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Sharma NS, Choudhary B. Good Cop, Bad Cop: Profiling the Immune Landscape in Multiple Myeloma. Biomolecules 2023; 13:1629. [PMID: 38002311 PMCID: PMC10669790 DOI: 10.3390/biom13111629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/26/2023] [Accepted: 10/29/2023] [Indexed: 11/26/2023] Open
Abstract
Multiple myeloma (MM) is a dyscrasia of plasma cells (PCs) characterized by abnormal immunoglobulin (Ig) production. The disease remains incurable due to a multitude of mutations and structural abnormalities in MM cells, coupled with a favorable microenvironment and immune suppression that eventually contribute to the development of drug resistance. The bone marrow microenvironment (BMME) is composed of a cellular component comprising stromal cells, endothelial cells, osteoclasts, osteoblasts, and immune cells, and a non-cellular component made of the extracellular matrix (ECM) and the liquid milieu, which contains cytokines, growth factors, and chemokines. The bone marrow stromal cells (BMSCs) are involved in the adhesion of MM cells, promote the growth, proliferation, invasion, and drug resistance of MM cells, and are also crucial in angiogenesis and the formation of lytic bone lesions. Classical immunophenotyping in combination with advanced immune profiling using single-cell sequencing technologies has enabled immune cell-specific gene expression analysis in MM to further elucidate the roles of specific immune cell fractions from peripheral blood and bone marrow (BM) in myelomagenesis and progression, immune evasion and exhaustion mechanisms, and development of drug resistance and relapse. The review describes the role of BMME components in MM development and ongoing clinical trials using immunotherapeutic approaches.
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Affiliation(s)
- Niyati Seshagiri Sharma
- Institute of Bioinformatics and Applied Biotechnology (IBAB), Electronic City, Bengaluru 560100, India
- Manipal Academy of Higher Education (MAHE), Manipal 576104, India
| | - Bibha Choudhary
- Institute of Bioinformatics and Applied Biotechnology (IBAB), Electronic City, Bengaluru 560100, India
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2
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Zeng L, Huang H, Qirong C, Ruan C, Liu Y, An W, Guo Q, Zhou J. Multiple myeloma patients undergoing chemotherapy: Which symptom clusters impact quality of life? J Clin Nurs 2023; 32:7247-7259. [PMID: 37303229 DOI: 10.1111/jocn.16791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 04/12/2023] [Accepted: 05/30/2023] [Indexed: 06/13/2023]
Abstract
AIMS AND OBJECTIVES To identify symptom clusters and examine their association with health-related quality of life. BACKGROUND Multiple myeloma patients undergoing chemotherapy suffer from disease symptoms and adverse effects during the course of the disease. However, single symptom management has little effect, and symptom management for these patients remains challenging. Symptom clusters open a new perspective and provide important clues for symptom management. DESIGN A cross-sectional study. METHOD Participants were invited to complete the Chinese version of the Memorial Symptom Assessment Scale and Quality of Life Questionnaire-core 30. Appropriate indicators were used for descriptive statistics. Principal component analysis was used to identify symptom clusters. Associations between symptom clusters and quality of life were examined with Pearson correlation coefficients, Pearson correlation matrix and multiple linear regression. This study was reported following the STROBE checklist. RESULTS A total of 177 participants were recruited from seven hospitals in this study. We identified self-image disorder, psychological, gastrointestinal, neurological, somatic and pain symptom clusters in multiple myeloma patients with chemotherapy. Approximately 97.65% of patients suffer from multiple symptom clusters. The pain, psychological and gastrointestinal symptom clusters have negatively influence on health-related quality of life. The strongest association was found with the pain symptom cluster. CONCLUSION Most of multiple myeloma patients suffer from multiple symptom clusters. When improving the multiple myeloma patients' health-related quality of life, the clinical staff should prioritise relieving the pain symptom cluster. RELEVANCE TO CLINICAL PRACTICE When multiple myeloma patients undergoing chemotherapy suffer from multiple symptom clusters, nurses should prioritise relieving the pain symptom cluster to improve their health-related quality of life. When drawing up and providing interventions, nurses should focus on the correlation among symptoms rather than single symptom. By relieving one symptom in a given cluster, other symptoms within the same symptom cluster may also be relieved.
