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Zhong H, Huang D, Wu J, Chen X, Chen Y, Huang C. 18F‑FDG PET/CT based radiomics features improve prediction of prognosis: multiple machine learning algorithms and multimodality applications for multiple myeloma. BMC Med Imaging 2023; 23:87. [PMID: 37370013 DOI: 10.1186/s12880-023-01033-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 05/23/2023] [Indexed: 06/29/2023] Open
Abstract
PURPOSE Multiple myeloma (MM), the second most hematological malignancy, have been studied extensively in the prognosis of the clinical parameters, however there are only a few studies have discussed the role of dual modalities and multiple algorithms of 18F-FDG (18F-fluorodeoxyglucose) PET/CT based radiomics signatures for prognosis in MM patients. We hope to deeply mine the utility of raiomics data in the prognosis of MM. METHODS We extensively explored the predictive ability and clinical decision-making ability of different combination image data of PET, CT, clinical parameters and six machine learning algorithms, Cox proportional hazards model (Cox), linear gradient boosting models based on Cox's partial likelihood (GB-Cox), Cox model by likelihood based boosting (CoxBoost), generalized boosted regression modelling (GBM), random forests for survival model (RFS) and support vector regression for censored data model (SVCR). And the model evaluation methods include Harrell concordance index, time dependent receiver operating characteristic (ROC) curve, and decision curve analysis (DCA). RESULTS We finally confirmed 5 PET based features, and 4 CT based features, as well as 6 clinical derived features significantly related to progression free survival (PFS) and we included them in the model construction. In various modalities combinations, RSF and GBM algorithms significantly improved the accuracy and clinical net benefit of predicting prognosis compared with other algorithms. For all combinations of various modalities based models, single-modality PET based prognostic models' performance was outperformed baseline clinical parameters based models, while the performance of models of PET and CT combined with clinical parameters was significantly improved in various algorithms. CONCLUSION 18F‑FDG PET/CT based radiomics models implemented with machine learning algorithms can significantly improve the clinical prediction of progress and increased clinical benefits providing prospects for clinical prognostic stratification for precision treatment as well as new research areas.
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Affiliation(s)
- Haoshu Zhong
- Department of Hematology, the Affiliated Hospital of Southwest Medical University, Luzhou City, Sichuan, China
- Stem Cell Laboratory, The Clinical Research Institute, Affiliated Hospital of Southwest Medical University, Luzhou City, Sichuan, China
| | - Delong Huang
- Southwest Medical University, Luzhou City, Sichuan, China
| | - Junhao Wu
- Department of Nuclear Medicine & PET Center, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Xiaomin Chen
- Department of Hematology, the Affiliated Hospital of Southwest Medical University, Luzhou City, Sichuan, China
- Stem Cell Laboratory, The Clinical Research Institute, Affiliated Hospital of Southwest Medical University, Luzhou City, Sichuan, China
| | - Yue Chen
- Department of Nuclear Medicine, the Affiliated Hospital of Southwest Medical University, Luzhou City, Sichuan, China
| | - Chunlan Huang
- Department of Hematology, the Affiliated Hospital of Southwest Medical University, Luzhou City, Sichuan, China.
- Stem Cell Laboratory, The Clinical Research Institute, Affiliated Hospital of Southwest Medical University, Luzhou City, Sichuan, China.
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Ly R, Terrier LM, Cognacq G, Benboubker L, Destrieux C, Velut S, Zemmoura I, Francois P, Aggad M, Amelot A. Spinal lesions in multiple myeloma: Primary bone tumors with distinct prognostic factors. Surg Oncol 2023; 48:101927. [PMID: 36966661 DOI: 10.1016/j.suronc.2023.101927] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 02/16/2023] [Accepted: 03/12/2023] [Indexed: 03/17/2023]
Abstract
PURPOSE Although prognostic factors of spinal multiple myeloma (MM) seem to differ from those of other spine metastases (SpM), the data in the literature remains scarce. METHODS A prospective population of 361 patients treated for spine MM lesions between January 2014 and 2017. RESULTS OS for our series was 59.6 months (SD 6.0 months; CI 95%: 47.7-71.3). Cox multivariate proportional-hazards analysis showed that bone marrow transplant [HR: 0.390, 95% CI 0.264-0.577; p < 0.0001] and light-chain isotype [HR: 0.748, 95% CI 0.318-1.759; p = 0.005] were independent predictors of longer survival. In contrast, age >80 years [HR: 2.7, 95% CI 1.6-4.3; p < 0.0001], ISS III [HR: 2.510, 95% CI 2.01-3.124; p = 0.001], IgA isotype [HR: 1.475, 95% CI 1.031-2.11; p = 0.034] and IgD/M isotype [HR: 2.753, 95% CI 1.230-6.130; p = 0.013] were independent poor prognostic factors. However, ECOG (p = 0.486), spine surgery (p = 0.391), spine radiotherapy (p = 0.260), epidural involvement (p = 0.259), the number of vertebra lesions (p = 0.222), and synchronous/metachronous timeline (p = 0.412) were not significantly associated with improved OS. CONCLUSIONS Spinal involvement in the context of MM does not influence OS. The main prognostic factors to consider before spinal surgery are the characteristics of the primary MM disease (ISS score, IgG isotype and systemic treatment).
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Affiliation(s)
- Raphael Ly
- Department of Neurosurgery, CHRU de Tours, Tours, France
| | - Louis-Marie Terrier
- Department of Neurosurgery, Clairval Private Hospital, Ramsay Generale de Sante, Marseille, France
| | - Gabrielle Cognacq
- University of Oxford, John Radcliffe Hospital, Headington, Oxford, Oxfordshire, OX3 9DU, UK
| | | | | | - Stéphane Velut
- Department of Neurosurgery, CHRU de Tours, Tours, France
| | | | | | - Mourad Aggad
- Department of Neurosurgery, CHRU de Tours, Tours, France
| | - Aymeric Amelot
- Department of Neurosurgery, CHRU de Tours, Tours, France.
