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Bazarbachi AH, Avet-Loiseau H, Harousseau JL, Bazarbachi A, Mohty M. Precision medicine for multiple myeloma: The case for translocation (11;14). Cancer Treat Rev 2024; 130:102823. [PMID: 39255732 DOI: 10.1016/j.ctrv.2024.102823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Revised: 08/11/2024] [Accepted: 09/02/2024] [Indexed: 09/12/2024]
Abstract
The t(11;14) translocation is among the most prevalent cytogenetic abnormalities in multiple myeloma (MM), distinguished by its unique features and biology that have been thoroughly explored for decades. What further sets this MM subtype apart is its oscillating prognostic significance, from initially being considered a favorable alteration to intermediate risk and potential future reclassification as favorable risk. Despite not being inherently a high-risk alteration indicative of an aggressive phenotype, it appears that t(11;14)-MM is less responsive to novel agents like proteasome inhibitors and immunomodulatory drugs which have otherwise transformed the disease's treatment landscape, perhaps partially explained by its reduced propensity for immunoglobulin production and oligosecretory nature. However, its distinct reliance on Bcl-2 has heightened its sensitivity to venetoclax. Further subclassification based on morphological and genomic characteristics could enhance our prediction models of treatment responses and enable more tailored therapeutic strategies for patients. This review aims to encapsulate the existing research evidence in this area.
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Affiliation(s)
- Abdul-Hamid Bazarbachi
- Division of Hematology/Oncology, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY, USA.
| | - Hervé Avet-Loiseau
- Cancer Research Center of Toulouse, INSERM, Myeloma Genomics Laboratory, University Cancer Institute Toulouse Oncopole, Université Paul Sabatier, Toulouse, France
| | - Jean-Luc Harousseau
- Institut de Cancerologie de l'Ouest, Centre René Gauducheau, Nantes-St Herblain, France
| | - Ali Bazarbachi
- Department of Internal Medicine, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Mohamad Mohty
- Sorbonne University, Service d'Hematologie Clinique et Thérapie Cellulaire, Hôpital Saint Antoine, and INSERM UMR 938, Paris, France.
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Steinbach M, Neupane K, Aziz M, Lee-Smith W, Julian K, Godara A, McClune B, Kelkar AH, Sborov D, Mohyuddin GR. Multiple Myeloma in Young Patients: A Scoping Review. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2024; 24:15-22. [PMID: 37722944 DOI: 10.1016/j.clml.2023.08.019] [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: 07/26/2023] [Revised: 08/19/2023] [Accepted: 08/24/2023] [Indexed: 09/20/2023]
Abstract
Data on the disease course, presenting features, outcomes, and prognosis of younger patients with multiple myeloma (MM) are lacking. Younger patients with MM have historically been considered to have better outcomes primarily based on better tolerance of treatment and lack of medical comorbidities, but the specific age range of this population has not been uniformly defined. Given the lack of consistent data reporting in patients considered to be young MM patients, we performed a scoping review to highlight the research currently available to start drawing conclusions about these patients and highlight unmet areas of need to focus on further investigation. We searched Embase, Cochrane Central Register of Controlled Trials, CINAHL Plus, Web of Science, and the OVID version of MEDLINE including broad terms that embody the concept of young patients with MM. Our final review included 201 studies which were then categorized according to age group, number of patients, outcomes, and comparators to older patients, along with location and database when available. We have chosen to categorize 3 age groupings: <50: young adults with MM (YA MM), 50 to 65: mid-life adults with multiple myeloma (ML MM) and 65+: older adults with multiple myeloma (OA MM). This review demonstrates the heterogeneity that exists in defining and describing young patients with MM, highlights the lack of studies specifically addressing the unique needs of younger patients, and emphasizes areas of future research unique to this population.
