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Ferla V, Farina F, Perini T, Marcatti M, Ciceri F. Monoclonal Antibodies in Smoldering Multiple Myeloma and Monoclonal Gammopathy of Undetermined Significance: Current Status and Future Directions. Pharmaceuticals (Basel) 2024; 17:901. [PMID: 39065751 PMCID: PMC11279454 DOI: 10.3390/ph17070901] [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: 05/17/2024] [Revised: 06/27/2024] [Accepted: 07/01/2024] [Indexed: 07/28/2024] Open
Abstract
Monoclonal antibodies (MoAbs) targeting several cellular receptors have significantly improved the prognosis of multiple myeloma (MM). Their high effectiveness and safety raise the question of whether earlier therapeutic intervention in monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM) influences the natural course of the disease. MM is preceded by clinically recognized conditions such as MGUS and SMM. Numerous studies are investigating the disease biology and immune profile of SMM and MGUS to unravel the intricate relationship between immunosurveillance and disease progression. The standard approach to MGUS and SMM remains close observation. Early studies indicate benefits in terms of progression or even survival for promptly treating high-risk SMM patients. Ongoing debates are focused on which patients with SMM and MGUS to treat, as well as on determining the optimal therapeutic approach. The first approach aims to cure by attempting to eliminate the pathological clone, while the second approach is preventive, aiming to manage disease progression to active MM and restore the immune system. In this review, we focus on the available and emerging data on early treatment, particularly with MoAbs alone or in combination with other therapies, in SMM and MGUS patients.
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Affiliation(s)
- Valeria Ferla
- Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (F.F.); (T.P.); (M.M.); (F.C.)
| | - Francesca Farina
- Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (F.F.); (T.P.); (M.M.); (F.C.)
| | - Tommaso Perini
- Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (F.F.); (T.P.); (M.M.); (F.C.)
- Age Related Diseases Laboratory, Division of Genetics and Cell Biology, IRCSS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Magda Marcatti
- Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (F.F.); (T.P.); (M.M.); (F.C.)
| | - Fabio Ciceri
- Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (F.F.); (T.P.); (M.M.); (F.C.)
- Faculty of Medicine and Surgery, Vita-Salute IRCCS San Raffaele University, 20132 Milan, Italy
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Ferreira SS, do Amaral JB, Pacheco JJ, Salazar F, Monteiro L. Osteonecrosis of the Jaw Associated with Bisphosphonates Infusion for Treatment of Plasma Cell Myeloma-A Retrospective Observational Study of Northern Portuguese Population. J Clin Med 2024; 13:2679. [PMID: 38731207 PMCID: PMC11084472 DOI: 10.3390/jcm13092679] [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: 03/13/2024] [Revised: 04/08/2024] [Accepted: 04/29/2024] [Indexed: 05/13/2024] Open
Abstract
Objectives: To verify medication-related osteonecrosis of the jaw (MRONJ) frequency among patients with plasma cell myeloma (PCM) that had been treated with bisphosphonates, to identify predisposing factors that could influence the development of osteonecrosis. Methods: This observational retrospective study was performed at the Department of Hematology of Hospital Center of Porto (CHUP), Portugal. Results: The study population (n = 112) had a 15.2% (n = 17) prevalence of osteonecrosis. Clinically, bone exposure was the most frequently observed sign, present in 100% (n = 17) of the patients, followed by inflammation in 82.4% (n = 14), orofacial pain in 70.6% (n = 12), suppuration in 47.1% (n = 8), and intra or extra-oral fistula in 17.6% (n = 3) of the cases. The most frequent triggering local factor was dental extraction (82.4%). There was a dependence between the presence of extractions and the development of MRONJ (p < 0.001) but not with the time elapsed from the initiation of infusions with BPs and dental extractions (p = 0.499). In the sample of patients with multiple myeloma (MM), 13.8% were found to be more likely to develop MRONJ after an extraction. Conclusions: The most common local predisposing factor was dental extraction. No dependence was observed between the development of osteonecrosis and the time elapsed from the beginning of treatment with bisphosphonates infusions to surgical procedures.
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Affiliation(s)
- Sara Sousa Ferreira
- UNIPRO, Unidade de Investigação de Patologia e Reabilitação Oral, Instituto Universitário de Ciências da Saúde do Norte (IUCS-CESPU), 4585-116 Gandra, Portugal; (J.J.P.); (F.S.); (L.M.)
- Oral Medicine and Oral Surgery Department, Instituto Universitário de Ciências da Saúde do Norte (IUCS-N), 4585-116 Gandra, Portugal;
| | - José Barbas do Amaral
- Oral Medicine and Oral Surgery Department, Instituto Universitário de Ciências da Saúde do Norte (IUCS-N), 4585-116 Gandra, Portugal;
| | - José Júlio Pacheco
- UNIPRO, Unidade de Investigação de Patologia e Reabilitação Oral, Instituto Universitário de Ciências da Saúde do Norte (IUCS-CESPU), 4585-116 Gandra, Portugal; (J.J.P.); (F.S.); (L.M.)
- Oral Medicine and Oral Surgery Department, Instituto Universitário de Ciências da Saúde do Norte (IUCS-N), 4585-116 Gandra, Portugal;
| | - Filomena Salazar
- UNIPRO, Unidade de Investigação de Patologia e Reabilitação Oral, Instituto Universitário de Ciências da Saúde do Norte (IUCS-CESPU), 4585-116 Gandra, Portugal; (J.J.P.); (F.S.); (L.M.)
- Oral Medicine and Oral Surgery Department, Instituto Universitário de Ciências da Saúde do Norte (IUCS-N), 4585-116 Gandra, Portugal;
| | - Luís Monteiro
- UNIPRO, Unidade de Investigação de Patologia e Reabilitação Oral, Instituto Universitário de Ciências da Saúde do Norte (IUCS-CESPU), 4585-116 Gandra, Portugal; (J.J.P.); (F.S.); (L.M.)
- Oral Medicine and Oral Surgery Department, Instituto Universitário de Ciências da Saúde do Norte (IUCS-N), 4585-116 Gandra, Portugal;
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Eythorsson E, Rognvaldsson S, Thorsteinsdottir S, Einarsson Long T, Reed ER, Sigurdardottir GA, Vidarsson B, Onundarson PT, Agnarsson BA, Sigurdardottir M, Olafsson I, Thorsteinsdottir I, Sveinsdottir SV, Sigurdsson F, Thordardottir AR, Palsson R, Indridason OS, Jonsson A, Gislason GK, Olafsson A, Sigurdsson J, Steingrimsdottir H, Hultcrantz M, Durie BGM, Harding S, Landgren O, Aspelund T, Love TJ, Kristinsson SY. Development of a Multivariable Model to Predict the Need for Bone Marrow Sampling in Persons With Monoclonal Gammopathy of Undetermined Significance : A Cohort Study Nested in a Clinical Trial. Ann Intern Med 2024; 177:449-457. [PMID: 38560901 DOI: 10.7326/m23-2540] [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: 04/04/2024] Open
Abstract
BACKGROUND Monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM) are asymptomatic precursor conditions to multiple myeloma and related disorders. Smoldering multiple myeloma is distinguished from MGUS by 10% or greater bone marrow plasma cells (BMPC) on sampling, has a higher risk for progression, and requires specialist management. OBJECTIVE To develop a multivariable prediction model that predicts the probability that a person with presumed MGUS has 10% or greater BMPC (SMM or worse by bone marrow criteria) to inform the decision to obtain a bone marrow sample and compare its performance to the Mayo Clinic risk stratification model. DESIGN iStopMM (Iceland Screens, Treats or Prevents Multiple Myeloma), a prospective population-based screening study of MGUS. (ClinicalTrials.gov: NCT03327597). SETTING Icelandic population of adults aged 40 years or older. PATIENTS 1043 persons with IgG, IgA, light-chain, and biclonal MGUS detected by screening and an interpretable bone marrow sample. MEASUREMENTS Monoclonal gammopathy of undetermined significance isotype; monoclonal protein concentration; free light-chain ratio; and total IgG, IgM, and IgA concentrations were used as predictors. Bone marrow plasma cells were categorized as 0% to 4%, 5% to 9%, 10% to 14%, or 15% or greater. RESULTS The c-statistic for SMM or worse was 0.85 (95% CI, 0.82 to 0.88), and calibration was excellent (intercept, -0.07; slope, 0.95). At a threshold of 10% predicted risk for SMM or worse, sensitivity was 86%, specificity was 67%, positive predictive value was 32%, and negative predictive value was 96%. Compared with the Mayo Clinic model, the net benefit for the decision to refer for sampling was between 0.13 and 0.30 higher over a range of plausible low-risk thresholds. LIMITATION The prediction model will require external validation. CONCLUSION This accurate prediction model for SMM or worse was developed in a population-based cohort of persons with presumed MGUS and may be used to defer bone marrow sampling and referral to hematology. PRIMARY FUNDING SOURCE International Myeloma Foundation and the European Research Council.