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3
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Xu Y, Xiao H, Hu W, Shen HC, Liu W, Tan S, Ren C, Zhang X, Yang X, Yu G, Yang T, Yu D, Zong L. CIMP-positive glioma is associated with better prognosis: A systematic analysis. Medicine (Baltimore) 2022; 101:e30635. [PMID: 36181110 PMCID: PMC9524892 DOI: 10.1097/md.0000000000030635] [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: 01/05/2023] Open
Abstract
BACKGROUND CpG island methylator phenotype (CIMP) was closely related to the degree of pathological differentiation of tumors, and it's an important determinant of glioma pathogenicity. However, the molecular and pathological features of CIMP-positive glioma have not been fully elucidated. In addition, CIMP have been reported to be a useful prognostic marker in several human cancers, yet its prognostic value in gliomas is still controversial. Therefore, we aimed to evaluate gene mutations and pathological features of CIMP-positive glioma and explore the prognostic value of CIMP in gliomas. METHODS We comprehensively searched PubMed, Embase, and MEDLINE for studies describing gene mutations, pathological features and overall survival of gliomas stratified by CIMP status. Odds ratios (OR), hazard ratios (HR), and their 95% confidence intervals (CI) were used to estimate the correlation between CIMP and the outcome parameters. RESULTS Twelve studies with 2386 gliomas (1051 CIMP-positive and 1335 CIMP-negative) were included. Our results showed that CIMP was more frequent in isocitrate dehydrogenase 1 (IDH1)-mutated gliomas (OR 229.07; 95% CI 138.72-378.26) and 1p19q loss of heterozygosis (LOH) gliomas (OR 5.65; 95% CI 2.66-12.01). Pathological analysis showed that CIMP was common in low-malignant oligodendroglioma (OR 5.51; 95% CI 3.95-7.70) with molecular features including IDH1 mutations and 1p19q LOH, but rare in glioblastoma (OR 0.14; 95% CI 0.10-0.19). However, CIMP showed no obvious correlation with anaplastic oligoastrocytomas (OR 1.57; 95% CI 1.24-2.00) or oligoastrocytomas (OR 0.79; 95% CI 0.35-1.76). Concerning the prognosis, we found that CIMP-positive gliomas had longer overall survival (HR 0.57; 95% CI 0.97-0.16) than CIMP-negative gliomas. CONCLUSIONS CIMP could be used as a potential independent prognostic indicator for glioma.
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Affiliation(s)
- Yingying Xu
- Department of General Surgery, Yizhen People’s Hospital, Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Huashi Xiao
- Clinical Medical College, Dalian Medical University, Liaoning Province, China
| | - Wenqing Hu
- Department of Gastrointestinal Surgery, Changzhi People’s Hospital, The Affiliated Hospital of Changzhi Medical College, Changzhi, Shanxi Province, China
| | - He-Chun Shen
- Department of General Practice, Northern Jiangsu People’s Hospital, Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Wanjun Liu
- Department of Clinical Medical Testing Laboratory, Clinical Medical School of Yangzhou University, Northern Jiangsu People’s Hospital, Yangzhou, Jiangsu Province, China
| | - Siyuan Tan
- Department of General Surgery, Yizhen People’s Hospital, Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Chuanli Ren
- Department of Clinical Medical Testing Laboratory, Clinical Medical School of Yangzhou University, Northern Jiangsu People’s Hospital, Yangzhou, Jiangsu Province, China
| | - Xiaomin Zhang
- Central Laboratory, Changzhi People’s Hospital, The Affiliated Hospital of Changzhi Medical College, Changzhi, Shanxi Province, China
| | - Xishuai Yang
- Neurology Department, Changzhi People’s Hospital, The Affiliated Hospital of Changzhi Medical College, Changzhi, Shanxi Province, China
| | - Guo Yu
- Laboratory of Pharmacogenomics and Pharmacokinetic Research, Subei People’s Hospital, Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Ting Yang
- Central Laboratory, Changzhi People’s Hospital, The Affiliated Hospital of Changzhi Medical College, Changzhi, Shanxi Province, China
| | - Duonan Yu
- Jiangsu Key Laboratory of Experimental & Translational Non-coding RNA Research, Yangzhou University School of Medicine, Yangzhou, Jiangsu Province, China
- Jiangsu Co-Innovation Center for Prevention and Control of Important Animal Infectious Disease and Zoonosis, Yangzhou, Jiangsu Province, China
| | - Liang Zong
- Department of Gastrointestinal Surgery, Changzhi People’s Hospital, The Affiliated Hospital of Changzhi Medical College, Changzhi, Shanxi Province, China
- *Correspondence: Liang Zong, Department of Gastrointestinal Surgery, Changzhi People’s Hospital, The Affiliated Hospital of Changzhi Medical College, Changzhi, 046000, Shanxi Province, China (e-mail: )
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Yurttaş NÖ, Eşkazan AE. Clinical Application of Biomarkers for Hematologic Malignancies. Biomark Med 2022. [DOI: 10.2174/9789815040463122010010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Over the last decade, significant advancements have been made in the
molecular mechanisms, diagnostic methods, prognostication, and treatment options in
hematologic malignancies. As the treatment landscape continues to expand,
personalized treatment is much more important.
With the development of new technologies, more sensitive evaluation of residual
disease using flow cytometry and next generation sequencing is possible nowadays.
Although some conventional biomarkers preserve their significance, novel potential
biomarkers accurately detect the mutational landscape of different cancers, and also,
serve as prognostic and predictive biomarkers, which can be used in evaluating therapy
responses and relapses. It is likely that we will be able to offer a more targeted and
risk-adapted therapeutic approach to patients with hematologic malignancies guided by
these potential biomarkers. This chapter summarizes the biomarkers used (or proposed
to be used) in the diagnosis and/or monitoring of hematologic neoplasms.;
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Affiliation(s)
- Nurgül Özgür Yurttaş
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine,
Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ahmet Emre Eşkazan
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine,
Istanbul University-Cerrahpasa, Istanbul, Turkey
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Barreto IV, Machado CB, Almeida DB, Pessoa FMCDP, Gadelha RB, Pantoja LDC, Oliveira DDS, Ribeiro RM, Lopes GS, de Moraes Filho MO, de Moraes MEA, Khayat AS, de Oliveira EHC, Moreira-Nunes CA. Kinase Inhibition in Multiple Myeloma: Current Scenario and Clinical Perspectives. Pharmaceutics 2022; 14:pharmaceutics14091784. [PMID: 36145532 PMCID: PMC9506264 DOI: 10.3390/pharmaceutics14091784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/16/2022] [Accepted: 08/23/2022] [Indexed: 11/16/2022] Open
Abstract
Multiple myeloma (MM) is a blood cell neoplasm characterized by excessive production of malignant monoclonal plasma cells (activated B lymphocytes) by the bone marrow, which end up synthesizing antibodies or antibody fragments, called M proteins, in excess. The accumulation of this production, both cells themselves and of the immunoglobulins, causes a series of problems for the patient, of a systemic and local nature, such as blood hyperviscosity, renal failure, anemia, bone lesions, and infections due to compromised immunity. MM is the third most common hematological neoplasm, constituting 1% of all cancer cases, and is a disease that is difficult to treat, still being considered an incurable disease. The treatments currently available cannot cure the patient, but only extend their lifespan, and the main and most effective alternative is autologous hematopoietic stem cell transplantation, but not every patient is eligible, often due to age and pre-existing comorbidities. In this context, the search for new therapies that can bring better results to patients is of utmost importance. Protein tyrosine kinases (PTKs) are involved in several biological processes, such as cell growth regulation and proliferation, thus, mutations that affect their functionality can have a great impact on crucial molecular pathways in the cells, leading to tumorigenesis. In the past couple of decades, the use of small-molecule inhibitors, which include tyrosine kinase inhibitors (TKIs), has been a hallmark in the treatment of hematological malignancies, and MM patients may also benefit from TKI-based treatment strategies. In this review, we seek to understand the applicability of TKIs used in MM clinical trials in the last 10 years.