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Affiliation(s)
- Mary Steinbach
- Division of Hematology and Hematologic Malignancies, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT.
| | - Karun Neupane
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, New York, NY
| | - Muhammad Aziz
- Division of Gastroenterology and Hepatology, University of Toledo, Toledo, OH
| | - Wade Lee-Smith
- Mulford Health Science Library, University of Toledo, Toledo, OH
| | - Kelley Julian
- Department of Pharmacy, Huntsman Cancer Hospital, Salt Lake City, UT
| | - Amandeep Godara
- Division of Hematology and Hematologic Malignancies, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT
| | - Brian McClune
- Division of Hematology and Hematologic Malignancies, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT
| | | | - Douglas Sborov
- Division of Hematology and Hematologic Malignancies, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT
| | - Ghulam Rehman Mohyuddin
- Division of Hematology and Hematologic Malignancies, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT
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Tanguay M, Dagenais C, LeBlanc R, Ahmad I, Claveau JS, Roy J. Young Myeloma Patients: A Systematic Review of Manifestations and Outcomes. Curr Oncol 2023; 30:5214-5226. [PMID: 37366879 DOI: 10.3390/curroncol30060396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/15/2023] [Accepted: 05/18/2023] [Indexed: 06/28/2023] Open
Abstract
Multiple myeloma usually affects older adults. However, younger patients constitute a significant subset as approximately 10% of cases occur in subjects younger than 50 years old. Young patients, who are underrepresented in the literature, are diagnosed during their most productive years of life, urging the need for tailored treatment approaches. This literature review aims to report recent studies specifically addressing young patients with a focus on characteristics at diagnosis, cytogenetics, treatments, and outcomes. We searched PubMed for studies involving young patients with multiple myeloma ≤50 years old. The time span of our literature review search was from 1 January 2010 to 31 December 2022. Overall, 16 retrospective studies were analyzed for this review. Young patients with multiple myeloma tend to have less advanced disease, more frequent light chain subtypes, and survive longer compared to their older counterparts. However, available studies included a limited number of patients; the newest revised international staging system was not used to stratify patients, cytogenetics varied from one cohort to another, and most patients did not receive contemporary triplet/quadruplet treatments. This review emphasizes the need to perform contemporary, large-scale retrospective studies to improve knowledge regarding the presentation and outcomes of young myeloma patients in the era of modern treatments.
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Affiliation(s)
- Mégane Tanguay
- Institut Universitaire d'Hémato-Oncologie et de Thérapie Cellulaire, Hôpital Maisonneuve-Rosemont, 5415 de l'Assomption, Montreal, QC H1T 2M4, Canada
- Departement of Medicine, Université de Montréal, 2900 Édouard-Montpetit, Montreal, QC H3T 1J4, Canada
| | - Christophe Dagenais
- Departement of Medicine, Université de Montréal, 2900 Édouard-Montpetit, Montreal, QC H3T 1J4, Canada
- Service de Médecine Interne, Hôpital Notre-Dame, 1560 Sherbrooke Est, Montreal, QC H2L 4M1, Canada
| | - Richard LeBlanc
- Institut Universitaire d'Hémato-Oncologie et de Thérapie Cellulaire, Hôpital Maisonneuve-Rosemont, 5415 de l'Assomption, Montreal, QC H1T 2M4, Canada
- Departement of Medicine, Université de Montréal, 2900 Édouard-Montpetit, Montreal, QC H3T 1J4, Canada
| | - Imran Ahmad
- Institut Universitaire d'Hémato-Oncologie et de Thérapie Cellulaire, Hôpital Maisonneuve-Rosemont, 5415 de l'Assomption, Montreal, QC H1T 2M4, Canada
- Departement of Medicine, Université de Montréal, 2900 Édouard-Montpetit, Montreal, QC H3T 1J4, Canada
| | - Jean-Sébastien Claveau
- Institut Universitaire d'Hémato-Oncologie et de Thérapie Cellulaire, Hôpital Maisonneuve-Rosemont, 5415 de l'Assomption, Montreal, QC H1T 2M4, Canada
- Departement of Medicine, Université de Montréal, 2900 Édouard-Montpetit, Montreal, QC H3T 1J4, Canada
| | - Jean Roy
- Institut Universitaire d'Hémato-Oncologie et de Thérapie Cellulaire, Hôpital Maisonneuve-Rosemont, 5415 de l'Assomption, Montreal, QC H1T 2M4, Canada
- Departement of Medicine, Université de Montréal, 2900 Édouard-Montpetit, Montreal, QC H3T 1J4, Canada