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Affiliation(s)
- Lihong Zeng
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Hui Huang
- The Third Xiangya Hospital, Central South University, Changsha, China
| | - Chen Qirong
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Chunhong Ruan
- The Third Xiangya Hospital, Central South University, Changsha, China
| | - Yaqi Liu
- The Third Xiangya Hospital, Central South University, Changsha, China
| | - Wenhong An
- School of Health and Wellness, Panzhihua University, Sichuan, China
| | - Qinqin Guo
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Jiandang Zhou
- The Third Xiangya Hospital, Central South University, Changsha, China
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Bakırtaş M, Dal MS, Yiğenoğlu TN, Giden AO, Serin I, Başcı S, Kalpakci Y, Korkmaz S, Ekinci O, Albayrak M, Basturk A, Ozatli D, Dogu MH, Hacıbekiroglu T, Çakar MK, Ulas T, Miskioglu M, Gulturk E, Eser B, Altuntas F. Real-world data on the effectiveness and safety of Ixazomib-Lenalidomide-Dexamethasone therapy in relapsed/refractory multiple myeloma patients: a multicenter experience in Turkey. J Chemother 2023; 35:563-569. [PMID: 37211906 DOI: 10.1080/1120009x.2023.2208439] [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: 07/08/2022] [Revised: 04/03/2023] [Accepted: 04/22/2023] [Indexed: 05/23/2023]
Abstract
A multicenter, retrospective, observational study was conducted to explore effectiveness and safety of ixazomib plus lenalidomide with dexamethasone (IRd) in relapsed/refractory multiple myeloma (RRMM) patients following at least ≥ two lines of therapy. Patients' treatment responses, overall response rate, progression-free survival rate, and adverse events were recorded. Mean age of 54 patients was 66.5 ± 9.1 years. There were 20 patients (37.0%) with progression. Median progression-free survival was 13 months in patients who received a median of three therapy lines in a 7.5-month follow-up period. Overall response rate was 38.5%. Of 54 patients, 19 (40.4%) had at least one adverse event, and nine (19.1%) had an adverse event of at least grade 3 or more. Of 72 adverse events observed in 47 patients, 68% were grade 1 or 2. Treatment was not stopped in any patient due to adverse events. IRd combination therapy was effective and safe in heavily treated RRMM patients.
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Affiliation(s)
- Mehmet Bakırtaş
- Ankara Oncology Training and Research Hospital, Department of Hematology & Apheresis Unit, University of Health Sciences, Ankara, Turkey
| | - Mehmet Sinan Dal
- Ankara Oncology Training and Research Hospital, Department of Hematology & Apheresis Unit, University of Health Sciences, Ankara, Turkey
| | - Tuğçe Nur Yiğenoğlu
- Ankara Oncology Training and Research Hospital, Department of Hematology & Apheresis Unit, University of Health Sciences, Ankara, Turkey
| | | | - Istemi Serin
- Istanbul Training and Research Hospital, Department of Hematology, University of Health Sciences, Istanbul, Turkey
| | - Semih Başcı
- Ankara Oncology Training and Research Hospital, Department of Hematology & Apheresis Unit, University of Health Sciences, Ankara, Turkey
| | - Yasin Kalpakci
- Department of Hematology, Sakarya University, Sakarya, Turkey
| | - Serdal Korkmaz
- Kayseri City Training and Research Hospital, Department of Hematology & Apheresis Unit, University of Health Sciences, Kayseri, Turkey
| | - Omer Ekinci
- Gazi Yasargil Training and Research Hospital, Department of Hematology, University of Health Sciences, Diyarbakir, Turkey
| | - Murat Albayrak
- Diskapi Yildirim Beyazit Training and Research Hospital, Department of Hematology, University of Health Sciences, Ankara, Turkey
| | | | - Duzgun Ozatli
- Department of Hematology, Ondokuz Mayis University, Samsun, Turkey
| | - Mehmet Hilmi Dogu
- Liv Hospital Ulus, Department of Hematology, Istinye University, Istanbul, Turkey
| | | | - Merih Kızıl Çakar
- Ankara Oncology Training and Research Hospital, Department of Hematology & Apheresis Unit, University of Health Sciences, Ankara, Turkey
| | - Turgay Ulas
- School of Medicine, Department of Internal Medicine, Division of Hematology, Near East University, Nicosia, Cyprus
| | - Mine Miskioglu
- Department of Hematology, Celal Bayar University, Manisa, Turkey
| | - Emine Gulturk
- Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Hematology, University of Health Sciences, Istanbul, Turkey
| | - Bulent Eser
- Department of Hematology, Medical Park Antalya Hospital, Antalya, Turkey
| | - Fevzi Altuntas
- Ankara Oncology Training and Research Hospital, Department of Hematology & Apheresis Unit, University of Health Sciences, Ankara, Turkey
- School of Medicine, Department of Internal Medicine, Division of Hematology, Ankara Yildirim Beyazit University, Ankara, Turkey
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Richter J, Lin PL, Garcia-Horton V, Guyot P, Singh E, Zhou ZY, Sievert M, Taiji R. Matching-adjusted indirect comparison of isatuximab plus carfilzomib and dexamethasone with daratumumab plus lenalidomide and dexamethasone in relapsed multiple myeloma. Cancer Med 2023; 12:8005-8017. [PMID: 36726287 PMCID: PMC10134287 DOI: 10.1002/cam4.5584] [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: 10/27/2022] [Revised: 11/28/2022] [Accepted: 12/17/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGOUND Lenalidomide-based regimens are commonly used for early relapse in patients with relapsed and/or refractory multiple myeloma (RRMM) receiving at least one prior line of therapy. In the absence of head-to-head comparison, matching-adjusted indirect comparison (MAIC) was conducted to demonstrate efficacy and safety of isatuximab+carfilzomib+dexamethasone (Isa-Kd) versus daratumumab + lenalidomide + dexamethasone (Dara-Rd) in RRMM. METHODS Patient-level data from IKEMA trial (Isa-Kd, n = 179) were matched to aggregate data from POLLUX (Dara-Rd, n = 286). Hazard ratios (HR) and 95% confidence intervals (CI) for progression-free survival (PFS) and overall survival (OS) were generated by weighted Cox proportional hazard models. Odds ratios (OR), 95% CI, and p-value were calculated for ≥very good partial response (≥VGPR) and treatment-emergent adverse events (TEAEs). RESULTS After matching, no significant differences were observed between Isa-Kd and Dara-Rd in baseline characteristics except for patients with >3 prior lines (0.0% vs. 4.9%). Isa-Kd showed significantly better PFS (HR [95% CI]: 0.46 [0.24-0.86]; p = 0.0155), statistically non-significant improvement favoring Isa-Kd in OS (0.47 [0.20-1.09]; 0.0798), and ≥VGPR (OR [95% CI]: 1.53 [0.89-2.64]; p = 0.1252) than Dara-Rd. Odds of occurrence were significantly lower for some all-grade and grade 3/4 TEAEs with Isa-Kd than Dara-Rd. CONCLUSION These results support Isa-Kd as an efficacious treatment for early relapse in non-lenalidomide refractory patients.