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Affiliation(s)
- Igor Valentim Barreto
- Pharmacogenetics Laboratory, Department of Medicine, Drug Research and Development Center (NPDM), Federal University of Ceará, Fortaleza 60430-275, CE, Brazil
| | - Caio Bezerra Machado
- Pharmacogenetics Laboratory, Department of Medicine, Drug Research and Development Center (NPDM), Federal University of Ceará, Fortaleza 60430-275, CE, Brazil
| | | | - Flávia Melo Cunha de Pinho Pessoa
- Pharmacogenetics Laboratory, Department of Medicine, Drug Research and Development Center (NPDM), Federal University of Ceará, Fortaleza 60430-275, CE, Brazil
| | - Renan Brito Gadelha
- Pharmacogenetics Laboratory, Department of Medicine, Drug Research and Development Center (NPDM), Federal University of Ceará, Fortaleza 60430-275, CE, Brazil
| | - Laudreísa da Costa Pantoja
- Department of Biological Sciences, Oncology Research Center, Federal University of Pará, Belém 66073-005, PA, Brazil
| | | | | | - Germison Silva Lopes
- Department of Hematology, César Cals General Hospital, Fortaleza 60015-152, CE, Brazil
| | - Manoel Odorico de Moraes Filho
- Pharmacogenetics Laboratory, Department of Medicine, Drug Research and Development Center (NPDM), Federal University of Ceará, Fortaleza 60430-275, CE, Brazil
| | - Maria Elisabete Amaral de Moraes
- Pharmacogenetics Laboratory, Department of Medicine, Drug Research and Development Center (NPDM), Federal University of Ceará, Fortaleza 60430-275, CE, Brazil
| | - André Salim Khayat
- Department of Biological Sciences, Oncology Research Center, Federal University of Pará, Belém 66073-005, PA, Brazil
| | - Edivaldo Herculano Correa de Oliveira
- Faculty of Natural Sciences, Institute of Exact and Natural Sciences, Federal University of Pará (UFPA), Rua Augusto Correa, 01, Belém 66075-990, PA, Brazil
- Laboratory of Cytogenomics and Environmental Mutagenesis, Environment Section (SAMAM), Evandro Chagas Institute (IEC), BR 316, KM 7, s/n, Levilândia, Ananindeua 67030-000, PA, Brazil
| | - Caroline Aquino Moreira-Nunes
- Pharmacogenetics Laboratory, Department of Medicine, Drug Research and Development Center (NPDM), Federal University of Ceará, Fortaleza 60430-275, CE, Brazil
- Department of Biological Sciences, Oncology Research Center, Federal University of Pará, Belém 66073-005, PA, Brazil
- Northeast Biotechnology Network (RENORBIO), Itaperi Campus, Ceará State University, Fortaleza 60740-903, CE, Brazil
- Correspondence:
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CD24 Is a Prognostic Marker for Multiple Myeloma Progression and Survival. J Clin Med 2022; 11:jcm11102913. [PMID: 35629039 PMCID: PMC9144978 DOI: 10.3390/jcm11102913] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/13/2022] [Accepted: 05/18/2022] [Indexed: 11/16/2022] Open
Abstract
Surface antigens are commonly used in flow cytometry assays for the diagnosis of multiple myeloma (MM). Some of these are directly involved in MM pathogenesis or interactions with the microenvironment, but most are used for either diagnostic or prognostic purposes. In a previous study, we showed that in-vitro, CD24-positive plasma cells exhibit a less tumorigenic phenotype. Here, we assessed the prognostic importance of CD24 expression in patients newly diagnosed with MM as it correlates to their clinical course. Immunophenotyping by flow cytometry of 124 patients uniformly treated by a bortezomib-based protocol was performed. The expression of CD24, CD117, CD19, CD45, and CD56 in bone marrow PCs was tested for correlations to clinical parameters. None of the CD markers correlated with the response rates to first-line therapy. However, patients with elevated CD24+ expression on their PCs at diagnosis had a significantly longer PFS (p = 0.002) and OS (p = 0.044). In contrast, the expression of CD117, CD56, or CD45 was found to have no prognostic value; CD19 expression was inversely correlated with PFS alone (p < 0.001) and not with OS. Thus, elevated CD24 expression on PCs appears to be strongly correlated with survival and can be used as a single-surface antigenic prognostic factor in MM.
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Kim K, Kim JS, Yoon SS, Yoon DH, Eom HS, Lee JJ, Yim HW, Park M, Lee H, Min CK. Characteristics and clinical outcome of high-risk multiple myeloma patients in Korea (KMM 1805). Int J Hematol 2022; 116:110-121. [PMID: 35543899 DOI: 10.1007/s12185-022-03332-w] [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: 10/07/2021] [Revised: 03/10/2022] [Accepted: 03/11/2022] [Indexed: 11/28/2022]
Abstract
Optimal treatments for multiple myeloma (MM) patients with high-risk cytogenetics must be determined, but subgroup features are not well-defined. We used real-world data from the Korean Myeloma Registry (KMR) to analyze the characteristics and clinical outcomes of newly diagnosed MM patients with ≥ 1 high-risk cytogenetic abnormality: Group 1: t(4;14) or t(14;16); Group 2: del(17p); Group 3: t(4;14)/del(17p) or t(14;16)/del(17p). Overall, 347 high-risk patients were identified (males, 48.7%; median age, 63 years). Median progression-free survival (PFS) and overall survival (OS) were 19.0 months (95% CI 17.0-20.0) and 50.0 months (95% CI 37.0-61.0), respectively. PFS (p = 0.047) and OS (p = 0.020) differed significantly between groups. After stratification by transplant eligibility, PFS and OS were significantly poorer in Group 3 among transplant-eligible patients, and even poorer in those with gain(1q). Patients stratified by cytogenetic abnormality and revised International Staging System (R-ISS) had significantly different PFS (p < 0.001) and OS (p = 0.003), with the worst survival in R-ISS III/Group 3 (median OS 21.0 months). Higher number of high-risk cytogenetic abnormalities was a negative prognostic marker for PFS and OS (p < 0.001). Real-world KMR data showed that risk factors for poor prognosis of MM patients included del(17p), R-ISS stage, and number of cytogenetic abnormalities.