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Affiliation(s)
- Elias Eythorsson
- Landspítali-The National University Hospital of Iceland and Faculty of Medicine, University of Iceland, Reykjavík, Iceland (E.E., S.R., P.T.O., B.A.A., R.P., O.S.I., S.Y.K.)
| | - Saemundur Rognvaldsson
- Landspítali-The National University Hospital of Iceland and Faculty of Medicine, University of Iceland, Reykjavík, Iceland (E.E., S.R., P.T.O., B.A.A., R.P., O.S.I., S.Y.K.)
| | - Sigrun Thorsteinsdottir
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland, and Department of Hematology, Rigshospitalet, Copenhagen, Denmark (S.T.)
| | - Thorir Einarsson Long
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland, and Skåne University Hospital, Lund, Sweden (T.E.L.)
| | - Elin Ruth Reed
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland (E.R.R., G.A.S., A.R.T., G.K.G., A.O., J.S., T.J.L.)
| | - Gudrun Asta Sigurdardottir
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland (E.R.R., G.A.S., A.R.T., G.K.G., A.O., J.S., T.J.L.)
| | - Brynjar Vidarsson
- Landspítali-The National University Hospital of Iceland, Reykjavík, Iceland (B.V., M.S., I.O., I.T., S.V.S., F.S., H.S.)
| | - Pall Torfi Onundarson
- Landspítali-The National University Hospital of Iceland and Faculty of Medicine, University of Iceland, Reykjavík, Iceland (E.E., S.R., P.T.O., B.A.A., R.P., O.S.I., S.Y.K.)
| | - Bjarni A Agnarsson
- Landspítali-The National University Hospital of Iceland and Faculty of Medicine, University of Iceland, Reykjavík, Iceland (E.E., S.R., P.T.O., B.A.A., R.P., O.S.I., S.Y.K.)
| | - Margret Sigurdardottir
- Landspítali-The National University Hospital of Iceland, Reykjavík, Iceland (B.V., M.S., I.O., I.T., S.V.S., F.S., H.S.)
| | - Isleifur Olafsson
- Landspítali-The National University Hospital of Iceland, Reykjavík, Iceland (B.V., M.S., I.O., I.T., S.V.S., F.S., H.S.)
| | - Ingunn Thorsteinsdottir
- Landspítali-The National University Hospital of Iceland, Reykjavík, Iceland (B.V., M.S., I.O., I.T., S.V.S., F.S., H.S.)
| | - Signy Vala Sveinsdottir
- Landspítali-The National University Hospital of Iceland, Reykjavík, Iceland (B.V., M.S., I.O., I.T., S.V.S., F.S., H.S.)
| | - Fridbjorn Sigurdsson
- Landspítali-The National University Hospital of Iceland, Reykjavík, Iceland (B.V., M.S., I.O., I.T., S.V.S., F.S., H.S.)
| | - Asdis Rosa Thordardottir
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland (E.R.R., G.A.S., A.R.T., G.K.G., A.O., J.S., T.J.L.)
| | - Runolfur Palsson
- Landspítali-The National University Hospital of Iceland and Faculty of Medicine, University of Iceland, Reykjavík, Iceland (E.E., S.R., P.T.O., B.A.A., R.P., O.S.I., S.Y.K.)
| | - Olafur Skuli Indridason
- Landspítali-The National University Hospital of Iceland and Faculty of Medicine, University of Iceland, Reykjavík, Iceland (E.E., S.R., P.T.O., B.A.A., R.P., O.S.I., S.Y.K.)
| | | | - Gauti Kjartan Gislason
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland (E.R.R., G.A.S., A.R.T., G.K.G., A.O., J.S., T.J.L.)
| | - Andri Olafsson
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland (E.R.R., G.A.S., A.R.T., G.K.G., A.O., J.S., T.J.L.)
| | - Jon Sigurdsson
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland (E.R.R., G.A.S., A.R.T., G.K.G., A.O., J.S., T.J.L.)
| | - Hlif Steingrimsdottir
- Landspítali-The National University Hospital of Iceland, Reykjavík, Iceland (B.V., M.S., I.O., I.T., S.V.S., F.S., H.S.)
| | - Malin Hultcrantz
- Myeloma Service, Memorial Sloan Kettering Cancer Center, New York, New York (M.H.)
| | - Brian G M Durie
- Cedars-Sinai Samuel Oschin Cancer Center, Los Angeles, California (B.G.M.D.)
| | - Stephen Harding
- The Binding Site, Birmingham, West Midlands, United Kingdom (S.H.)
| | - Ola Landgren
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida (O.L.)
| | - Thor Aspelund
- Center for Public Health Sciences, University of Iceland, Reykjavík, Iceland (T.A.)
| | - Thorvardur Jon Love
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland (E.R.R., G.A.S., A.R.T., G.K.G., A.O., J.S., T.J.L.)
| | - Sigurdur Yngvi Kristinsson
- Landspítali-The National University Hospital of Iceland and Faculty of Medicine, University of Iceland, Reykjavík, Iceland (E.E., S.R., P.T.O., B.A.A., R.P., O.S.I., S.Y.K.)
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Sharman R, Harris Z, Ernst B, Mussallem D, Larsen A, Gowin K. Lifestyle Factors and Cancer: A Narrative Review. Mayo Clin Proc Innov Qual Outcomes 2024; 8:166-183. [PMID: 38468817 PMCID: PMC10925935 DOI: 10.1016/j.mayocpiqo.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024] Open
Abstract
Lifestyle factors and their impact on cancer prevention, prognosis, and survivorship are increasingly recognized in the medical literature. Lifestyle factors are primarily defined here as diet and physical activity. We conducted a narrative review of the primary published data, including randomized controlled trials and prospective studies, on the impact of primary lifestyle factors on oncogenesis and clinical outcomes in the preventative and survivorship setting. First, we discuss the oncogenic mechanisms behind primary lifestyle factors (diet, physical activity and, within these 2, obesity). Then, we discuss the impact of adherence to lifestyle guidelines and dietary patterns on cancer incidence based on primary data. Owing to the plethora of published literature, to summarize the data in a more efficient manner, we describe the role of physical activity on cancer incidence using summative systematic reviews. We end by synthesizing the primary data on lifestyle factors in the survivorship setting and conclude with potential future directions. In brief, the various large-scale studies investigating the role diet and physical activity have reported a beneficial effect on cancer prevention and survivorship. Although the impact of single lifestyle factors on cancer incidence risk reduction is generally supported, holistic approaches to address the potential synergistic impact of multiple lifestyle factors together in concert is limited. Future research to identify the potentially synergistic effects of lifestyle modifications on oncogenesis and clinical outcomes is needed, particularly in cancer subtypes beyond colorectal and breast cancers.
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Affiliation(s)
- Reya Sharman
- Division of Hematology Oncology, Department of Medicine, University of Arizona, Tucson, AZ
| | - Zoey Harris
- Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic, Phoenix, AZ
| | - Brenda Ernst
- Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic, Phoenix, AZ
| | - Dawn Mussallem
- Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic, Jacksonville, FL
| | - Ashley Larsen
- Division of Hematology Oncology, Department of Medicine, University of Arizona, Tucson, AZ
| | - Krisstina Gowin
- Division of Hematology Oncology, Department of Medicine, University of Arizona, Tucson, AZ
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Vlasschaert C, Lanktree MB, Rauh MJ, Kelly TN, Natarajan P. Clonal haematopoiesis, ageing and kidney disease. Nat Rev Nephrol 2024; 20:161-174. [PMID: 37884787 PMCID: PMC10922936 DOI: 10.1038/s41581-023-00778-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 10/28/2023]
Abstract
Clonal haematopoiesis of indeterminate potential (CHIP) is a preclinical condition wherein a sizeable proportion of an individual's circulating blood cells are derived from a single mutated haematopoietic stem cell. CHIP occurs frequently with ageing - more than 10% of individuals over 65 years of age are affected - and is associated with an increased risk of disease across several organ systems and premature death. Emerging evidence suggests that CHIP has a role in kidney health, including associations with predisposition to acute kidney injury, impaired recovery from acute kidney injury and kidney function decline, both in the general population and among those with chronic kidney disease. Beyond its direct effect on the kidney, CHIP elevates the susceptibility of individuals to various conditions that can detrimentally affect the kidneys, including cardiovascular disease, obesity and insulin resistance, liver disease, gout, osteoporosis and certain autoimmune diseases. Aberrant pro-inflammatory signalling, telomere attrition and epigenetic ageing are potential causal pathophysiological pathways and mediators that underlie CHIP-related disease risk. Experimental animal models have shown that inhibition of inflammatory cytokine signalling can ameliorate many of the pathological effects of CHIP, and assessment of the efficacy and safety of this class of medications for human CHIP-associated pathology is ongoing.
