsube A, Masuoka H, Katori M, Machishima T, Ouchi A, Dobashi N, Kaito K, Usui N, Aiba K. Clinical significance of granule-containing myeloma cells in patients with newly diagnosed multiple myeloma. Cancer Med 2016; 5:3051-3058. [PMID: 27734595 PMCID: PMC5119959 DOI: 10.1002/cam4.875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 07/26/2016] [Accepted: 07/28/2016] [Indexed: 12/16/2022] Open
Abstract
The clinical features and prognostic significance of myeloma cells containing granules remain unclear. The purpose of this retrospective study was to investigate the clinical significance of granule-containing myeloma cells in patients with newly diagnosed multiple myeloma (NDMM). We retrospectively analyzed the records of 122 patients diagnosed with NDMM between January 2007 and December 2013. Granule-containing myeloma cells were defined as myeloma cells that exhibited three or more granules in their cytoplasm by May-Giemsa staining. The patients were classified into two groups, the granule-containing myeloma (GM) and nongranule-containing myeloma (non-GM) groups, depending on the proportion of myeloma cells that contained granules (cut-off value: 10%). There were 25 (20.5%) patients in the GM group. Patients in the GM group displayed significantly higher CD56 and CD49e expression than those in the non-GM group (t-test, P = 0.027 and 0.042). None of the patient characteristics differed significantly between the two groups. There was no significant difference in the chemotherapy profiles of the two groups, and the overall response rates of the two groups were similar. During the median follow-up period of 33.9 months, the overall survival (OS) in the GM group was similar to that in the non-GM group; 4-year OS of the GM and non-GM groups were 78.5% and 51.9%, respectively (P = 0.126). We concluded that cases of NDMM involving granule-containing myeloma cells are not infrequent. Moreover, CD56 and CD49e expression was significantly higher in the presence of myeloma cell populations, and the presence of granules did not affect survival.
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Affiliation(s)
- Kazuhito Suzuki
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Shingo Yano
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Kaichi Nishiwaki
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Koji Sano
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Takaki Shimada
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Yuichi Yahagi
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Yoji Ogasawara
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Katsuki Sugiyama
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Shinobu Takahara
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Takeshi Saito
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Kinuyo Kasama
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Jiro Minami
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Hiroki Yokoyama
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Yutaro Kamiyama
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Atsushi Katsube
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Hidekazu Masuoka
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Mitsuji Katori
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Tomohito Machishima
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Aya Ouchi
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Nobuaki Dobashi
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Ken Kaito
- Central Clinical LaboratoryThe Jikei University HospitalTokyoJapan
| | - Noriko Usui
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
- Division of Transfusion MedicineThe Jikei University School of MedicineTokyoJapan
| | - Keisuke Aiba
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
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20
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Tazawa S, Shiozawa E, Homma M, Arai N, Kabasawa N, Kawaguchi Y, Fujiwara S, Okino K, Kobayashi K, Yamochi T, Tate G, Nakamaki T, Takimoto M. CD200 Expression on Plasma Cell Myeloma Cells is Associated with the Efficacies of Bortezomib, Lenalidomide and Thalidomide. J Clin Exp Hematop 2016; 55:121-6. [PMID: 26763359 DOI: 10.3960/jslrt.55.121] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Plasma cell myeloma (PCM) is a devastating disease with a highly heterogeneous outcome, with survival ranging from a few months to longer than 10 years. Treatment of multiple myeloma has changed markedly in the past decade due to the development of new drugs such as bortezomib, lenalidomide and thalidomide, which have greatly improved the outcome of PCM. The clinical and prognostic value of immunophenotyping in PCM remains questionable. The aim of this study was to determine the diagnostic and prognostic significance of CD200 expression in newly diagnosed PCM. We retrospectively reviewed the records of 107 patients newly diagnosed with PCM at Showa University Hospital between January 2004 and September 2013. Expression of CD200 was studied by immunohistochemistry. Clinical and pathological parameters were compared between CD200-positive and CD200-negative cases. CD200-positive PCM cases had lower serum albumin (p = 0.0001) compared to those without CD200 expression. Our results showed no significant difference in median overall survival between patients with CD200-positive and CD200-negative PCM. However, there was a strong correlation between CD200 expression and serum albumin level. In the CD200-negative group, median overall survival was significantly longer in patients who received new drug treatment. These findings suggest that CD200 expression is a useful marker for evaluation of the severity of PCM and that lack of CD200 expression may improve the sensitivity of PCM to therapy with new drugs.