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Affiliation(s)
- Kihyun Kim
- Division of Hematology-Oncology, Department of Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
| | - Jin Seok Kim
- Division of Hematology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung-Soo Yoon
- Division of Hematology-Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Dok Hyun Yoon
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyeon-Seok Eom
- Department of Hematology-Oncology, Center for Hematologic Malignancy, National Cancer Center, Goyang-si, Gyunggi-do, Korea
| | - Je-Jung Lee
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Jeollanm-do, Korea
| | - Hyeon Woo Yim
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Clinical Research Coordinating Center, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Misun Park
- Clinical Research Coordinating Center, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | | | - Chang-Ki Min
- Department of Hematology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
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Bazzoni R, Tanasi I, Turazzi N, Krampera M. Update on the role and utility of extracellular vesicles in hematological malignancies. Stem Cells 2022; 40:619-629. [PMID: 35442447 DOI: 10.1093/stmcls/sxac032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 04/12/2022] [Indexed: 11/12/2022]
Abstract
Extracellular vesicles (EVs) are membrane-surrounded cellular particles released by virtually any cell type, containing numerous bioactive molecules, including lipids, proteins, and nucleic acids. EVs act as a very efficient intercellular communication system by releasing their content into target cells, thus affecting their fate and influencing several biological processes. EVs are released both in physiological and pathological conditions, including several types of cancers. In hematological malignancies (HM), EVs have emerged as new critical players, contributing to tumor-to-stroma, stroma-to-tumor, and tumor-to-tumor cell communication. Therefore, EVs have been shown to play a crucial role in the pathogenesis and clinical course of several HM, contributing to tumor development, progression, and drug resistance. Furthermore, tumor EVs can reprogram the bone marrow (BM) microenvironment and turn it into a sanctuary, in which cancer cells suppress both the normal hematopoiesis and the immunological anti-tumor activity, conferring a therapy-resistant phenotype. Due to their physicochemical characteristics and pro-tumor properties, EVs have been suggested as new diagnostic biomarkers, therapeutic targets, and pharmacological nanocarriers. This review aims to provide an update on the pathogenetic contribution and the putative therapeutic utility of EVs in hematological diseases.
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Affiliation(s)
- Riccardo Bazzoni
- Stem Cell Research Laboratory, Section of Hematology, Department of Medicine, University of Verona, P. le Scuro 10, 37134 Verona, Italy
| | - Ilaria Tanasi
- Stem Cell Research Laboratory, Section of Hematology, Department of Medicine, University of Verona, P. le Scuro 10, 37134 Verona, Italy
| | - Nice Turazzi
- Stem Cell Research Laboratory, Section of Hematology, Department of Medicine, University of Verona, P. le Scuro 10, 37134 Verona, Italy
| | - Mauro Krampera
- Stem Cell Research Laboratory, Section of Hematology, Department of Medicine, University of Verona, P. le Scuro 10, 37134 Verona, Italy
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Chen M, Zhu W, Du J, Yang C, Han B, Zhou D, Huo L, Zhuang J. 11C-acetate positron emission tomography is more precise than 18F-fluorodeoxyglucose positron emission tomography in evaluating tumor burden and predicting disease risk of multiple myeloma. Sci Rep 2021; 11:22188. [PMID: 34773054 PMCID: PMC8590058 DOI: 10.1038/s41598-021-01740-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 09/17/2021] [Indexed: 11/25/2022] Open
Abstract
The optimal method of tumor burden evaluation in newly diagnosed multiple myeloma (NDMM) is yet to be determined. This study aimed to compare the value of 11C-acetate positron-emission tomography (PET)/computed tomography (CT) (AC-PET and 18F-fluorodeoxyglucose PET/CT (FDG-PET) in the assessment of tumor burden in NDMM.
This study evaluated 64 NDMM patients between February 2015 and July 2018. AC-PET and FDG-PET were used to assess myeloma lesions. The clinical data, imaging results, and their correlations were analyzed. Diffuse bone marrow uptake in AC-PET was significantly correlated with biomarkers for tumor burden, including serum hemoglobin (P = 0.020), M protein (P = 0.054), the percentage of bone marrow plasma cells (P < 0.001), and the Durie–Salmon stage of the disease (P = 0.007). The maximum standard uptake value (SUVmax) of focal lesions and high diffuse bone marrow uptake in AC-PET showed stronger correlations with high-risk disease (P = 0.017, P = 0.013) than those in FDG-PET. Moreover, the presence of diffuse bone marrow uptake, more than ten focal lesions, and an SUVmax of focal lesions of > 6.0 in AC-PET, but not in FDG-PET, predicted a higher probability of disease progression and shorter progression-free survival (P < 0.05). AC-PET outperformed FDG-PET in tumor burden evaluation and disease progression prediction in NDMM.
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Affiliation(s)
- Miao Chen
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Wenjia Zhu
- Department of Nuclear Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jianhua Du
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Chen Yang
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Bing Han
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Daobin Zhou
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Li Huo
- Department of Nuclear Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Junling Zhuang
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
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Lebel E, Li X, Paul H, Masih-Khan E, Bhella S, Chen C, Prica A, Reece D, Tiedemann R, Trudel S, Kukreti V. Kinetics of response to first- and second-line therapies in multiple myeloma: Assessment by both M-spikes and light chains. Eur J Haematol 2021; 108:204-211. [PMID: 34767270 DOI: 10.1111/ejh.13726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/06/2021] [Accepted: 11/08/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The prognostic value of kinetics of response to multiple myeloma (MM) therapy is controversial. We aimed to expand the knowledge on this topic by reviewing the kinetics of response to both first- and second-line MM therapy, utilizing a homogeneously treated cohort and analyzing separately both M-spike and light chain (LC) responses for each patient. METHODS We reviewed all patients who received first-line cyclophosphamide, bortezomib and dexamethasone induction followed by autologous transplant with melphalan and lenalidomide maintenance in our center between 2007 and 2019. RESULTS Analyzing 360 patients, we observed no correlation between response kinetics to first- versus second-line therapy at the individual patient level. Time to best response to first-line therapy was not a predictor of outcome; however, longer time to best response was highly predictive of a favorable outcome in the second-line setting, independent of other factors. Patients with IgA-MM cleared their M-spike faster than IgG-MM, probably reflecting different half-lives of these isotypes rather than disease biology, as the clearance of LC in both subtypes was similar. CONCLUSIONS Analyzing both M-spike and LC responses in a homogenously treated cohort, we identified important insights regarding the prognostic value of kinetic patterns. Prospective analysis may shed more light on unsolved questions.