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Puertas B, González-Calle V, Sobejano-Fuertes E, Escalante F, Rey-Bua B, Padilla I, García-Sanz R, Puig N, Gutiérrez NC, Mateos MV. Multiple myeloma with t(11;14): impact of novel agents on outcome. Blood Cancer J 2023; 13:40. [PMID: 36935422 PMCID: PMC10025259 DOI: 10.1038/s41408-023-00807-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/23/2023] [Accepted: 02/27/2023] [Indexed: 03/21/2023] Open
Abstract
Multiple myeloma (MM) patients with t(11;14) present unique biological features and their prognosis is not well established. We report a retrospective study of 591 MM patients, 17.3% of whom had t(11;14). It was designed to determine the prognostic impact of this abnormality and the effect of novel agents on the response and outcomes. Three groups were established based on their cytogenetics: (1) t(11;14); (2) high-risk chromosomal abnormalities; and (3) standard risk (SR). After 80.1 months (1.2-273.8 months) of follow-up, no differences were observed in overall survival (OS) between the t(11;14) and SR groups (75.8 vs. 87.2 months; P = 0.438). Treatment of MM t(11;14) with novel agents did not improve their overall response rate (ORR) or complete response (CR) compared with those who received conventional therapy (ORR: 87.2 vs. 79.5%, P = 0.336; CR: 23.4 vs. 12.8%, P = 0.215). This effect translated into a similar PFS (39.6 vs. 30.0 months; P = 0.450) and OS (107.6 vs. 75.7 months; P = 0.175). In summary, MM t(11;14) patients did not benefit from the introduction of novel agents as much as SR patients did, indicating that other therapies are needed to improve their outcomes.
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Affiliation(s)
- Borja Puertas
- University Hospital of Salamanca/IBSAL/Cancer Research Center-IBMCC (USAL-CSIC), CIBERONC, Salamanca, Spain
| | - Verónica González-Calle
- University Hospital of Salamanca/IBSAL/Cancer Research Center-IBMCC (USAL-CSIC), CIBERONC, Salamanca, Spain
| | - Eduardo Sobejano-Fuertes
- Department of Hematology, University Hospital Dr. José Molina Orosa, Lanzarote, Canary Islands, Palmas, Spain
| | | | - Beatriz Rey-Bua
- University Hospital of Salamanca/IBSAL/Cancer Research Center-IBMCC (USAL-CSIC), CIBERONC, Salamanca, Spain
| | - Irene Padilla
- Department of Hematology, University Hospital of León, León, Spain
| | - Ramón García-Sanz
- University Hospital of Salamanca/IBSAL/Cancer Research Center-IBMCC (USAL-CSIC), CIBERONC, Salamanca, Spain
| | - Noemi Puig
- University Hospital of Salamanca/IBSAL/Cancer Research Center-IBMCC (USAL-CSIC), CIBERONC, Salamanca, Spain
| | - Norma C Gutiérrez
- University Hospital of Salamanca/IBSAL/Cancer Research Center-IBMCC (USAL-CSIC), CIBERONC, Salamanca, Spain
| | - María-Victoria Mateos
- University Hospital of Salamanca/IBSAL/Cancer Research Center-IBMCC (USAL-CSIC), CIBERONC, Salamanca, Spain.
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Kaloyannidis P, Abdulla F, Mutahar E, Al Hashim H, Al Harbi S, Estanislao A, Al Hashmi H. Risk Assessment for Newly Diagnosed Fit Young Patients with Multiple Myeloma in the Era of Novel Treatment Modalities: Should There Be Additional Factors Taken into Consideration?? J Blood Med 2022; 13:619-630. [PMID: 36317167 PMCID: PMC9617519 DOI: 10.2147/jbm.s380133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/09/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction The optimal treatment for young patients with high-risk newly diagnosed multiple myeloma (NDMM) remains a challenge. Methods We retrospectively evaluated 58 NDMM patients younger than 55 years treated in our center from 2010 to 2021 with the current recommended protocols. Results After a median follow-up of 48 months, median overall survival (OS) was not reached; however, approximately 25% of them died within 4 years after diagnosis. Advanced disease stage, presence of extramedullary disease, elevated LDH, and less than very good remission before autologous hematopoietic stem-cell transplantation adversely affected patient survival. Based on these factors, we created a risk-assessment scoring system that sufficiently discriminated young NDMM patients at risk of poor outcome. The 4-year OS was superior for patients with zero to two factors to those with three to five factors (86% vs 44%, p<0.001). Conclusion The proposed scoring system could be reliably used at diagnosis and at interim disease evaluation in aiming for personalized treatment for young NDMM patients.
