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Malard F, Neri P, Bahlis NJ, Terpos E, Moukalled N, Hungria VTM, Manier S, Mohty M. Multiple myeloma. Nat Rev Dis Primers 2024; 10:45. [PMID: 38937492 DOI: 10.1038/s41572-024-00529-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/16/2024] [Indexed: 06/29/2024]
Abstract
Multiple myeloma (MM) is a haematological lymphoid malignancy involving tumoural plasma cells and is usually characterized by the presence of a monoclonal immunoglobulin protein. MM is the second most common haematological malignancy, with an increasing global incidence. It remains incurable because most patients relapse or become refractory to treatments. MM is a genetically complex disease with high heterogeneity that develops as a multistep process, involving acquisition of genetic alterations in the tumour cells and changes in the bone marrow microenvironment. Symptomatic MM is diagnosed using the International Myeloma Working Group criteria as a bone marrow infiltration of ≥10% clonal plasma cells, and the presence of at least one myeloma-defining event, either standard CRAB features (hypercalcaemia, renal failure, anaemia and/or lytic bone lesions) or biomarkers of imminent organ damage. Younger and fit patients are considered eligible for transplant. They receive an induction, followed by consolidation with high-dose melphalan and autologous haematopoietic cell transplantation, and maintenance therapy. In older adults (ineligible for transplant), the combination of daratumumab, lenalidomide and dexamethasone is the preferred option. If relapse occurs and requires further therapy, the choice of therapy will be based on previous treatment and response and now includes immunotherapies, such as bi-specific monoclonal antibodies and chimeric antigen receptor T cell therapy.
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Affiliation(s)
- Florent Malard
- Sorbonne Université, Centre de Recherche Saint-Antoine INSERM UMRs938, Service d'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France.
| | - Paola Neri
- Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Canada
| | - Nizar J Bahlis
- Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Canada
| | - Evangelos Terpos
- Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Nour Moukalled
- Bone Marrow Transplantation Program, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Salomon Manier
- Department of Hematology, Lille University Hospital and INSERM UMR-S1277 and CNRS UMR9020, Lille, France
| | - Mohamad Mohty
- Sorbonne Université, Centre de Recherche Saint-Antoine INSERM UMRs938, Service d'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France.
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Sverrisdottir I, Thorsteinsdottir S, Rognvaldsson S, Aspelund T, Vidarsson B, Onundarson PT, Agnarsson BA, Sigurdardottir M, Thorsteinsdóttir I, Sveinsdottir SV, Palmason R, Olafsson I, Sigurdsson F, Thordardóttir AR, Eythorsson E, Jonsson A, Palsson R, Indridason OS, Gislason GK, Olafsson A, Sigurdsson J, Steingrímsdóttir H, Einarsson Long T, Hultcrantz M, Durie BGM, Harding S, Landgren O, Kristinsson SY, Love TJ. Association Between Autoimmune Diseases and Monoclonal Gammopathy of Undetermined Significance : An Analysis From a Population-Based Screening Study. Ann Intern Med 2024; 177:711-718. [PMID: 38768457 DOI: 10.7326/m23-2867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Monoclonal gammopathy of undetermined significance (MGUS) is a precursor of multiple myeloma (MM) and related conditions. In previous registry-based, retrospective studies, autoimmune diseases have been associated with MGUS. However, these studies were not based on a screened population and are therefore prone to ascertainment bias. OBJECTIVE To examine whether MGUS is associated with autoimmune diseases. DESIGN A cross-sectional study within iStopMM (Iceland Screens, Treats, or Prevents MM), a prospective, population-based screening study of MGUS. SETTING Icelandic population of adults aged 40 years or older. PATIENTS 75 422 persons screened for MGUS. MEASUREMENTS Poisson regression for prevalence ratios (PRs) of MGUS among persons with or without an autoimmune disease, adjusted for age and sex. RESULTS A total of 10 818 participants had an autoimmune disorder, of whom 599 had MGUS (61 with a prior clinical diagnosis and 538 diagnosed at study screening or evaluation). A diagnosis of an autoimmune disease was not associated with MGUS (PR, 1.05 [95% CI, 0.97 to 1.15]). However, autoimmune disease diagnoses were associated with a prior clinical diagnosis of MGUS (PR, 2.11 [CI, 1.64 to 2.70]). LIMITATION Registry data were used to gather information on autoimmune diseases, and the homogeneity of the Icelandic population may limit the generalizability of these results. CONCLUSION The study did not find an association between autoimmune disease and MGUS in a systematically screened population. Previous studies not done in systematically screened populations have likely been subject to ascertainment bias. The findings indicate that recommendations to routinely screen patients with autoimmune disease for MGUS may not be warranted. PRIMARY FUNDING SOURCE The International Myeloma Foundation and the European Research Council.
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Affiliation(s)
- Ingigerdur Sverrisdottir
- University of Iceland, Reykjavik, Iceland, and Sahlgrenska University Hospital, Gothenburg, Sweden (I.S.)
| | | | - Sæmundur Rognvaldsson
- University of Iceland and Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland (S.R., R.Palmason, S.Y.K., T.J.L.)
| | - Thor Aspelund
- University of Iceland, Reykjavik, Iceland (T.A., A.R.T., G.K.G., A.O., J.S.)
| | - Brynjar Vidarsson
- Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland (B.V., P.T.O., B.A.A., M.S., I.T., S.V.S., I.O., F.S., E.E., A.J., O.S.I., H.S.)
| | - Pall Torfi Onundarson
- Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland (B.V., P.T.O., B.A.A., M.S., I.T., S.V.S., I.O., F.S., E.E., A.J., O.S.I., H.S.)
| | - Bjarni A Agnarsson
- Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland (B.V., P.T.O., B.A.A., M.S., I.T., S.V.S., I.O., F.S., E.E., A.J., O.S.I., H.S.)
| | - Margret Sigurdardottir
- Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland (B.V., P.T.O., B.A.A., M.S., I.T., S.V.S., I.O., F.S., E.E., A.J., O.S.I., H.S.)
| | - Ingunn Thorsteinsdóttir
- Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland (B.V., P.T.O., B.A.A., M.S., I.T., S.V.S., I.O., F.S., E.E., A.J., O.S.I., H.S.)
| | - Signy Vala Sveinsdottir
- Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland (B.V., P.T.O., B.A.A., M.S., I.T., S.V.S., I.O., F.S., E.E., A.J., O.S.I., H.S.)
| | - Robert Palmason
- University of Iceland and Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland, and Skåne University Hospital, Lund, Sweden (R.Palsson)
| | - Isleifur Olafsson
- Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland (B.V., P.T.O., B.A.A., M.S., I.T., S.V.S., I.O., F.S., E.E., A.J., O.S.I., H.S.)
| | - Fridbjorn Sigurdsson
- Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland (B.V., P.T.O., B.A.A., M.S., I.T., S.V.S., I.O., F.S., E.E., A.J., O.S.I., H.S.)
| | | | - Elias Eythorsson
- Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland (B.V., P.T.O., B.A.A., M.S., I.T., S.V.S., I.O., F.S., E.E., A.J., O.S.I., H.S.)
| | - Asbjorn Jonsson
- Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland (B.V., P.T.O., B.A.A., M.S., I.T., S.V.S., I.O., F.S., E.E., A.J., O.S.I., H.S.)
| | - Runolfur Palsson
- University of Iceland and Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland (S.R., R.Palmason, S.Y.K., T.J.L.)
| | - Olafur Skuli Indridason
- Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland (B.V., P.T.O., B.A.A., M.S., I.T., S.V.S., I.O., F.S., E.E., A.J., O.S.I., H.S.)
| | | | - Andri Olafsson
- University of Iceland, Reykjavik, Iceland (T.A., A.R.T., G.K.G., A.O., J.S.)
| | - Jon Sigurdsson
- University of Iceland, Reykjavik, Iceland (T.A., A.R.T., G.K.G., A.O., J.S.)
| | - Hlif Steingrímsdóttir
- Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland (B.V., P.T.O., B.A.A., M.S., I.T., S.V.S., I.O., F.S., E.E., A.J., O.S.I., H.S.)
| | - Thorir Einarsson Long
- University of Iceland, Reykjavik, Iceland, and Skåne University Hospital, Lund, Sweden (T.E.L.)
| | - Malin Hultcrantz
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York (M.H.)
| | - Brian G M Durie
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Outpatient Cancer Center, Los Angeles, California (B.G.M.D.)
| | | | - Ola Landgren
- Myeloma Program, Department of Medicine, University of Miami, Sylvester Comprehensive Cancer Center, Miami, Florida (O.L.)
| | - Sigurdur Yngvi Kristinsson
- University of Iceland and Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland (S.R., R.Palmason, S.Y.K., T.J.L.)
| | - Thorvardur Jon Love
- University of Iceland and Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland (S.R., R.Palmason, S.Y.K., T.J.L.)
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Choi S, Kim E, Jung J, Park SS, Min CK, Han S. Quantitative risk factor analysis of prior disease condition and socioeconomic status with the multiple myeloma development: nationwide cohort study. Sci Rep 2024; 14:4885. [PMID: 38418448 PMCID: PMC10902317 DOI: 10.1038/s41598-024-52720-1] [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: 05/21/2023] [Accepted: 01/23/2024] [Indexed: 03/01/2024] Open
Abstract
Early diagnosis and following management are important determinants of the prognosis of multiple myeloma (MM). However, screening for MM is not routinely performed because it is rare disease. In this study, we evaluated the association of prior disease condition and socioeconomic status (SES) with MM diagnosis and developed a simple predictive model that can identify patients at high risk of developing MM who may need screening using nationwide database from South Korea. According to multivariate logistic regression analysis, eight prior disease conditions and SES before diagnosis were shown to be predictors of MM development and selected for score development. Total prediction scores were categorized into four groups: patients without any risk (≤ 0) intermediate-1 (0.5-9), intermediate-2 (9-14), and high risk (> 14). The odds ratios for developing MM in the intermediate-1, intermediate-2, and high-risk groups were 1.29, 3.07, and 4.62, respectively. The association of prior disease conditions and SES with MM diagnosis were demonstrated and the simple scoring system to predict the MM risk was developed. This scoring system is also provided by web-based application and could be a useful tool to support clinicians in identifying potential candidates for MM screening.
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Affiliation(s)
- Suein Choi
- Department of Pharmacology, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul, Republic of Korea
- Pharmacometrics Institute for Practical Education and Training (PIPET), College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eunjin Kim
- Department of Pharmacology, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul, Republic of Korea
- Pharmacometrics Institute for Practical Education and Training (PIPET), College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jinhee Jung
- Department of Pharmacology, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul, Republic of Korea
- Pharmacometrics Institute for Practical Education and Training (PIPET), College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung-Soo Park
- Department of Hematology, Seoul St. Mary's Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Catholic Research Network for Multiple Myeloma, Seoul, Republic of Korea
| | - Chang-Ki Min
- Department of Hematology, Seoul St. Mary's Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Catholic Research Network for Multiple Myeloma, Seoul, Republic of Korea
| | - Seunghoon Han
- Department of Pharmacology, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul, Republic of Korea.
- Pharmacometrics Institute for Practical Education and Training (PIPET), College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Zhao Q, Li F, Li J, Xia Y, Wang J, Chen L. An inflammatory response-related gene signature can predict the prognosis and impact the immune infiltration of multiple myeloma. Clin Exp Med 2024; 24:16. [PMID: 38280104 PMCID: PMC10821848 DOI: 10.1007/s10238-023-01277-w] [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: 11/06/2023] [Accepted: 11/25/2023] [Indexed: 01/29/2024]
Abstract
Multiple myeloma (MM) is a highly heterogeneous and incurable disease. Inflammation plays a vital role in cancer genesis and progression. However, the relationship between inflammatory response-related genes (IRRGs) and the prognosis of MM patients remains unknown. We constructed a IRRGs prognosis model by least absolute shrinkage and selection operator regression analysis. Moreover, clinical multivariate regression was performed to identify clinical implications. Gene set enrichment analysis was implemented to conduct its biological properties. CIBERSORT deconvolution algorithm was utilized to calculate the immune cell infiltration in different risk groups. The flow cytometry was utilized to perform protein expression of prognostic gene. A Six-IRRGs (VCAM1, RGS1, KIT, CD81, BLNK, and BIRC3) prognostic risk model was successfully constructed and validated. The risk model was an independent predictor for overall survival. Enrichment analysis revealed autophagy and PI3K-Akt signaling pathways were enriched in the high-risk group. Furthermore, we found CD81 widely impacted on the infiltration of immune cells, especially on monocytes and macrophages2. At last, the role of CD81 in MM was confirmed to be an adverse prognostic factor in clinical. Our study explores the potential application value of IRRGs in MM. These findings may provide new insights into the treatment for MM patients.