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Affiliation(s)
- Joshua Richter
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Vashist A, Gupta N, Nafees S, Sharma A. Habb-e-Asgandh Suppresses Cell Proliferation and Induces Apoptosis through Mitochondria Dysfunction in Multiple Myeloma Cells (RPMI8226). Asian Pac J Cancer Prev 2022; 23:3629-3639. [PMID: 36444574 PMCID: PMC9930948 DOI: 10.31557/apjcp.2022.23.11.3629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE This study was conducted to assess the anti-neoplastic properties of Habb-e-Asgandh in multiple myeloma cells (RPMI8226). METHODS Multiple myeloma cells (RPMI8226) were cultured according to the ATCC's instruction. The anti-proliferative effect of HeA was assessed by MTT assay and proliferating cellnuclear antigen (PCNA) activity. Cell cycle analysis, cellular apoptosis, and mitochondria membrane potential analysis was done by flow cytometry. Total antioxidants, migratory potential, angiogenesis and inflammatory biomarkers were also estimated after treatment of RPMI8226 with HeA. RESULTS LD30 and LD50 dose of HeA was 0.3mg/ml and 0.5mg/ml respectively determined by MTT assay and also confirmed by a reduced PCNA activity. Cell cycle analysis of RPMI8226 cells revealed that sub-G0/G1 phase increases upon treatment with HeA alone or in combination with lenalidomide. Annexin V-FITC/PI is used to detect early apoptosis, late apoptosis and necrotic cells and results showed that percentage of apoptotic cells increased in RPMI8226 cells after treatment with HeA. Also, HeA induces loss of mitochondria membrane potential (MMP) in MM cells in-vitro as measured by cationic JC1 dye staining. Upon treatment, the abnormal overexpression of oncogenic protein, AKT serine/threonine kinase has also been reduced. Furthermore, anti-oxidants level also increased while migratory potential, angiogenesis and inflammation decreased in multiple myeloma cell line upon treatment with HeA. CONCLUSION Collectively, our results demonstrated that integrative therapy of habb-e-asgandh efficiently eliminates the need to use higher dose of lenalidomide for multiple myeloma treatment.
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Soekojo CY, Chng WJ. Treatment Horizon in Multiple Myeloma. Eur J Haematol Suppl 2022; 109:425-440. [PMID: 35880395 DOI: 10.1111/ejh.13840] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 07/23/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This paper reviews current and emerging therapies for MM. METHODS Narrative review RESULTS: Multiple myeloma (MM) is a complex, heterogenous condition, and in recent years there has been an expansion in the number and range of treatments. Several new treatment approaches, including enhanced monoclonal antibodies, antibody-drug conjugates (ADC), bispecific T-cell engagers (BiTE) and chimeric antigen-T-cell therapy (CAR-T) are under development. CONCLUSIONS The emergence of new treatments that aim to tackle MM-associated immune dysfunction has led to improvements in overall survival.
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Affiliation(s)
- Cinnie Yentia Soekojo
- Department of Hematology-Oncology, National University Cancer Institute, Singapore, National University Health System
| | - Wee Joo Chng
- Department of Hematology-Oncology, National University Cancer Institute, Singapore, National University Health System
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Rinaldi I, Muthalib A, Edina BC, Wiyono L, Winston K. Role of Anti-B-Cell Maturation Antigen (BCMA) in the Management of Multiple Myeloma. Cancers (Basel) 2022; 14:cancers14143507. [PMID: 35884566 PMCID: PMC9317279 DOI: 10.3390/cancers14143507] [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: 06/16/2022] [Revised: 07/15/2022] [Accepted: 07/18/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Multiple myeloma is the most prevalent hematological cancer, and further treatments for this disease are required. Despite progress in the development of treatment regimens, multiple myeloma is still an incurable disease because of its poor response to therapy and high rate of resistance to treatment. However, anti-BCMA (B-cell maturation antigen) has shown promise in the treatment of multiple myeloma, and it may have the potential to be a new first-line treatment for patients. Thus, in this review, we objectively discussed the treatment potential of anti-BCMA, its mechanisms, and its future clinical implications for multiple myeloma patients. Abstract Over the past few decades, treatment options have become more advanced for multiple myeloma (MM), one of the most prevalent hematological cancers; however, multiple myeloma remains an incurable disease due to its poor response to therapy and high rates of resistance, which cause relapsed/refractory or multiple myeloma. Researchers have described anti-BCMA (B-cell maturation antigen) as a promising treatment regimen that targets the BCMA biomarker in the affected plasma cells. BCMA is a protein that is specifically expressed in plasma-cell neoplasms by using several mechanisms, such as CAR T cells (Chimeric Antigen Receptor T cells), antibody-drug conjugates, and bispecific T-cell engagers, thus allowing for a rapid response in the treatment of resistant or relapsed/refractory multiple myeloma patients. Anti-BCMA treatment is novel and specific in its mechanisms of action, with noninferior complete responses, higher overall survival rates, and fewer reported adverse events compared to other currently available treatment of MM. In this review, we compared anti-BCMA mechanisms with those of previously available therapies, such as those using immunomodulators and proteasome inhibitors, and discussed the advantages of using anti-BCMA as a potential first-line treatment for multiple myeloma patients.
