1
|
Matsunaga N, Suzuki T, Nishitarumizu N, Nakanishi Y, Kondo A, Kato Y, Ebina T, Marumo Y, Nakamura T, Nakashima T, Kinoshita S, Narita T, Ri M, Kusumoto S, Komatsu H, Iida S. Clinical Significance of Cytomegalovirus Reactivation in Patients With Plasma Cell Dyscrasia Who Were Treated With Anti-CD38 Monoclonal Antibody: A Retrospective Analysis in a Single Institution. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2024; 24:531-536.e1. [PMID: 38653670 DOI: 10.1016/j.clml.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/19/2024] [Accepted: 03/28/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Anti-CD38 monoclonal antibodies (mAbs) have improved the prognosis of patients with plasma cell dyscrasia (PCD), but are also associated with increased infectious adverse events. Cytomegalovirus (CMV) is a common latent pathogen that is reactivated in immunocompromised individuals. Although CMV reactivation has mostly been reported after high-dose chemotherapy followed by stem cell transplantation in patients with PCD, cases of reactivation during anti-CD38 mAb therapy have been reported recently. Due to limited studies, we aimed to determine the frequency and impact of CMV reactivation during anti-CD38 mAb therapy. PATIENTS AND METHODS This retrospective analysis included 154 consecutive patients with PCD who were treated with anti-CD38 mAbs at a single institution. RESULTS Seventy-six patients were evaluated for CMV reactivation by CMV pp65 antigen testing, and 29 (38%) patients, including nine with newly diagnosed PCD, showed positive results. Patients who tested positive for the CMV pp65 antigen had substantially lower serum albumin levels than those who tested negative. However, the two groups showed no marked difference in the concurrent anti-PCD medications or baseline absolute lymphocyte count. Although most patients showing positive results in the CMV pp65 antigen test had mild or no symptoms, with fever being the most common symptom, some patients developed CMV end-organ disease. In addition, CMV reactivation interfered with the course of anti-PCD treatment in most patients, necessitating dose reductions, delays, and discontinuation of chemotherapy. CONCLUSION This study provides an overview of the clinical impact of CMV reactivation in patients with PCD treated with anti-CD38 mAb-containing regimens.
Collapse
Affiliation(s)
- Naohiro Matsunaga
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, Nagoya,Aichi, Japan
| | - Tomotaka Suzuki
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, Nagoya,Aichi, Japan.
| | - Nozomi Nishitarumizu
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, Nagoya,Aichi, Japan
| | - Yoko Nakanishi
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, Nagoya,Aichi, Japan
| | - Aki Kondo
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, Nagoya,Aichi, Japan
| | - Yukiyasu Kato
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, Nagoya,Aichi, Japan
| | - Toru Ebina
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, Nagoya,Aichi, Japan
| | - Yoshiaki Marumo
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, Nagoya,Aichi, Japan
| | - Tomoyuki Nakamura
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, Nagoya,Aichi, Japan
| | - Takahiro Nakashima
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, Nagoya,Aichi, Japan
| | - Shiori Kinoshita
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, Nagoya,Aichi, Japan
| | - Tomoko Narita
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, Nagoya,Aichi, Japan
| | - Masaki Ri
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, Nagoya,Aichi, Japan
| | - Shigeru Kusumoto
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, Nagoya,Aichi, Japan
| | - Hirokazu Komatsu
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, Nagoya,Aichi, Japan
| | - Shinsuke Iida
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, Nagoya,Aichi, Japan
| |
Collapse
|
2
|
De Novellis D, Fontana R, Serio B, Vaccaro E, Guariglia R, Morini D, Rizzo M, Giudice V, Selleri C. Cytomegalovirus reactivation is frequent in multiple myeloma patients treated with daratumumab-based regimens. Cancer Med 2024; 13:e7402. [PMID: 39034465 PMCID: PMC11260764 DOI: 10.1002/cam4.7402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 05/27/2024] [Accepted: 06/07/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND Viral reactivations are frequent in hematologial patients due to their cancer-related and drug-induced immunosuppressive status. Daratumumab, an anti-CD38 monoclonal antibody, is used for multiple myeloma (MM) treatment, and causes immunosuppression by targeting CD38-expressing normal lymphocytes. In this single-center two-arm real-life experience, we evaluated incidence of cytomegalovirus (CMV) reactivation in MM patients treated with daratumumab-based regimens as first- or second-line therapy. METHODS A total of 101 consecutive MM patients were included in this study and were divided into two cohorts: daratumumab and nondaratumumab-based (control) regimens. Patients treated with >2 lines of therapies were excluded to reduce the confounding factor of multi-treated cases. Primary endpoint was the CMV reactivation rate. RESULTS CMV reactivation rate was significantly higher in the daratumumab cohort compared to control group (33% vs. 4%; p < 0.001), also with higher CMV-DNA levels (>1000 UI/mL in 12% of cases; p < 0.05). However, only one subject developed a CMV disease with severe pneumonia, while 12% of patients were successfully treated with preemptive therapy with valganciclovir. No subjects in the control cohort required anti-CMV agents (p = 0.02). CONCLUSION Our single-center retrospective experience showed that daratumumab might significantly increase the risk of CMV reactivation in MM, while currently underestimated and related to morbility and mortality in MM patients under treatments. However, further validation on larger and prospective clinical trials are required.
