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McCachren SS, Dhodapkar KM, Dhodapkar MV. Co-evolution of Immune Response in Multiple Myeloma: Implications for Immune Prevention. Front Immunol 2021; 12:632564. [PMID: 33717170 PMCID: PMC7952530 DOI: 10.3389/fimmu.2021.632564] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/25/2021] [Indexed: 12/15/2022] Open
Abstract
Multiple myeloma (MM), a malignant neoplasm of plasma cells that reside in the bone marrow (BM), is universally preceded by a precursor state termed monoclonal gammopathy of undetermined significance (MGUS). Many individuals with MGUS never progress to MM or progress over many years. Therefore, MGUS provides a unique opportunity to surveil changes in the BM tumor microenvironment throughout disease progression. It is increasingly appreciated that MGUS cells carry many of the genetic changes found in MM. Prior studies have also shown that MGUS cells can be recognized by the immune system, leading to early changes in the BM immune environment compared to that of healthy individuals, including alterations in both innate and adaptive immunity. Progression to clinical MM is associated with attrition of T cells with stem memory-like features and instead accumulation of T cells with more terminally differentiated features. Recent clinical studies have suggested that early application of immune-modulatory drugs, which are known to activate both innate and adaptive immunity, can delay the progression to clinical MM. Understanding the biology of how the immune response and tumors coevolve over time is needed to develop novel immune-based approaches to achieve durable and effective prevention of clinical malignancy.
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Affiliation(s)
- Samuel S. McCachren
- Department of Hematology and Oncology, Emory University School of Medicine, Atlanta, GA, United States
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States
| | - Kavita M. Dhodapkar
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, GA, United States
- Winship Cancer Institute, Atlanta, GA, United States
| | - Madhav V. Dhodapkar
- Department of Hematology and Oncology, Emory University School of Medicine, Atlanta, GA, United States
- Winship Cancer Institute, Atlanta, GA, United States
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Notarfranchi L, Marchica V, Dalla Palma B, Pelagatti L, Burroughs-Garcia J, Pedrazzoni M, Ruffini L, Cetani F, Marcocci C, Giuliani N. Concomitant Primary Hyperparathyroidism in Patients with Multiple Myeloma: A Possible Link? Acta Haematol 2020; 144:302-307. [PMID: 32906140 DOI: 10.1159/000509768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/27/2020] [Indexed: 01/23/2023]
Abstract
Hypercalcemia is a significant feature of patients with active multiple myeloma (MM) with extensive bone disease. Among the causes of non-neoplastic hypercalcemia, primary hyperparathyroidism (PHPT) is one of the most common, leading to osteoporosis and bone fractures. Interestingly, some preclinical data indicate that high secretion of parathyroid hormone (PTH) may have a negative impact on bone disease and MM progression. However, concomitant diagnosis of MM and PHPT has rarely been described. Here, we present 4 cases of patients with active MM and hypercalcemia with high or inappropriately normal PTH levels. Interestingly, CD138+ cells from these 4 MM patients lack PTH receptor 1 and PTH-related peptide expressions, indicating that PTH could have a paracrine rather than a direct pro-tumoral effect. Moreover, these cases suggest that the concomitant diagnosis of MM and PHTP may not be so rare and should be considered for the clinical management of MM patients with hypercalcemia.
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Affiliation(s)
- Laura Notarfranchi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Hematology, "Azienda Ospedaliero-Universitaria di Parma,", Parma, Italy
| | | | - Benedetta Dalla Palma
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Hematology, "Azienda Ospedaliero-Universitaria di Parma,", Parma, Italy
| | - Laura Pelagatti
- Hematology, "Azienda Ospedaliero-Universitaria di Parma,", Parma, Italy
| | | | - Mario Pedrazzoni
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Livia Ruffini
- Nuclear Medicine Unit, University Hospital of Parma, Parma, Italy
| | - Filomena Cetani
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Claudio Marcocci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Nicola Giuliani
- Department of Medicine and Surgery, University of Parma, Parma, Italy,
- Hematology, "Azienda Ospedaliero-Universitaria di Parma,", Parma, Italy,
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Storti P, Agnelli L, Palma BD, Todoerti K, Marchica V, Accardi F, Sammarelli G, Deluca F, Toscani D, Costa F, Vicario E, Todaro G, Martella E, Neri A, Giuliani N. The transcriptomic profile of CD138 + cells from patients with early progression from smoldering to active multiple myeloma remains substantially unchanged. Haematologica 2019; 104:e465-e469. [PMID: 30846495 DOI: 10.3324/haematol.2018.209999] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
- Paola Storti
- Department of Medicine and Surgery, University of Parma, Parma .,CORELAB Azienda Ospedaliero-Universitaria di Parma, Parma
| | - Luca Agnelli
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan.,Department of Oncology and Hemato-oncology, University of Milan, Milan
| | - Benedetta Dalla Palma
- Department of Medicine and Surgery, University of Parma, Parma.,Hematological Unit Azienda Ospedaliero-Universitaria di Parma, Parma
| | - Katia Todoerti
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan.,Department of Oncology and Hemato-oncology, University of Milan, Milan
| | - Valentina Marchica
- Department of Medicine and Surgery, University of Parma, Parma.,CORELAB Azienda Ospedaliero-Universitaria di Parma, Parma
| | - Fabrizio Accardi
- Department of Medicine and Surgery, University of Parma, Parma.,Hematological Unit Azienda Ospedaliero-Universitaria di Parma, Parma
| | | | - Federica Deluca
- Department of Medicine and Surgery, University of Parma, Parma
| | - Denise Toscani
- Department of Medicine and Surgery, University of Parma, Parma
| | - Federica Costa
- Department of Medicine and Surgery, University of Parma, Parma
| | | | | | - Eugenia Martella
- Pathology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Antonino Neri
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan.,Department of Oncology and Hemato-oncology, University of Milan, Milan
| | - Nicola Giuliani
- Department of Medicine and Surgery, University of Parma, Parma .,CORELAB Azienda Ospedaliero-Universitaria di Parma, Parma.,Hematological Unit Azienda Ospedaliero-Universitaria di Parma, Parma
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