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Affiliation(s)
- Ikhwan Rinaldi
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Ciptomangunkusumo General Hospital—Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia;
- Correspondence: ; Tel.: +62-811-1001-758
| | - Abdul Muthalib
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Ciptomangunkusumo General Hospital—Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia;
| | - Brenda Cristie Edina
- Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia; (B.C.E.); (L.W.); (K.W.)
| | - Lowilius Wiyono
- Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia; (B.C.E.); (L.W.); (K.W.)
| | - Kevin Winston
- Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia; (B.C.E.); (L.W.); (K.W.)
- Hospital Medicine, Bhakti Medicare Hospital, Cicurug 43359, Indonesia
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Capalbo A, Lauritano C. Multiple Myeloma: Possible Cure from the Sea. Cancers (Basel) 2022; 14:cancers14122965. [PMID: 35740630 PMCID: PMC9220879 DOI: 10.3390/cancers14122965] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/03/2022] [Accepted: 06/12/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Multiple myeloma (MM) is a complex white blood cell (plasma cell, PC) cancer. The aetiology of MM is still unknown, and it is still an incurable disease despite efforts by the scientific community. The high level of PC genetic heterogeneity renders MM a complex puzzle to be solved. Combinations of drugs are generally used to treat MM patients, with a general increase in overall survival. Relapsed and refractory MM patients are the generation of patients who resist or do not respond to first-line therapy and need additional treatments. Exploring new sources, such as marine organisms, for drug discovery is fundamental to fighting MM. Various studies have shown that marine natural products (MNPs) might have antiproliferative and cancer-specific cytotoxic properties, giving MNPs a pivotal role in anticancer drug discovery. This review recaps updated frontline treatment options, including new ones developed from MNP research. Abstract Multiple myeloma (MM) is a blood cancer that occurs in the plasma cells (PCs), a type of white blood cell. Despite the progress of several current treatments that prolong the overall patient’s survival, most MM cases are incurable. For this reason, many efforts have been undertaken by the scientific community in the search for new treatments. BLENREPTM and Aplidin® are two marine-derived drugs currently in use for MM. In addition, other natural products have been identified from marine organisms, tested for their possible anticancer properties, and are in preclinical or clinical trials for MM, including cytarabine, a compound in use for leukaemia treatment. Between the most successful marine compounds in fighting MM, there are molecules with specific targets, such as the elongation factor 1-alpha 2 and proteasome inhibitors, and compounds conjugated with antibodies that recognise specific cell types and direct the drug to the correct cell target. Active compounds belong to different chemical classes, from cyclic peptides to alkaloids, highlighting the importance of screening the plethora of compounds produced by marine organisms. In this review, we summarise the current state of art of MM therapies focusing on the marine natural product emerging roles.
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Rafae A, Ehsan H, Wahab A, Khan SI, Khan I, Ashraf S, Ali S, Khalid F, Neupane K, Valent J, Khouri J, Samaras C, Mazzoni S, Anwer F. Evidence-based recommendations for induction and maintenance treatment of newly diagnosed transplant-ineligible multiple myeloma patients. Crit Rev Oncol Hematol 2022; 176:103744. [PMID: 35717005 DOI: 10.1016/j.critrevonc.2022.103744] [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: 06/27/2021] [Revised: 05/23/2022] [Accepted: 06/13/2022] [Indexed: 11/28/2022] Open
Abstract
There is increasing evidence regarding the role of various maintenance therapy (MT) strategies after initial induction to treat newly diagnosed transplant-ineligible patients with MM. We reviewed the literature on available regimens for patients with transplant-ineligible newly diagnosed multiple myeloma (NDMM). Lenalidomide (R)-based regimens are still the front-line therapy, but there is an increasing use of bortezomib-based regimens. The MT regimen is mainly based on the initial induction regimen. MT has shown survival benefits compared with patients without maintenance therapy. The most common adverse effects of MT include anemia, neutropenia, thrombocytopenia, infections, and peripheral neuropathy. In conclusion, induction followed by maintenance based on lenalidomide, bortezomib, ixazomib, or daratumumab-based regimens has shown promising results. Therefore, it is essential to conduct more clinical trials to better understand the role of MT in the treatment of NDMM patients who are not candidates for autologous stem cell transplantation.