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Affiliation(s)
- Qian Zhao
- Department of Hematology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210003, China
- Department of Hematology, Jinling Hospital, Nanjing Medical University, Nanjing, 210002, China
| | - Feng Li
- Department of Hematology, Jinling Hospital, Nanjing Medical University, Nanjing, 210002, China
| | - Jing Li
- Department of Hematology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210003, China
| | - Yuan Xia
- Department of Hematology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210003, China
| | - Jing Wang
- Department of Hematology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210003, China
| | - Lijuan Chen
- Department of Hematology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210003, China.
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Rögnvaldsson S, Thorsteinsdóttir S, Kristinsson SY. Screening in Multiple Myeloma and Its Precursors: Are We There Yet? Clin Chem 2024; 70:128-139. [PMID: 38175579 DOI: 10.1093/clinchem/hvad148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 06/05/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Multiple myeloma (MM) is a hematological malignancy that develops over years from the asymptomatic precursors, monoclonal gammopathy of undetermined significance, and smoldering multiple myeloma. Recent evidence shows that by initiating treatment at an asymptomatic stage, outcomes in MM can be significantly improved. However, a vast majority of MM patients are diagnosed after the development of symptomatic end-organ damage and cannot reap the benefits of early treatment. The precursors of MM are easily detected by serum protein electrophoresis and free light chain assay of the serum, raising the question of whether population-based screening could detect MM at an asymptomatic stage and significantly expand the availability of early treatment in MM. Screening is a hallmark of care in many malignancies, and there are accepted criteria for when screening is appropriate. CONTENT Here we review the available relevant evidence for the introduction of screening and discuss whether screening for MM and its precursors fulfills these criteria. We also highlight gaps in our current knowledge, most notably a lack of data on the benefits and harms of screening and the lack of a defined target population. There are ongoing studies that may fill these critical gaps in the literature, but their results are still pending. SUMMARY Screening could lead to a paradigm shift in the care of patients with MM, but critical scientific questions need to be answered before screening of healthy individuals can be recommended. In short, we should not screen for MM and its precursors-yet.
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Affiliation(s)
- Sæmundur Rögnvaldsson
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Landspítali-The National University Hospital of Iceland, Reykjavík, Iceland
| | - Sigrún Thorsteinsdóttir
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark
| | - Sigurður Yngvi Kristinsson
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Landspítali-The National University Hospital of Iceland, Reykjavík, Iceland
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Sigurbergsdóttir AÝ, Rögnvaldsson S, Thorsteinsdóttir S, Sverrisdóttir I, Sigurðardóttir GÁ, Viðarsson B, Önundarson PT, Agnarsson BA, Sigurðardóttir M, Þorsteinsdóttir I, Ólafsson Í, Þórðardóttir ÁR, Gíslason GK, Ólafsson A, Hultcrantz M, Durie BGM, Harding S, Landgren O, Löve TJ, Kristinsson SY. Disease associations with monoclonal gammopathy of undetermined significance can only be evaluated using screened cohorts: results from the population-based iStopMM study. Haematologica 2023; 108:3392-3398. [PMID: 37439374 PMCID: PMC10690899 DOI: 10.3324/haematol.2023.283191] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/30/2023] [Indexed: 07/14/2023] Open
Abstract
Monoclonal gammopathy of undetermined significance (MGUS) is an asymptomatic precursor condition that precedes multiple myeloma and related disorders but has also been associated with other medical conditions. Since systematic screening is not recommended, MGUS is typically diagnosed due to underlying diseases and most cases are not diagnosed. Most previous studies on MGUS disease associations have been based on clinical cohorts, possibly resulting in selection bias. Here we estimate this selection bias by comparing clinically diagnosed and screened individuals with MGUS with regards to demographics, laboratory features, and comorbidities. A total of 75,422 participants in the Iceland Screens, Treats, or Prevents Multiple Myeloma (iStopMM) study were screened for MGUS by serum protein electrophoresis, immunofixation and free light chain assay (clinicaltrials gov. Identifier: NCT03327597). We identified 3,352 individuals with MGUS, whereof 240 had previously been clinically diagnosed (clinical MGUS), and crosslinked our data with large, nationwide registries for information on comorbidities. Those with clinical MGUS were more likely to have at least one comorbidity (odds ratio=2.24; 95% confidence interval: 1.30-4.19), and on average had more comorbidities than the screened MGUS group (3.23 vs. 2.36, mean difference 0.68; 95% confidence interval: 0.46-0.90). They were also more likely to have rheumatological disease, neurological disease, chronic kidney disease, liver disease, heart failure, or endocrine disorders. These findings indicate that individuals with clinical MGUS have more comorbidities than the general MGUS population and that previous studies have been affected by significant selection bias. Our findings highlight the importance of screening data when studying biological and epidemiological implications of MGUS.
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Affiliation(s)
| | - Sæmundur Rögnvaldsson
- University of Iceland, Reykjavík, Iceland; Landspítali - The National University Hospital of Iceland, Reykjavík
| | | | | | | | - Brynjar Viðarsson
- Landspítali - The National University Hospital of Iceland, Reykjavík
| | - Páll Torfi Önundarson
- University of Iceland, Reykjavík, Iceland; Landspítali - The National University Hospital of Iceland, Reykjavík
| | | | | | | | - Ísleifur Ólafsson
- Landspítali - The National University Hospital of Iceland, Reykjavík
| | | | | | | | | | | | | | - Ola Landgren
- Sylvester Comprehensive Cancer Center, Miami, FL
| | - Thorvarður Jón Löve
- University of Iceland, Reykjavík, Iceland; Landspítali - The National University Hospital of Iceland, Reykjavík
| | - Sigurður Yngvi Kristinsson
- University of Iceland, Reykjavík, Iceland; Landspítali - The National University Hospital of Iceland, Reykjavík.
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Ashruf OS, Orozco Z, Kaelber DC. Risk and Severity of COVID-19 Infection in Monoclonal Gammopathy of Undetermined Significance: A 3-Year Propensity Matched Cohort Study. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2023; 23:626-632. [PMID: 37208255 PMCID: PMC10140469 DOI: 10.1016/j.clml.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/21/2023] [Accepted: 04/24/2023] [Indexed: 05/21/2023]
Abstract
INTRODUCTION Monoclonal gammopathy of undetermined significance (MGUS) is a premalignant disorder causing monoclonal plasma cell proliferation in bone marrow. This population is at risk of developing multiple myeloma (MM) and severe viral infections; risk factors of severe COVID-19 infection. Using TriNetX, a global platform providing data of 120 million patients, we aimed to quantify the risk and severity of COVID-19 in MGUS patients. PATIENTS AND METHODS A retrospective cohort analysis was performed using the TriNetX Global Collaborative Network. From January 20, 2020, to January 20, 2023, we identified a cohort of 58,859 MGUS patients and compared to non-MGUS patients, determined by relevant diagnosis/LOINC test codes. After 1:1 propensity score-matching, we identified COVID-19 cases to quantify risk and identify patients who had been hospitalized, ventilated/intubated, and deceased to quantify severity. Measures of association and Kaplan-Meier analysis were conducted. RESULTS After propensity-score matching, there were 58,668 patients in both cohorts. MGUS patients were found to be at a reduced risk of contracting COVID-19 (RR 0.88, 95% CI 0.85-0.91). MGUS patients with COVID-19 showed higher mortality risk and decreased survival time compared to the general population (HR 1.14, 95% CI 1.01-1.27). MGUS patients with COVID-19 who were hospitalized exhibited significantly decreased survival time (log-rank test, P = 0.04). CONCLUSION As COVID-19 remains a looming health concern, especially amongst vulnerable populations, our analysis emphasizes the need for adequate vaccination and treatment regimens as well as an understanding of the severity of infection in MGUS patients and justification for precautionary measures.
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Affiliation(s)
- Omer S Ashruf
- Northeast Ohio Medical University, College of Medicine, Rootstown, OH, United States.
| | - Zara Orozco
- Northeast Ohio Medical University, College of Medicine, Rootstown, OH, United States
| | - David C Kaelber
- Center for Education and Training in Health Informatics, The Metro Health System and the Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, United States
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Kaur J, Valisekka SS, Hameed M, Bandi PS, Varma S, Onwughalu CJ, Ibrahim H, Mongia H. Monoclonal Gammopathy of Undetermined Significance: A Comprehensive Review. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2023; 23:e195-e212. [PMID: 36966041 DOI: 10.1016/j.clml.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 02/24/2023]
Abstract
Monoclonal Gammopathy of Undetermined Significance (MGUS) is an asymptomatic premalignant plasma cell dyscrasia with a predominate rise of the IgG immunoglobulin fraction without end-organ damage, often diagnosed incidentally. Despite its progression into various subsequent forms of hematological malignancies, MGUS remains underdiagnosed. A literature search was conducted using the Medline, Cochrane, Embase, and Google Scholar databases, including articles published until December 2022. Keywords used encompassed "Monoclonal Gammopathy of Undetermined Significance," "Plasma Cell dyscrasia," "Monoclonal gammopathy of renal significance," and "IgM Monoclonal gammopathy of Undetermined Significance," This study aimed to conduct a critical review to update knowledge regarding the pathophysiology, risk factors, clinical features, diagnostic protocols, complications, and current and novel treatments for MGUS. We recommend a multidisciplinary approach to manage MGUS due to the complexity of the illness's etiology, diagnosis, and therapy. This comprehensive review also highlights future prospects, such as developing screening protocols for at-risk populations, prevention of disease progression by early diagnosis through genome-wide association studies, and management using Daratumumab and NSAIDs.
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Affiliation(s)
- Jasneet Kaur
- Internal Medicine, Nassau University Medical Center, East Meadow, New York, USA..
| | | | - Maha Hameed
- Internal Medicine, Florida State University/Sarasota Memorial Hospital, Sarasota, Florida, USA.
| | | | | | | | - Hany Ibrahim
- Ain Shams University, Faculty of Medicine, Cairo, Egypt.
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Alehashemi S, Ward MM. Risk of Hematologic Malignancies in Elderly Patients With Ankylosing Spondylitis: A Cohort Study and Systematic Review. Mayo Clin Proc 2023; 98:100-110. [PMID: 36470752 PMCID: PMC9822846 DOI: 10.1016/j.mayocp.2022.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 05/09/2022] [Accepted: 06/30/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVE To examine the risk of hematologic malignancies in older adults with ankylosing spondylitis (AS). PATIENTS AND METHODS We used US Medicare data from January 1, 1999, to December 31, 2010, to identify a population-based cohort of beneficiaries with AS. We also included beneficiaries with inflammatory bowel disease (IBD) as disease controls and beneficiaries without AS or IBD as unaffected controls. We excluded those treated with tumor necrosis factor inhibitors in this period. We followed up each group for new diagnosis claims for hematologic malignancies until September 30, 2015. RESULTS We included 12,451 beneficiaries with AS, 234,905 with IBD, and 10,975,340 unaffected controls, with a mean follow-up of 9.9, 9.3, and 8.0 years, respectively. We identified 297 hematologic malignancies in the AS group, 4538 malignancies in the IBD group, and 128,239 malignancies in unaffected controls. The standardized incidence ratio in AS vs unaffected controls was 1.39 (95% CI, 1.05 to 1.61) for non-Hodgkin lymphoma, 1.50 (95% CI, 1.17 to 1.92) for chronic lymphocytic leukemia, and 1.52 (95% CI, 1.12 to 2.06) for multiple myeloma. Risks of acute myeloid leukemia and chronic myeloid leukemia were not elevated in AS, and there were too few cases of Hodgkin lymphoma to compute risks. Risks were comparable to those of beneficiaries with IBD. We also performed a systematic literature review of the risk of hematologic malignancy in AS, focusing on age associations, which have not been previously examined. We identified 21 studies in the systematic literature review, which included mainly young or middle-aged patients. Results suggested that AS was largely not associated with an increased risk of hematologic malignancies. Two cohort studies reported an increased risk of multiple myeloma in AS. CONCLUSION The risks of non-Hodgkin lymphoma, chronic lymphocytic leukemia, and multiple myeloma are increased among elderly patients with AS.