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Affiliation(s)
- Sakiko Tazawa
- Department of Pathology and Laboratory Medicine, Showa University School of Medicine
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21
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Yokoi S, Sakai H, Uchida A, Uemura Y, Sato K, Tsuruoka Y, Nishio Y, Matsunawa M, Suzuki Y, Isobe Y, Kato M, Inoue Y, Hoshikawa M, Miura I. Cytogenetic Study and Analysis of Protein Expression in Plasma Cell Myeloma with t(11;14)(q13;q32): Absence of BCL6 and SOX11, and Infrequent Expression of CD20 and PAX5. J Clin Exp Hematop 2016; 55:137-43. [PMID: 26763361 DOI: 10.3960/jslrt.55.137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
The t(11;14)(q13;q32) translocation is the most common chromosomal translocation in plasma cell myeloma (PCM), but the cytogenetic and immunophenotypic features of PCM with t(11;14)(q13;q32) remain to be fully elucidated. To address the issue, we retrospectively analyzed 21 newly diagnosed PCM patients with the t(11;14)(q13;q32) translocation in our institute. CD20 is a B-cell-specific transmembrane protein that is the topic of much focus as a potential target in immunotherapy. We observed a low incidence of CD20 expression (2 of 21 patients, 11%), although the expression of CD20 was previously reported to be associated with t(11;14)(q13;q32). PAX5 is an essential transcriptional factor involved in B-cell development and commitment, and is down-regulated upon plasma cell differentiation. We observed one patient (6%) with expression of PAX5. The expression of CD19, CD56, and CD138 was detected in one (0.7%), nine (60%), and 13 patients (87%), respectively. Cyclin D1, CD38, and BCL2 were detected in all patients; on the other hand, neither BCL6 nor SOX11 was detected in any of the evaluated patients. Abnormalities of chromosome 13 were detected in six patients (38%), but deletion of TP53 was not observed in any of the evaluated patients. Our results suggest the absence of BCL6 and SOX11 expression, and infrequent expression of CD20, PAX5, and CD56 in PCM with t(11;14)(q13;q32), in contrast to the findings of earlier reports.
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Affiliation(s)
- Satoshi Yokoi
- Department of Pathology and Laboratory Medicine, Showa University School of Medicine
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22
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Krishnan SR, Jaiswal R, Brown RD, Luk F, Bebawy M. Multiple myeloma and persistence of drug resistance in the age of novel drugs (Review). Int J Oncol 2016; 49:33-50. [PMID: 27175906 DOI: 10.3892/ijo.2016.3516] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 12/17/2015] [Indexed: 11/06/2022] Open
Abstract
Multiple myeloma (MM) is a mature B cell neoplasm that results in multi-organ failure. The median age of onset, diverse clinical manifestations, heterogeneous survival rate, clonal evolution, intrinsic and acquired drug resistance have impact on the therapeutic management of the disease. Specifically, the emergence of multidrug resistance (MDR) during the course of treatment contributes significantly to treatment failure. The introduction of the immunomodulatory agents and proteasome inhibitors has seen an increase in overall patient survival, however, for the majority of patients, relapse remains inevitable with evidence that these agents, like the conventional chemotherapeutics are also subject to the development of MDR. Clinical management of patients with MM is currently compromised by lack of a suitable procedure to monitor the development of clinical drug resistance in individual patients. The current MM prognostic measures fail to pick the clonotypic tumor cells overexpressing drug efflux pumps, and invasive biopsy is insufficient in detecting sporadic tumors in the skeletal system. This review summarizes the challenges associated with treating the complex disease spectrum of myeloma, with an emphasis on the role of deleterious multidrug resistant clones orchestrating relapse.
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Affiliation(s)
- Sabna Rajeev Krishnan
- Graduate School of Health, Discipline of Pharmacy, University of Technology, Sydney, NSW 2007, Australia
| | - Ritu Jaiswal
- Graduate School of Health, Discipline of Pharmacy, University of Technology, Sydney, NSW 2007, Australia
| | - Ross D Brown
- Institute of Haematology, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia
| | - Frederick Luk
- Graduate School of Health, Discipline of Pharmacy, University of Technology, Sydney, NSW 2007, Australia
| | - Mary Bebawy
- Graduate School of Health, Discipline of Pharmacy, University of Technology, Sydney, NSW 2007, Australia
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Limvorapitak W, Srisum-Ang T, Chimres C, Warnnissorn N, Kanitsap N. Accuracy of Bone Marrow Flow Cytometry Analysis in Patients With Plasma Cell Neoplasm in Thailand: A Single Institutional Study. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2016; 16:e27-37. [PMID: 26796980 DOI: 10.1016/j.clml.2015.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Revised: 11/25/2015] [Accepted: 12/08/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Plasma cell neoplasm is a common hematologic malignancy. Treatment with novel agents results in favorable outcomes. Reliable investigations are required to monitor the residual disease, especially after such effective treatments. Flow cytometric analysis is a speedy and accurate method to detect abnormal cells. The aim of this study was to determine diagnostic performance of flow cytometry in the detection of abnormal plasma cells in bone marrow specimens. MATERIALS AND METHODS We included bone marrow samples taken from patients suspected to harbor plasma cell neoplasm at the time of diagnosis or follow-up after treatment from 2013 to 2015. Flow cytometric analyses, using cluster of differentiation (CD)19/CD20/CD27/CD38/CD45/CD56/CD117/CD138 and cytoplasmic κ/λ, were done and results compared with morphologic evaluation of marrow aspirate smear, histology, and immunohistochemistry of marrow biopsy and protein electrophoretic analyses. RESULTS A total of 154 specimens were included. Plasma cell neoplasm was detected in 56 samples (36.4%). Most abnormal plasma cells in this study were CD19-negative (CD19(-))/CD20(-)/CD27(+)/CD38(+)/CD45(-) (or weakly positive)/CD56(+)/CD117(+)/CD138(+). Light chain restriction was found only in 18 samples (32.1%). Sensitivity and specificity of flow cytometric analysis were 91.1% and 96.9%, respectively. For the follow-up cohort, sensitivity and specificity were 86.7% and 66.7%, respectively. CONCLUSION Analysis of plasma cell neoplasm using flow cytometry has high sensitivity and specificity. As an adjunct to marrow histology and immunohistochemistry, flow cytometry can be used in diagnosis of plasma cell neoplasm and more importantly in monitoring the disease after treatment. We propose a limited panel of CD19/CD38/CD45/CD56/CD117/CD138 for detecting minimal residual disease in Thai patients.