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Affiliation(s)
- Abdul Rafae
- Department of Internal Medicine, McLaren Flint-Michigan State University, Flint, MI, USA.
| | | | - Ahsan Wahab
- Internal Medicine/Hospital Medicine Department, University of Alabama at Birmingham, Montgomery, AL, USA
| | - Sana Irfan Khan
- SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | | | - Sara Ashraf
- Sharif Medical and Dental College, Lahore, Pakistan
| | - Sundas Ali
- Department of Internal Medicine, Ascension St. Agnes Hospital, Baltimore, MD, USA
| | - Farhan Khalid
- Department of Internal Medicine, Monmouth Medical Center, Long Branch, NJ, USA
| | - Karun Neupane
- Department of Internal Medicine, Jacobi Medical Center, Bronx, NY, USA
| | - Jason Valent
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - Jack Khouri
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - Christy Samaras
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - Sandra Mazzoni
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - Faiz Anwer
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH, USA
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Yang P, Qu Y, Wang M, Chu B, Chen W, Zheng Y, Niu T, Qian Z. Pathogenesis and treatment of multiple myeloma. MedComm (Beijing) 2022; 3:e146. [PMID: 35665368 PMCID: PMC9162151 DOI: 10.1002/mco2.146] [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: 12/06/2021] [Revised: 04/27/2022] [Accepted: 04/27/2022] [Indexed: 02/05/2023] Open
Abstract
Multiple myeloma (MM) is the second‐ranking malignancy in hematological tumors. The pathogenesis of MM is complex with high heterogeneity, and the development of the disease is a multistep process. Chromosomal translocations, aneuploidy, genetic mutations, and epigenetic aberrations are essential in disease initiation and progression. The correlation between MM cells and the bone marrow microenvironment is associated with the survival, progression, migration, and drug resistance of MM cells. In recent decades, there has been a significant change in the paradigm for the management of MM. With the development of proteasome inhibitors, immunomodulatory drugs, monoclonal antibodies, chimeric antigen receptor T‐cell therapies, and novel agents, the survival of MM patients has been significantly improved. In addition, nanotechnology acts as both a nanocarrier and a treatment tool for MM. The properties and responsive conditions of nanomedicine can be tailored to reach different goals. Nanomedicine with a precise targeting property has offered great potential for drug delivery and assisted in tumor immunotherapy. In this review, we summarize the pathogenesis and current treatment options of MM, then overview recent advances in nanomedicine‐based systems, aiming to provide more insights into the treatment of MM.
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Affiliation(s)
- Peipei Yang
- Department of Hematology and Institute of Hematology, State Key Laboratory of Biotherapy and Cancer Center West China Hospital Sichuan University Chengdu Sichuan China
| | - Ying Qu
- Department of Hematology and Institute of Hematology, State Key Laboratory of Biotherapy and Cancer Center West China Hospital Sichuan University Chengdu Sichuan China
| | - Mengyao Wang
- Department of Hematology and Institute of Hematology, State Key Laboratory of Biotherapy and Cancer Center West China Hospital Sichuan University Chengdu Sichuan China
| | - Bingyang Chu
- Department of Hematology and Institute of Hematology, State Key Laboratory of Biotherapy and Cancer Center West China Hospital Sichuan University Chengdu Sichuan China
| | - Wen Chen
- Department of Hematology and Institute of Hematology, State Key Laboratory of Biotherapy and Cancer Center West China Hospital Sichuan University Chengdu Sichuan China
| | - Yuhuan Zheng
- Department of Hematology and Institute of Hematology, State Key Laboratory of Biotherapy and Cancer Center West China Hospital Sichuan University Chengdu Sichuan China
| | - Ting Niu
- Department of Hematology and Institute of Hematology, State Key Laboratory of Biotherapy and Cancer Center West China Hospital Sichuan University Chengdu Sichuan China
| | - Zhiyong Qian
- Department of Hematology and Institute of Hematology, State Key Laboratory of Biotherapy and Cancer Center West China Hospital Sichuan University Chengdu Sichuan China
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Fazio F, Franceschini L, Tomarchio V, Rago A, Garzia MG, Cupelli L, Bongarzoni V, Andriani A, Gumenyuk S, Tafuri A, Siniscalchi A, Piciocchi A, De Fabritiis P, De Rosa L, Caravita di Toritto T, Annibali O, Cantonetti M, Petrucci MT. Daratumumab combined with dexamethasone and lenalidomide or bortezomib in relapsed/refractory multiple myeloma (RRMM) patients: Report from the multiple myeloma GIMEMA Lazio group. EJHAEM 2022; 3:121-128. [PMID: 35846211 PMCID: PMC9175681 DOI: 10.1002/jha2.359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/14/2021] [Accepted: 11/18/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Francesca Fazio
- Department of Translational and Precision Medicine, Hematology Azienda Policlinico Umberto I Sapienza University of RomeSapienza Università di Roma
| | | | | | - Angela Rago
- ASL RM/A UOSD Ematologia Asl Roma 1 Rome Italy
| | - Maria Grazia Garzia
- Department of Hematology, Hematology San Camillo Forlanini Hospital Rome Italy
| | - Luca Cupelli
- Department of Hematology, Hematology Ospedale Sant'Eugenio Rome Italy
| | - Velia Bongarzoni
- Department of Hematology San Giovanni‐Addolorata Hospital Rome Italy
| | | | - Svitlana Gumenyuk
- Haematology and Stem Cell Transplant Regina Elena National Cancer Institute Rome Italy
| | | | | | - Alfonso Piciocchi
- Data Center, Italian Group for Adult Hematologic Diseases, (GIMEMA) Rome Italy
| | | | - Luca De Rosa
- Hematology and Bone Marrow Transplantation Unit Azienda Ospedaliera San Camillo‐Forlanini Rome Italy
| | | | - Ombretta Annibali
- Department of Haematology Campus Bio‐Medico University of Rome Rome Italy
| | | | - Maria Teresa Petrucci
- Department of Translational and Precision Medicine, Hematology Azienda Policlinico Umberto I Sapienza University of RomeSapienza Università di Roma
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Magen H, Simchen MJ, Erman S, Avigdor A. Diagnosis and management of multiple myeloma during pregnancy: case report, review of the literature, and an update on current treatments. Ther Adv Hematol 2022; 13:20406207211066173. [PMID: 35083030 PMCID: PMC8785339 DOI: 10.1177/20406207211066173] [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: 08/29/2021] [Accepted: 11/19/2021] [Indexed: 11/15/2022] Open
Abstract
The simultaneous occurrence of pregnancy and multiple myeloma (MM) is rare. The challenge of diagnosing MM during pregnancy is demonstrated in the case presented here. Despite the rarity of concurrent MM and pregnancy, this possibility should be considered in patients with signs and symptoms that may be attributed to MM so as not to delay the diagnosis and decision about pregnancy continuation and initiation of an appropriate and safe therapy to the mother and fetus. Treating physicians should be aware of the potential effects of MM therapies on the fetus and pregnancy outcomes.