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MESH Headings
- Middle Aged
- Humans
- Aged
- United States/epidemiology
- Multiple Myeloma/complications
- Cohort Studies
- Leukemia, Lymphocytic, Chronic, B-Cell/epidemiology
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Spondylitis, Ankylosing/complications
- Spondylitis, Ankylosing/drug therapy
- Spondylitis, Ankylosing/epidemiology
- Medicare
- Hematologic Neoplasms/complications
- Lymphoma, Non-Hodgkin/epidemiology
- Lymphoma, Non-Hodgkin/etiology
- Lymphoma, Non-Hodgkin/pathology
- Inflammatory Bowel Diseases/complications
- Inflammatory Bowel Diseases/drug therapy
- Inflammatory Bowel Diseases/epidemiology
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Affiliation(s)
- Sara Alehashemi
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD.
| | - Michael M Ward
- Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD
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10
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Sun H, Fang T, Wang T, Yu Z, Gong L, Wei X, Wang H, He Y, Liu L, Yan Y, Sui W, Xu Y, Yi S, Qiu L, Hao M. Single-cell profiles reveal tumor cell heterogeneity and immunosuppressive microenvironment in Waldenström macroglobulinemia. J Transl Med 2022; 20:576. [PMID: 36494694 PMCID: PMC9733185 DOI: 10.1186/s12967-022-03798-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Waldenström macroglobulinemia (WM) is a rare and incurable indolent B-cell malignancy. The molecular pathogenesis and the role of immunosuppressive microenvironment in WM development are still incompletely understood. METHODS The multicellular ecosystem in bone marrow (BM) of WM were delineated by single-cell RNA-sequencing (scRNA-seq) and investigated the underlying molecular characteristics. RESULTS Our data uncovered the heterogeneity of malignant cells in WM, and investigated the kinetic co-evolution of WM and immune cells, which played pivotal roles in disease development and progression. Two novel subpopulations of malignant cells, CD19+CD3+ and CD138+CD3+, co-expressing T-cell marker genes were identified at single-cell resolution. Pseudotime-ordered analysis elucidated that CD19+CD3+ malignant cells presented at an early stage of WM-B cell differentiation. Colony formation assay further identified that CD19+CD3+ malignant cells acted as potential WM precursors. Based on the findings of T cell marker aberrant expressed on WM tumor cells, we speculate the long-time activation of tumor antigen-induced immunosuppressive microenvironment that is involved in the pathogenesis of WM. Therefore, our study further investigated the possible molecular mechanism of immune cell dysfunction. A precursor exhausted CD8-T cells and functional deletion of NK cells were identified in WM, and CD47 would be a potential therapeutic target to reverse the dysfunction of immune cells. CONCLUSIONS Our study facilitates further understanding of the biological heterogeneity of tumor cells and immunosuppressive microenvironment in WM. These data may have implications for the development of novel immunotherapies, such as targeting pre-exhausted CD8-T cells in WM.
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Affiliation(s)
- Hao Sun
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020 China ,Tianjin Institutes of Health Science, Tianjin, 301600 China
| | - Teng Fang
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020 China ,Tianjin Institutes of Health Science, Tianjin, 301600 China
| | - Tingyu Wang
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020 China
| | - Zhen Yu
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020 China ,Tianjin Institutes of Health Science, Tianjin, 301600 China
| | - Lixin Gong
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020 China ,Tianjin Institutes of Health Science, Tianjin, 301600 China
| | - Xiaojing Wei
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020 China
| | - Huijun Wang
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020 China
| | - Yi He
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020 China
| | - Lanting Liu
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020 China ,Tianjin Institutes of Health Science, Tianjin, 301600 China
| | - Yuting Yan
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020 China
| | - Weiwei Sui
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020 China
| | - Yan Xu
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020 China
| | - Shuhua Yi
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020 China
| | - Lugui Qiu
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020 China ,Tianjin Institutes of Health Science, Tianjin, 301600 China
| | - Mu Hao
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020 China ,Tianjin Institutes of Health Science, Tianjin, 301600 China
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11
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Abstract
Monoclonal gammopathy of undetermined significance (MGUS) is of considerable clinical importance to primary care physicians given its high prevalence in the general population. MGUS has a variable but lifelong risk for progression to hematologic cancer, such as multiple myeloma, Waldenström macroglobulinemia, or light-chain amyloidosis. In addition, MGUS has been associated with several nonmalignant yet symptomatic disorders that require therapy directed toward eliminating the monoclonal gammopathy. Thus, it is important not only to understand the essentials of diagnosing and monitoring patients with MGUS but also to recognize when to refer patients with MGUS to a specialist.
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Affiliation(s)
- Wilson I Gonsalves
- Division of Hematology, Mayo Clinic, Rochester, Minnesota (W.I.G., S.V.R.)
| | - S Vincent Rajkumar
- Division of Hematology, Mayo Clinic, Rochester, Minnesota (W.I.G., S.V.R.)
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12
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Yohannan B, Omo-Ogboi AC, Tammisetti VS, Rios A. Synchronous Presentation of Autoimmune Hepatitis and Multiple Myeloma. J Hematol 2022; 11:216-222. [PMID: 36632578 PMCID: PMC9822655 DOI: 10.14740/jh1049] [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: 09/02/2022] [Accepted: 10/10/2022] [Indexed: 01/04/2023] Open
Abstract
Autoimmune hepatitis (AIH) is a rare immune-mediated disease predominantly seen in women and triggered by various environmental factors. Rarely, AIH can be triggered by an underlying malignancy. We report a woman in her 60s who presented with markedly abnormal liver biochemical tests. Serology was positive for anti-smooth muscle antibodies and a liver biopsy confirmed AIH. During the hospital course, she developed sepsis and acute renal failure requiring dialysis support. Serum protein electrophoresis (SPEP) showed a monoclonal IgG kappa protein of 1.92 g/dL and a bone marrow biopsy revealed 7% clonal plasma cells. She had lytic lesions on skeletal survey confirming the diagnosis of a coexisting multiple myeloma (MM). Given her markedly abnormal liver chemistries, we decided to treat the AIH first and use the steroids (an important anti-myeloma therapy) as a bridge to the specific treatment of the MM once her clinical condition improved. She was treated with oral prednisone and azathioprine for AIH. One month later, a marked improvement in liver biochemical test results was noted and she was started on oral ixazomib, lenalidomide and dexamethasone. She received palliative radiotherapy to the lumbar spine (L2), left femur, and ischium lesions. This case highlights a rare co-occurrence of AIH and MM, the underlying mechanism of which is unknown.
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Affiliation(s)
- Binoy Yohannan
- Division of Hematology and Oncology, McGovern Medical School, The University of Texas Health Science Center at Houston, Huston, TX, USA
| | - Allen C. Omo-Ogboi
- Department of Pathology and Laboratory Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Huston, TX, USA
| | - Varaha S. Tammisetti
- Division of Diagnostic and Interventional Imaging, McGovern Medical School, The University of Texas Health Science Center at Houston, Huston, TX, USA
| | - Adan Rios
- Division of Hematology and Oncology, The University of Texas Health Science Center at Houston, Huston, TX, USA,Corresponding Author: Adan Rios, Division of Hematology and Oncology, The University of Texas Health Science Center at Houston, Huston, TX, USA.
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13
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Bai Z, Hu C, Zhong J, Dong L. Prevalence and Risk Factors of Monoclonal Gammopathy in Patients with Autoimmune Inflammatory Rheumatic Disease: A Systematic Review and Meta-Analysis. Mod Rheumatol 2022:6628361. [PMID: 35786736 DOI: 10.1093/mr/roac066] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/09/2022] [Accepted: 07/03/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To systemically investigate the prevalence and risk factors of monoclonal gammopathy (MG) in patients with autoimmune inflammatory rheumatic disease (AIIRD). METHODS A literature search was conducted using databases of PubMed, EMBASE and Web of Science for relevant studies from inception to July 31, 2021. The pooled prevalence, odds ratio (OR), weighted mean difference (WMD) and 95% confidence interval (CI) were calculated with Stata 16.0 using a random or fixed effects model. RESULTS In 17 included studies involving 6667 AIIRD patients, the pooled prevalence of MG in AIIRD patients was 7% (95%CI: 0.06-0.09). Compared to general populations, patients with Sjögren's syndrome (pSS) possessed the highest risk for MG (OR 4.51; 95%CI: 3.39-5.74), followed by systemic lupus erythematosus (OR 3.99; 95%CI: 2.84-5.14), ankylosing spondylitis (OR 2.04; 95%CI: 1.11-2.97), and rheumatoid arthritis (OR 2.00; 95%CI: 1.79-2.22). Older age (WMD=5.17 years; 95%CI: 0.68-9.66), higher erythrocyte sedimentation rate (WMD=14.04 mm/H; 95%CI: 7.77-20.30), higher serum gammaglobulins level (WMD=1.92 mg/dL, 95%CI: 0.51-3.32) were associated with a greater risk of MG in AIIRD patients. CONCLUSIONS Monoclonal gammopathy prevalence was higher in AIIRD patients, especially in pSS patients. Older age, higher ESR, and hypergammaglobulins were risk factors for MG in AIIRD patients.
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Affiliation(s)
- Zhiqian Bai
- Department of Rheumatology and Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chuanyu Hu
- Department of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jixin Zhong
- Department of Rheumatology and Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lingli Dong
- Department of Rheumatology and Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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14
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Sigurbergsdóttir AÝ, Love TJ, Kristinsson SY. Autoimmunity, Infections, and the Risk of Monoclonal Gammopathy of Undetermined Significance. Front Immunol 2022; 13:876271. [PMID: 35572590 PMCID: PMC9096784 DOI: 10.3389/fimmu.2022.876271] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/04/2022] [Indexed: 11/13/2022] Open
Abstract
Various epidemiological studies, including case reports and -series in addition to larger, population-based studies, have reported an increased prevalence of monoclonal gammopathy of undetermined significance (MGUS) and multiple myeloma in individuals with a prior history of immune-related conditions. This is believed to support the role of chronic antigen stimulation in the pathogenesis of these conditions. In this short review, we summarize some of the largest population-based studies researching autoimmune diseases, infections, and the subsequent risk of MGUS, and discuss our understanding on its etiology and pathogenesis. Furthermore, we highlight important methodological limitations of previous studies in the field, but almost all studies on MGUS have been based on clinical, possibly biased, cohorts. Finally, we discuss future directions in researching the associations of MGUS and other disorders, including immune-related conditions, where screening studies play an important role.
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Affiliation(s)
| | - Thorvardur Jon Love
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Department of Science and Research, Landspitali University Hospital, Reykjavik, Iceland
| | - Sigurður Yngvi Kristinsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Department of Haematology, Landspitali University Hospital, Reykjavik, Iceland
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15
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Liu H, Li P, Li K, Zhou Z, Zhou Y, Leng X, Zhao L, Zhang X. Monoclonal gammopathy in autoimmune diseases: Analysis and follow-up of 160 cases in a tertiary center in China. Clin Immunol 2021; 234:108909. [PMID: 34915197 DOI: 10.1016/j.clim.2021.108909] [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: 11/10/2021] [Revised: 12/07/2021] [Accepted: 12/07/2021] [Indexed: 11/28/2022]
Abstract
Monoclonal gammopathy (MG) is common in autoimmune diseases (AID), but its progression to hematological neoplasm (HN) and the predictors for the progression are unclear. Patients diagnosed with AID and MG in our hospital from January 2010 to June 2017 were reviewed and followed. Cox proportional hazard regression analysis was applied. Of 160 patients with AID and MG, the most common AID was primary Sjӧgren's syndrome (37, 23.1%). Thirty-nine (24.4%) patients developed HN during follow-up (median: 3.7 years, IQR: 0.3-5.5 years). The cumulative probability of HN progression was 21.8% at one year and 29.3% at six years after the finding of MG. High levels of monoclonal protein (> 14.35% of total serum protein) (HR 11.71, 95%CI: 5.37-25.54), significant weight loss (HR 6.24, 95%CI: 2.87-13.59), and reduction of other types of immunoglobulins (HR 3.02, 95%CI: 1.40-6.48) are independent risk indicators for HN whose presence warrants vigorous follow-up and monitoring.
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Affiliation(s)
- Huazhen Liu
- Department of Rheumatology and Clinical Immunology, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China; Clinical Immunology Centre, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Pengchong Li
- Department of Rheumatology and Clinical Immunology, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China; Clinical Immunology Centre, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Ketian Li
- Department of Rheumatology and Clinical Immunology, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China; Clinical Immunology Centre, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Ziyue Zhou
- Department of Rheumatology and Clinical Immunology, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China; Clinical Immunology Centre, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yangzhong Zhou
- Department of internal medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, The Ministry of Education Key Laboratory, Beijing 100730, China
| | - Xiaomei Leng
- Department of Rheumatology and Clinical Immunology, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Lidan Zhao
- Department of Rheumatology and Clinical Immunology, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
| | - Xuan Zhang
- Department of Rheumatology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, 1th Dongdan Dahua Road, Beijing 100730, China.
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16
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Weinstein R, Parikh-Das AM, Salonga R, Schuemie M, Ryan PB, Atillasoy E, Hermanowski-Vosatka A, Eichenbaum G, Berlin JA. A systematic assessment of the epidemiologic literature regarding an association between acetaminophen exposure and cancer. Regul Toxicol Pharmacol 2021; 127:105043. [PMID: 34517075 DOI: 10.1016/j.yrtph.2021.105043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 08/02/2021] [Accepted: 09/03/2021] [Indexed: 01/05/2023]
Abstract
Introduced in the 1950s, acetaminophen is one of the most widely used antipyretics and analgesics worldwide. In 1999, the International Agency for Research on Cancer (IARC) reviewed the epidemiologic studies of acetaminophen and the data were judged to be "inadequate" to conclude that it is carcinogenic. In 2019 the California Office of Environmental Health Hazard Assessment initiated a review process on the carcinogenic hazard potential of acetaminophen. To inform this review process, the authors performed a comprehensive literature search and identified 136 epidemiologic studies, which for most cancer types suggest no alteration in risk associated with acetaminophen use. For 3 cancer types, renal cell, liver, and some forms of lymphohematopoietic, some studies suggest an increased risk; however, multiple factors unique to acetaminophen need to be considered to determine if these results are real and clinically meaningful. The objective of this publication is to analyze the results of these epidemiologic studies using a framework that accounts for the inherent challenge of evaluating acetaminophen, including, broad population-wide use in multiple disease states, challenges with exposure measurement, protopathic bias, channeling bias, and recall bias. When evaluated using this framework, the data do not support a causal association between acetaminophen use and cancer.