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Affiliation(s)
- Wasithep Limvorapitak
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand.
| | | | - Chutima Chimres
- Pathology Unit, Thammasat University Hospital, Pathumthani, Thailand
| | - Naree Warnnissorn
- Department of Pathology and Forensic Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Nonglak Kanitsap
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
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Munker R, Shi R, Nair B, Devarakonda S, Cotelingam JD, McLarty J, Mills GM, Glass J. The Shreveport Myeloma Experience: Survival, Risk Factors and Other Malignancies in the Age of Stem Cell Transplantation. Acta Haematol 2015; 135:146-55. [PMID: 26588024 DOI: 10.1159/000440970] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 09/06/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND The overall prognosis of multiple myeloma has improved significantly over the last 15 years. We wondered whether the overall improvement would also be seen in unselected patients in an academic center in Northwest Louisiana with a high proportion of minority patients, and if second malignant neoplasms are relevant for our patients. MATERIALS AND METHODS Between 1998 and 2009, 215 patients were treated for multiple myeloma at our center and had complete follow-up until May 2013. RESULTS The mean survival of patients with multiple myeloma increased from 3.25 to 5.34 years, which is comparable to patients treated at larger centers. No prognostic difference was observed in the subgroups of myeloma patients. Among 215 patients followed for the development of secondary cancers, 16 already had a preexisting or concomitant malignancy (7.4%) and 10 developed secondary cancers. Our data indicate a significant background of histologically unrelated cancers and a cumulative incidence of new cancers of about 20% after 10 years of follow-up. Based on SEER data, preexisting or secondary cancers were not statistically increased in our population. CONCLUSIONS The use of autologous transplantation and the introduction of new agents resulted in a significant improvement in the prognosis of multiple myeloma. Other cancers are not statistically increased before or after multiple myeloma is diagnosed and are not prognostically relevant.
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Shin SY, Lee ST, Kim HJ, Kim SJ, Kim K, Kang ES, Kim SH. Antigen Expression Patterns of Plasma Cell Myeloma: An Association of Cytogenetic Abnormality and International Staging System (ISS) for Myeloma. J Clin Lab Anal 2014; 29:505-10. [PMID: 25277787 DOI: 10.1002/jcla.21801] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Accepted: 08/07/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Immunophenotyping of plasma cell has become an important diagnostic tool for plasma cell myeloma. There have been a few studies for association of antigen expression and cytogenetic abnormality of plasma cell myeloma. METHODS A total of 68 symptomatic/smoldering plasma cell myeloma case were analyzed by multicolor flow cytometry using CD38 and CD138 for primary gating of plasma cells. A conventional cytogenetics and fluorescence in situ hybridization (FISH) studies for detection of del(13q) or aneuploidy, del(17p), and IGH/FGFR translocation were done. We statistically analyzed the association of antigen expression and cytogenetic abnormality/myeloma stage (international staging system for multiple myeloma). RESULTS Positive expression of CD19, CD28, CD45, CD56, CD117, and CD274 was detected in 8.8%, 50.0%, 50.0%, 75.0%, 39.7%, and 2.9% of cases, respectively. CD117-negative cases were associated with hypodiploidy (P = 0.017). CD45-negative cases were associated with deletion 13 or aneuploidy (P < 0.001) and del(17p)(P = 0.011) by FISH. CD45-negativity or CD117-negativity was associated with advanced stage (P = 0.012 and P = 0.016, respectively). CONCLUSION The antigen expression patterns of myeloma plasma cell were associated with cytogenetic abnormality and stage.