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Affiliation(s)
- Eyal Lebel
- Division of Medical Oncology and Hematology at Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Xuan Li
- Biostatistics Research Unit, University Health Network, Toronto, Ontario, Canada
| | - Harminder Paul
- Division of Medical Oncology and Hematology at Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Esther Masih-Khan
- Division of Medical Oncology and Hematology at Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Sita Bhella
- Division of Medical Oncology and Hematology at Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Christine Chen
- Division of Medical Oncology and Hematology at Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Anca Prica
- Division of Medical Oncology and Hematology at Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Donna Reece
- Division of Medical Oncology and Hematology at Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Rodger Tiedemann
- Division of Medical Oncology and Hematology at Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Suzanne Trudel
- Division of Medical Oncology and Hematology at Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Vishal Kukreti
- Division of Medical Oncology and Hematology at Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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11
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ElMenshawy N, Farag NA, Atia DM, Abousamra N, Shahin D, Fawzi E, Ghazi H, El-Kott AF, Eissa M. Prognostic Relevance of Concordant Expression CD69 and CD56 in Response to Bortezomib Combination Therapy in Multiple Myeloma Patients. Cancer Invest 2021; 39:777-782. [PMID: 34344244 DOI: 10.1080/07357907.2021.1964521] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Multiple myeloma is an incurable hematological malignancy. Currently, the use of proteasome inhibitors could be superior to chemotherapy-based regimen in the treatment of this disease. However, resistance to bortezomib combination therapy still occurs in some patients. So, this research work aims to assess CD69 and CD56 expression in these cases and their relation to the response to therapy. MATERIALS AND METHODS Immunophenotyping by 4-color multi-parameter flow cytometry was carried out on 98 multiple myeloma cases. Clonal plasma cells were gated by co-expression of CD38 with CD138 with low SSC, negative or dim CD45. RESULTS Double negative CD69 and CD56 (47.9%) multiple myeloma cases were associated with high serum β2 microglobulin, creatinine, calcium and low serum albumin. There was also a significant correlation between the absence of these markers with osteolytic lesions and unfavorable cytogenetic t (4;14) (p < 0.001). Moreover, there was a highly significant correlation between CD69- and CD56- with non-response to bortezomib combination therapy in multiple myeloma patients (p < 0.0001). Regression analysis for the prediction of non- response to treatment in these cases using different prognostic indicators revealed that high serum β2 microglobulin, unfavorable cytogenetic, advanced stage, and low expression of CD69 and CD56 were poor predictors of non-response. CONCLUSION CD69 in association with CD56 could be an independent prognostic factor in multiple myeloma cases. It could be used in the routine laboratory assessment for refining stratification and timely therapeutic decision for highly cost therapy in developing countries.
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Affiliation(s)
- Nadia ElMenshawy
- Clinical Pathology Department, Hematology Unit, Mansoura Medical School, Mansoura University, Mansoura, Egypt
| | - Nora A Farag
- Clinical Pathology Department, Hematology Unit, Mansoura Medical School, Mansoura University, Mansoura, Egypt
| | - Doaa M Atia
- Clinical Pathology Department, Hematology Unit, Mansoura Medical School, Mansoura University, Mansoura, Egypt
| | - Nashwa Abousamra
- Clinical Pathology Department, Hematology Unit, Mansoura Medical School, Mansoura University, Mansoura, Egypt
| | - Doaa Shahin
- Clinical Pathology Department, Hematology Unit, Mansoura Medical School, Mansoura University, Mansoura, Egypt
| | - Eman Fawzi
- Clinical Pathology Department, Hematology Unit, Mansoura Medical School, Mansoura University, Mansoura, Egypt
| | - Hayam Ghazi
- Department of Medical Oncology, Mansoura Oncology Center, Mansoura University, Mansoura, Egypt
| | - Attalla F El-Kott
- Department of Biology, College of Science, King Khalid University, Saudi Arabia.,Department of Zoology, Faculty of Science, Damanhour University, Damanhour, Egypt
| | - Mohamed Eissa
- Pathology Department, College of Medicine, King Khalid University, Abha, KSA.,Clinical Pathology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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12
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Cejalvo MJ, Bustamante G, González E, Vázquez-Álvarez J, García R, Ramírez-Payer Á, Pérez-Persona E, Abella E, Garzón S, García A, Jarque I, González MS, Sampol A, Motlló C, Martí JM, Alcalá M, Duro R, González Y, Sastre JL, Sarrà J, Lostaunau G, López R, de la Rubia J. Treatment patterns and outcomes in real-world transplant-ineligible patients newly diagnosed with multiple myeloma. Ann Hematol 2021; 100:1769-1778. [PMID: 33885924 DOI: 10.1007/s00277-021-04529-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Abstract
Despite the significant proportion of older patients with newly diagnosed multiple myeloma (MM), most clinical trials driving therapeutic decisions in routine practice include younger and presumably healthier patients than those in the real world. Furthermore, longitudinal studies suggest that elderly, transplant-ineligible patients with MM are not benefitting enough from new anti-MM agents. We retrospectively analyzed the profile of and treatment patterns and outcomes in 675 transplant-ineligible patients with MM who started frontline therapy in routine practice. The mean (SD) age was 75.6 (6.7) years; 152 (47.4%) had Eastern Cooperative Oncology Group performance status (ECOG PS) 2-4, and 73 (25.1%) had high cytogenetic risk. The most frequent frontline therapy was non-VMP bortezomib-based regimens (n=207; 30.7%), which were more frequent among patients with ECOG PS 0/1 and higher risk (e.g., international staging system (ISS) stage III, severely impaired glomerular filtrate rate (GFR), high lactate dehydrogenase (LDH), and high-risk cytogenetics); 185 patients (27.4%) started an attenuated (lite) VMP regimen, and 159 (23.6%) a VMP (VISTA) regimen. Median progression-free survival and overall survival (OS) were 15.3 months (95%CI 14.0-16.9) and 33.5 months (95%CI 29.1-37.2), respectively; 405 patients (78.2%) achieved partial response or better. Age, ECOG PS, ISS stage, serum LDH, GFR, cytogenetic risk, and treatment regimen significantly influenced OS. In this study, a remarkable proportion of transplant-ineligible patients with MM were older, frontline regimens were highly heterogeneous, and patients at higher risk often received less efficacious combinations. These findings suggest that clinicians have limited objective criteria for therapeutic decisions for this patient group.