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Affiliation(s)
| | | | | | | | | | - Evren Atillasoy
- Johnson & Johnson Consumer Products US, Fort Washington, PA, USA
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17
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Hemminki K, Försti A, Houlston R, Sud A. Epidemiology, genetics and treatment of multiple myeloma and precursor diseases. Int J Cancer 2021; 149:1980-1996. [PMID: 34398972 DOI: 10.1002/ijc.33762] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/20/2021] [Accepted: 07/26/2021] [Indexed: 12/17/2022]
Abstract
Multiple myeloma (MM) is a hematological malignancy caused by the clonal expansion of plasma cells. The incidence of MM worldwide is increasing with greater than 140 000 people being diagnosed with MM per year. Whereas 5-year survival after a diagnosis of MM has improved from 28% in 1975 to 56% in 2012, the disease remains essentially incurable. In this review, we summarize our current understanding of MM including its epidemiology, genetics and biology. We will also provide an overview of MM management that has led to improvements in survival, including recent changes to diagnosis and therapies. Areas of unmet need include the management of patients with high-risk MM, those with reduced performance status and those refractory to standard therapies. Ongoing research into the biology and early detection of MM as well as the development of novel therapies, such as immunotherapies, has the potential to influence MM practice in the future.
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Affiliation(s)
- Kari Hemminki
- Biomedical Center, Faculty of Medicine, Charles University in Pilsen, Pilsen, Czech Republic.,Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Asta Försti
- Hopp Children's Cancer Center (KiTZ), Heidelberg, Germany.,Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Richard Houlston
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - Amit Sud
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK.,The Department of Haemato-Oncology, The Royal Marsden Hospital NHS Foundation Trust, London, UK
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18
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Abstract
PURPOSE OF REVIEW There is a complex interaction between sarcoidosis and malignancy. Since tumors can elicit a granulomatous reaction, the presence of granulomas alone is insufficient to diagnose sarcoidosis in a patient with cancer. In addition, check point inhibitors can also lead to a granulomatous reaction which can be misdiagnosed as sarcoidosis. These issues need to be considered when exploring the relationship between sarcoidosis and malignancy. Despite these limitations, a growing amount of evidence supports the potential interaction of sarcoidosis and malignancy. RECENT FINDINGS Several large epidemiologic studies of patients from Europe, the USA, and Japan reveal an increased relative risk for cancer in sarcoidosis patients. The highest relative risks are seen in patients with lymphoma and breast cancer. New criteria have been developed to standardize the diagnosis of sarcoidosis, which should further clarify the association. SUMMARY The diagnosis of sarcoidosis may precede or occur after malignancy. In a sarcoidosis patient with an atypical lesion, such as a breast mass, a biopsy should be considered.
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19
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Rheumatologic diseases impact the risk of progression of MGUS to overt multiple myeloma. Blood Adv 2021; 5:1746-1754. [PMID: 33749761 DOI: 10.1182/bloodadvances.2020003193] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 02/04/2021] [Indexed: 12/15/2022] Open
Abstract
Monoclonal gammopathy of undetermined significance (MGUS), a premalignant condition, is associated with various chronic inflammatory rheumatic diseases (RDs) and is frequently observed as an incidental finding during routine work-up. The association of MGUS and chronic RDs is well established, but the impact of RDs on the risk of transformation into overt multiple myeloma (MM) has not been evaluated so far. MGUS patients diagnosed between January 2000 and August 2016 were identified and screened for concomitant RDs. RDs were grouped into antibody (Ab)-mediated RDs and non-Ab-mediated RDs (polymyalgia rheumatica, large-vessel giant cell arteritis, spondyloarthritis, and gout). Progression to MM was defined as a categorical (yes/no) or continuous time-dependent (time to progression) variable. Of 2935 MGUS patients, 255 (9%) had a concomitant RD. MGUS patients diagnosed with non-Ab-mediated RDs had a doubled risk of progression compared with those without a concomitant RD (hazard ratio, 2.1; 95% CI, 1.1-3.9; P = .02). These data translate into a 5-year risk of progression of 4% in MGUS patients without rheumatologic comorbidity, 10% in those with concomitant non-Ab-mediated RDS, and 2% in those with Ab-mediated RDs. By using the complex risk stratification model that includes myeloma protein (M-protein) concentration, immunoglobulin type, and level of free light chain ratio as variables, patients with non-Ab-mediated RDs (n = 57) had the highest risk for progression (hazard ratio, 6.8; 95% CI, 1.5-30.7; P = .01) compared with patients with Ab-mediated RDs (n = 77). Chronic inflammatory diseases have an impact on the risk of MGUS progressing into overt MM, with a doubled risk of transformation observed in patients with non-Ab-mediated RDs. Future research can elucidate whether comorbidities such as RDs should be included in currently applied prognostic MGUS scores.
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20
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Search for multiple myeloma risk factors using Mendelian randomization. Blood Adv 2021; 4:2172-2179. [PMID: 32433745 DOI: 10.1182/bloodadvances.2020001502] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 04/10/2020] [Indexed: 01/01/2023] Open
Abstract
The etiology of multiple myeloma (MM) is poorly understood. Summary data from genome-wide association studies (GWASs) of multiple phenotypes can be exploited in a Mendelian randomization (MR) phenome-wide association study (PheWAS) to search for factors influencing MM risk. We performed an MR-PheWAS analyzing 249 phenotypes, proxied by 10 225 genetic variants, and summary genetic data from a GWAS of 7717 MM cases and 29 304 controls. Odds ratios (ORs) per 1 standard deviation increase in each phenotype were estimated under an inverse variance weighted random effects model. A Bonferroni-corrected threshold of P = 2 × 10-4 was considered significant, whereas P < .05 was considered suggestive of an association. Although no significant associations with MM risk were observed among the 249 phenotypes, 28 phenotypes showed evidence suggestive of association, including increased levels of serum vitamin B6 and blood carnitine (P = 1.1 × 10-3) with greater MM risk and ω-3 fatty acids (P = 5.4 × 10-4) with reduced MM risk. A suggestive association between increased telomere length and reduced MM risk was also noted; however, this association was primarily driven by the previously identified risk variant rs10936599 at 3q26 (TERC). Although not statistically significant, increased body mass index was associated with increased risk (OR, 1.10; 95% confidence interval, 0.99-1.22), supporting findings from a previous meta-analysis of prospective observational studies. Our study did not provide evidence supporting any modifiable factors examined as having a major influence on MM risk; however, it provides insight into factors for which the evidence has previously been mixed.
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21
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Prognosis of young patients with monoclonal gammopathy of undetermined significance (MGUS). Blood Cancer J 2021; 11:26. [PMID: 33563898 PMCID: PMC7873268 DOI: 10.1038/s41408-021-00406-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 10/28/2020] [Indexed: 12/17/2022] Open
Abstract
Monoclonal gammopathy of undetermined significance (MGUS) is rare in young patients (age <40 years at diagnosis), with a prevalence of <0.3%, representing ~2% of all patients with MGUS. We hypothesized that MGUS detected in young patients may be associated with a higher risk of progression. We examined 249 patients with MGUS < 40 years old. Among these, 135 patients had immune-related conditions, including infections, autoimmune and inflammatory disorders at the time of diagnosis of MGUS. The risk of progression to multiple myeloma or a related disorder at 5 years and 10 years was 6.0% and 13.8%, respectively. The size of M protein was a significant risk factor for progression (HR 4.2, 95% CI 2.2–7.9). There was a trend that the risk of progression was higher in patients without immune-related conditions (HR 2.36, 95% CI 0.85–6.52, p = 0.088). The M protein resolved in 36 (14%) patients, with a greater likelihood of resolution in patients with immune-related conditions (RR 1.9, 95% CI 1.02–3.6). Young patients with MGUS have a similar risk of progression as older patients, 1.4% per year. Over 50% are diagnosed in the setting of immune-related disorders. Patients with immune-related disorders may have a lower risk of progression.
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22
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Risk factors for monoclonal gammopathy of undetermined significance: a systematic review. Ann Hematol 2021; 100:855-863. [PMID: 33416902 DOI: 10.1007/s00277-021-04400-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 01/03/2021] [Indexed: 12/11/2022]
Abstract
Monoclonal gammopathy of undetermined significance (MGUS), precursor of multiple myeloma, is an asymptomatic plasma cell disorder that overproduces serum monoclonal protein. Older age, male sex, black race, and family history of MGUS increase the risk of MGUS, yet other risk factors are known. We systematically reviewed observational epidemiological studies that examined sociodemographic, clinical, and behavioral risk factors for the development of MGUS. The protocol for this study was registered on the PROSPERO registry for systematic reviews. We identified epidemiological studies from PubMed and Scopus. Articles were limited to those written in English and published before February 2019. Five case-control and three cohort studies were eligible for data extraction. Studies evaluating factors associated with MGUS risk are limited, with conflicting conclusions regarding risk associated with obesity. Despite the limited research, a significant elevated risk for being diagnosed with MGUS was associated with several specific prior infections, inflammatory disorders, and smoking. The sparse existing literature suggests an increased risk of MGUS associated with several risk factors related to immune function. Further research is needed to explore the potential mechanisms underlying the development of MGUS and to confirm risk factors, both modifiable and non-modifiable.
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23
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Baldursdóttir TR, Löve ÞJ, Gíslason GK, Björkholm M, Mellqvist UH, Lund SH, Blimark CH, Turesson I, Hultcrantz M, Landgren O, Kristinsson SY. Autoimmune disease is associated with a lower risk of progression in monoclonal gammopathy of undetermined significance. Eur J Haematol 2020; 106:380-388. [PMID: 33295006 DOI: 10.1111/ejh.13563] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/03/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVES AND METHODS We conducted a population-based study including 19 303 individuals diagnosed with MGUS in Sweden from 1985 to 2013, with the aim to determine whether a prior history of autoimmune disease, a well-described risk factor for MGUS is a risk factor for progression of MGUS to multiple myeloma (MM) or lymphoproliferative diseases (LPs). Using the nationwide Swedish Patient registry, we identified MGUS cases with versus without an autoimmune disease present at the time of MGUS diagnosis and estimated their risk of progression. RESULTS A total of 5612 (29.1%) MGUS cases had preceding autoimmune diseases. Using Cox proportional hazards models, we found the risk of progression from MGUS to MM (HR = 0.83, 95% CI 0.73-0.94) and LPs (HR = 0.84, 95% CI 0.75-0.94) to be significantly lower in MGUS cases with prior autoimmune disease (compared to MGUS cases without). CONCLUSIONS In this large population-based study, a history of autoimmune disease was associated with a reduced risk of progression from MGUS to MM/other LPs. Potential underlying reason is that MGUS caused by chronic antigen stimulation is biologically less likely to undergo the genetic events that trigger progression. Our results may have implications in clinical counseling for patients with MGUS and underlying autoimmune disease.
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Affiliation(s)
| | - Þorvarður Jón Löve
- Landspítali, National University Hospital, Reykjavík, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | | | - Magnus Björkholm
- Department of Medicine, Division of Hematology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | | | | | | | | | - Malin Hultcrantz
- Department of Medicine, Division of Hematology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.,Myeloma Service, Division of Hematologic Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Ola Landgren
- Myeloma Program, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Sigurður Yngvi Kristinsson
- Landspítali, National University Hospital, Reykjavík, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
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24
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Mirouse A, Vigneron C, Llitjos JF, Chiche JD, Mira JP, Mokart D, Azoulay E, Pène F. Sepsis and Cancer: An Interplay of Friends and Foes. Am J Respir Crit Care Med 2020; 202:1625-1635. [PMID: 32813980 DOI: 10.1164/rccm.202004-1116tr] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Sepsis and cancer share a number of pathophysiological features, and both result from the inability of the host's immune system to cope with the initial insult (tissue invasion by pathogens and malignant cell transformation, respectively). The common coexistence of both disorders and the profound related alterations in immune homeostasis raise the question of their mutual impact on each other's course. This translational review aims to discuss the interactions between cancer and sepsis supported by clinical data and the translation to experimental models. The dramatic improvement in cancer has come at a cost of increased risks of life-threatening infectious complications. Investigating the long-term outcomes of sepsis survivors has revealed an unexpected susceptibility to cancer long after discharge from the ICU. Nonetheless, it is noteworthy that an acute septic episode may harbor antitumoral properties under particular circumstances. Relevant double-hit animal models have provided clues to whether and how bacterial sepsis may impact malignant tumor growth. In sequential sepsis-then-cancer models, postseptic mice exhibited accelerated tumor growth. When using reverse cancer-then-sepsis models, bacterial sepsis applied to mice with cancer conversely resulted in inhibition or even regression of tumor growth. Experimental models thus highlight dual effects of sepsis on tumor growth, mostly depending on the sequence of insults, and allow deciphering the immune mechanisms and their relation with microorganisms.