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Affiliation(s)
- Sang-Yong Shin
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Tae Lee
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee-Jin Kim
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Suk Jin Kim
- Department of Laboratory Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kihyun Kim
- Department of Laboratory Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Suk Kang
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sun-Hee Kim
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Geyer JT, Niesvizky R, Jayabalan DS, Mathew S, Subramaniyam S, Geyer AI, Orazi A, Ely SA. IgG4 plasma cell myeloma: new insights into the pathogenesis of IgG4-related disease. Mod Pathol 2014; 27:375-81. [PMID: 24030741 DOI: 10.1038/modpathol.2013.159] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 07/09/2013] [Accepted: 07/14/2013] [Indexed: 12/24/2022]
Abstract
IgG4-related disease is a newly described systemic fibroinflammatory process, characterized by increase in IgG4-positive plasma cells. Its pathogenesis, including the role of IgG4, remains poorly understood. Plasma cell myeloma is typically associated with a large monoclonal serum spike, which is frequently of IgG isotype. We sought to identify and characterize a subset of IgG4-secreting myeloma, as it may provide a biological model of disease with high serum levels of IgG4. Six out of 158 bone marrow biopsies (4%) from patients with IgG myeloma expressed IgG4. Four patients were men and two were women, with a mean age of 64 (range 53-87) years. Imaging showed fullness of pancreatic head (1), small non-metabolic lymphadenopathy (1), and bone lytic lesions (6). Two patients developed necrotizing fasciitis. All had elevated serum M-protein (mean 2.4, range 0.5-4.2 g/dl), and none had definite signs or symptoms of IgG4-related disease. Four myelomas had plasmablastic morphology. Four had kappa and two had lambda light chain expression. Three cases expressed CD56. Two patients had a complex karyotype. In conclusion, the frequency of IgG4 myeloma correlates with the normal distribution of IgG4 isoform. The patients with IgG4 myeloma appear to have a high rate of plasmablastic morphology and could be predisposed to necrotizing fasciitis. Despite high serum levels of IgG4, none had evidence of IgG4-related disease. These findings suggest that the increased number of IgG4-positive plasma cells is not the primary etiologic agent in IgG4-related disease. Elevated serum levels of IgG4 is not sufficient to produce the typical disease presentation and should not be considered diagnostic of IgG4-related disease.
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Affiliation(s)
- Julia T Geyer
- Department of Pathology and Laboratory Medicine, New York Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
| | - Ruben Niesvizky
- Department of Pathology and Laboratory Medicine, New York Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
| | - David S Jayabalan
- Department of Pathology and Laboratory Medicine, New York Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
| | - Susan Mathew
- Department of Pathology and Laboratory Medicine, New York Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
| | - Shivakumar Subramaniyam
- Department of Pathology and Laboratory Medicine, New York Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
| | - Alexander I Geyer
- Department of Pathology and Laboratory Medicine, New York Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
| | - Attilio Orazi
- Department of Pathology and Laboratory Medicine, New York Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
| | - Scott A Ely
- Department of Pathology and Laboratory Medicine, New York Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
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An G, Xu Y, Shi L, Zou D, Deng S, Sui W, Xie Z, Hao M, Chang H, Qiu L. t(11;14) multiple myeloma: A subtype associated with distinct immunological features, immunophenotypic characteristics but divergent outcome. Leuk Res 2013; 37:1251-7. [DOI: 10.1016/j.leukres.2013.06.020] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 05/29/2013] [Accepted: 06/15/2013] [Indexed: 12/11/2022]
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28
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Bao L, Lai Y, Liu Y, Qin Y, Zhao X, Lu X, Jiang Q, Lu J, Huang X. CXCR4 is a good survival prognostic indicator in multiple myeloma patients. Leuk Res 2013; 37:1083-8. [DOI: 10.1016/j.leukres.2013.06.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 05/29/2013] [Accepted: 06/01/2013] [Indexed: 01/08/2023]
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Global methylation analysis identifies prognostically important epigenetically inactivated tumor suppressor genes in multiple myeloma. Blood 2013; 122:219-26. [PMID: 23699600 DOI: 10.1182/blood-2013-03-487884] [Citation(s) in RCA: 134] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Outcome in multiple myeloma is highly variable and a better understanding of the factors that influence disease biology is essential to understand and predict behavior in individual patients. In the present study, we analyzed combined genomewide DNA methylation and gene expression data of patients treated in the Medical Research Council Myeloma IX trial. We used these data to identify epigenetically repressed tumor suppressor genes with prognostic relevance in myeloma. We identified 195 genes with changes in methylation status that were significantly associated with prognosis. Combining DNA methylation and gene expression data led to the identification of the epigenetically regulated tumor modulating genes GPX3, RBP1, SPARC, and TGFBI. Hypermethylation of these genes was associated with significantly shorter overall survival, independent of age, International Staging System score, and adverse cytogenetics. The 4 differentially methylated and expressed genes are known to mediate important tumor suppressive functions including response to chemotherapy (TGFBI), interaction with the microenvironment (SPARC), retinoic acid signaling (RBP1), and the response to oxidative stress (GPX3), which could explain the prognostic impact of their differential methylation. Assessment of the DNA methylation status of the identified genes could contribute to the molecular characterization of myeloma, which is prerequisite for an individualized treatment approach.