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Affiliation(s)
| | - Matthew B Lanktree
- Department of Medicine and Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Michael J Rauh
- Department of Pathology and Molecular Medicine, Kingston, Ontario, Canada
| | - Tanika N Kelly
- Division of Nephrology, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Pradeep Natarajan
- Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA.
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, MA, USA.
- Department of Medicine, Harvard Medical School, Boston, MA, USA.
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Drayson M, Jennis T, Laketic-Ljubojevic I, Patel D, Pratt G, Renwick S, Richter A, Wheeler R, Sheldon J, Sadler R, Stapleton M, Willis F, Whiston M. Laboratory practice is central to earlier myeloma diagnosis: Utilizing a primary care diagnostic tool and laboratory guidelines integrated into haematology services. Br J Haematol 2024; 204:476-486. [PMID: 38168756 DOI: 10.1111/bjh.19224] [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: 08/14/2023] [Revised: 10/13/2023] [Accepted: 11/13/2023] [Indexed: 01/05/2024]
Abstract
Treatment advances have greatly improved survival, but myeloma is among the worst of all cancers for delayed diagnosis, causing serious morbidities and early deaths. This delay is largely because the symptom profile of myeloma has very low specificity, and in primary care, myeloma is rare. However, initiating the journey to diagnosis simply requires considering myeloma and sending blood to test for monoclonal immunoglobulin. Laboratory tests reliably detect monoclonal immunoglobulin, which is present in 99% of myeloma cases, so why do health care systems have such a problem with delayed diagnosis? The Myeloma UK early diagnosis programme has brought together diverse expertise to investigate this problem, and this article was prepared by the programme's working group for laboratory best practice. It reviews evidence for test requesting, analysis and reporting, for which there is large variation in practice across the United Kingdom. It presents a 'GP Myeloma diagnostic tool' and how it can be integrated into laboratory practice alongside a laboratory best practice tool. It proposes improved requesting and integration with haematology services for reporting and interpretation. Here the laboratory has a central role in creating efficient and cost-effective pathways for appropriate and timely bone marrow examination for myeloma diagnosis.
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Affiliation(s)
- Mark Drayson
- Clinical Immunology Service, University of Birmingham, Birmingham, UK
| | | | | | - Dina Patel
- UK NEQAS Immunology, Immunochemistry & Allergy, Sheffield Teaching Hospitals, Sheffield, UK
| | - Guy Pratt
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | | | - Alex Richter
- Clinical Immunology Service, University of Birmingham, Birmingham, UK
| | - Rachel Wheeler
- Protein Reference Unit, South West London Pathology, St Georges Hospital, London, UK
| | - Joanna Sheldon
- Protein Reference Unit, South West London Pathology, St Georges Hospital, London, UK
| | - Ross Sadler
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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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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Meuleman MS, Mouyabi S, Gueguen J, Vicca S, Divard G, Aubert O, Bienaimé F, Arnulf B, Anglicheau D, Bridoux F, Cohen C. Monoclonal gammopathy of unknown significance in kidney transplanted patients: novel insights into long-term outcomes. Nephrol Dial Transplant 2023; 39:64-73. [PMID: 37403344 DOI: 10.1093/ndt/gfad144] [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: 03/13/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Because of increased access to kidney transplantation in elderly subjects, the prevalence of monoclonal gammopathies of unknown significance (MGUS) in kidney transplantation (KT) is growing. However, little is known about the consequences of MGUS on long-term outcomes. METHODS We identified 70 recipients with MGUS present at transplantation (KTMG) and 114 patients with MGUS occurring after KT (DNMG), among 3059 patients who underwent a KT in two French kidney transplantation centers. We compared outcomes of KTMG with those of matched controls. RESULTS Baseline characteristics were similar except for an older age in KTMG compared with the DNMG group (62 vs 57 years, P = .03). Transient MGUS occurred more frequently in DNMG patients (45% vs 24%, P = .007). When compared with matched controls without MGUS, KTMG patients showed higher frequency and earlier post-transplant solid cancers (15% vs 5%, P = .04) and a trend for more bacterial infections (63% vs 48%, P = .08), without difference regarding patient and graft survival, rejection episodes or hematological complications. KTMG patients with an abnormal kappa/lambda ratio and/or severe hypogammaglobulinemia at the time of KT experienced shorter overall survival. CONCLUSIONS MGUS detection at the time of KT is neither associated with a higher occurrence of graft rejection, nor adversely affects graft or overall survival. MGUS should not contraindicate KT. However, MGUS at the time of KT may be associated with higher risk of early neoplastic and infectious complications and warrants prolonged surveillance. Measurement of serum free light chain should be performed before transplant to refine the risk evaluation of KTMG patients and propose personalized follow-up and immunosuppression.
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Affiliation(s)
- Marie-Sophie Meuleman
- Department of Nephrology and Transplantation, Hôpital Necker, APHP. Université de Paris Cité, France
| | - Steven Mouyabi
- Department of Nephrology, CHU Poitiers, Vienne, France. Centre de référence « Amylose AL et autres maladies à dépôts d'immunoglobuline monoclonales»
| | | | - Stéphanie Vicca
- Biochemistry Laboratory, Hôpital Necker, APHP, Paris, France
| | - Gillian Divard
- Department of Nephrology and Transplantation, Hôpital Necker, APHP. Université de Paris Cité, France
| | - Olivier Aubert
- Department of Nephrology and Transplantation, Hôpital Necker, APHP. Université de Paris Cité, France
| | - Frank Bienaimé
- Service d'Explorations Fonctionnelles rénales, Hôpital Necker, APHP. Université de, Paris, France
- Institut Necker Enfant Malade, INSERMU1151, Paris, France
| | - Bertrand Arnulf
- Hematology and Oncology, Hôpital Saint Louis, APHP, France. Université de Paris, France
| | - Dany Anglicheau
- Department of Nephrology and Transplantation, Hôpital Necker, APHP. Université de Paris Cité, France
| | - Frank Bridoux
- Department of Nephrology, CHU Poitiers, Vienne, France. Centre de référence « Amylose AL et autres maladies à dépôts d'immunoglobuline monoclonales»
| | - Camille Cohen
- Department of Nephrology and Transplantation, Hôpital Necker, APHP. Université de Paris Cité, France
- Stress and cancer laboratory, INSERM U830, Institut Curie, Paris, France
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9
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Pérez-Escurza O, Flores-Montero J, Óskarsson JÞ, Sanoja-Flores L, Del Pozo J, Lecrevisse Q, Martín S, Reed ER, Hákonardóttir GK, Harding S, Þorsteinsdóttir S, Rögnvaldsson S, Love TJ, Durie B, Kristinsson SY, Orfao A. Immunophenotypic assessment of clonal plasma cells and B-cells in bone marrow and blood in the diagnostic classification of early stage monoclonal gammopathies: an iSTOPMM study. Blood Cancer J 2023; 13:182. [PMID: 38072838 PMCID: PMC10711003 DOI: 10.1038/s41408-023-00944-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/26/2023] [Accepted: 11/03/2023] [Indexed: 12/18/2023] Open
Abstract
Monoclonal gammopathy of undetermined significance (MGUS) is the earliest discernible stage of multiple myeloma (MM) and Waldenström's macroglobulinemia (WM). Early diagnosis of MG may be compromised by the low-level infiltration, undetectable to low-sensitive methodologies. Here, we investigated the prevalence and immunophenotypic profile of clonal (c) plasma cells (PC) and/or cB-lymphocytes in bone marrow (BM) and blood of subjects with a serum M-component from the iSTOPMM program, using high-sensitive next-generation flow cytometry (NGF), and its utility in the diagnostic classification of early-stage MG. We studied 164 paired BM and blood samples from 82 subjects, focusing the analysis on: 55 MGUS, 12 smoldering MM (SMM) and 8 smoldering WM (SWM). cPC were detected in 84% of the BM samples and cB-lymphocytes in 45%, coexisting in 39% of cases. In 29% of patients, the phenotypic features of cPC and/or cB-lymphocytes allowed a more accurate disease classification, including: 19/55 (35%) MGUS, 1/12 (8%) SMM and 2/8 (25%) SWM. Blood samples were informative in 49% of the BM-positive cases. We demonstrated the utility of NGF for a more accurate diagnostic classification of early-stage MG.