Collapse
Affiliation(s)
- Danilo De Novellis
- Hematology and Transplant CenterUniversity Hospital “San Giovanni di Dio e Ruggi d'Aragona”SalernoItaly
- Department of MedicineSurgery and Dentistry “Scuola Medica Salernitana”, University of SalernoBaronissiItaly
| | - Raffaele Fontana
- Hematology and Transplant CenterUniversity Hospital “San Giovanni di Dio e Ruggi d'Aragona”SalernoItaly
| | - Bianca Serio
- Hematology and Transplant CenterUniversity Hospital “San Giovanni di Dio e Ruggi d'Aragona”SalernoItaly
| | - Emilia Vaccaro
- Transfusion MedicineUniversity Hospital “San Giovanni di Dio e Ruggi d'Aragona”SalernoItaly
| | - Roberto Guariglia
- Hematology and Transplant CenterUniversity Hospital “San Giovanni di Dio e Ruggi d'Aragona”SalernoItaly
| | - Denise Morini
- Hematology and Transplant CenterUniversity Hospital “San Giovanni di Dio e Ruggi d'Aragona”SalernoItaly
| | - Michela Rizzo
- Hematology and Transplant CenterUniversity Hospital “San Giovanni di Dio e Ruggi d'Aragona”SalernoItaly
| | - Valentina Giudice
- Hematology and Transplant CenterUniversity Hospital “San Giovanni di Dio e Ruggi d'Aragona”SalernoItaly
- Department of MedicineSurgery and Dentistry “Scuola Medica Salernitana”, University of SalernoBaronissiItaly
| | - Carmine Selleri
- Hematology and Transplant CenterUniversity Hospital “San Giovanni di Dio e Ruggi d'Aragona”SalernoItaly
- Department of MedicineSurgery and Dentistry “Scuola Medica Salernitana”, University of SalernoBaronissiItaly
| |
Collapse
|
3
|
Li S, Zheng G, He J, Wu W, Chen Q, Yang Y, He D, Zhao Y, Han X, Cai Z. Cytomegalovirus and Epstein-Barr virus infection during daratumumab treatment in patients with multiple myeloma. Leuk Lymphoma 2023; 64:835-845. [PMID: 36735513 DOI: 10.1080/10428194.2023.2172982] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
ABSTRACTSWe explored the incidence of Epstein-Barr virus (EBV) and cytomegalovirus (CMV) infections in 131 patients with multiple myeloma (MM), 53 of whom received daratumumab (Dara) treatments. The Dara group had more RRMM patients than the group without Dara. CMV infection was significantly more common in patients treated with Dara (16.98%) than in patients treated with regimens without Dara (2.56%). During Dara treatments, 24.53% of patients developed CMV and/or EBV infections. Patients who developed infections had significantly lower levels of albumin and lymphocytes in their peripheral blood. The median time from the first Dara infusion to infection was 27 days. We observed NK cell depletion and T cell expansion during Dara-treatment. Patients with CMV and/or EBV infections had significantly lower numbers of NK cells, total T cells, and CD8 + T cells at 1 month, and lower numbers of CD8 + T cells at 2 months after the first Dara infusion than those without infections.