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30
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Cho YU, Park CJ, Park SJ, Chi HS, Jang S, Park SH, Seo EJ, Yoon DH, Lee JH, Suh C. Immunophenotypic characterization and quantification of neoplastic bone marrow plasma cells by multiparametric flow cytometry and its clinical significance in Korean myeloma patients. J Korean Med Sci 2013; 28:542-9. [PMID: 23580331 PMCID: PMC3617306 DOI: 10.3346/jkms.2013.28.4.542] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 01/18/2013] [Indexed: 11/20/2022] Open
Abstract
Multiparametric flow cytometry (MFC) allows discrimination between normal and neoplastic plasma cells (NeoPCs) within the bone marrow plasma cell (BMPC) compartment. This study sought to characterize immunophenotypes and quantitate the proportion of NeoPCs in BMPCs to diagnose plasma cell myeoma (PCM) and evaluate the prognostic impact of this method. We analyzed the MFC data of the bone marrow aspirates of 76 patients with PCM and 33 patients with reactive plasmacytosis. MFC analysis was performed using three combinations: CD38/CD138/-/CD45; CD56/CD20/CD138/CD19; and CD27/CD28/CD138/CD117. The plasma cells of patients with reactive plasmacytosis demonstrated normal immunophenotypic patterns. Aberrant marker expression was observed in NeoPCs, with negative CD19 expression observed in 100% of cases, CD56+ in 73.7%, CD117+ in 15.2%, CD27- in 10.5%, CD20+ in 9.2%, and CD28+ in 1.3%. In PCM patients, more than 20% of NeoPCs/BMPCs were significantly associated with factors suggestive of poor clinical outcomes. Patients who were CD27- or CD56+/CD27-, demonstrated shorter overall survival than patients of other CD56/CD27 combinations. Our results support the clinical value of immunophenotyping and quantifying NeoPCs in PCM patients. This strategy could help to reveal poor prognostic categories and delineate surrogate markers for risk stratification in PCM patients.
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Affiliation(s)
- Young-Uk Cho
- Department of Laboratory Medicine, University of Ulsan, College of Medicine and Asan Medical Center, Seoul, Korea
| | - Chan-Jeoung Park
- Department of Laboratory Medicine, University of Ulsan, College of Medicine and Asan Medical Center, Seoul, Korea
| | - Seo-Jin Park
- Department of Laboratory Medicine, University of Ulsan, College of Medicine and Asan Medical Center, Seoul, Korea
| | - Hyun-Sook Chi
- Department of Laboratory Medicine, University of Ulsan, College of Medicine and Asan Medical Center, Seoul, Korea
| | - Seongsoo Jang
- Department of Laboratory Medicine, University of Ulsan, College of Medicine and Asan Medical Center, Seoul, Korea
| | - Sang Hyuk Park
- Department of Laboratory Medicine, University of Ulsan, College of Medicine and Asan Medical Center, Seoul, Korea
| | - Eul-Ju Seo
- Department of Laboratory Medicine, University of Ulsan, College of Medicine and Asan Medical Center, Seoul, Korea
| | - Dok Hyun Yoon
- Department of Internal Medicine, University of Ulsan, College of Medicine and Asan Medical Center, Seoul, Korea
| | - Jung-Hee Lee
- Department of Internal Medicine, University of Ulsan, College of Medicine and Asan Medical Center, Seoul, Korea
| | - Cheolwon Suh
- Department of Internal Medicine, University of Ulsan, College of Medicine and Asan Medical Center, Seoul, Korea
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Abstract
Primary plasma cell leukemia (pPCL) is a rare and aggressive plasma cell proliferative disorder with a very poor prognosis and with distinct biologic, clinical, and laboratory features. Compared with multiple myeloma, pPCL presents more often with extramedullary involvement, anemia, thrombocytopenia, hypercalcemia, elevated serum β(2)-microglobulin and lactate dehydrogenase levels, as well as impaired renal function. Many of the genetic aberrations observed in newly diagnosed pPCL are typically found in advanced multiple myeloma. These cytogenetic abnormalities and mutations lead to increased proliferation, enhanced inhibition of apoptosis, escape from immune surveillance, and independence from the BM microenvironment, with changes in expression of adhesion molecules or chemokine receptors. The outcome of pPCL has improved with the introduction of autologous stem cell transplantation and combination approaches with novel agents, including bortezomib and immunomodulatory drugs, such as lenalidomide. In this review, we provide an overview of currently available therapeutic options with recommendations of how these treatment modalities can best be used to improve outcome for plasma cell leukemia patients.