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Affiliation(s)
- María José Cejalvo
- Department of Hematology, Hospital Universitario Doctor Peset, Av. de Gaspar Aguilar, 90 46017, Valencia, Spain
| | - Gabriela Bustamante
- Department of Hematology, Institut Català d'Oncologia, Hospital Duran i Reynals, Barcelona, Spain
| | - Esther González
- Department of Hematology, Hospital de Cabueñes, Gijón, Spain
| | | | - Ricarda García
- Department of Hematology, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Ángel Ramírez-Payer
- Department of Hematology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Eugenia Abella
- Department of Hematology, Hospital del Mar, Barcelona, Spain
| | - Sebastián Garzón
- Department of Hematology, Hospital de Jerez, Jerez de la Frontera, Spain
| | - Antoni García
- Department of Hematology, Hospital Arnau de Vilanova, Lleida, Spain
| | - Isidro Jarque
- Department of Hematology, Hospital Universitario y Politécnico La Fe, Valencia & CIBERONC, Instituto de Salud Carlos III, Valencia, Spain
| | | | - Antonia Sampol
- Department of Hematology, Hospital Son Espases, Palma de Mallorca, Spain
| | | | - Josep María Martí
- Department of Hematology, Hospital Mútua de Terrassa, Terrassa, Spain
| | - Magdalena Alcalá
- Department of Hematology, Hospital Universitario Carlos Haya, Málaga, Spain
| | - Rafael Duro
- Department of Hematology, Hospital Universitario Virgen de la Macarena, Sevilla, Spain
| | - Yolanda González
- Department of Hematology, Hospital Universitario de Girona Doctor Josep Trueta, Girona, Spain
| | - José Luis Sastre
- Department of Hematology, Complejo Hospitalario Universitario de Ourense, Ourense, Spain
| | - Josep Sarrà
- Department of Hematology, Hospital Universitario Joan XXIII, Tarragona, Spain
| | | | - Rocío López
- Celgene S.L.U., Bristol-Myers Squibb Company, Madrid, Spain
| | - Javier de la Rubia
- Department of Hematology, Hospital Universitario Doctor Peset, Av. de Gaspar Aguilar, 90 46017, Valencia, Spain. .,Departamento de Medicina Interna y Odontología, Universidad Católica de Valencia, Valencia, Spain.
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13
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Telomere Architecture Correlates with Aggressiveness in Multiple Myeloma. Cancers (Basel) 2021; 13:cancers13081969. [PMID: 33921898 PMCID: PMC8073772 DOI: 10.3390/cancers13081969] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/12/2021] [Accepted: 04/14/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Multiple myeloma (MM) remains an incurable blood cancer. One of the current challenges in patient management is the risk assessment and subsequent treatment management for each patient with MM. Patients with an identical diagnosis may present very different disease courses and outcomes. This challenge of MM is a current focus of the scientific and medical communities. In our research, we have used an imaging approach to determine the risk of MM patients to progressive/aggressive disease. Using three-dimensional (3D) imaging of telomeres, the ends of chromosomes, we report that specific telomeric profiles are associated with aggressive disease. Abstract The prognosis of multiple myeloma (MM), an incurable B-cell malignancy, has significantly improved through the introduction of novel therapeutic modalities. Myeloma prognosis is essentially determined by cytogenetics, both at diagnosis and at disease progression. However, for a large cohort of patients, cytogenetic analysis is not always available. In addition, myeloma patients with favorable cytogenetics can display an aggressive clinical course. Therefore, it is necessary to develop additional prognostic and predictive markers for this disease to allow for patient risk stratification and personalized clinical decision-making. Genomic instability is a prominent characteristic in MM, and we have previously shown that the three-dimensional (3D) nuclear organization of telomeres is a marker of both genomic instability and genetic heterogeneity in myeloma. In this study, we compared in a longitudinal prospective study blindly the 3D telomeric profiles from bone marrow samples of 214 initially treatment-naïve patients with either monoclonal gammopathy of undetermined significance (MGUS), smoldering multiple myeloma (SMM), or MM, with a minimum follow-up of 5 years. Here, we report distinctive 3D telomeric profiles correlating with disease aggressiveness and patient response to treatment in MM patients, and also distinctive 3D telomeric profiles for disease progression in smoldering multiple myeloma patients. In particular, lower average intensity (telomere length, below 13,500 arbitrary units) and increased number of telomere aggregates are associated with shorter survival and could be used as a prognostic factor to identify high-risk SMM and MM patients.
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14
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Wang H, Geng C, Zhou H, Zhang Z, Chen W. Cyclopamine sensitizes multiple myeloma cells to circularly permuted TRAIL-induced apoptosis. Oncol Lett 2021; 21:295. [PMID: 33732371 DOI: 10.3892/ol.2021.12556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 01/27/2021] [Indexed: 11/06/2022] Open
Abstract
Tumor necrosis factor related apoptosis inducing ligand (TRAIL) is a promising anti-myeloma drug prototype. The aim of the present study was to investigate the synergistic effects of cyclopamine and circularly permuted TRAIL (CPT) on the proliferation and apoptosis of multiple myeloma cells. The results showed that the inhibitory effects of cyclopamine on the proliferation of human myeloma RPMI-8226 and SKO-007 cells were weak. RPMI-8226 cells were sensitive to CPT; however, the proliferation of SKO-007 cells was not effectively inhibited by CPT. SKO-007 cells were thus considered resistant to cyclopamine and CPT and used for subsequent experiments. Treatment with a combination of cyclopamine and CPT significantly inhibited cell proliferation. Moreover, the Q value showed that cyclopamine combined with CPT could synergistically inhibit the proliferation of SKO-007 cells. Cyclopamine increased CPT-induced apoptosis in the SKO-007 cells and exhibited a synergistic induction of apoptosis when combined with CPT. Moreover, the combination of cyclopamine and CPT decreased the ratio of myeloma stem cells. Quantitative PCR showed that cyclopamine decreased the mRNA expression levels of GLI1/GLI2/GLI3 and increased the expression levels of death receptor 4. In conclusion, the present study showed that a combination of cyclopamine and CPT exhibited synergistic effects on the inhibition of proliferation and induction of apoptosis in myeloma cells.