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Affiliation(s)
- Oihane Pérez-Escurza
- Translational and Clinical Research Program, Cancer Research Center (IBMCC, CSIC-University of Salamanca); Cytometry Service, NUCLEUS; Department of Medicine, University of Salamanca (Universidad de Salamanca), Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Department of Medicine, University of Salamanca (Universidad de Salamanca), Salamanca, Spain
| | - Juan Flores-Montero
- Translational and Clinical Research Program, Cancer Research Center (IBMCC, CSIC-University of Salamanca); Cytometry Service, NUCLEUS; Department of Medicine, University of Salamanca (Universidad de Salamanca), Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Department of Medicine, University of Salamanca (Universidad de Salamanca), Salamanca, Spain
- Biomedical Research Networking Centre Consortium of Oncology (CIBERONC), Instituto de Salud Carlos III, Madrid, Spain
- Department of Hematology, University Hospital of Salamanca, Salamanca, Spain
| | | | - Luzalba Sanoja-Flores
- Biomedical Research Networking Centre Consortium of Oncology (CIBERONC), Instituto de Salud Carlos III, Madrid, Spain
- Institute of Biomedicine of Seville, Department of Hematology, University Hospital Virgen del Rocío of the Consejo Superior de Investigaciones Científicas (CSIC), University of Seville, Seville, Spain
| | - Julio Del Pozo
- Translational and Clinical Research Program, Cancer Research Center (IBMCC, CSIC-University of Salamanca); Cytometry Service, NUCLEUS; Department of Medicine, University of Salamanca (Universidad de Salamanca), Salamanca, Spain
| | - Quentin Lecrevisse
- Translational and Clinical Research Program, Cancer Research Center (IBMCC, CSIC-University of Salamanca); Cytometry Service, NUCLEUS; Department of Medicine, University of Salamanca (Universidad de Salamanca), Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Department of Medicine, University of Salamanca (Universidad de Salamanca), Salamanca, Spain
- Biomedical Research Networking Centre Consortium of Oncology (CIBERONC), Instituto de Salud Carlos III, Madrid, Spain
| | - Silvia Martín
- Translational and Clinical Research Program, Cancer Research Center (IBMCC, CSIC-University of Salamanca); Cytometry Service, NUCLEUS; Department of Medicine, University of Salamanca (Universidad de Salamanca), Salamanca, Spain
| | - Elín Ruth Reed
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | | | | | - Sigrún Þorsteinsdóttir
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Rigshospitalet, Copenhagen, Denmark
| | - Sæmundur Rögnvaldsson
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Department of Science, Landspitali University Hospital, Reykjavík, Iceland
| | - Thorvardur Jon Love
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Department of Science, Landspitali University Hospital, Reykjavík, Iceland
| | - Brian Durie
- Department of Hematology and Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sigurður Yngvi Kristinsson
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Department of Science, Landspitali University Hospital, Reykjavík, Iceland
| | - Alberto Orfao
- Translational and Clinical Research Program, Cancer Research Center (IBMCC, CSIC-University of Salamanca); Cytometry Service, NUCLEUS; Department of Medicine, University of Salamanca (Universidad de Salamanca), Salamanca, Spain.
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.
- Department of Medicine, University of Salamanca (Universidad de Salamanca), Salamanca, Spain.
- Biomedical Research Networking Centre Consortium of Oncology (CIBERONC), Instituto de Salud Carlos III, Madrid, Spain.
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10
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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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11
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Chen LY, Drayson M, Bunce C, Ramasamy K. Monoclonal gammopathy of increasing significance: time to screen? Haematologica 2023; 108:1476-1486. [PMID: 36373250 PMCID: PMC10233333 DOI: 10.3324/haematol.2022.281802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 10/28/2022] [Indexed: 11/11/2022] Open
Abstract
Monoclonal gammopathy (MG) is a frequently detected clonal B-cell or plasma-cell disorder. Importantly, every multiple myeloma (MM) case is preceded by MG. Although clinical algorithms now allow earlier treatment of patients with biomarkers of malignancy before MM-induced tissue damage (CRAB) occurs, most patients are still diagnosed late. It is important to revisit how MG should be managed in clinical practice and whether screening is required. As the prevalence of MG and other medical co-morbidities both rise with increasing age, the degree of contribution of MG to disease states other than malignant progression is often unclear. This can lead to monitoring lapses and under recognition of the organ dysfunction that can occur with monoclonal gammopathy of clinical significance (MGCS). Therefore, models of progression to MM and/or MGCS require further refinement. While MG is currently detected incidentally, a case for screening has been made with ongoing studies in this area. Screening has the potential benefit of earlier detection and prevention of both MGCS and delayed MM presentations, but important drawbacks include the psychosocial impact on individuals and resource burden on healthcare services. MG terminology should transition alongside our increasing understanding of the condition and genomic characterization that have already begun to revise the MG nomenclature. The biology of MG has been poorly understood and is often inferred from the biology of MM, which is unhelpful. We review the literature and case for MG screening in this paper. In particular, we highlight areas that require focus to establish screening for MG.
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Affiliation(s)
- Lucia Y Chen
- Oxford University Hospitals NHS Foundation Trust
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12
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Monoclonal Gammopathies of Clinical Significance: A Critical Appraisal. Cancers (Basel) 2022; 14:cancers14215247. [PMID: 36358666 PMCID: PMC9659226 DOI: 10.3390/cancers14215247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/15/2022] [Accepted: 10/24/2022] [Indexed: 11/26/2022] Open
Abstract
Simple Summary Monoclonal gammopathy of clinical significance (MGCS) refers to a recently coined term describing a complex and heterogeneous group of nonmalignant monoclonal gammopathies. These patients are characterized by the presence of a commonly small clone and the occurrence of symptoms that may be associated with the clone or with the monoclonal protein through diverse mechanisms. This is an evolving, challenging, and rapidly changing field. Patients are classified according to the key organ or system involved, with kidneys, skin, nerves, and eyes being the most frequently affected. However, multiorgan involvement may be the most relevant clinical feature at the presentation or during the course. This review delves into the definition, history, differential diagnosis, classification, prognosis, and treatment of this group of entities by analyzing the evidence accumulated to date from a critical perspective. Abstract Monoclonal gammopathies of clinical significance (MGCSs) represent a group of diseases featuring the association of a nonmalignant B cells or plasma cells clone, the production of an M-protein, and singularly, the existence of organ damage. They present a current framework that is difficult to approach from a practical clinical perspective. Several points should be addressed in order to move further toward a better understanding. Overall, these entities are only partially included in the international classifications of diseases. Its definition and classification remain ambiguous. Remarkably, its real incidence is unknown, provided that a diagnostic biopsy is mandatory in most cases. In fact, amyloidosis AL is the final diagnosis in a large percentage of patients with renal significance. On the other hand, many of these young entities are syndromes that are based on a dynamic set of diagnostic criteria, challenging a timely diagnosis. Moreover, a specific risk score for progression is lacking. Despite the key role of the clinical laboratory in the diagnosis and prognosis of these patients, information about laboratory biomarkers is limited. Besides, the evidence accumulated for many of these entities is scarce. Hence, national and international registries are stimulated. In particular, IgM MGCS deserves special attention. Until now, therapy is far from being standardized, and it should be planned on a risk and patient-adapted basis. Finally, a comprehensive and coordinated multidisciplinary approach is needed, and specific clinical trials are encouraged.
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13
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Papachristou S, Popovic DS, Papanas N. Reduced Progression of Monoclonal Gammopathy of Undetermined Significance to Multiple Myeloma in Type 2 Diabetes Mellitus: Will Metformin Never Stop Its Pleasant Surprises? Adv Ther 2022; 39:2283-2286. [PMID: 35344184 DOI: 10.1007/s12325-022-02125-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/10/2022] [Indexed: 11/29/2022]
Abstract
Monoclonal gammopathy of undetermined significance (MGUS) is an asymptomatic plasma cell disorder characterised by a serum M protein level below 3 g/dL, percentage of bone marrow clonal plasma cells below 10%, absence of end-organ damage (hypercalcaemia, renal insufficiency, anaemia, bone lesions) and absence of any other disease known to produce M protein. MGUS may progress to myeloproliferative disorders or multiple myeloma, but very little is known about any modifiable risk factors or any preventative treatment that might delay this progression. Metformin has begun to be discussed as a potentially useful agent on the basis of the results of epidemiological and preclinical research showing that it may be beneficial in patients with leukaemia, lymphomas and multiple myeloma. Metformin studies dedicated to MGUS are currently very limited, yet it would appear that there may be hope for reducing progression of MGUS to multiple myeloma with metformin in type 2 diabetes mellitus. However, more data is needed until we reach a clearer view of what is to be gained with metformin in this setting.