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Cannizzo E, Carulli G, Del Vecchio L, Ottaviano V, Bellio E, Zenari E, Azzarà A, Petrini M, Preffer F. The role of CD19 and CD27 in the diagnosis of multiple myeloma by flow cytometry: a new statistical model. Am J Clin Pathol 2012; 137:377-86. [PMID: 22338049 DOI: 10.1309/ajcp63tocfnamdms] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
We have developed a new statistical diagnostic model that examines the correlation between immunophenotype and clonality as detected by flow cytometry (FC) and histology, defining the diagnostic role of FC in multiple myeloma (MM). The 192 bone marrow samples from patients and control subjects were studied for routine diagnostic analysis of MM; a minimum of 100 plasma cells (PCs) were analyzed for each patient sample. A direct 7- or 8-color method was applied to study the immunophenotype of PCs, utilizing a FACSCanto II (BD Biosciences, San Jose, CA). Samples were labeled with fluorochrome-conjugated monoclonal antibodies (AmCyan, Pac Blue, fluorescein isothiocyanate, phycoerythrin [PE], PECy7, peridinin-chlorophyll protein, allophycocyanin [APC], and APC-Cy7) to the following antigens: CD138, CD81, CD200, CD221, CD45, CD38, CD28, CD19, CD27, CD117, CD38, CD33, CD20, CD56, CD10, and immunoglobulin κ and λ light chains. Among all antigens tested, CD19 and CD27, when applied to our model, resulted in optimal concordance with histology. This model defines the effective diagnostic role FC could have in MM and in the detection of minimal residual disease.
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Yuan CM, Stetler-Stevenson M. Role of flow cytometry of peripheral blood and bone marrow aspirates in early myeloma. Semin Hematol 2011; 48:32-8. [PMID: 21232656 DOI: 10.1053/j.seminhematol.2010.11.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Flow cytometric immunophenotyping (FCM) of multiple myeloma (MM) is commonly accepted in academic centers as providing clinically significant information and is becoming increasingly utilized in the private setting. FCM has established clinical relevance in the following: (1) differential diagnosis of MM from other plasma cell dyscrasias; (2) differentiating MM from lymphoplasmacytic lymphoma (LPL) and other non-Hodgkin lymphomas; (3) diagnosis of unusual cases of myeloma (eg, to confirm the diagnosis of rare cases of IgM MM); (4) determining the risk of progression of monoclonal gammopathy of uncertain significance (MGUS) and smoldering MM; (5) prognostication in MM; and (6) minimal residual disease detection (MRD) post therapy. FCM may have an emerging role in the enumeration of abnormal plasma cells in diagnosis of MM, but further studies are needed. We review the clinical value of FCM in evaluation of peripheral blood and bone marrow in early myeloma.
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Affiliation(s)
- Constance M Yuan
- Flow Cytometry Unit, Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
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Buonaccorsi JN, Kroft SH, Harrington AM, VanTuinen P, Olteanu H. Clinicopathologic analysis of the impact of CD23 expression in plasma cell myeloma with t(11;14)(q13;q32). Ann Diagn Pathol 2011; 15:385-8. [PMID: 21724429 DOI: 10.1016/j.anndiagpath.2011.04.004] [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: 03/26/2011] [Accepted: 04/07/2011] [Indexed: 11/19/2022]
Abstract
A recent study has shown that 10% of plasma cell myelomas (PCMs) express CD23 and that expression is associated with abnormalities of chromosome 11, mainly t(11;14)(q13;q32); however, only 40% of t(11;14)(+) PCMs express CD23. Because these results were generated in a limited patient cohort and because the clinical relevance of CD23 expression in PCMs with t(11;14)(q13;q32) has not been fully characterized, we addressed this question in a large series of patients with t(11;14)(+) PCM. Forty-two bone marrow biopsies from patients with t(11;14)(+) PCM were evaluated for CD23 expression by immunohistochemistry. CD23 expression was correlated with laboratory and clinical data and outcome after autologous stem cell transplantation, including event-free survival and overall survival (OS). Plasma cell myelomas with t(11;14)(q13;q32) were frequently CD20(+) (46.4%) and CD56(-) (53.8%) and had a nonhyperdiploid karyotype (97.6%) with frequent 13q deletion (33.3%). Of 42 cases, 19 (45.2%) expressed CD23. CD23(+) PCMs were more likely to present with platelet counts less than 150 × 10(3)/μL (100% vs 50%, P = .006). There were no significant differences in other laboratory or presenting clinical data. The median event-free survival in patients treated with autologous stem cell transplantation (n = 29) was similar regardless of CD23 status, whereas the median OS (all patients) was longer in CD23(-) than in CD23(+) PCMs: not reached vs 3365 days (P = .08). Our findings suggest that patients with t(11;14)(+)/CD23(+) PCM present with lower platelet counts and may have a shorter OS than those with t(11;14)(+)/CD23(-) PCM.