Collapse
Affiliation(s)
- Shuchan Li
- Bone Marrow Transplantation Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Institute of Hematology, Zhejiang University, Hangzhou, Zhejiang, China
| | - Gaofeng Zheng
- Bone Marrow Transplantation Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Institute of Hematology, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jingsong He
- Bone Marrow Transplantation Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Institute of Hematology, Zhejiang University, Hangzhou, Zhejiang, China
| | - Wenjun Wu
- Bone Marrow Transplantation Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Institute of Hematology, Zhejiang University, Hangzhou, Zhejiang, China
| | - Qingxiao Chen
- Bone Marrow Transplantation Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Institute of Hematology, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yang Yang
- Bone Marrow Transplantation Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Institute of Hematology, Zhejiang University, Hangzhou, Zhejiang, China
| | - Donghua He
- Bone Marrow Transplantation Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Institute of Hematology, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yi Zhao
- Bone Marrow Transplantation Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Institute of Hematology, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xiaoyan Han
- Bone Marrow Transplantation Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Institute of Hematology, Zhejiang University, Hangzhou, Zhejiang, China
| | - Zhen Cai
- Bone Marrow Transplantation Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Institute of Hematology, Zhejiang University, Hangzhou, Zhejiang, China
| |
Collapse
|
4
|
Wang Y, Xu L, Zhao W, Chen X, Wen L, Duan W, Yu X, De Zhou F, Liu Y, Hao J, Huang X, Lu J, Ge Q. T cell landscape and dynamics in immunoglobulin light chain amyloidosis before and after daratumumab-based therapy. Clin Transl Med 2021; 11:e582. [PMID: 34845849 PMCID: PMC8630449 DOI: 10.1002/ctm2.582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 09/05/2021] [Accepted: 09/10/2021] [Indexed: 11/07/2022] Open
Abstract
Amyloid light-chain (AL) is characterized by the presence of small, poorly proliferating plasma cell clones with the production and deposition of light chains into tissues. T cell changes within the tumour microenvironment in AL are poorly understood. By sequencing at a single-cell level of CD3+ T cells purified from bone marrow (BM) and blood of newly diagnosed AL patients before and after a combination of daratumumab with cyclophosphamide, bortezomib, and dexamethasone (Dara-BCD), we analysed the transcriptomic features of T cells and found an expansion, activation and type I cytokine upregulation in BM and circulating T cells after the treatment. More prominent changes were shown in CD8+ T cells. In particular, we found the presence of CD8+ BM resident memory T cells (TRM ) with high expression of inhibitory molecules in AL patients at diagnosis. After Dara-BCD, these TRM cells were quickly activated with downregulation of suppressive molecules and upregulation of IFNG expression. These data collectively demonstrate that Dara-based therapy in patients with AL amyloidosis promotes anti-tumour T cell responses. The similar transcriptomic features of BM and circulating T cells before and after therapy further provide a less invasive approach for molecular monitoring of T cell response in AL amyloidosis.