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Affiliation(s)
- Adrien Mirouse
- Université de Paris, Paris, France.,Institut Cochin, INSERM U1016, CNRS UMR 8104, Paris, France.,Médecine Intensive et Réanimation, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP) Nord, Paris, France
| | - Clara Vigneron
- Université de Paris, Paris, France.,Institut Cochin, INSERM U1016, CNRS UMR 8104, Paris, France.,Médecine Intensive et Réanimation, Hôpital Cochin, AP-HP Centre, Paris, France; and
| | - Jean-François Llitjos
- Université de Paris, Paris, France.,Institut Cochin, INSERM U1016, CNRS UMR 8104, Paris, France.,Médecine Intensive et Réanimation, Hôpital Cochin, AP-HP Centre, Paris, France; and
| | - Jean-Daniel Chiche
- Université de Paris, Paris, France.,Institut Cochin, INSERM U1016, CNRS UMR 8104, Paris, France.,Médecine Intensive et Réanimation, Hôpital Cochin, AP-HP Centre, Paris, France; and
| | - Jean-Paul Mira
- Université de Paris, Paris, France.,Institut Cochin, INSERM U1016, CNRS UMR 8104, Paris, France.,Médecine Intensive et Réanimation, Hôpital Cochin, AP-HP Centre, Paris, France; and
| | - Djamel Mokart
- Réanimation Polyvalente, Département d'Anesthésie et de Réanimation, Institut Paoli Calmettes, Marseille, France
| | - Elie Azoulay
- Université de Paris, Paris, France.,Médecine Intensive et Réanimation, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP) Nord, Paris, France
| | - Frédéric Pène
- Université de Paris, Paris, France.,Institut Cochin, INSERM U1016, CNRS UMR 8104, Paris, France.,Médecine Intensive et Réanimation, Hôpital Cochin, AP-HP Centre, Paris, France; and
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25
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Emamifar A, Hess S, Ellingsen T, Due Kay S, Christian Bang J, Gerke O, Syrak Hansen P, Ahangarani Farahani Z, Petersen H, Marcussen N, Jensen Hansen IM, Thye Rønn P. Prevalence of Newly Diagnosed Malignancies in Patients with Polymyalgia Rheumatica and Giant Cell Arteritis, Comparison of 18F-FDG PET/CT Scan with Chest X-ray and Abdominal Ultrasound: Data from a 40 Week Prospective, Exploratory, Single Centre Study. J Clin Med 2020; 9:E3940. [PMID: 33291857 PMCID: PMC7762038 DOI: 10.3390/jcm9123940] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 02/06/2023] Open
Abstract
The aim of the study was to identify the prevalence of newly diagnosed malignancies in patients with polymyalgia rheumatica (PMR) and giant cell arteritis (GCA), with the aid of 18F-FDG PET/CT scan compared to conventional imaging techniques: Chest X-ray (CXR) and abdominal ultrasound (US). Secondarily, to examine the relative diagnostic accuracy of these two imaging modalities for the detection of cancer. Eighty consecutive patients with newly diagnosed PMR, GCA, or concomitant PMR and GCA, were included and followed up for 40 weeks. All patients underwent an 18F-FDG PET/CT scan, CXR, and abdominal US at diagnosis. Imaging findings were dichotomously categorized into malignant or benign. Among 80 patients, three patients were diagnosed with seronegative rheumatoid arthritis and were excluded from the analysis. Of the remaining 77, 64 (83.1%) patients were diagnosed with pure PMR, 3 (3.9%) with pure GCA, and 10 (13.0%) with concomitant PMR and GCA. Five types of cancer that were more prevalent than the one-year prevalence of 1.2% among the background population were found in four (5.2%; 95%CI: 1.4-12.8%) patients. CXR/abdominal US could detect the solid cancer in one patient, whereas 18F-FDG PET/CT could identify all four solid cancers. Furthermore, four (5.2%; 95%CI: 1.4-12.8%) cases of monoclonal gammopathy of undetermined significance (MGUS) were found. An increase in C reactive protein (CRP) implicated an increased risk for cancer of 2.4% (OR: 1.024, 95%CI: 1.001-1.047; p = 0.041). 18F-FDG PET/CT can reveal occult cancers at an early stage with a high negative predictive value, and it is specifically beneficial in PMR/GCA patients with nonspecific symptoms.
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Affiliation(s)
- Amir Emamifar
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, 5000 Odense, Denmark; (H.P.); (P.T.R.)
- Diagnostic Center, Svendborg Hospital, OUH, 5700 Svendborg, Denmark;
- Department of Rheumatology, Svendborg Hospital, OUH, 5700 Svendborg, Denmark; (S.D.K.); (I.M.J.H.)
- OPEN, Odense Patient data Explorative Network, Odense University Hospital, 5000 Odense, Denmark
| | - Søren Hess
- Department of Radiology and Nuclear Medicine, Hospital of Southwest Jutland, 6700 Esbjerg, Denmark;
- Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, 5000 Odense, Denmark
| | - Torkell Ellingsen
- Rheumatology Research Unit, Odense University Hospital and University of Southern Denmark, 5000 Odense, Denmark;
| | - Susan Due Kay
- Department of Rheumatology, Svendborg Hospital, OUH, 5700 Svendborg, Denmark; (S.D.K.); (I.M.J.H.)
| | | | - Oke Gerke
- Research Unit of Clinical Physiology and Nuclear Medicine, Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark;
- Department of Nuclear Medicine, Odense University Hospital, 5000 Odense, Denmark;
| | - Per Syrak Hansen
- Diagnostic Center, Svendborg Hospital, OUH, 5700 Svendborg, Denmark;
| | | | - Henrik Petersen
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, 5000 Odense, Denmark; (H.P.); (P.T.R.)
- Department of Nuclear Medicine, Odense University Hospital, 5000 Odense, Denmark;
| | - Niels Marcussen
- Department of Pathology, Odense University Hospital, 5000 Odense, Denmark;
| | | | - Peter Thye Rønn
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, 5000 Odense, Denmark; (H.P.); (P.T.R.)
- Diagnostic Center, Svendborg Hospital, OUH, 5700 Svendborg, Denmark;
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26
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Karmacharya P, Shahukhal R, Ogdie A. Risk of Malignancy in Spondyloarthritis: A Systematic Review. Rheum Dis Clin North Am 2020; 46:463-511. [PMID: 32631600 DOI: 10.1016/j.rdc.2020.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Systematic inflammatory diseases, including rheumatoid arthritis (RA), are associated with an increased risk of malignancies. However, the pathogenesis of spondyloarthritis (SpA), which includes both ankylosing spondylitis and psoriatic arthritis, is different from RA, and the risk of malignancy and sites involved may also be different. It is important to better understand associations of SpA with site-specific cancers to facilitate appropriate cancer screening. The goal of this review was to examine the association of SpA with malignancy and the potential impact of therapy for SpA on development of malignancy.
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Affiliation(s)
- Paras Karmacharya
- Division of Rheumatology, Department of Medicine, Mayo Clinic, Mayo Clinic College of Medicine, 200 First Street Southwest, Rochester, MN 55905, USA. https://twitter.com/paraskarmachary
| | - Ravi Shahukhal
- Division of Internal Medicine, Lakes Regional General Hospital, 80 Highland Street, Laconia, NH 03246, USA
| | - Alexis Ogdie
- Division of Rheumatology, Hospital of the University of Pennsylvania, Perelman Center for Advanced Medicine, 3400 Civic Center Boulevard, South Pavilion, 1st Floor, Philadelphia, PA 19104, USA.
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27
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Zhang B, Gu J, Liu J, Huang B, Li J. Fecal Microbiota Taxonomic Shifts in Chinese Multiple Myeloma Patients Analyzed by Quantitative Polimerase Chain Reaction (QPCR) and 16S rRNA High-Throughput Sequencing. Med Sci Monit 2019; 25:8269-8280. [PMID: 31678982 PMCID: PMC6855177 DOI: 10.12659/msm.919988] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Increasing evidence has suggested that gut flora play an important role in tumor progression and prognosis. However, the relationship between fecal microbiota and hematologic malignancy requires further investigation. This study aimed to characterize the relationship of the fecal microbial community in multiple myeloma (MM) patients. Material/Methods A total of 40 MM patients and healthy controls (n=17) were retrospectively collected from the First Affiliated Hospital of Sun Yat-sen University between October 2018 and May 2019. The fecal samples were collected for 16S rRNA high-throughput sequencing for the fecal microbial community, as well as diversity and correlation analysis. Furthermore, 21 MM patients and their family members were selected for the matched pair analysis to confirm the fecal microbiota taxonomic changes by qRT-PCR assay. Results Diversity analysis showed that diversity measured by Shannon index was lower in MM patients compared with healthy controls. At the phylum level, higher abundances of Proteobacteria but lower abundances of Actinobacteria were identified in the MM group in comparison with the healthy control group. At the genus level, the proportion of Bacteroides, Faecalibacterium, and Roseburia was significantly higher in the MM group. The matched pair analysis showed that Pseudomonas aeruginosa and Faecalibacterium were significantly more abundant in the MM group. Further analysis on prognostic risk factors revealed that the Faecalibacterium prausnitzii level was significantly correlated with ISS stage. Conclusions Our study highlights the imbalanced composition and diversity of the gastrointestinal microbiome in MM patients, which could be further used as a potential biomarker for MM risk screening, therapeutic strategies, and prognostic prediction.
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Affiliation(s)
- Bingqing Zhang
- Department of Hematology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
| | - Jingli Gu
- Department of Hematology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
| | - Junru Liu
- Department of Hematology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
| | - Beihui Huang
- Department of Hematology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
| | - Juan Li
- Department of Hematology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
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28
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Monoclonal gammopathy of undetermined significance. Blood 2019; 133:2484-2494. [PMID: 31010848 DOI: 10.1182/blood.2019846782] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 04/19/2019] [Indexed: 12/13/2022] Open
Abstract
Monoclonal gammopathy of undetermined significance (MGUS) is a premalignant plasma cell dyscrasia that consistently precedes multiple myeloma (MM) with a 1% risk of progression per year. Recent advances have improved understanding of the complex genetic and immunologic factors that permit progression from the aberrant plasma cell clone to MGUS and overt MM. Additional evidence supports bidirectional interaction of MGUS cells with surrounding cells in the bone marrow niche that regulates malignant transformation. However, there are no robust prognostic biomarkers. Herein we review the current body of literature on the biology of MGUS and provide a rationale for the improved identification of high-risk MGUS patients who may be appropriate for novel clinical interventions to prevent progression or eradicate premalignant clones prior to the development of overt MM.
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29
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Li L, Wang L. Multiple Myeloma: What Do We Do About Immunodeficiency? J Cancer 2019; 10:1675-1684. [PMID: 31205523 PMCID: PMC6548011 DOI: 10.7150/jca.29993] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 01/30/2019] [Indexed: 02/06/2023] Open
Abstract
Multiple myeloma (MM) is an incurable hematological malignancy. Immunodeficiency results in the incapability of immunity to eradicate both tumor cells and pathogens. Immunotherapies along with antibiotics and other anti-infectious agents are applied as substitutes for immunity in MM. Immunotherapies including monoclonal antibodies, immune checkpoints inhibitors, affinity- enhanced T cells, chimeric antigen receptor T cells and dendritic cell vaccines are revolutionizing MM treatment. By suppressing the pro-inflammatory milieu and pathogens, prophylactic and therapeutic antibiotics represent anti-tumor and anti-infection properties. It is expected that deeper understanding of infection, immunity and tumor physio-pathologies in MM will accelerate the optimization of combined therapies, thus improving prognosis in MM.