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Kumar S, Kimlinger T, Morice W. Immunophenotyping in multiple myeloma and related plasma cell disorders. Best Pract Res Clin Haematol 2011; 23:433-51. [PMID: 21112041 DOI: 10.1016/j.beha.2010.09.002] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Plasma cell disorders form a spectrum ranging from the asymptomatic presence of small monoclonal populations of plasma cells to conditions like plasma cell leukemia and multiple myeloma, in which the bone marrow can be replaced by the accumulation of neoplastic plasma cells. Immunophenotyping has become an invaluable tool in the management of hematological malignancies and is increasingly finding a role in the diagnosis and monitoring of plasma cell disorders. Multiparameter flow cytometry has evolved considerably during the past decade with an increasing ability to screen large numbers of events and to detect multiple antigens at the same time. This, along with a better understanding of the phenotypic heterogeneity of the clonal plasma cells in different disorders, has made immunophenotyping an indispensible tool in the diagnosis, prognostic classification and management of plasma cell disorders. This book chapter addresses the approaches taken to evaluate monoclonal plasma cell disorders, and the different markers and techniques that are important for the study of these diseases.
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Affiliation(s)
- Shaji Kumar
- Divisions of Hematology and Hematopathology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States.
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36
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Cannizzo E, Bellio E, Sohani AR, Hasserjian RP, Ferry JA, Dorn ME, Sadowski C, Bucci JJ, Carulli G, Preffer F. Multiparameter immunophenotyping by flow cytometry in multiple myeloma: The diagnostic utility of defining ranges of normal antigenic expression in comparison to histology. CYTOMETRY PART B-CLINICAL CYTOMETRY 2010; 78:231-8. [PMID: 20198608 DOI: 10.1002/cyto.b.20517] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Numerous studies have reported on the immunophenotype of plasma cells (PCs) in monoclonal gammopathy of undetermined significance (MGUS) and in plasma cell myeloma (PCM), but very few have examined the immunophenotype of normal PCs. In this study, an objective definition of normal range of expression for each antigen was found on normal control PCs. Using these new ranges of normal expression (new method) is different from using a static 20% of PCs cut-off for all antigens as described in the literature (traditional method). These newly calculated normal ranges for each antigen were applied to our data, and compared to histologic and immunohistochemical findings. METHODS Bone marrow samples from 46 patients with PC neoplasms and 15 normal controls were studied. A minimum of 100 PC were analyzed for each patient and control sample. An 8-color staining method was applied to study the immunophenotype of PCs, using a BD FACSCanto II. RESULTS By the new ranges of normality calculated in this study it was determined that different antigens have different level of expression on polyclonal PCs. CD19 correlated with histology by both the traditional and new methods, but had superior correlation by the new method. CONCLUSIONS This report is the first 8-color immunophenotypic study of PCM in which a "range of normal expression" for each antigen is defined. This is a critical step to help distinguish between a normal and neoplastic PC immunophenotype and discern which antigens are of diagnostic importance.
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Affiliation(s)
- Elisa Cannizzo
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, USA.
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Paiva B, Almeida J, Pérez-Andrés M, Mateo G, López A, Rasillo A, Vídriales MB, López-Berges MC, Miguel JFS, Orfao A. Utility of flow cytometry immunophenotyping in multiple myeloma and other clonal plasma cell-related disorders. CYTOMETRY PART B-CLINICAL CYTOMETRY 2010; 78:239-52. [PMID: 20155853 DOI: 10.1002/cyto.b.20512] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In recent years, multiparameter flow cytometry (MFC) immunophenotyping has become mandatory in the clinical management of hematological malignancies, both for diagnostic and monitoring purposes. Multiple myeloma (MM) and other clonal plasma cell-related (PC) disorders should be no exception to this paradigm, but incorporation of immunophenotypic studies in the management of patients with PC disorders is still far from being routinely established in many diagnostic flow cytometry laboratories. For clonal PC disorders, MFC is of clear and established clinical relevance in: (1) the differential diagnosis between MM and other PC-related disorders; (2) the identification of high-risk MGUS and smoldering MM; (3) minimal residual disease investigation after therapy; additionally it may also be useful for (4) the definition of prognosis-associated antigenic profiles; and (5) the identification of new therapeutic targets. In this article, we review the clinical value of MFC in the study of PC disorders, with specific emphasis in those areas where consensus exists on the need to incorporate MFC into routine evaluation of MM and other clonal PC-related disorders.
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Affiliation(s)
- Bruno Paiva
- Department of Medicine, Services of Cytometry and Hematology and Cancer Research Center (CIC, IBMCC USAL-CSIC), University of Salamanca and University Hospital of Salamanca, Salamanca, Spain
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Abstract
An increasing number of neoplasms are associated with variably specific genetic abnormalities. This is best exemplified by hematological malignancies, in which there is a growing list of entities that are defined by their genetic lesion(s); this is not (yet) the case in mature B-cell lymphomas. However, enhanced insights into the pathogenesis of this large and diverse group of lymphomas have emerged with the ongoing unraveling of a plethora of fascinating genetic abnormalities. The purpose of this review is to synthesize well-recognized data and nascent discoveries in our understanding of the genetic basis of a spectrum of mature B-cell lymphomas, and how this may be applied to contemporary clinical practice. Despite the explosion of new and exciting knowledge in this arena, with the potential for enhanced diagnostic and prognostic strategies, it is essential to remain cognizant of the limitations (and complexity) of genetic investigations, so that assays can be developed and used both judiciously and rationally.