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Affiliation(s)
- Stella Papachristou
- Second Department of Internal Medicine, Diabetes Centre-Diabetic Foot Clinic, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Djordje S Popovic
- Clinic for Endocrinology, Diabetes and Metabolic Disorders, Clinical Centre of Vojvodina, Novi Sad, Serbia
- Medical Faculty, University of Novi Sad, Novi Sad, Serbia
| | - Nikolaos Papanas
- Second Department of Internal Medicine, Diabetes Centre-Diabetic Foot Clinic, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece.
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14
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Soma S. Multiple Myeloma With a Rare Presentation at Preserved Uninvolved Immunoglobulins. Cureus 2022; 14:e25513. [PMID: 35800800 PMCID: PMC9246476 DOI: 10.7759/cureus.25513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2022] [Indexed: 11/24/2022] Open
Abstract
Multiple myeloma is a neoplastic disease of plasma cells that produces monoclonal immunoglobulins, known as monoclonal proteins, causing hypercalcemia, anemia, renal insufficiency, bone lesion, and other organ damage. In most multiple myeloma, the amount of monoclonal protein correlates with the tumor burden and reflects its prognosis. Uninvolved immunoglobulins are often suppressed as monoclonal protein levels increase as a result of the increasing percentage of myeloma cells in the bone marrow. Detection of monoclonal protein by protein electrophoresis, immunofixation, and serum-free light chain assay is a highly sensitive analysis and is not suitable as a screening test because it is positive in a few percent of healthy elderly people, the majority of whom are classified as benign monoclonal gammopathy of undetermined significance. Therefore, it is widely used in practice to measure quantitation of immunoglobulins by nephelometer, and only when uninvolved immunoglobulins are decreasing in the values for each subtype, monoclonal protein identification by immunofixation, serum-free light chain assay, and bone marrow examination must be additionally performed for proactively diagnosing multiple myeloma. However, we experienced symptomatic multiple myeloma in which uninvolved immunoglobulins were not suppressed and there were no significant changes in immunoglobulin levels despite the relatively rapid progression. It would suggest that if you suspect symptomatic myeloma, you should not rule out the possibility of multiple myeloma because of preserved uninvolved immunoglobulins in laboratory findings.
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15
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Keren DF, Bocsi G, Billman BL, Etzell J, Faix JD, Kumar S, Lipe B, McCudden C, Montgomery R, Murray DL, Rai AJ, Redondo TC, Souter L, Ventura CB, Ansari MQ. Laboratory Detection and Initial Diagnosis of Monoclonal Gammopathies. Arch Pathol Lab Med 2022; 146:575-590. [PMID: 34347866 DOI: 10.5858/arpa.2020-0794-cp] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The process for identifying patients with monoclonal gammopathies is complex. Initial detection of a monoclonal immunoglobulin protein (M protein) in the serum or urine often requires compilation of analytical data from several areas of the laboratory. The detection of M proteins depends on adequacy of the sample provided, available clinical information, and the laboratory tests used. OBJECTIVE.— To develop an evidence-based guideline for the initial laboratory detection of M proteins. DESIGN.— To develop evidence-based recommendations, the College of American Pathologists convened a panel of experts in the diagnosis and treatment of monoclonal gammopathies and the laboratory procedures used for the initial detection of M proteins. The panel conducted a systematic literature review to address key questions. Using the Grading of Recommendations Assessment, Development, and Evaluation approach, recommendations were created based on the available evidence, strength of that evidence, and key judgements as defined in the Grading of Recommendations Assessment, Development, and Evaluation Evidence to Decision framework. RESULTS.— Nine guideline statements were established to optimize sample selection and testing for the initial detection and quantitative measurement of M proteins used to diagnose monoclonal gammopathies. CONCLUSIONS.— This guideline was constructed to harmonize and strengthen the initial detection of an M protein in patients displaying symptoms or laboratory features of a monoclonal gammopathy. It endorses more comprehensive initial testing when there is suspicion of amyloid light chain amyloidosis or neuropathies, such as POEMS (polyneuropathy, organomegaly, endocrinopathy, M protein, and skin changes) syndrome, associated with an M protein.
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Affiliation(s)
- David F Keren
- From the Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor (Keren).,Keren and Ansari served as guideline cochairs
| | - Gregary Bocsi
- The Department of Pathology, University of Colorado Anschutz, Aurora (Bocsi)
| | - Brooke L Billman
- Governance Services (Billman), College of American Pathologists, Northfield, Illinois
| | - Joan Etzell
- The Department of Pathology, Sutter Health Shared Laboratory, Livermore, California (Etzell)
| | - James D Faix
- tHe Department of Pathology, Montefiore Medical Center, Bronx, New York (Faix)
| | - Shaji Kumar
- The Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota (Kumar)
| | - Brea Lipe
- The Department of Medicine, University of Rochester Medical Center, Rochester, New York (Lipe)
| | - Christopher McCudden
- The Department of Pathology and Laboratory Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada (McCudden)
| | | | - David L Murray
- The Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Murray)
| | - Alex J Rai
- The Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York (Rai)
| | | | - Lesley Souter
- Methodology Consultant, Hamilton, Ontario, Canada (Souter)
| | | | - Mohammad Qasim Ansari
- and the Department of Pathology and Laboratory Medicine, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio (Ansari).,Keren and Ansari served as guideline cochairs
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16
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Jasiński M, Biliński J, Basak GW. The Role of the Crosstalk Between Gut Microbiota and Immune Cells in the Pathogenesis and Treatment of Multiple Myeloma. Front Immunol 2022; 13:853540. [PMID: 35432306 PMCID: PMC9009288 DOI: 10.3389/fimmu.2022.853540] [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: 01/12/2022] [Accepted: 02/28/2022] [Indexed: 11/26/2022] Open
Abstract
Around 10% of all hematologic malignancies are classified as multiple myeloma (MM), the second most common malignancy within that group. Although massive progress in developing of new drugs against MM has been made in recent years, MM is still an incurable disease, and every patient eventually has relapse refractory to any known treatment. That is why further and non-conventional research elucidating the role of new factors in MM pathogenesis is needed, facilitating discoveries of the new drugs. One of these factors is the gut microbiota, whose role in health and disease is still being explored. This review presents the continuous changes in the gut microbiota composition during our whole life with a particular focus on its impact on our immune system. Additionally, it mainly focuses on the chronic antigenic stimulation of B-cells as the leading mechanism responsible for MM promotion. The sophisticated interactions between microorganisms colonizing our gut, immune cells (dendritic cells, macrophages, neutrophils, T/B cells, plasma cells), and intestinal epithelial cells will be shown. That article summarizes the current knowledge about the initiation of MM cells, emphasizing the role of microorganisms in that process.
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Affiliation(s)
- Marcin Jasiński
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, Warsaw, Poland.,Doctoral School, Medical University of Warsaw, Warsaw, Poland
| | - Jarosław Biliński
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, Warsaw, Poland.,Human Biome Institute, Gdańsk, Poland
| | - Grzegorz W Basak
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, Warsaw, Poland.,Human Biome Institute, Gdańsk, Poland
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17
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Kleinstern G, Larson DR, Allmer C, Norman AD, Muntifering G, Sinnwell J, Visram A, Rajkumar V, Dispenzieri A, Kyle RA, Slager SL, Kumar S, Vachon CM. Body mass index associated with monoclonal gammopathy of undetermined significance (MGUS) progression in Olmsted County, Minnesota. Blood Cancer J 2022; 12:67. [PMID: 35440099 PMCID: PMC9018764 DOI: 10.1038/s41408-022-00659-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 02/16/2022] [Accepted: 02/22/2022] [Indexed: 12/14/2022] Open
Abstract
Monoclonal gammopathy of undetermined significance (MGUS) is a premalignant clonal disorder that progresses to multiple myeloma (MM), or other plasma-cell or lymphoid disorders at a rate of 1%/year. We evaluate the contribution of body mass index (BMI) to MGUS progression beyond established clinical factors in a population-based study. We identified 594 MGUS through a population-based screening study in Olmsted County, Minnesota, between 1995 and 2003. Follow-up time was calculated from the date of MGUS to last follow-up, death, or progression to MM/another plasma-cell/lymphoid disorder. BMI (kg/m2 < 25/≥25) was measured close to screening date. We used Cox regression to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association of BMI ≥ 25 versus BMI < 25 with MGUS progression and also evaluated the corresponding c-statistic and 95% CI to describe discrimination of the model for MGUS progression. Median follow-up was 10.5 years (range:0-25), while 465 patients died and 57 progressed and developed MM (N = 39), AL amyloidosis (N = 8), lymphoma (N = 5), or Waldenstrom-macroglobulinemia (N = 5). In univariate analyses, BMI ≥ 25 (HR = 2.14,CI:1.05-4.36, P = 0.04), non-IgG (HR = 2.84, CI:1.68-4.80, P = 0.0001), high monoclonal (M) protein (HR = 2.57, CI:1.50-4.42, P = 0.001), and abnormal free light chain ratio (FLCr) (HR = 3.39, CI:1.98-5.82, P < 0.0001) were associated with increased risk of MGUS progression, and were independently associated in a multivariable model (c-statistic = 0.75, CI:0.68-0.82). The BMI association was stronger among females (HR = 3.55, CI:1.06-11.9, P = 0.04) vs. males (HR = 1.39, CI:0.57-3.36, P = 0.47), although the interaction between BMI and sex was not significant (P = 0.15). In conclusion, high BMI is a prognostic factor for MGUS progression, independent of isotype, M protein, and FLCr. This association may be stronger among females.