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Affiliation(s)
- Linrong Li
- Second Clinical Medical College, Southern Medical University, Guangzhou, China
| | - Liang Wang
- Department of Hematology, ZhuJiang Hospital of Southern Medical University, Guangzhou, China
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30
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Autoimmune autonomic ganglionopathy associated with monoclonal gammopathy of undetermined significance: a case report. Neurol Sci 2019; 40:1481-1483. [PMID: 30685800 DOI: 10.1007/s10072-019-3731-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 01/17/2019] [Indexed: 10/27/2022]
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31
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González-Calle V, Mateos MV. Monoclonal gammopathies of unknown significance and smoldering myeloma: Assessment and management of the elderly patients. Eur J Intern Med 2018; 58:57-63. [PMID: 29907380 DOI: 10.1016/j.ejim.2018.05.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 05/09/2018] [Accepted: 05/23/2018] [Indexed: 11/16/2022]
Abstract
Monoclonal gammopathy of unknown significance (MGUS) is the most frequent plasma cell disorder that commonly affects elderly patients. Although it is an asymptomatic condition, as well as smoldering myeloma (SMM), the risk of progression to multiple myeloma requiring therapy or other B-cell disorders varies greatly for individual patients, remaining low for MGUS (1% per year), while higher and not uniform for SMM patients (10% per year). This scenario implies some special considerations regarding assessment and follow-up, especially in the elderly. In this review, we provide the updated diagnostic criteria of monoclonal gammopathies proposed by the International Myeloma Working Group (IMGW); the current recommendations for the assessment of asymptomatic plasma cell disorders, with some concerns about the need of geriatric evaluation in the elderly population, the importance of distinguishing myeloma-related symptomatology from signs or symptoms caused by multiple chronic conditions typically found in the elderly. Finally, the identification of predictor markers of progression has enabled a proposal of risk-adapted follow-up strategies in MGUS and SMM that should be implemented in clinical practice. Although the standard of care is observation for MGUS and SMM patients as well, a recent randomized trial targeting high-risk SMM showed the clinical benefit of early intervention. The change of the treatment paradigm is also very promising and feasible for elderly patients, as long as a comprehensive geriatric assessment is conducted to optimize early treatment and reach maximum benefit with minimum toxicity, in other words, to ensure a better quality of life for these patients.
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Affiliation(s)
- Verónica González-Calle
- Complejo Asistencial Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain.
| | - María Victoria Mateos
- Complejo Asistencial Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain.
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32
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Partington R, Helliwell T, Muller S, Abdul Sultan A, Mallen C. Comorbidities in polymyalgia rheumatica: a systematic review. Arthritis Res Ther 2018; 20:258. [PMID: 30458857 PMCID: PMC6247740 DOI: 10.1186/s13075-018-1757-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 10/31/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND AND AIM Comorbidities are known to exist in many rheumatological conditions. Polymyalgia rheumatica (PMR) is a common inflammatory rheumatological condition affecting older people which, prior to effective treatment, causes severe disability. Our understanding of associated comorbidities in PMR is based only on case reports or series and small cohort studies. The objective of this study is to review systematically the existing literature on the comorbidities associated with PMR. METHODS MEDLINE, EMBASE, PsycINFO and CINAHL databases were searched for original observational research from inception to November 2016. Papers containing the words 'Polymyalgia Rheumatica' OR 'Giant Cell Arteritis' OR the terms 'PMR' OR 'GCA' were included. Article titles were reviewed based on pre-defined criteria by two reviewers. Following selection for inclusion, studies were quality assessed using the Newcastle-Ottawa tool and data were extracted. RESULTS A total of 17,329 papers were reviewed and 41 were incorporated in this review, including three published after the search took place. Wide variations were found in study design, comorbidities reported and populations studied. Positive associations were found between PMR diagnosis and stroke, cardiovascular disease, peripheral arterial disease, diverticular disease and hypothyroidism. Two studies reported a positive association between PMR and overall malignancy rate. Seven studies reported an association between PMR and specific types of cancer, such as leukaemia, lymphoma, myeloproliferative disease and specified solid tumours, although nine studies found either no or negative association between cancer and PMR. CONCLUSION Quantification of the prevalence of comorbidities in PMR is important to accurately plan service provision and enable identification of cases of PMR which may be more difficult to treat. This review highlights that research into comorbidities in PMR is, overall, methodologically inadequate and does not comprehensively cover all comorbidities. Future studies should consider a range of comorbidities in patients with a validated diagnosis of PMR in representative populations.
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Affiliation(s)
- Richard Partington
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, ST5 5BG UK
| | - Toby Helliwell
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, ST5 5BG UK
| | - Sara Muller
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, ST5 5BG UK
| | - Alyshah Abdul Sultan
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, ST5 5BG UK
| | - Christian Mallen
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, ST5 5BG UK
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Thordardottir M, Lindqvist EK, Lund SH, Costello R, Burton D, Steingrimsdottir L, Korde N, Mailankody S, Eiriksdottir G, Launer LJ, Gudnason V, Harris TB, Landgren O, Torfadottir JE, Kristinsson SY. Dietary intake is associated with risk of multiple myeloma and its precursor disease. PLoS One 2018; 13:e0206047. [PMID: 30383820 PMCID: PMC6211667 DOI: 10.1371/journal.pone.0206047] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 10/05/2018] [Indexed: 11/18/2022] Open
Abstract
The etiology of monoclonal gammopathy of undetermined significance (MGUS), the precursor state of multiple myeloma (MM), is mostly unknown and no studies have been conducted on the effect of diet on MGUS or progression from MGUS to MM. We aimed to explore the association between common foods and MGUS and progression to MM. Data from the population-based AGES Study (N = 5,764) were utilized. Food frequency questionnaire was used to assess dietary intake during adolescence, midlife, and late life. Serum protein electrophoresis and serum free light-chain assay was performed to identify MGUS (n = 300) and LC-MGUS cases (n = 275). We cross linked our data with the Icelandic Cancer Registry to find cases of MM in the study group. We found that intake of fruit at least three times per week during adolescence was associated with lower risk of MGUS when compared to lower fruit consumption (OR = 0.62, 95% CI 0.41–0.95). We additionally found that intake of fruit at least three times per week during the late life period was associated with decreased risk of progressing from MGUS to MM (HR = 0.34, 95% CI 0.13–0.89) when compared to lower intake. Adolescent intake of fruit may reduce risk of MGUS, whereas fruit intake after MGUS onset may reduce risk of progressing to MM. Our findings suggest that diet might alter the risk of developing MGUS and progression to MM.
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Affiliation(s)
| | - Ebba K. Lindqvist
- Department of Medicine, Division of Hematology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Sigrun H. Lund
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Rene Costello
- Multiple Myeloma Section, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Debra Burton
- Multiple Myeloma Section, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | | | - Neha Korde
- Myeloma Service, Division of Hematologic Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York, United States of America
| | - Sham Mailankody
- Myeloma Service, Division of Hematologic Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York, United States of America
| | | | - Lenore J. Launer
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, Bethesda, Maryland, United States of America
| | - Vilmundur Gudnason
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- The Icelandic Heart Association, Kopavogur, Iceland
| | - Tamara B. Harris
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, Bethesda, Maryland, United States of America
| | - Ola Landgren
- Myeloma Service, Division of Hematologic Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York, United States of America
| | - Johanna E. Torfadottir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- The Icelandic Cancer Society, Reykjavik, Iceland
| | - Sigurdur Y. Kristinsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Department of Medicine, Division of Hematology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
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Lahner E, Capasso M, Carabotti M, Annibale B. Incidence of cancer (other than gastric cancer) in pernicious anaemia: A systematic review with meta-analysis. Dig Liver Dis 2018; 50:780-786. [PMID: 29887343 DOI: 10.1016/j.dld.2018.05.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 05/16/2018] [Accepted: 05/17/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Pernicious anaemia (PA) is associated with increased gastric cancer risk, but the evidence is conflicting regarding the associated risk of other cancers. AIM To systematically determine the incidence rates of gastro-intestinal cancers other than gastric cancers (GI-other-than-GC) and non-gastrointestinal cancers (non-GIC) in PA adults, globally and per tumour site, and the risk associated with PA for GI-other than GC and non-GIC. METHODS Studies of PA patients reporting the incidence of GI-other-than-GCs and non-GICs were identified with MEDLINE (PubMed)-EMBASE (from first date available to April 2017). A meta-analysis of annual cancer incidence rates was performed. The outcome was the cumulative incidence of GI-other-than-GCs and non-GICs (ratio between the numbers of new cancer cases identified during the follow-up period and the number of PA patients) and the incidence rate expressed as the rate of events-per-time-unit (person-years). RESULTS Of 82,257 PA patients, the pooled incidence rates/100 person-years for non-GCs and non-GICs of 0.27 (95% CI:0.16-0.42) and 0.23 (95% CI:0.22-0.25) were calculated by meta-analysis. Compared to the GLOBOCAN data for the general population from the countries of the included studies, the meta-analysis showed an overall relative risk (RR) of cancer in PA of 0.68 (95% CI:0.48-0.95). PA patients had a lower RR of colorectal, breast, liver, oesophageal, lung, thyroid, ovary, non-melanoma skin and kidney cancers but had a higher RR of biliary tract cancer (1.81:1.21-2.70), multiple myeloma (2.83:1.76-4.55), Hodgkin's lymphoma (3.0:1.35-6.68), non-Hodgkin's lymphoma (2.08: 1.58-2.75), and leukaemia (1.56:1.16-2.12). CONCLUSION An overall lower RR of cancers-other-than-gastric-cancer in PA patients but an increased RR of biliary tract cancers and haematological malignancies was observed.
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Affiliation(s)
- Edith Lahner
- Medical-Surgical Department of Clinical Sciences and Translational Medicine, Sapienza University of Rome, Italy.
| | - Marina Capasso
- Medical-Surgical Department of Clinical Sciences and Translational Medicine, Sapienza University of Rome, Italy
| | - Marilia Carabotti
- Medical-Surgical Department of Clinical Sciences and Translational Medicine, Sapienza University of Rome, Italy
| | - Bruno Annibale
- Medical-Surgical Department of Clinical Sciences and Translational Medicine, Sapienza University of Rome, Italy
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35
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Chikanza I, Akpenyi O. Association of Monoclonal Gammopathy of Undetermined Significance with Behcet's Disease: A Review of Shared Common Disease Pathogenetic Mechanisms. Mediterr J Rheumatol 2018; 29:80-85. [PMID: 32185304 PMCID: PMC7046073 DOI: 10.31138/mjr.29.2.80] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 03/30/2018] [Accepted: 04/15/2018] [Indexed: 12/05/2022] Open
Abstract
An association between a number of chronic inflammatory rheumatic diseases and Monoclonal Gammopathy of Undetermined Significance (MGUS) has been reported. To date no cases of Behcet’s disease (BD) and MGUS have been documented. BD sits at the interphase of auto-inflammatory and chronic auto-immune disease spectrums. Alterations in the cellular and cytokine microenvironments can promote a pro-inflammatory state in which persistent antigenic stimulation and cellular proliferation can progressively induce cytogenetic abnormalities which could perturbate plasma cell functions such as seen in MGUS. Herein, we present a rare case of a woman presenting with BD who subsequently developed MGUS. Pathogenetic mechanisms that could potentially contribute to development of both conditions, are reviewed and demonstrate that this disease association is not coincidental but is an evolutionary association driven by shared common disease pathogenetic mechanisms.
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Affiliation(s)
- Ian Chikanza
- Department of Rheumatology, St Barts & The Royal London Hospital, London, United Kingdom
| | - Onyinye Akpenyi
- Department of Rheumatology, St Barts & The Royal London Hospital, London, United Kingdom
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36
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Monoclonal Gammopathy of Undetermined Significance After Kidney Transplantation. Transplantation 2017; 101:e337-e342. [DOI: 10.1097/tp.0000000000001884] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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37
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Obesity and risk of monoclonal gammopathy of undetermined significance and progression to multiple myeloma: a population-based study. Blood Adv 2017; 1:2186-2192. [PMID: 29296866 DOI: 10.1182/bloodadvances.2017007609] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 09/12/2017] [Indexed: 11/20/2022] Open
Abstract
All multiple myeloma (MM) cases are preceded by the premalignant state monoclonal gammopathy of undetermined significance (MGUS). Results from previous studies show a positive association between obesity and MM; however, the association between obesity and MGUS is controversial. The aims were to determine (1) if obesity is associated with an increased risk of MGUS and light-chain MGUS (LC-MGUS) and (2) whether obesity is associated with a higher risk of progression to MM and other lymphoproliferative (LP) diseases. Data from the population-based Age, Gene/Environment Susceptibility-Reykjavik Study (N = 5764) were used. We performed serum protein electrophoresis and serum free light-chain assay on all subjects to identify MGUS and LC-MGUS cases. We included 11 different measures on current and previous obesity in our analysis. Logistic regression and Cox proportional-hazard regression were used to analyze the associations. A total of 300 (5.2%) MGUS and 275 (4.8%) LC-MGUS cases were identified. During a median follow-up of 8 years, 18 had progressed to MM and 11 to other LP diseases. We found no association between the 11 obesity markers and MGUS or LC-MGUS (odds ratios 0.81 to 1.15 for all 11 variables in both conditions). Interestingly, we found that high midlife body mass index increased risk of progression to MM and other LP diseases (hazard ratio, 2.66; 95% confidence interval, 1.17-6.05). To conclude, obesity was not associated with MGUS. However, we found overweight/obesity to be a risk factor for progression from MGUS to MM and other LP diseases, suggesting that obesity plays a role in the transformation of MGUS to MM.