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Affiliation(s)
- Huijuan Wang
- Department of Hematology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, P.R. China
| | - Chuanying Geng
- Department of Hematology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, P.R. China
| | - Huixing Zhou
- Department of Hematology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, P.R. China
| | - Zhiyao Zhang
- Department of Hematology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, P.R. China
| | - Wenming Chen
- Department of Hematology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, P.R. China
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15
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Paschali A, Panagiotidis E, Triantafyllou T, Palaska V, Tsirou K, Verrou E, Υiannaki E, Markala D, Papanikolaou A, Pouli A, Konstantinidou P, Chatzipavlidou V, Terpos E, Katodritou E. A proposed index of diffuse bone marrow [18F]-FDG uptake and PET skeletal patterns correlate with myeloma prognostic markers, plasma cell morphology, and response to therapy. Eur J Nucl Med Mol Imaging 2020; 48:1487-1497. [PMID: 33099659 DOI: 10.1007/s00259-020-05078-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 10/15/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE The investigation of a semi-quantitative index in the pelvis to assess for diffuse bone marrow (BM) [18F]-FDG uptake and the investigation of PET skeletal patterns in multiple myeloma (MM) patients, in accordance with prognostic markers, clonal plasma cell (cPC) morphology, and response to therapy. METHODS We prospectively analyzed [18F]-FDG PET/CT in 90 MM patients (newly diagnosed, 60; relapsed/refractory, 30). Among other PET/CT parameters, we calculated the ratio SUVmax pelvis/liver and examined for correlations with known MM prognostic parameters, cPC morphology (good vs. low/intermediate differentiation), and response to therapy. RESULTS SUVmax pelvis/liver ratio was significantly lower for the group of good differentiation vs. intermediate/low differentiation cPCs (p < 0.001) and showed a positive correlation with BM infiltration rate, β2 microglobulin, serum ferritin, international staging system (ISS), and revised ISS; no significant correlation was found with hemoglobin. A cutoff value of 1.1 showed an excellent specificity (99%) and high sensitivity (76%) for diffuse BM involvement (AUC 0.94; p < 0.001). Mixed pattern and appendicular involvement correlated with poor prognostic features while normal pattern, found in 30% of patients, correlated with good prognostic features. Presence of ≥ 10 focal lesions negatively predicted for overall response (p < 0.05; OR 4.8). The CT component improved the diagnostic performance of PET. CONCLUSION This study showed, for the first time, that cPC morphology and markers related with MM biology, correlate with SUVmax pelvis/liver index, which could be used as a surrogate marker for BM assessment and disease prognosis; PET patterns correlate with MM prognostic features and response rates.
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Affiliation(s)
- A Paschali
- Department of Nuclear Medicine, Theagenion Cancer Hospital, Thessaloniki, Greece.
| | - E Panagiotidis
- Department of Nuclear Medicine, Theagenion Cancer Hospital, Thessaloniki, Greece
| | - T Triantafyllou
- Department of Hematology, Theagenion Cancer Hospital, Thessaloniki, Greece
| | - V Palaska
- Department of Hematology, Theagenion Cancer Hospital, Thessaloniki, Greece
| | - K Tsirou
- Department of Hematology, Theagenion Cancer Hospital, Thessaloniki, Greece
| | - E Verrou
- Department of Hematology, Theagenion Cancer Hospital, Thessaloniki, Greece
| | - E Υiannaki
- Hematology/Flow cytometry Lab, Theagenion Cancer Hospital, Thessaloniki, Greece
| | - D Markala
- Hematology/Flow cytometry Lab, Theagenion Cancer Hospital, Thessaloniki, Greece
| | - A Papanikolaou
- Hematopathology Department, Evangelismos General Hospital, Athens, Greece
| | - A Pouli
- Hematology Department, "St Savvas" Oncology Hospital, Athens, Greece
| | - P Konstantinidou
- Department of Hematology, Theagenion Cancer Hospital, Thessaloniki, Greece
| | - V Chatzipavlidou
- Department of Nuclear Medicine, Theagenion Cancer Hospital, Thessaloniki, Greece
| | - E Terpos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - E Katodritou
- Department of Hematology, Theagenion Cancer Hospital, Thessaloniki, Greece
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16
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Upfront stem cell transplantation for newly diagnosed multiple myeloma with del(17p) and t(4;14): a study from the CMWP-EBMT. Bone Marrow Transplant 2020; 56:210-217. [PMID: 32710010 DOI: 10.1038/s41409-020-01007-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/13/2020] [Accepted: 07/17/2020] [Indexed: 12/15/2022]
Abstract
We analyzed newly diagnosed multiple myeloma patients with del(17p) and/or t(4;14) undergoing either upfront single autologous (auto), tandem autologous (auto-auto) or tandem autologous/reduced-intensity allogeneic (auto-allo) stem cell transplantation. 623 patients underwent either auto (n = 446), auto-auto (n = 105), or auto-allo (n = 72) between 2000 and 2015. 46% of patients had t(4;14), 45% had del(17p) while 9% were reported having both abnormalities. Five-year overall survival (OS) was 51% (95% confidence interval [CI], 45-58%) for single auto, 60% (95% CI, 49-72%) for auto-auto, and 67% (95% CI, 53-80%) for auto-allo (p = 0.187). Five-year progression-free survival (PFS) was 17% (95% CI, 12-22%), 33% (95% CI, 22-43%), and 34% (95% CI, 21-38%; p = 0.048). Five-year relapse rate was 82, 63, and 56%, while non-relapse mortality was 1, 4, and 10%. In multivariable analysis, in t(4;14) with single auto as reference, auto-auto (hazard ratio [HR], 0.44; p = 0.007) and auto-allo (HR, 0.45; p = 0.018) were associated with better PFS. In terms of t(4;14) and OS, auto-auto appeared to improve outcome compared with single auto (HR, 0.49; p = 0.096). In del(17p), outcome in PFS was similar between single auto and auto-auto, while auto-allo appeared to improve PFS (HR, 0.65; p = 0.097). No significant difference in OS was identified between the groups in patients with del(17p).