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Affiliation(s)
- Hila Magen
- Head of Multiple Myeloma Unit, Hematology Department, Chaim Sheba Medical Center, 2 Derech Sheba, Ramat Gan 5266202, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal J. Simchen
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Shira Erman
- Hematology Department, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Abraham Avigdor
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Hematology Department, Chaim Sheba Medical Center, Ramat Gan, Israel
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Ding T, Hao J. Sirtuin 2 knockdown inhibits cell proliferation and RAS/ERK signaling, and promotes cell apoptosis and cell cycle arrest in multiple myeloma. Mol Med Rep 2021; 24:760. [PMID: 34476507 PMCID: PMC8436222 DOI: 10.3892/mmr.2021.12400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 11/02/2020] [Indexed: 01/29/2023] Open
Abstract
The present study aimed to explore the regulatory role of sirtuin 2 (SIRT2) in malignant progression of multiple myeloma (MM) and the potential associated signaling pathways. In total, 30 patients with MM and 15 healthy bone marrow donors were enrolled in the current study and their bone marrow samples were collected to isolate the plasma cells. The expression levels of SIRT2 were detected in MM cell lines (KMS-28BM, U266, RPMI-8226 and NCI-H929) and normal plasma cells (collected from healthy bone marrow donors as the control) via reverse transcription-quantitative PCR (RT-qPCR) and western blot analysis. SIRT2 knockdown was established by transfecting two MM cell lines (RPMI-8226 and NCI-H929 cells) with short hairpin RNA-SIRT2 recombinant plasmid; the control group was transfected with a control recombinant plasmid. Subsequently, the effect of SIRT2 knockdown on MM cell proliferation, apoptosis, cell cycle progression and RAS/ERK signaling was investigated via Cell Counting Kit-8, flow cytometry, RT-qPCR and western blot assays, respectively. The mRNA and protein expression levels of SIRT2 were increased in U266 (P<0.001), KMS-28BM (P<0.001), RPMI-8226 (P<0.001) and NCI-H929 (P<0.001) cells compared with those in the control cells. In NCI-H929 and RPMI-8226 cells, cell proliferation was decreased 48 h (P<0.05) and 72 h (P<0.05) after SIRT2 knockdown. Furthermore, the cell apoptotic rate was elevated 48 h after SIRT2 knockdown (P<0.01). In addition, the percentage of cells at the G0/G1 phase was increased (P<0.01), whereas the percentage of cells at the S phase was reduced (P<0.01) 48 h after SIRT2 knockdown. The expression levels of HRAS and phosphorylated-ERK were also reduced 48 h after SIRT2 knockdown. In conclusion, SIRT2 was highly expressed in MM cell lines, and knockdown of SIRT2 inhibited MM cell proliferation, inactivated the RAS/ERK signaling pathway, and promoted cell apoptosis and cell cycle arrest.
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Affiliation(s)
- Tianling Ding
- Department of Hematology, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China
| | - Jie Hao
- Department of Hematology, Shanghai Jing'an District Beizhan Hospital, Shanghai 200070, P.R. China
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Khattak ZE, Hashmi H, Khan SI, Aamir S, Arif U, Khan AI, Darwin A, Singh AD, Khouri J, Anwer F. Dawn of a new era of antibody-drug conjugates and bispecific T-cell engagers for treatment of multiple myeloma: a systematic review of literature. Ann Hematol 2021; 100:2155-2172. [PMID: 34318356 DOI: 10.1007/s00277-021-04599-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/03/2021] [Indexed: 11/26/2022]
Abstract
Multiple myeloma (MM) remains an incurable disease with the majority of patients experiencing disease relapse despite response to initial therapy. Antibody-drug conjugates (ADCs) and bispecific T-cell engagers are innovative immunotherapeutic approaches currently in development for the treatment of MM. This systematic review summarizes the efficacy and safety of ADCs and bispecific T-cell engagers in relapsed refractory (RR) MM patients from 2010 to date. Comprehensive literature search was conducted on PubMed, EMBASE, Wiley Cochrane Library, Web of Science, and Clinicaltrials.gov . A total of 13 studies (n = 529) met inclusion eligibility. All studies were prospective in nature investigating ADCs or bispecific T-cell engagers in RR MM; 10 trials were phase 1 and 3 were phase 2. The median age of patients ranged from 24 to 82 years. Among trials with ADC regimens, the overall response (OR) ranged from 34 to 60% and complete response (CR) ranged from 3 to 6%. The most common non-hematologic adverse event (AE) of ADCs was keratopathy, while anemia and thrombocytopenia were the most common hematological AEs. With bispecific T-cell engagers , ORR ranged from 31 to 83%, CR ranged from 7 to 22%, and partial response (PR) ranged from 5 to 16%. The most common non-hematologic AE of bispecific T-cell engagers was cytokine release syndrome (CRS) while the most common hematological AE was neutropenia. Initial data appears to show good clinical activity and tolerable safety profiles, making ADCs and bispecific T-cell engagers promising agents for RRMM. Future studies with newer combinations and a longer follow-up are needed to determine the precise role of these novel therapies in the evolving paradigm of MM treatment.