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Duenisch P, Reichart R, Mueller U, Brodhun M, Bjerkvig R, Romeike B, Walter J, Herbold C, Regenbrecht CRA, Kalff R, Kuhn SA. Neural cell adhesion molecule isoform 140 declines with rise of WHO grade in human gliomas and serves as indicator for the invasion zone of multiform glioblastomas and brain metastases. J Cancer Res Clin Oncol 2010; 137:399-414. [PMID: 20440511 DOI: 10.1007/s00432-010-0888-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Accepted: 04/06/2010] [Indexed: 01/07/2023]
Abstract
PURPOSE Gliomas are highly invasive neuroepithelial tumors with a propensity of malignant transformation and very restricted treatment options. The neural cell adhesion molecule (NCAM) modulates cellular migration, proliferation, and synaptic plasticity by homophilic and heterophilic interactions. Hereby, we investigated its relevance as a glioma tissue marker for the biological aggressiveness of these tumors and compared these features with the carcinoma brain metastasis invasion zone. MATERIALS AND METHODS We analyzed 194 human brain samples. Human tumor-free brain specimens served as control for the white and gray matter. In addition to that, we used human glioblastomas from nude rats. All tissues were investigated immunohistochemically for the expression of the NCAM isoform 140. Additionally, the multiplanar MRI-CT fusion neuronavigation-guided serial stereotactic biopsy was performed and completed by histopathological workup. RESULTS Human gliomas loose NCAM-140 with the rise of their WHO grade. Meningiomas are NCAM-140 negative. As the most striking feature, human brain metastases and the majority of human glioblastomas of our patients and of nude rats were totally NCAM-140 negative. This NCAM negativity led us to the conclusion of three different main glioblastoma invasion patterns. Surprisingly, the majority of brain metastasis samples that contained surrounding brain parenchyma demonstrated invasive tumor cell nests beyond the sharply demarcated metastasis border. We also found invasive metastatic cell nests outside the contrast enhancing tumor zone by means of the MRI-CT fusion neuronavigation-guided serial stereotactic biopsy. CONCLUSION The expression of NCAM-140 inversely correlates with the WHO grade of human gliomas. The lost expression of NCAM-140 in human glioblastomas and in brain metastases enables the investigation of the brain-tumor interface and the definition of glioblastoma invasion patterns and shows that brain metastases are more invasive than ever thought.
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Affiliation(s)
- Pedro Duenisch
- Department of Neurosurgery, Medical Center, Friedrich-Schiller-University, Erlanger Allee 101, 07747, Jena, Germany
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Raja KRM, Kovarova L, Hajek R. Review of phenotypic markers used in flow cytometric analysis of MGUS and MM, and applicability of flow cytometry in other plasma cell disorders. Br J Haematol 2010; 149:334-51. [DOI: 10.1111/j.1365-2141.2010.08121.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Walters M, Olteanu H, Van Tuinen P, Kroft SH. CD23 expression in plasma cell myeloma is specific for abnormalities of chromosome 11, and is associated with primary plasma cell leukaemia in this cytogenetic sub-group. Br J Haematol 2010; 149:292-3. [PMID: 20064156 DOI: 10.1111/j.1365-2141.2009.08042.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Damgaard T, Knudsen LM, Dahl IMS, Gimsing P, Lodahl M, Rasmussen T. Regulation of the CD56 promoter and its association with proliferation, anti-apoptosis and clinical factors in multiple myeloma. Leuk Lymphoma 2009; 50:236-46. [PMID: 19235015 DOI: 10.1080/10428190802699332] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Multiple myeloma (MM) is an incurable B-cell malignancy characterised by uncontrolled growth and accumulation of malignant plasma cells in the bone marrow. Aberrant expression of CD56 in patients with MM is thought to contribute to a worsened disease course and metastasis. We therefore investigated the regulation of the CD56 promoter in relation to typical clinical factors. We used qPCR and FACS to measure the expression levels of CD56, and potential regulatory factors in patients with MM and related these with MM progression/prognosis. The transcription factors BTBD3, Pax5, RUNX1 and MMSET were positively associated with CD56 expression, as was CYCLIN D1, which is involved in disease progression, anti-apoptosis and proliferation. RUNX1 was negatively associated with the survival of stem-cell transplanted patients. Our findings propose four potential activators of the CD56 promoter and for CD56 to be involved in proliferation and anti-apoptosis, leading to disease progression in MM.
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Affiliation(s)
- Tina Damgaard
- Department of Haematology 54P4, Herlev University Hospital of Copenhagen, Herlev, Denmark.
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Current Awareness in Hematological Oncology. Hematol Oncol 2008. [DOI: 10.1002/hon.832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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