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17
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Chari A, Cornell RF, Gasparetto C, Karanes C, Matous JV, Niesvizky R, Lunning M, Usmani SZ, Anderson LD, Chhabra S, Girnius S, Shustik C, Stuart R, Lee Y, Salman Z, Liu E, Valent J. Final analysis of a phase 1/2b study of ibrutinib combined with carfilzomib/dexamethasone in patients with relapsed/refractory multiple myeloma. Hematol Oncol 2020; 38:353-362. [PMID: 32053229 PMCID: PMC7496325 DOI: 10.1002/hon.2723] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/31/2020] [Accepted: 02/08/2020] [Indexed: 01/10/2023]
Abstract
Patients with multiple myeloma (MM) inevitably relapse on initial treatment regimens, and novel combination therapies are needed. Ibrutinib is a first‐in‐class, once‐daily inhibitor of Bruton's tyrosine kinase, an enzyme implicated in growth and survival of MM cells. Preclinical data suggest supra‐additivity or synergy between ibrutinib and proteasome inhibitors (PIs) against MM. This phase 1/2b study evaluated the efficacy and safety of ibrutinib plus the PI carfilzomib and dexamethasone in patients with relapsed/refractory MM (RRMM). In this final analysis, we report results in patients who received the recommended phase 2 dose (RP2D; ibrutinib 840 mg and carfilzomib 36 mg/m2 with dexamethasone), which was determined in phase 1. The primary efficacy endpoint was overall response rate (ORR). Fifty‐nine patients with RRMM received the RP2D (18 in phase 1 and 41 in phase 2b). These patients had received a median of three prior lines of therapy; 69% were refractory to bortezomib, and 90% were refractory to their last treatment. ORR in the RP2D population was 71% (stringent complete response and complete response: 3% each). Median duration of clinical benefit and median duration of response were both 6.5 months. Median progression‐free survival (PFS) was 7.4 months, and median overall survival (OS) was 35.9 months. High‐risk patients had comparable ORR and median PFS (67% and 7.7 months, respectively) to non–high‐risk patients, whose ORR was 73% and median PFS was 6.9 months, whereas median OS in high‐risk patients was 13.9 months and not reached in non–high‐risk patients. The most common grade ≥3 hematologic treatment‐emergent adverse events (TEAEs) were anemia and thrombocytopenia (17% each); the most common grade ≥3 non‐hematologic TEAE was hypertension (19%). In patients with RRMM treated with multiple previous lines of therapy, ibrutinib plus carfilzomib demonstrated anticancer activity within the expected efficacy range. No new safety signals were identified and the combination was well‐tolerated.
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Affiliation(s)
- Ajai Chari
- Department of Hematology and Medical Oncology, Mount Sinai School of Medicine, New York, New York
| | - Robert F Cornell
- Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Cristina Gasparetto
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Health System, Durham, North Carolina
| | - Chatchada Karanes
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Jeffrey V Matous
- Department of Hematology/Oncology, Colorado Blood Cancer Institute, Denver, Colorado
| | - Ruben Niesvizky
- Department of Medical Oncology, Weill Cornell Medicine, New York, New York
| | - Matthew Lunning
- Division of Oncology & Hematology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Saad Z Usmani
- Department of Hematologic Oncology & Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina
| | - Larry D Anderson
- Division of Hematology Oncology, Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas
| | - Saurabh Chhabra
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Saulius Girnius
- Department of Medicine, University of Cincinnati Cancer Institute, Cincinnati, Ohio
| | - Chaim Shustik
- Division of Hematology, Cedars Cancer Centre, McGill University Health Centre, Montreal, Quebec, Canada
| | - Robert Stuart
- Division of Hematology/Oncology, Medical University of South Carolina, Charleston, South Carolina
| | - Yihua Lee
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, California
| | - Zeena Salman
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, California
| | - Emily Liu
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, California
| | - Jason Valent
- Department of Hematology and Medical Oncology, Cleveland Clinic Foundation, Cleveland, Ohio
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18
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Mitrović M, Sretenović A, Bila J. The significance of prognostic profiling in the treatment of patients with multiple myeloma. MEDICINSKI PODMLADAK 2020. [DOI: 10.5937/mp71-28137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Multiple myeloma (MM) is a hematological neoplasia characterized by clonal expansion of the most mature B lymphocytes, plasma cells (Plc), in the bone marrow (BM). Due to new treatment modalities, the 5-years survival has improved in the last 15 years, and nowdays ranges from 60-70%. The individual prognostic profile is based on the biological characteristics of the disease, clinical characteristics of patients and therapeutics response characteristics. The biological characteristics of the disease are defined by the clinical stage according to the Durie-Salmon classification and prognostic indices such the international staging system (ISS) and revised ISS (R-ISS). Numerous different mutations of prognostic significance have been discovered applying methods of molecular genetics such as next generation sequencing (NGS). The age and comorbity status of patients are the most important clinical characteristics because they are crucial for therapeutic choice and suitability for treatment with high-dose chemotherapy and autologous stem cell transplantation. The prognostic influence of therapeutic response is very important and the most powerful prognostic factors are achievements of complete remission (CR) and minimal residual disease (MRD) negativity.
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19
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LeBlanc R, Song K, White D, Christofides A, Doucette S. Updates from the 2019 American Society of Clinical Oncology and European Hematology Association annual meetings: a Canadian perspective on high-risk cytogenetics in multiple myeloma. Curr Oncol 2019; 26:e581-e594. [PMID: 31548829 PMCID: PMC6726268 DOI: 10.3747/co.26.5565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The 2019 annual meetings of the American Society of Clinical Oncology and the European Hematology Association took place, respectively, in Chicago, Illinois, 31 May-4 June, and in Amsterdam, Netherlands, 13-16 June. At the meetings, results from key studies on the treatment of patients with relapsed or refractory multiple myeloma with high-risk cytogenetics were presented. Our meeting report describes those studies and includes interviews with investigators and commentaries by Canadian hematologists about the potential impact on Canadian practice.
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Affiliation(s)
- R LeBlanc
- Université de Montréal and Hôpital Maisonneuve-Rosemont, Montreal, QC
| | - K Song
- University of British Columbia and Vancouver General Hospital, Vancouver, BC
| | - D White
- Dalhousie University and Queen Elizabeth iiHealth Sciences Centre, Halifax, NS
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20
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Nanni C, Zamagni E. Fluorodeoxyglucose-PET/Computed Tomography as a Predictor of Prognosis in Multiple Myeloma. PET Clin 2019; 14:383-389. [PMID: 31084777 DOI: 10.1016/j.cpet.2019.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Fluorodeoxyglucose-PET/CT is a valuable tool for the work-up of patients with newly diagnosed and relapsed/refractory multiple myeloma, because it assesses bone damage with high sensitivity and specificity and detects extramedullary sites of proliferating clonal plasma cells (extramedullary diseases). PET/CT provides valuable prognostic data at diagnosis and at restaging during the course of the disease. Consistencies between independent studies confirm the negative prognostic value of extramedullary disease and greater than 3 focal lesions, whereas the role of standardized uptake value is more conflicting. Standardization of the technique is ongoing.
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Affiliation(s)
- Cristina Nanni
- Metropolitan nuclear medicine, Azienda Ospedaliera-Universitaria di Bologna S. Orsola Malpighi, Bologna, Italy
| | - Elena Zamagni
- "Seràgnoli" Institute of Hematology, Bologna University School of Medicine, Bologna, Italy.
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