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Affiliation(s)
- Geffen Kleinstern
- School of Public Health, University of Haifa, Haifa, Israel
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Dirk R Larson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Cristine Allmer
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Aaron D Norman
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | - Jason Sinnwell
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Alissa Visram
- Department of Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
- The Ottawa Hospital, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Vincent Rajkumar
- Department of Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Angela Dispenzieri
- Department of Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Robert A Kyle
- Department of Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Susan L Slager
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Department of Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Shaji Kumar
- Department of Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Celine M Vachon
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA.
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18
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Caro J, Cairns D, Menzies T, Boyle E, Pawlyn C, Cook G, Kaiser M, Walker BA, Owen R, Jackson GH, Morgan GJ, Heaney J, Drayson MT, Davies FE. Impact of Etiological Cytogenetic Abnormalities on the Depth of Immunoparesis and Survival in Newly Diagnosed Multiple Myeloma. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2022; 22:e279-e284. [PMID: 34876373 DOI: 10.1016/j.clml.2021.10.008] [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: 06/30/2021] [Accepted: 10/13/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION/BACKGROUND Immunoparesis, or low polyclonal immunoglobulin levels, is commonly seen in multiple myeloma (MM), and is associated with poor clinical outcomes. MM can be divided into subgroups with distinct biology and outcomes based on etiologic cytogenetic abnormalities. These include hyperdiploidy and translocations of t(11;14), t(4;14), t(14;16), and t(14;20), with the latter 3 associated with high-risk disease. We hypothesized that the different etiologic cytogenetic abnormalities drive bone marrow microenvironmental changes, resulting in different degrees of immunoparesis, and subgroup-dependent effects on clinical outcomes. MATERIALS AND METHODS We performed a retrospective review of 985 newly diagnosed patients enrolled in the Myeloma IX and XI trials. Immunoglobulin levels, survival outcomes, and infection rates were evaluated for each cytogenetic subgroup. RESULTS A significant proportion of patients with high-risk t(4;14), t(14;16), or t(14;20) had suppressed polyclonal immunoglobulins compared to standard-risk patients with hyperdiploidy or t(11;14). The clinical impact of immunoparesis depended on the cytogenetic subgroup, with the degree of IgM suppression effecting progression-free and overall survival only in the hyperdiploid subgroup. There was no significant difference in infection rates amongst the etiologic subgroups. CONCLUSION These findings demonstrate that the etiologic cytogenetic subgroup influences the degree and clinical impact of immunoparesis. This suggests that the underlying cytogenetic abnormality affects remodeling of the bone marrow plasma cell niche, resulting in suppressed normal plasma cell function, and low immunoglobulin levels.
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Affiliation(s)
- Jessica Caro
- Perlmutter Cancer Center, NYU Langone Health, New York, NY.
| | - David Cairns
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Tom Menzies
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Eileen Boyle
- Perlmutter Cancer Center, NYU Langone Health, New York, NY
| | | | - Gordon Cook
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Martin Kaiser
- The Institute of Cancer Research, London, United Kingdom
| | | | - Roger Owen
- St James's University Hospital, Leeds, United Kingdom
| | - Graham H Jackson
- Department of Hematology, Newcastle University, Newcastle upon Tyne, United Kingdom
| | | | - Jennifer Heaney
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Mark T Drayson
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Faith E Davies
- Perlmutter Cancer Center, NYU Langone Health, New York, NY
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19
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Advances in MGUS diagnosis, risk stratification, and management: introducing myeloma-defining genomic events. Hematology 2021; 2021:662-672. [DOI: 10.1182/hematology.2021000303] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
In the 1960s, Dr Jan Waldenström argued that patients who had monoclonal proteins without any symptoms or evidence of end-organ damage represented a benign monoclonal gammopathy. In 1978, Dr Robert Kyle introduced the concept of “monoclonal gammopathy of undetermined significance” (MGUS) given that, at diagnosis, it was not possible with available methods (ie, serum protein electrophoresis to define the concentration of M-proteins and microscopy to determine the plasma cell percentage in bone marrow aspirates) to determine which patients would ultimately progress to multiple myeloma. The application of low-input whole-genome sequencing (WGS) technology has circumvented previous problems related to volume of clonal plasma cells and contamination by normal plasma cells and allowed for the interrogation of the WGS landscape of MGUS. As discussed in this chapter, the distribution of genetic events reveals striking differences and the existence of 2 biologically and clinically distinct entities of asymptomatic monoclonal gammopathies. Thus, we already have genomic tools to identify “myeloma-defining genomic events,” and consequently, it is reasonable to consider updating our preferred terminologies. When the clinical field is ready to move forward, we should be able to consolidate current terminologies—from current 7 clinical categories: low-risk MGUS, intermediate-risk MGUS, high-risk MGUS, low-risk smoldering myeloma, intermediate-risk smoldering myeloma, high-risk smoldering myeloma, and multiple myeloma—to future 3 genomic-based categories: monoclonal gammopathy, early detection of multiple myeloma (in which myeloma-defining genomic events already have been acquired), and multiple myeloma (patients who are already progressing and clinically defined cases). Ongoing investigations will continue to advance the field.
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20
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Aksenova AY, Zhuk AS, Lada AG, Zotova IV, Stepchenkova EI, Kostroma II, Gritsaev SV, Pavlov YI. Genome Instability in Multiple Myeloma: Facts and Factors. Cancers (Basel) 2021; 13:5949. [PMID: 34885058 PMCID: PMC8656811 DOI: 10.3390/cancers13235949] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/20/2021] [Accepted: 11/22/2021] [Indexed: 02/06/2023] Open
Abstract
Multiple myeloma (MM) is a malignant neoplasm of terminally differentiated immunoglobulin-producing B lymphocytes called plasma cells. MM is the second most common hematologic malignancy, and it poses a heavy economic and social burden because it remains incurable and confers a profound disability to patients. Despite current progress in MM treatment, the disease invariably recurs, even after the transplantation of autologous hematopoietic stem cells (ASCT). Biological processes leading to a pathological myeloma clone and the mechanisms of further evolution of the disease are far from complete understanding. Genetically, MM is a complex disease that demonstrates a high level of heterogeneity. Myeloma genomes carry numerous genetic changes, including structural genome variations and chromosomal gains and losses, and these changes occur in combinations with point mutations affecting various cellular pathways, including genome maintenance. MM genome instability in its extreme is manifested in mutation kataegis and complex genomic rearrangements: chromothripsis, templated insertions, and chromoplexy. Chemotherapeutic agents used to treat MM add another level of complexity because many of them exacerbate genome instability. Genome abnormalities are driver events and deciphering their mechanisms will help understand the causes of MM and play a pivotal role in developing new therapies.
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Affiliation(s)
- Anna Y. Aksenova
- Laboratory of Amyloid Biology, St. Petersburg State University, 199034 St. Petersburg, Russia
| | - Anna S. Zhuk
- International Laboratory “Computer Technologies”, ITMO University, 197101 St. Petersburg, Russia;
| | - Artem G. Lada
- Department of Microbiology and Molecular Genetics, University of California, Davis, CA 95616, USA;
| | - Irina V. Zotova
- Department of Genetics and Biotechnology, St. Petersburg State University, 199034 St. Petersburg, Russia; (I.V.Z.); (E.I.S.)
- Vavilov Institute of General Genetics, St. Petersburg Branch, Russian Academy of Sciences, 199034 St. Petersburg, Russia
| | - Elena I. Stepchenkova
- Department of Genetics and Biotechnology, St. Petersburg State University, 199034 St. Petersburg, Russia; (I.V.Z.); (E.I.S.)