Collapse
Affiliation(s)
- Yujia Wang
- Department of ImmunologySchool of Basic Medical SciencesPeking University. NHC Key Laboratory of Medical Immunology (Peking University)BeijingChina
| | - Lushuang Xu
- Department of ImmunologySchool of Basic Medical SciencesPeking University. NHC Key Laboratory of Medical Immunology (Peking University)BeijingChina
| | - Weijia Zhao
- Department of ImmunologySchool of Basic Medical SciencesPeking University. NHC Key Laboratory of Medical Immunology (Peking University)BeijingChina
| | | | - Lei Wen
- Beijing Key Laboratory of Hematopoietic Stem Cell TransplantationPeking University People's Hospital & Institute of HematologyBeijingChina
| | - Wenbing Duan
- Beijing Key Laboratory of Hematopoietic Stem Cell TransplantationPeking University People's Hospital & Institute of HematologyBeijingChina
| | - Xiao‐Juan Yu
- Renal DivisionDepartment of MedicineInstitute of NephrologyPeking University First Hospital, & Renal Pathology CenterPeking UniversityBeijingChina
- Renal Pathology CenterInstitute of NephrologyPeking UniversityBeijingChina
- Key Laboratory of Renal DiseaseMinistry of Health of ChinaBeijingChina
- Key Laboratory of CKD Prevention and TreatmentMinistry of Education of ChinaBeijingChina
| | - Fu‐ De Zhou
- Renal DivisionDepartment of MedicineInstitute of NephrologyPeking University First Hospital, & Renal Pathology CenterPeking UniversityBeijingChina
- Renal Pathology CenterInstitute of NephrologyPeking UniversityBeijingChina
- Key Laboratory of Renal DiseaseMinistry of Health of ChinaBeijingChina
- Key Laboratory of CKD Prevention and TreatmentMinistry of Education of ChinaBeijingChina
| | - Yang Liu
- Beijing Key Laboratory of Hematopoietic Stem Cell TransplantationPeking University People's Hospital & Institute of HematologyBeijingChina
| | - Jie Hao
- Department of ImmunologySchool of Basic Medical SciencesPeking University. NHC Key Laboratory of Medical Immunology (Peking University)BeijingChina
| | - Xiaojun Huang
- Beijing Key Laboratory of Hematopoietic Stem Cell TransplantationPeking University People's Hospital & Institute of HematologyBeijingChina
| | - Jin Lu
- Beijing Key Laboratory of Hematopoietic Stem Cell TransplantationPeking University People's Hospital & Institute of HematologyBeijingChina
- Collaborative Innovation Center of HaematologySoochow UniversitySuzhouJiangsuChina
| | - Qing Ge
- Department of ImmunologySchool of Basic Medical SciencesPeking University. NHC Key Laboratory of Medical Immunology (Peking University)BeijingChina
- Department of Integration of Chinese and Western MedicineSchool of Basic Medical SciencesPeking UniversityBeijingChina
- National Key Laboratory of Human Factors EngineeringChina Astronauts Research and Training CenterBeijingChina
| |
Collapse
|
5
|
Bortezomib and rituximab in de novo adolescent/adult CD20-positive, Ph-negative pre-B-cell acute lymphoblastic leukemia. Blood Adv 2021; 5:3436-3444. [PMID: 34461632 DOI: 10.1182/bloodadvances.2020003368] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 05/03/2021] [Indexed: 12/30/2022] Open
Abstract
The expression of CD20 in precursor B-cell acute lymphoblastic leukemia (B-ALL) is associated with poor outcomes. The addition of rituximab to intensive chemotherapy in CD20+ ALL has led to improved outcomes in several studies. However, there is no clear evidence regarding the optimal number of doses and its benefit without an allogeneic stem cell transplant. Achieving measurable residual disease (MRD)-negative status postinduction would reduce the requirement for a transplant. Novel approaches are needed to induce a higher proportion of MRD-negative complete remission in patients with high-risk ALL. Given bortezomib's activity in relapsed ALL and its synergism with rituximab in B-cell lymphomas, the addition of bortezomib to rituximab and chemotherapy may provide an incremental benefit in CD20+ precursor B-ALL. We conducted a phase 2 study to test the activity of bortezomib and rituximab in combination with a pediatric-inspired regimen during induction therapy in newly diagnosed adolescents and adults (aged >14 years) with CD20+, Philadelphia-negative precursor B-ALL; bone marrow MRD negativity at the end of induction was the primary end point. From December 2017 through August 2019, a total of 35 patients were enrolled. End-of-induction MRD-negative status was achieved in 70.9% of patients, as opposed to 51.7% in the historical cohort treated with chemotherapy alone. MRD-negative rates improved to 87.5% post-consolidation. At a median follow-up of 21 months, event-free survival and overall survival rates were 78.8% (95% confidence interval, 66-94) and 78.7% (95% confidence interval, 65.8-94), respectively. There was no significant increase in toxicity with bortezomib and rituximab compared with the historical cohort. The incidence of neuropathy was 26% (all less than grade 3). The combination of bortezomib, rituximab, and a pediatric-inspired ALL regimen was active and well tolerated in de novo CD20+ Philadelphia-negative precursor B-ALL. This trial was registered with the Clinical Trials Registry-India as CTRI/2017/04/008393(http://ctri.nic.in/Clinicaltrials).