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Affiliation(s)
- Panayotis Kaloyannidis
- Adult Hematology and Stem Cell Transplantation Department, King Fahad Specialist Hospital, Dammam, Saudi Arabia,Correspondence: Panayotis Kaloyannidis, Adults Hematology and Stem Cell Transplantation Department, King Fahad Specialist Hospital, Ammar Bin Thabit Street, Al Muraikabat, Dammam, 31444, Saudi Arabia, Tel +966-330-1174, Fax +966 13 844-2222, Email ;
| | - Fatema Abdulla
- Adult Hematology and Stem Cell Transplantation Department, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Enas Mutahar
- Adult Hematology and Stem Cell Transplantation Department, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Haidar Al Hashim
- Adult Hematology and Stem Cell Transplantation Department, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Salman Al Harbi
- Adult Hematology and Stem Cell Transplantation Department, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Analie Estanislao
- Adult Hematology and Stem Cell Transplantation Department, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Hani Al Hashmi
- Adult Hematology and Stem Cell Transplantation Department, King Fahad Specialist Hospital, Dammam, Saudi Arabia
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Reddy A, Rapiti N, Gounden V. Comparison of 24-hour versus random urine samples for determination and quantification of Bence Jones protein in a South African population. Afr J Lab Med 2021; 10:1228. [PMID: 34522630 PMCID: PMC8424753 DOI: 10.4102/ajlm.v10i1.1228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 03/04/2021] [Indexed: 11/15/2022] Open
Abstract
Background The International Myeloma Working Group and College of American Pathologists recommend a 24-h urine collection to determine the Bence Jones protein (BJP) excretion level for monitoring treatment response in patients with multiple myeloma (MM). There are several issues related to sample collection and the method is prone to inaccuracy. Objective This study compared measured 24-h to random urine collections for the quantitation of BJP in a South African population. Methods Sixty-six patients with MM submitted random urine samples with their routine 24-h urine collection from April 2016 – March 2018. Measured 24-h urine BJP was compared to two estimated 24-h BJP excretions calculated as follows: Estimation 1 (E1): Estimated 24-h BJP (mg/24 h) = Urine BJP/Creatinine ratio (mg/mmol) × 10. Estimation 2 (E2): Estimated 24-h BJP (mg/24 h) = Urine BJP/Creatinine ratio (mg/mmol) × 15 mg/kg for women or × 20 mg/kg for men. Results Correlation of estimation equations E1 and E2 to the measured 24-h urine BJP was 0.893. Patients showed no difference in classification of treatment response using either the E1 or E2 estimation equations when compared to the measured 24-h urine BJP results. Conclusion This study demonstrates that the estimated 24-h BJP shows a high degree of correlation with the measured 24-h BJP and can likely be used to monitor treatment response in South African patients with MM.
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Affiliation(s)
- Ashandree Reddy
- Department of Chemical Pathology, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.,National Health Laboratory Service, Durban, South Africa
| | - Nadine Rapiti
- National Health Laboratory Service, Durban, South Africa.,Department of Haematology, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Verena Gounden
- Department of Chemical Pathology, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.,National Health Laboratory Service, Durban, South Africa
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Gonsalves WI, Parmar H. Ageism in the t(11;14) Subtype of Multiple Myeloma. Acta Haematol 2020; 144:6-7. [PMID: 32506066 DOI: 10.1159/000508234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 04/24/2020] [Indexed: 11/19/2022]
Affiliation(s)
| | - Harsh Parmar
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
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