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Affiliation(s)
| | - Hamza Hashmi
- Medical University of South Carolina, Charleston, SC, USA
| | | | - Sobia Aamir
- Children Hospital and Institute of Child Health, Lahore, Pakistan
| | - Uroosa Arif
- Khyber Teaching Hospital, Peshawar, Pakistan
| | | | - Alicia Darwin
- University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - Arun D Singh
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Faiz Anwer
- Taussig Cancer Center, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.
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15
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Introduction to "Immunotherapies for Multiple Myeloma". Pharmaceuticals (Basel) 2020; 13:ph13110396. [PMID: 33212754 PMCID: PMC7696150 DOI: 10.3390/ph13110396] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 12/14/2022] Open
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Pure red cell aplasia after major or bidirectional ABO incompatible hematopoietic stem cell transplantation: to treat or not to treat, that is the question. Bone Marrow Transplant 2020; 56:769-778. [PMID: 33188257 DOI: 10.1038/s41409-020-01124-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 10/19/2020] [Accepted: 10/30/2020] [Indexed: 12/15/2022]
Abstract
Pure red cell aplasia (PRCA) is a complication related to major or bidirectional ABO mismatched hematopoietic stem cell transplantation. This disorder is characterized by anemia, reticulocytopenia, and the absence or virtual absence of erythroid progenitors, other causes such as infections, hemolysis, disease relapse, or drug toxicity having been excluded. Patients with PRCA may become RBC transfusion dependent for long periods, suffering an important long-term iron overload, alloimmunization, and transfusion reactions. The persistence of recipient isoagglutinins against donor ABO antigens produced by host residual plasmatic cells has been considered as the immunological cause of the prolonged erythroid aplasia. PRCA behaves in many cases as a self-limited condition and resolution may occur spontaneously within weeks, months, and even years. Many different therapeutic approaches have been reported for posttransplant PRCA as plasmapheresis, high doses of erythropoietin, donor lymphocyte infusions, anti-thymocyte globulin, Rituximab and steroids, among others. However, to date there is no standard of care and the question if patients with PRCA should be treated and at which point remains. The objective of this article is to review the natural evolution of PRCA, and the treatments that have been used over time focusing on their suitability and efficacy.
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Development of [ 89Zr]DFO-elotuzumab for immunoPET imaging of CS1 in multiple myeloma. Eur J Nucl Med Mol Imaging 2020; 48:1302-1311. [PMID: 33179150 DOI: 10.1007/s00259-020-05097-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/26/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Multiple myeloma (MM) is a bone marrow malignancy that remains mostly incurable. Elotuzumab is an FDA-approved therapeutic monoclonal antibody targeted to the cell surface glycoprotein CS1, which is overexpressed in MM cells. Identifying patients who will respond to CS1-targeted treatments such as elotuzumab requires the development of a companion diagnostic to assess the presence of CS1. Here, we evaluated [89Zr]DFO-elotuzumab as a novel PET tracer for imaging CS1 expression in preclinical MM models. METHODS Conjugation of desferrioxamine-p-benzyl-isothiocyanate (DFO-Bz-NCS) to elotuzumab enabled zirconium-89 radiolabeling. MM.1S-CG cells were intravenously injected in NOD SCID gamma (NSG) mice. Small animal PET imaging with [89Zr]DFO-elotuzumab (1.11 MBq/mouse, 7 days post-injection), [89Zr]DFO-IgG (1.11 MBq/mouse, 7 days post-injection), and [18F]FDG (7-8 MBq, 1 h post-injection) was performed. Additionally, biodistribution of [89Zr]DFO-elotuzumab post-imaging at 7 days was also done. In vivo specificity of [89Zr]DFO-elotuzumab was further evaluated with a blocking study and ex vivo autoradiography. RESULTS [89Zr]DFO-elotuzumab was produced with high specific activity (56 ± 0.75 MBq/nmol), radiochemical purity (99% ± 0.5), and yield (93.3% ± 1.5). Dissociation constant of 40.4 nM and receptor density of 126 fmol/mg was determined in MM.1S-CG cells. Compared to [89Zr]DFO-IgG, [89Zr]DFO-elotuzumab localized with a significantly higher standard uptake value in tumor-bearing bone tissue (8.59 versus 4.77). Blocking with unlabeled elotuzumab significantly reduced (P < 0.05) uptake of [89Zr]DFO-elotuzumab in the bones. Importantly, while [18F]FDG demonstrated similar uptake in the bone and muscle, [89Zr]DFO-elotuzumab showed > 3-fold enhanced uptake in bones. CONCLUSION These data demonstrate the feasibility of [89Zr]DFO-elotuzumab as a companion diagnostic for CS1-targeted therapies.