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38
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Jones SJ, Voong J, Thomas R, English A, Schuetz J, Slack GW, Graham J, Connors JM, Brooks-Wilson A. Nonrandom occurrence of lymphoid cancer types in 140 families. Leuk Lymphoma 2017; 58:1-10. [PMID: 28278712 DOI: 10.1080/10428194.2017.1281412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We studied 140 families with two or more lymphoid cancers, including non-Hodgkin lymphoma (NHL), Hodgkin lymphoma (HL), chronic lymphocytic leukemia (CLL), and multiple myeloma (MM), for deviation from the population age of onset and lymphoid cancer co-occurrence patterns. Median familial NHL, HL, CLL and MM ages of onset are substantially earlier than comparable population data. NHL, HL and CLL (but not MM) also show earlier age of onset in later generations, known as anticipation. The co-occurrence of lymphoid cancers is significantly different from that expected based on population frequencies (p < .0001), and the pattern differs more in families with more affected members (p < .0001), suggesting specific lymphoid cancer combinations have a shared genetic basis. These families provide evidence for inherited factors that increase the risk of multiple lymphoid cancers. This study was approved by the BC Cancer Agency - University of British Columbia Clinical Research Ethics Board.
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Affiliation(s)
- Samantha J Jones
- a Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency , Vancouver , British Columbia , Canada.,b Department of Medical Genetics , University of British Columbia , Vancouver , British Columbia , Canada
| | - Jackson Voong
- c Department of Statistics and Actuarial Science , Simon Fraser University , Burnaby , British Columbia , Canada
| | - Ruth Thomas
- a Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency , Vancouver , British Columbia , Canada
| | - Amy English
- a Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency , Vancouver , British Columbia , Canada
| | - Johanna Schuetz
- a Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency , Vancouver , British Columbia , Canada
| | - Graham W Slack
- d Centre for Lymphoid Cancer, British Columbia Cancer Agency , Vancouver , British Columbia , Canada.,e Department of Pathology & Laboratory Medicine , British Columbia Cancer Agency , Vancouver , BC , Canada
| | - Jinko Graham
- c Department of Statistics and Actuarial Science , Simon Fraser University , Burnaby , British Columbia , Canada
| | - Joseph M Connors
- d Centre for Lymphoid Cancer, British Columbia Cancer Agency , Vancouver , British Columbia , Canada
| | - Angela Brooks-Wilson
- a Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency , Vancouver , British Columbia , Canada.,f Department of Biomedical Physiology and Kinesiology , Simon Fraser University , Burnaby , British Columbia , Canada
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39
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Lindqvist EK, Landgren O, Lund SH, Turesson I, Hultcrantz M, Goldin L, Björkholm M, Kristinsson SY. History of autoimmune disease is associated with impaired survival in multiple myeloma and monoclonal gammopathy of undetermined significance: a population-based study. Ann Hematol 2017; 96:261-269. [PMID: 27807648 PMCID: PMC5226986 DOI: 10.1007/s00277-016-2859-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 10/11/2016] [Indexed: 12/25/2022]
Abstract
Multiple myeloma (MM) is a plasma cell disorder preceded by monoclonal gammopathy of undetermined significance (MGUS). Incidence of MM and MGUS is higher among patients with autoimmune disease. The aim of this study was to determine whether a history of autoimmunity has an impact on survival in MM and MGUS. Using high-quality national Swedish registries, we identified 8367 patients with MM, 18,768 patients with MGUS, and 110,251 matched control subjects, and obtained information on previous autoimmune disease in patients and controls. Cox regression was used to calculate hazard ratios (HRs) for overall survival with 95 % confidence intervals (CIs). In patients with MM and a prior autoimmune disease, the risk of death was significantly increased, HR = 1.2 (95 % CI 1.2-1.3) compared to MM patients with no history of autoimmunity. In MGUS patients, a prior autoimmune disease was associated with a significantly 1.4-fold elevated risk of death (95 % CI 1.3-1.4). When analyzing different types of autoimmune diseases, a history of ulcerative colitis had a stronger impact on survival in MM than in controls. Our findings that a history of autoimmune disease has a negative impact on survival in MM and MGUS could be due to shared underlying common genetic factors, or that patients with a history of autoimmunity develop more severe cases of MM and MGUS, or cumulative comorbidity in the individual. Our results suggest that more attention should be paid to comorbidity as a prognostic factor in MGUS and MM, and underlines the need for studies aimed at tailoring therapy according to comorbidity.
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Affiliation(s)
- Ebba K Lindqvist
- Department of Medicine, Division of Hematology, Karolinska University Hospital and Karolinska Institutet, 171 76, Stockholm, Sweden.
| | - Ola Landgren
- Department of Medicine, Myeloma Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Sigrún H Lund
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Ingemar Turesson
- Department of Hematology and Coagulation Disorders, Skåne University Hospital, Malmö, Sweden
| | - Malin Hultcrantz
- Department of Medicine, Division of Hematology, Karolinska University Hospital and Karolinska Institutet, 171 76, Stockholm, Sweden
- Department of Medicine, Myeloma Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Lynn Goldin
- Division of Cancer Epidemiology and Genetics, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Magnus Björkholm
- Department of Medicine, Division of Hematology, Karolinska University Hospital and Karolinska Institutet, 171 76, Stockholm, Sweden
| | - Sigurdur Y Kristinsson
- Department of Medicine, Division of Hematology, Karolinska University Hospital and Karolinska Institutet, 171 76, Stockholm, Sweden
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
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40
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Li Y, Bai O, Liu C, Du Z, Wang X, Wang G, Li W. Association between hepatitis B virus infection and risk of multiple myeloma: a systematic review and meta-analysis. Intern Med J 2016; 46:307-14. [PMID: 26662071 DOI: 10.1111/imj.12981] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 08/02/2015] [Accepted: 12/03/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Hepatitis B virus (HBV) infection is a major global public health concern. Although recent findings suggest an inverse relationship between HBV infection and multiple myeloma (MM), the true relationship between these two conditions remains unclear. AIM The primary aim of this meta-analysis was to evaluate the association between HBV infection, defined as hepatitis B surface antigen positivity, and the incidence of MM. METHODS We searched the PubMed/Medline, Cochrane Library and EMBASE databases from January 1975 to July 2014 and reviewed the reference lists of all retrieved articles. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using fixed- and random-effects models. RESULTS We identified nine case-control studies involving 30,646 patients with MM and 379,837 controls. HBV infection was not significantly associated with the development of MM (OR = 1.3; 95% CI: 0.92-1.82; P = 0.14). A similar risk of developing MM was present in different HBV-prevalent countries. However, significant heterogeneity was observed among studies (P = 0.01). A statistically significant relationship between HBV infection and increased MM risk was detected in sub-analyses evaluating high-quality studies and those with hospital-based controls (P < 0.05). CONCLUSION HBV infection may be associated with an increased risk of MM. However, confirmation of this relationship and the specific molecular mechanisms involved in the association between HBV infection and the development of MM require further exploration.
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Affiliation(s)
- Y Li
- Cancer Center, First Hospital of Jilin University, Changchun, Jilin Province, China
| | - O Bai
- Cancer Center, First Hospital of Jilin University, Changchun, Jilin Province, China
| | - C Liu
- Cancer Center, First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Z Du
- Cancer Center, First Hospital of Jilin University, Changchun, Jilin Province, China
| | - X Wang
- Cancer Center, First Hospital of Jilin University, Changchun, Jilin Province, China
| | - G Wang
- Cancer Center, First Hospital of Jilin University, Changchun, Jilin Province, China
| | - W Li
- Cancer Center, First Hospital of Jilin University, Changchun, Jilin Province, China
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41
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Risk of malignancy in ankylosing spondylitis: a systematic review and meta-analysis. Sci Rep 2016; 6:32063. [PMID: 27534810 PMCID: PMC4989281 DOI: 10.1038/srep32063] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 08/01/2016] [Indexed: 01/20/2023] Open
Abstract
Current knowledge about the overall and site-specific risk of malignancy associated with ankylosing spondylitis (AS) is inconsistent. We conducted a systematic review and meta-analysis to address this knowledge gap. Five databases (PubMed, EMBASE, Web of Science, the Cochrane library and the virtual health library) were systematically searched. A manual search of publications within the last 2 years in key journals in the field (Annals of the Rheumatic Diseases, Rheumatology and Arthritis & rheumatology) was also performed. STATA 11.2 software was used to conduct the meta-analysis. After screening, twenty-three studies, of different designs, were eligible for meta-analysis. AS is associated with a 14% (pooled RR 1.14; 95% CI 1.03–1.25) increase in the overall risk for malignancy. Compared to controls, patients with AS are at a specific increased risk for malignancy of the digestive system (pooled RR 1.20; 95% CI 1.01 to 1.42), multiple myelomas (pooled RR 1.92; 95% CI 1.37 to 3.69) and lymphomas (pooled RR 1.32; 95% CI 1.11 to 1.57). On subgroup analysis, evidence from high quality cohort studies indicated that AS patients from Asia are at highest risk for malignancy overall. Confirmation of findings from large-scale longitudinal studies is needed to identify specific risk factors and to evaluate treatment effects.