- Vavilov Institute of General Genetics, St. Petersburg Branch, Russian Academy of Sciences, 199034 St. Petersburg, Russia
| | - Ivan I. Kostroma
- Russian Research Institute of Hematology and Transfusiology, 191024 St. Petersburg, Russia; (I.I.K.); (S.V.G.)
| | - Sergey V. Gritsaev
- Russian Research Institute of Hematology and Transfusiology, 191024 St. Petersburg, Russia; (I.I.K.); (S.V.G.)
| | - Youri I. Pavlov
- Eppley Institute for Research in Cancer, Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE 68198, USA
- Departments of Biochemistry and Molecular Biology, Microbiology and Pathology, Genetics Cell Biology and Anatomy, University of Nebraska Medical Center, Omaha, NE 68198, USA
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21
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Abstract
Multiple myeloma is the second most common hematological malignancy in adults, accounting for 2% of all cancer-related deaths in the UK. Current chemotherapy-based regimes are insufficient, as most patients relapse and develop therapy resistance. This review focuses on current novel antibody- and aptamer-based therapies aiming to overcome current therapy limitations, as well as their respective limitations and areas of improvement. The use of computer modeling methods, as a tool to study and improve ligand-receptor alignments for the use of novel therapy development will also be discussed, as it has become a rapid, reliable and comparatively inexpensive method of investigation.
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22
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López Gómez JM, Sacristán Enciso B, Fernández-Cavada Pollo MJ, Bueno García V, Gómez Vera S. [Monoclonal gammopathy of undetermined significance and evolution to myeloma: Experience in 153 patients]. Semergen 2021; 47:441-447. [PMID: 34479794 DOI: 10.1016/j.semerg.2021.05.011] [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: 11/09/2020] [Revised: 05/05/2021] [Accepted: 05/28/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Based on risk factors, the Mayo Clinic Multiple Myeloma Group (MCMMG) established a model of progression from monoclonal gammopathy of undetermined significance (MGUS) to multiple myeloma (MM) at 20 years. It is also described that MGUS with a progressive increase of monoclonal protein (M-protein) and/or immunoparesis (IMP) may be more predisposed to progress to myeloma. Our objective was to make a review of MGUS, to see how those who presented IMP and/or progression of their M-protein, contrasting them with MGUS that presented intermediate/high and high risk according to MCMMG. METHODOLOGY AND MATERIALS A review of the MGUS objectified during the realization of a serum proteinogram (SPEP) was carried out during 2010-2014, in our area. Serum immunoglobulins, serum immunofixation (IFs), and serum free light chain ratio (FLCr) were determined for all MGUS. RESULTS Of the 153 MGUS that are followed up for 4 years, 6 progress to MM. Of these 6 MM, 5 progress from MGUS with intermediate/high risk taking into account the MCMMG. Of these 5, 3 have IMP or progression of their M-protein. 2 present IMP plus progression of their M-protein. The sixth MM evolves from a MGUS without any risk factor, but with progression of its M-protein plus IMP. CONCLUSIONS IMP and/or M-protein progression are important risk factors to be taken into account in the MGUS, in the first years after diagnosis, due to their possible evolution to MM.
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Affiliation(s)
- Juan Manuel López Gómez
- Laboratorio de Análisis Clínicos, Complejo Hospitalario Universitario de Badajoz, Badajoz, España
| | | | | | | | - Sergio Gómez Vera
- Laboratorio de Análisis Clínicos, Hospital San Pedro de Alcántara, Cáceres, España
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23
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Beuvon C, Martin M, Baillou C, Roblot P, Puyade M. Etiologies of Polyclonal Hypergammaglobulinemia: A scoping review. Eur J Intern Med 2021; 90:119-121. [PMID: 34127335 DOI: 10.1016/j.ejim.2021.05.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/14/2021] [Accepted: 05/16/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Clément Beuvon
- Service de Médecine Interne, Maladies infectieuses et Tropicales, Centre Hospitalier Universitaire (CHU) de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France; Université de Poitiers, 6, rue de la Milétrie, TSA 51115, 86073 Poitiers cedex 9, France.
| | - Mickaël Martin
- Service de Médecine Interne, Maladies infectieuses et Tropicales, Centre Hospitalier Universitaire (CHU) de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France; Université de Poitiers, 6, rue de la Milétrie, TSA 51115, 86073 Poitiers cedex 9, France
| | - Chloé Baillou
- Service de Médecine Interne, Maladies infectieuses et Tropicales, Centre Hospitalier Universitaire (CHU) de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France
| | - Pascal Roblot
- Service de Médecine Interne, Maladies infectieuses et Tropicales, Centre Hospitalier Universitaire (CHU) de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France; Université de Poitiers, 6, rue de la Milétrie, TSA 51115, 86073 Poitiers cedex 9, France
| | - Mathieu Puyade
- Service de Médecine Interne, Maladies infectieuses et Tropicales, Centre Hospitalier Universitaire (CHU) de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France
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24
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Search for AL amyloidosis risk factors using Mendelian randomization. Blood Adv 2021; 5:2725-2731. [PMID: 34228109 DOI: 10.1182/bloodadvances.2021004423] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 04/12/2021] [Indexed: 01/10/2023] Open
Abstract
In amyloid light chain (AL) amyloidosis, amyloid fibrils derived from immunoglobulin light chain are deposited in many organs, interfering with their function. The etiology of AL amyloidosis is poorly understood. Summary data from genome-wide association studies (GWASs) of multiple phenotypes can be exploited by Mendelian randomization (MR) methodology to search for factors influencing AL amyloidosis risk. We performed a 2-sample MR analyzing 72 phenotypes, proxied by 3461 genetic variants, and summary genetic data from a GWAS of 1129 AL amyloidosis cases and 7589 controls. Associations with a Bonferroni-defined significance level were observed for genetically predicted increased monocyte counts (P = 3.8 × 10-4) and the tumor necrosis factor receptor superfamily member 17 (TNFRSF17) gene (P = 3.4 × 10-5). Two other associations with the TNFRSF (members 6 and 19L) reached a nominal significance level. The association between genetically predicted decreased fibrinogen levels may be related to roles of fibrinogen other than blood clotting. be related to its nonhemostatic role. It is plausible that a causal relationship with monocyte concentration could be explained by selection of a light chain-producing clone during progression of monoclonal gammopathy of unknown significance toward AL amyloidosis. Because TNFRSF proteins have key functions in lymphocyte biology, it is entirely plausible that they offer a potential link to AL amyloidosis pathophysiology. Our study provides insight into AL amyloidosis etiology, suggesting high circulating levels of monocytes and TNFRSF proteins as risk factors.
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25
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Defining an Ultra-Low Risk Group in Asymptomatic IgM Monoclonal Gammopathy. Cancers (Basel) 2021; 13:cancers13092055. [PMID: 33922804 PMCID: PMC8122982 DOI: 10.3390/cancers13092055] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/12/2021] [Accepted: 04/21/2021] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Patients with asymptomatic IgM monoclonal gammopathies include IgM monoclonal gammopathy of undetermined significance (IgM MGUS) and smoldering Waldenström macroglobulinemia (SWM), all with some risk of progression to symptomatic Waldenström macroglobulinemia, amyloidosis, or other lymphoproliferative disorder. Due to their low incidence, few studies have focused on the risk of progression, with SWM being the most studied. As both are recognized clinical-pathological entities that share similar clonal and phenotypical features, we focus on defining new biomarkers of progression in this population with long follow-up. Abstract We analyzed 171 patients with asymptomatic IgM monoclonal gammopathies (64 with IgM monoclonal gammopathy of undetermined significance—MGUS and 107 with smoldering Waldenström macroglobulinemia - SWM) who had a bone marrow (BM) evaluation performed at diagnosis. Abnormal free-light chain ratio (53% vs. 31%) and MYD88 mutation prevalence (66% vs. 30%) were higher in patients with SWM. No other differences were found among groups. With a median follow-up of 4.3 years, 14 patients progressed to Waldenström macroglobulinemia, 1 to amyloidosis, and 28 died without progression. The MYD88 mutation was found in 53% of patients (available in 160 patients). Multivariate analysis showed that immunoparesis (subhazard ratio—SHR 10.2, 95% confidence interval—CI: 4.2–24.8; p < 0.001) and BM lymphoplasmacytic infiltration ≥ 20% (SHR: 6, 95% CI: 1.6–22.1; p = 0.007) were associated with higher risk of progression. We developed a risk model based on these two risk factors. In the absence of both variables, an ultra-low risk group was identified (SHR 0.1, 95% CI 0.02–0.5; p = 0.004), with 3% and 6% of cumulative incidence of progression at 10 and 20 years, respectively. Bootstrap analysis confirmed the reproducibility of these results. This study finds immunoparesis and BM infiltration as biomarkers of progression as well as a low-risk group of progression in asymptomatic IgM monoclonal gammopathies.