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Luo S, Wang M, Wang H, Hu D, Zipfel PF, Hu Y. How Does Complement Affect Hematological Malignancies: From Basic Mechanisms to Clinical Application. Front Immunol 2020; 11:593610. [PMID: 33193442 PMCID: PMC7658260 DOI: 10.3389/fimmu.2020.593610] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/02/2020] [Indexed: 12/24/2022] Open
Abstract
Complement, as a central immune surveillance system, can be activated within seconds upon stimulation, thereby displaying multiple immune effector functions. However, in pathologic scenarios (like in tumor progression), activated complement can both display protective effects to control tumor development and passively promotes the tumor growth. Clinical investigations show that patients with several hematological malignancies often display abnormal level of specific complement components, which in turn modulates complement activation or deregulated cascade. In the past decades, complement-dependent cytotoxicity and complement-dependent cell-mediated phagocytosis were fully approved to display vital roles in monoclonal antibody-based immunotherapies, especially in therapies against hematological malignancies. However, tumor-mediated complement evasion presents a big challenge for such a therapy. This review aims to provide an integrative overview on the roles of the complement in tumor promotion, highlights complement mediated effects on antibody-based immunotherapy against distinct hematological tumors, hopefully provides a theoretical basis for the development of complement-based cancer targeted therapies.
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Affiliation(s)
- Shanshan Luo
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Moran Wang
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huafang Wang
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Desheng Hu
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Integrated Traditional Chinese and Western Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Peter F Zipfel
- Department of Infection Biology, Leibniz Institute for Natural Product Research and Infection Biology, Hans Knöll Institute, Jena, Germany.,Faculty of Biological Sciences, Friedrich Schiller University, Jena, Germany
| | - Yu Hu
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Yang Y, Sun M, Yu Z, Liu J, Yan W, Liu Z, Wei M, Wang H. Designing high affinity target-binding peptides to HLA-E: a key membrane antigen of multiple myeloma. Aging (Albany NY) 2020; 12:20457-20470. [PMID: 33115963 PMCID: PMC7655190 DOI: 10.18632/aging.103858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/21/2020] [Indexed: 01/10/2023]
Abstract
Multiple myeloma (MM) is a plasma cell malignancy that is currently incurable. Finding new targets and designing drugs are crucial for the treatment of MM. The two datasets (GSE6691 and GSE39754) are used to screen highly expressed antigen on MM cells. HLA-E was an ideal target for it was a hub gene, and also located in one of the key clusters. Highly expression of HLA-E mRNA on MM cells was also confirmed by real-time qPCR testing the MM patients' samples in Shengjing hospital. Crystal structure of HLA-E was obtained from Protein Data Bank (PDB ID: 3CDG) which was used to design targeting peptides with Molecular Operating Environment software. By analyzing interaction between CD94/NKG2A and HLA-E, a peptide with twelve amino acids was screened as a model peptide. Peptides library was constructed by randomly replaced non-key amino acid. Peptide-protein docking method was used to identify high affinity peptides. PEPTIDE 1-3 and model peptide were synthesized and identified the affinity to HLA-E by flow cytometer and confocal laser microscopy. At last, PEPTIDE3 (NALDEYCEDKNR) was found with the highest affinity. Taking all, HLA-E is a new treatment target, and PEPTIDE 3 is an ideal high affinity target-binding peptide candidate.
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Affiliation(s)
- Ying Yang
- Department of Hematology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
- Department of Pharmacology, School of Pharmacy, China Medical University, Shenyang, Liaoning, China
| | - Mingli Sun
- Department of Pharmacology, School of Pharmacy, China Medical University, Shenyang, Liaoning, China
| | - Zhaojin Yu
- Department of Pharmacology, School of Pharmacy, China Medical University, Shenyang, Liaoning, China
| | - Jinwei Liu
- Department of Pharmacology, School of Pharmacy, China Medical University, Shenyang, Liaoning, China
- Department of Pharmacy, Chifeng Municipal Hospital, Chifeng Inner Mongolia, China
| | - Wei Yan
- Department of Hematology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Zhuogang Liu
- Department of Hematology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Minjie Wei
- Department of Pharmacology, School of Pharmacy, China Medical University, Shenyang, Liaoning, China
| | - Hongtao Wang
- Department of Hematology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
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Soekojo CY, Ooi M, de Mel S, Chng WJ. Immunotherapy in Multiple Myeloma. Cells 2020; 9:E601. [PMID: 32138182 PMCID: PMC7140529 DOI: 10.3390/cells9030601] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 02/27/2020] [Accepted: 02/27/2020] [Indexed: 12/15/2022] Open
Abstract
Multiple myeloma is a complex disease and immune dysfunction has been known to play an important role in the disease pathogenesis, progression, and drug resistance. Recent efforts in drug development have been focused on immunotherapies to modify the MM disease process. Here, we summarize the emerging immunotherapies in the MM treatment landscape.
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Affiliation(s)
| | | | | | - Wee Joo Chng
- Department of Hematology-Oncology, National University Cancer Institute, Singapore, National University Health System, 1E Kent Ridge Road, Singapore 119228, Singapore; (C.Y.S.); (M.O.); (S.d.M.)
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