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42
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Llitjos JF, Auffray C, Alby-Laurent F, Rousseau C, Merdji H, Bonilla N, Toubiana J, Belaïdouni N, Mira JP, Lucas B, Chiche JD, Pène F. Sepsis-induced expansion of granulocytic myeloid-derived suppressor cells promotes tumour growth through Toll-like receptor 4. J Pathol 2016; 239:473-83. [PMID: 27178223 DOI: 10.1002/path.4744] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 03/25/2016] [Accepted: 04/27/2016] [Indexed: 02/02/2023]
Abstract
Severe sepsis remains a frequent and dreaded complication in cancer patients. Beyond the often fatal short-term outcome, the long-term sequelae of severe sepsis may also impact directly on the prognosis of the underlying malignancy in survivors. The immune system is involved in all stages of tumour development, in the detection of transforming and dying cells and in the prevention of tumour growth and dissemination. In fact, the profound and sustained immune defects induced by sepsis may constitute a privileged environment likely to favour tumour growth. We investigated the impact of sepsis on malignant tumour growth in a double-hit animal model of polymicrobial peritonitis, followed by subcutaneous inoculation of MCA205 fibrosarcoma cells. As compared to their sham-operated counterparts, post-septic mice exhibited accelerated tumour growth. This was associated with intratumoural accumulation of CD11b(+) Ly6G(high) polymorphonuclear cells (PMNs) that could be characterized as granulocytic myeloid-derived suppressor cells (G-MDSCs). Depletion of granulocytic cells in post-septic mice inhibited the sepsis-enhanced tumour growth. Toll-like receptor (TLR)-4 (Tlr4) and Myd88 deficiencies prevented sepsis-induced expansion of G-MDSCs and tumour growth. Our results demonstrate that the myelosuppressive environment induced by severe bacterial infections promotes malignant tumour growth, and highlight a critical role of CD11b(+) Ly6G(high) G-MDSCs under the control of TLR-dependent signalling. Copyright © 2016 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Jean-François Llitjos
- Institut Cochin, INSERM U1016, CNRS UMR8104, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Réanimation Médicale, Hôpital Cochin, Hôpitaux Universitaires Paris Centre, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Cédric Auffray
- Institut Cochin, INSERM U1016, CNRS UMR8104, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Fanny Alby-Laurent
- Institut Cochin, INSERM U1016, CNRS UMR8104, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Christophe Rousseau
- Institut Cochin, INSERM U1016, CNRS UMR8104, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Hamid Merdji
- Institut Cochin, INSERM U1016, CNRS UMR8104, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Nelly Bonilla
- Institut Cochin, INSERM U1016, CNRS UMR8104, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Julie Toubiana
- Institut Cochin, INSERM U1016, CNRS UMR8104, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Nadia Belaïdouni
- Institut Cochin, INSERM U1016, CNRS UMR8104, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Jean-Paul Mira
- Institut Cochin, INSERM U1016, CNRS UMR8104, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Réanimation Médicale, Hôpital Cochin, Hôpitaux Universitaires Paris Centre, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Bruno Lucas
- Institut Cochin, INSERM U1016, CNRS UMR8104, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Jean-Daniel Chiche
- Institut Cochin, INSERM U1016, CNRS UMR8104, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Réanimation Médicale, Hôpital Cochin, Hôpitaux Universitaires Paris Centre, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Frédéric Pène
- Institut Cochin, INSERM U1016, CNRS UMR8104, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Réanimation Médicale, Hôpital Cochin, Hôpitaux Universitaires Paris Centre, Assistance Publique-Hôpitaux de Paris, Paris, France
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Shimanovsky A, Alvarez Argote J, Murali S, Dasanu CA. Autoimmune manifestations in patients with multiple myeloma and monoclonal gammopathy of undetermined significance. BBA CLINICAL 2016; 6:12-8. [PMID: 27331023 PMCID: PMC4900299 DOI: 10.1016/j.bbacli.2016.05.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 05/15/2016] [Accepted: 05/23/2016] [Indexed: 12/20/2022]
Abstract
Background Multiple myeloma (MM) and its precursor, monoclonal gammopathy of undetermined significance (MGUS), have been linked with several autoimmune conditions in the medical literature. Yet, significance of these associations is not well understood. Methods Herein, we provide a comprehensive literature review on autoimmune disorders identified in patients with MM and MGUS. Most relevant papers were identified via searching the PubMed/Medline and EMBASE databases for articles published from inception until May 1, 2016. Findings Scientific literature on autoimmune conditions in patients with MM and MGUS consists of several case series and a multitude of case reports. Our analysis suggests an increased prevalence of autoimmune conditions in patients with MM and monoclonal gammopathy of undetermined significance (MGUS), including various autoimmune hematologic and rheumatologic conditions among other entities. Conversely, persons with various autoimmune conditions tend to have a higher prevalence of MGUS and MM than the general population. Conclusions Future research is required to explore further the link between MGUS/MM and autoimmune disorders. Inflammation in the setting of autoimmunity may serve as a trigger for MGUS and MM. In addition, a common genetic susceptibility for developing both an autoimmune disease and MM/MGUS might also exist. Autoimmune hematologic and rheumatologic diseases may pose important clinical problems for the MM patients. Therefore, a catalogue of these problems is important so that physicians are able to consider, identify and address them promptly. A comprehensive review linking MM and MGUS with autoimmune disorders There is increased prevalence of autoimmune conditions in patients with MM and MGUS Most autoimmune disorders precede the development of plasma cell dyscrasias
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Affiliation(s)
- Alexei Shimanovsky
- Department of Hematology and Oncology, University of Connecticut Health Science Center, Farmington, CT, USA
| | - Juliana Alvarez Argote
- Department of Medicine, University of Connecticut Health Science Center, Farmington, CT, USA
| | - Shruti Murali
- Department of Medicine, University of Connecticut Health Science Center, Farmington, CT, USA
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Hemminki K, Försti A, Sundquist K, Sundquist J, Li X. Familial associations of monoclonal gammopathy of unknown significance with autoimmune diseases. Leukemia 2016; 30:1766-9. [PMID: 26975726 DOI: 10.1038/leu.2016.43] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- K Hemminki
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - A Försti
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - K Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden.,Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA
| | - J Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden.,Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA
| | - X Li
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
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45
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VanValkenburg ME, Pruitt GI, Brill IK, Costa L, Ehtsham M, Justement IT, Innis-Shelton RD, Salzman D, Reddy ESP, Godby KN, Mikhail FM, Carroll AJ, Reddy VB, Sanderson RD, Justement LB, Sanders PW, Brown EE. Family history of hematologic malignancies and risk of multiple myeloma: differences by race and clinical features. Cancer Causes Control 2016; 27:81-91. [PMID: 26596855 PMCID: PMC4703620 DOI: 10.1007/s10552-015-0685-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 10/16/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE Multiple myeloma (MM) is the most common hematologic malignancy affecting Blacks in the USA, with standardized incidence rates that are twofold to threefold higher than Whites. The rationale for the disparity is unclear. METHODS Using participants enrolled in the Molecular And Genetic Epidemiology study of myeloma (259 MM cases; 461 controls), we examined the risk of MM associated with family history of cancer, differences by race and among cases, defining clinical features. Risk estimates were calculated using odds ratios and corresponding 95% confidence intervals from logistic regression adjusted for confounders. RESULTS Overall, MM risk in cases with relatives affected with any hematologic malignancy was significantly elevated compared to controls (OR 1.89, 95% CI 1.25-2.86). Myeloma risk associated with a family history of MM was higher than the risk associated with any hematologic malignancy (OR 3.75, 95% CI 1.75-8.05), and the effect was greater for Blacks (OR 20.9, 95% CI 2.59-168) than Whites (OR 2.04, 95% 0.83-5.04), among cases with early onset (≤60 years; OR 4.58, 95% CI 1.21-17.3) and with increasing numbers of affected relatives (p trend = 0.001). Overall, frequencies of end organ damage differed in cases with relatives affected with any hematologic malignancy and significantly more cases exhibited κ light chain restriction (OR 3.23, 95% CI 1.13-9.26). CONCLUSIONS The excess risk of MM observed in Blacks and the variation in clinical features observed in MM patients according to family history of hematologic malignancy may be attributed to a shared germline and environmental susceptibility.
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Affiliation(s)
- MaryAnn E VanValkenburg
- Department of Pathology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, 35294-3300, USA
| | - Gwendolyn I Pruitt
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ilene K Brill
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Luciano Costa
- Division of Hematology and Medical Oncology, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- UAB Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Maryam Ehtsham
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ian T Justement
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Racquel D Innis-Shelton
- Division of Hematology and Medical Oncology, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- UAB Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Donna Salzman
- Division of Hematology and Medical Oncology, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- UAB Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - E Shyam P Reddy
- Cancer Biology Program, Department of Obstetrics and Gynecology, Morehouse School of Medicine, Atlanta, GA, USA
| | - Kelly N Godby
- Division of Hematology and Medical Oncology, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- UAB Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Fady M Mikhail
- Department of Genetics, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andrew J Carroll
- Department of Genetics, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Vishnu B Reddy
- Department of Pathology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, 35294-3300, USA
- UAB Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ralph D Sanderson
- Department of Pathology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, 35294-3300, USA
- UAB Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Louis B Justement
- UAB Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Microbiology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Paul W Sanders
- UAB Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
- Division of Nephrology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Elizabeth E Brown
- Department of Pathology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, 35294-3300, USA.
- UAB Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA.
- , 1824 6th Avenue South, WTI 602C, Birmingham, AL, 35294-3300, USA.
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46
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Andreotti G, Katz M, Hoering A, Van Ness B, Crowley J, Morgan G, Hoover RN, Baris D, Durie B. Risk of multiple myeloma in a case-spouse study. Leuk Lymphoma 2015; 57:1450-9. [PMID: 26422532 DOI: 10.3109/10428194.2015.1094693] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study examined lifestyle, occupation, medical history and medication use with multiple myeloma risk in a case-spouse study (481 patients, 351 spouses). Odds ratios (ORs) and 95% confidence intervals (CI) were calculated using logistic regression. Compared to spouse controls, cases were more likely to have a family history of multiple myeloma (OR = 2.8, 95% CI = 1.2-6.4) and smoked cigarettes (OR = 1.7, 95% CI = 1.2-2.5), but less likely to have consumed alcohol (OR = 0.6, 95% CI = 0.4-0.9). Nurse/health practitioners (OR = 2.8, 95% CI = 1.3-6.2) and production workers (OR = 3.7, 95% CI = 1.0-13.7) had significantly increased risks; and some occupations linked to diesel exhaust had elevated, but non-significant, risks. History of herpes simplex (OR = 1.7, 95% CI = 1.2-2.4), shingles (OR = 1.7, 95% CI = 1.1-2.7), sexually transmitted diseases (OR = 2.0, 95% CI = 1.0-3.7) and medication allergies (OR = 1.7, 95% CI = 1.2-2.4) were associated with higher risks. Use of angiotensin-converting enzyme inhibitors, anti-convulsants, antidepressants, statins and diuretics were associated with reduced risks. The results are consistent with previous population-based studies and support the utility of patient databanks and spouse controls as a resource in epidemiologic research.
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Affiliation(s)
- Gabriella Andreotti
- a Division of Cancer Epidemiology and Genetics , National Cancer Institute, NIH, DHHS , Rockville , MD , USA
| | - Michael Katz
- b International Myeloma Foundation , Hollywood , CA , USA
| | - Antje Hoering
- c Cancer Research and Biostatistics , Seattle , WA , USA
| | - Brian Van Ness
- d Cancer Center, University of Minnesota , Minneapolis , MN , USA
| | - John Crowley
- c Cancer Research and Biostatistics , Seattle , WA , USA
| | - Gareth Morgan
- e Haemato-Oncology, Institute of Cancer Research , Sutton , UK
| | - Robert N Hoover
- a Division of Cancer Epidemiology and Genetics , National Cancer Institute, NIH, DHHS , Rockville , MD , USA
| | - Dalsu Baris
- a Division of Cancer Epidemiology and Genetics , National Cancer Institute, NIH, DHHS , Rockville , MD , USA
| | - Brian Durie
- b International Myeloma Foundation , Hollywood , CA , USA ;,f Cedar Sinai Medical Center , Los Angeles , CA , USA
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47
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Schmidt KLM, Vangsted AJ, Hansen B, Vogel UB, Hermansen NEU, Jensen SB, Laska MJ, Nexø BA. Synergy of two human endogenous retroviruses in multiple myeloma. Leuk Res 2015; 39:1125-8. [PMID: 26231931 DOI: 10.1016/j.leukres.2015.06.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 06/14/2015] [Accepted: 06/22/2015] [Indexed: 11/19/2022]
Abstract
Multiple myeloma (MM) is a severe, incurable neoplasm of the plasma cells. In this study we have used genetic epidemiology to associate the risk of MM with endogenous retroviral loci in humans. We used SNP analysis on a Sequenom platform and statistical analysis in SPSS. Markers near two endogenous retroviral loci, HERV-Fc1 on chromosome X and HERV-K on chromosome 1, were associated with MM. Moreover, there was strong gene-gene interaction in relation to risk of MM. We take this as indirect confirmation of the association.
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Affiliation(s)
| | - Annette J Vangsted
- Department of Hematology, Rigshospitalet, Copenhagen University, DK-2100 Copenhagen, Denmark
| | - Bettina Hansen
- Department of Biomedicin, Aarhus University, DK-8000 Aarhus C, Denmark
| | - Ulla B Vogel
- National Institute of Occupational Health, DK-2100 Copenhagen O, Denmark
| | - N Emil U Hermansen
- Department of Hematology, Rigshospitalet, Copenhagen University, DK-2100 Copenhagen, Denmark
| | - Sara B Jensen
- Department of Biomedicin, Aarhus University, DK-8000 Aarhus C, Denmark
| | - Magdalena J Laska
- Department of Biomedicin, Aarhus University, DK-8000 Aarhus C, Denmark
| | - Bjørn A Nexø
- Department of Biomedicin, Aarhus University, DK-8000 Aarhus C, Denmark.
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48
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Boyle EM, Davies FE, Leleu X, Morgan GJ. Understanding the multiple biological aspects leading to myeloma. Haematologica 2015; 99:605-12. [PMID: 24688108 DOI: 10.3324/haematol.2013.097907] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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49
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The cellular origin and malignant transformation of Waldenström macroglobulinemia. Blood 2015; 125:2370-80. [DOI: 10.1182/blood-2014-09-602565] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 01/27/2015] [Indexed: 01/14/2023] Open
Abstract
Key Points
Benign (ie, IgM MGUS and smoldering WM) clonal B cells already harbor the phenotypic and molecular signatures of the malignant WM clone. Multistep transformation from benign (ie, IgM MGUS and smoldering WM) to malignant WM may require specific copy number abnormalities.
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50
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Kristinsson SY, Gao Y, Björkholm M, Lund SH, Sjöberg J, Caporaso N, Goldin LR, Landgren O. Hodgkin lymphoma risk following infectious and chronic inflammatory diseases: a large population-based case-control study from Sweden. Int J Hematol 2015; 101:563-8. [PMID: 25758095 DOI: 10.1007/s12185-015-1772-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 02/24/2015] [Accepted: 02/24/2015] [Indexed: 11/30/2022]
Abstract
Patients with Hodgkin lymphoma (HL) have a well-characterized immune deficiency of T cell function, originally identified by increased susceptibility to certain infections. Epidemiological evidence has long pointed to infectious etiologies in younger HL patients. With the aim of expanding our knowledge on the potential role of pre-existing immune deficiency in HL and an infectious/inflammatory etiology, we conducted a comprehensive population-based case-control study in HL patients diagnosed in Sweden in the period 1965-2004, and their matched controls. In a large population-based study including 7,414 HL patients and 29,240 matched controls, we evaluated the subsequent risk of HL in relation to a broad range of infectious and inflammatory conditions, using unconditional logistic regression. A previous history of any reported infection was associated with an 11 % increased risk of HL (P < 0.05). More specifically, we found sinusitis (odds ratio = 1.81; 95 % confidence interval = 1.06-3.07), tuberculosis (1.76; 1.01-3.07), encephalitis (7.88; 1.97-31.5), and herpes zoster (2.20; 1.11-4.35) to be associated with excess HL risk. A personal prior history of chronic inflammatory condition was not associated with an increased risk of HL (0.94; 0.71-1.14). Our results suggest that underlying immune deficiency is a primary phenomenon in HL. Alternatively, certain infectious agents may be potential HL triggers.
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Affiliation(s)
- Sigurdur Y Kristinsson
- Division of Hematology, Department of Medicine, Karolinska University Hospital Solna and Institutet, 171 76, Stockholm, Sweden,
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