Collapse
|
6
|
HCMV-Mediated Interference of Bortezomib-Induced Apoptosis in Colon Carcinoma Cell Line Caco-2. Viruses 2021; 13:v13010083. [PMID: 33435377 PMCID: PMC7827311 DOI: 10.3390/v13010083] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/04/2021] [Accepted: 01/06/2021] [Indexed: 11/18/2022] Open
Abstract
Human cytomegalovirus (HCMV) has been implicated in the development of human malignancies, for instance in colon cancer. Proteasome inhibitors were developed for cancer therapy and have also been shown to influence HCMV infection. The aim of this study was to investigate if proteasome inhibitors have therapeutic potential for colon carcinoma and how this is influenced by HCMV infection. We show by immunofluorescence and flow cytometry that the colon carcinoma cell line Caco-2 is susceptible to HCMV infection. Growth curve analysis as well as protein expression kinetics and quantitative genome analysis further confirm these results. HCMV has an anti-apoptotic effect on Caco-2 cells by inhibiting very early events of the apoptosis cascade. Further investigations showed that HCMV stabilizes the membrane potential of the mitochondria, which is typically lost very early during apoptosis. This stabilization is resistant to proteasome inhibitor Bortezomib treatment, allowing HCMV-infected cells to survive apoptotic signals. Our findings indicate a possible role of proteasome inhibitors in colon carcinoma therapy.
Collapse
|
7
|
Kastritis E, Wechalekar A, Schönland S, Sanchorawala V, Merlini G, Palladini G, Minnema M, Roussel M, Jaccard A, Hegenbart U, Kumar S, Cibeira MT, Blade J, Dimopoulos MA. Challenges in the management of patients with systemic light chain (AL) amyloidosis during the COVID-19 pandemic. Br J Haematol 2020; 190:346-357. [PMID: 32480420 PMCID: PMC7300844 DOI: 10.1111/bjh.16898] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/29/2020] [Indexed: 01/08/2023]
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2)‐associated coronavirus disease 2019 (COVID‐19) is primarily manifested as a respiratory tract infection, but may affect and cause complications in multiple organ systems (cardiovascular, gastrointestinal, kidneys, haematopoietic and immune systems), while no proven specific therapy exists. The challenges associated with COVID‐19 are even greater for patients with light chain (AL) amyloidosis, a rare multisystemic disease affecting the heart, kidneys, liver, gastrointestinal and nervous system. Patients with AL amyloidosis may need to receive chemotherapy, which probably increases infection risk. Management of COVID‐19 may be particularly challenging in patients with AL amyloidosis, who often present with cardiac dysfunction, nephrotic syndrome, neuropathy, low blood pressure and gastrointestinal symptoms. In addition, patients with AL amyloidosis may be more susceptible to toxicities of drugs used to manage COVID‐19. Access to health care may be difficult or limited, diagnosis of AL amyloidosis may be delayed with detrimental consequences and treatment administration may need modification. Both patients and treating physicians need to adapt in a new reality.
Collapse
Affiliation(s)
- Efstathios Kastritis
- Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Stefan Schönland
- Medical Department V, Amyloidosis Centre, University Hospital Heidelberg, Heidelberg, Germany
| | - Vaishali Sanchorawala
- Amyloidosis Center, School of Medicine and Boston Medical Center, Boston University, Boston, MA, USA
| | - Giampaolo Merlini
- Department of Molecular Medicine, Amyloidosis Research and Treatment Center, Foundation "Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo", University of Pavia, Pavia, Italy
| | - Giovanni Palladini
- Department of Molecular Medicine, Amyloidosis Research and Treatment Center, Foundation "Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo", University of Pavia, Pavia, Italy
| | - Monique Minnema
- Department of Hematology, UMC Utrecht Cancer Center, Utrecht, The Netherlands
| | - Murielle Roussel
- Clinical Hematology, IUC Oncopole/CHU Toulouse, Toulouse, France
| | | | - Ute Hegenbart
- Medical Department V, Amyloidosis Centre, University Hospital Heidelberg, Heidelberg, Germany
| | - Shaji Kumar
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Maria T Cibeira
- Hematology Department, Amyloidosis and Myeloma Unit, Hospital Clínic of Barcelona, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Joan Blade
- Hematology Department, Amyloidosis and Myeloma Unit, Hospital Clínic of Barcelona, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Meletios A Dimopoulos
- Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|