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26
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Lv LY, Shi DB, Jia ZW. Do not measure an extra high value monoclonal IgM by immunoturbidity: a case report. Clin Chem Lab Med 2021; 59:e149-e152. [PMID: 33068378 DOI: 10.1515/cclm-2020-0973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 10/08/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Li-Ying Lv
- Department of Clinical Laboratory, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, P.R. China
| | - De-Bao Shi
- Department of Clinical Laboratory, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, P.R. China
| | - Zhong-Wei Jia
- Department of Clinical Laboratory, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, P.R. China
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27
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Lamb MJ, Smith A, Painter D, Kane E, Bagguley T, Newton R, Howell D, Cook G, de Tute R, Rawstron A, Patmore R, Roman E. Health impact of monoclonal gammopathy of undetermined significance (MGUS) and monoclonal B-cell lymphocytosis (MBL): findings from a UK population-based cohort. BMJ Open 2021; 11:e041296. [PMID: 33619185 PMCID: PMC7903106 DOI: 10.1136/bmjopen-2020-041296] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To examine mortality and morbidity patterns before and after premalignancy diagnosis in individuals with monoclonal gammopathy of undetermined significance (MGUS) and monoclonal B-cell lymphocytosis (MBL) and compare their secondary healthcare activity to that of the general population. DESIGN Population-based patient cohort, within which each patient is matched at diagnosis to 10 age-matched and sex-matched individuals from the general population. Both cohorts are linked to nationwide information on deaths, cancer registrations and Hospital Episode Statistics. SETTING The UK's Haematological Malignancy Research Network, which has a catchment population of around 4 million served by 14 hospitals and a central diagnostic laboratory. PARTICIPANTS All patients newly diagnosed during 2009-2015 with MGUS (n=2193) or MBL (n=561) and their age and sex-matched comparators (n=27 538). MAIN OUTCOME MEASURES Mortality and hospital inpatient and outpatient activity in the 5 years before and 3 years after diagnosis. RESULTS Individuals with MGUS experienced excess morbidity in the 5 years before diagnosis and excess mortality and morbidity in the 3 years after diagnosis. Increased rate ratios (RRs) were evident for nearly all clinical specialties, the largest, both before and after diagnosis, being for nephrology (before RR=4.29, 95% CI 3.90 to 4.71; after RR=13.8, 95% CI 12.8 to 15.0) and rheumatology (before RR=3.40, 95% CI 3.18 to 3.63; after RR=5.44, 95% CI 5.08 to 5.83). Strong effects were also evident for endocrinology, neurology, dermatology and respiratory medicine. Conversely, only marginal increases in mortality and morbidity were evident for MBL. CONCLUSIONS MGUS and MBL are generally considered to be relatively benign, since most individuals with monoclonal immunoglobulins never develop a B-cell malignancy or any other monoclonal protein-related organ/tissue-related disorder. Nonetheless, our findings offer strong support for the view that in some individuals, monoclonal gammopathy has the potential to cause systemic disease resulting in wide-ranging organ/tissue damage and excess mortality.
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Affiliation(s)
- Maxine Je Lamb
- Department of Health Sciences, University of York, York, UK
| | | | - Daniel Painter
- Department of Health Sciences, University of York, York, UK
| | - Eleanor Kane
- Department of Health Sciences, University of York, York, UK
| | | | - Robert Newton
- Department of Health Sciences, University of York, York, UK
- Epidemiology and Prevention Programme, Uganda Virus Research Institute, Entebbe, Uganda
| | - Debra Howell
- Department of Health Sciences, University of York, York, UK
| | - Gordon Cook
- Haematology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ruth de Tute
- Haematological Malignancy Diagnostic Service (HMDS), Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Andrew Rawstron
- Haematological Malignancy Diagnostic Service (HMDS), Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Russell Patmore
- Haematology, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Eve Roman
- Department of Health Sciences, University of York, York, UK
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28
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Gran C, Liwing J, Wagner AK, Verhoek A, Gezin A, Alici E, Nahi H. Comparative evaluation of involved free light chain and monoclonal spike as markers for progression from monoclonal gammopathy of undetermined significance to multiple myeloma. Am J Hematol 2021; 96:23-30. [PMID: 32936979 PMCID: PMC7756706 DOI: 10.1002/ajh.25999] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 01/30/2023]
Abstract
Monoclonal gammopathy of undetermined significance (MGUS) is a premalignant clonal plasma cell disorder, with a 1% yearly risk of progression to multiple myeloma (MM). Evolution of M-spike and serum free light chain (sFLC) during follow-up could identify patients at high risk of progression. In this region-wide study, including 4756 individuals, 987 patients with MGUS were identified, and baseline factors as well as evolving involved FLC (iFLC) were evaluated as potential markers for risk of progression from MGUS to MM. Furthermore, evolving iFLC and M-spike were assessed quarterly for a median of 5 years. At baseline, patients that progressed had significantly higher iFLC compared to non-progressors. The risk factors of M-spike >1.5 g/dL, age >65 years and iFLC >100 mg/L were all independently associated with increased risk of MGUS to MM progression. For patients that had any two or three risk factors, the 5-year cumulative probability of progression was significantly higher (31%) compared to no risk factors (2%). Evolving iFLC >100 mg/L during follow-up was consistently associated with increased risk of progression. Based on our observations, we propose to include iFLC as a monitoring tool for all MGUS patients. Furthermore, we recommend a quarterly monitoring in all high-risk patients. Finally, we suggest that the risk of MGUS progression should be stratified with age, M-spike, and iFLC at baseline.
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Affiliation(s)
- Charlotte Gran
- Department of Medicine Karolinska Institutet Stockholm Sweden
- Department of Clinical Chemistry Karolinska University Laboratory Stockholm Sweden
| | - Johan Liwing
- Department of Medicine Karolinska Institutet Stockholm Sweden
| | | | - Andre Verhoek
- Ingress‐Health Nederland BV Rotterdam The Netherlands
| | - Ana Gezin
- Ingress‐Health Nederland BV Rotterdam The Netherlands
| | - Evren Alici
- Department of Medicine Karolinska Institutet Stockholm Sweden
- Haematology Center Karolinska University Hospital Stockholm Sweden
| | - Hareth Nahi
- Department of Medicine Karolinska Institutet Stockholm Sweden
- Haematology Center Karolinska University Hospital Stockholm Sweden
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29
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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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30
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[Gamma heavy chain disease associated with aggressive B lymphoma in the context of myelodysplastic syndrome]. Rev Med Interne 2020; 42:355-358. [PMID: 33229056 DOI: 10.1016/j.revmed.2020.10.381] [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: 07/28/2020] [Revised: 10/09/2020] [Accepted: 10/28/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Heavy chain disease is a rare entity characterized by the production of incomplete immunoglobulin heavy chain without associated light chain. It is a B-cell lymphoproliferation, categorized according to the immunoglobulin involved. It is often associated with lymphomas but also with autoimmune diseases. OBSERVATION We report the case of a 70-year-old patient who presented a gamma-type heavy chain disease, associated with a diffuse large B-cell lymphoma in the context of myelodysplastic syndrome. CONCLUSION This is the first case of diffuse large B-cell lymphoma associated gamma heavy chain disease described in the context of myelodysplastic syndrome.
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31
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Changing paradigms in diagnosis and treatment of monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM). Leukemia 2020; 34:3111-3125. [PMID: 33046818 DOI: 10.1038/s41375-020-01051-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/18/2020] [Accepted: 09/29/2020] [Indexed: 12/13/2022]
Abstract
Multiple myeloma (MM) is a highly heterogenous disease that exists along a continuous disease spectrum starting with premalignant conditions monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM) that inevitably precede MM. Over the past two decades, significant progress has been made in the genetic characterization and risk stratification of precursor plasma cell disorders. Indeed, the clinical introduction of highly effective and well-tolerated drugs begs the question: would earlier therapeutic intervention with novel therapies in MGUS and SMM patients alter natural history, providing a potential curative option? In this review, we discuss the epidemiology of MGUS and SMM and current models for risk stratification that predict MGUS and SMM progression to MM. We further discuss genetic heterogeneity and clonal evolution in MM and the interplay between tumor cells and the bone marrow (BM) microenvironment. Finally, we provide an overview of the current recommendations for the management of MGUS and SMM and discuss the open controversies in the field in light of promising results from early intervention clinical trials.
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Liang D, Liu J, Liang S, Xu F, Cheng Z, Huang X, Zeng C, Liu Z. Types of M protein and clinicopathological profiles in patients with monoclonal gammopathy of renal significance. J Nephrol 2020; 34:1137-1146. [PMID: 32725498 DOI: 10.1007/s40620-020-00817-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 07/22/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND The development of renal disease in patients with monoclonal gammopathy of renal significance (MGRS) depends on the pathogenicity of the secreted monoclonal protein (M protein). However, the correlation between the types of M proteins and clinical and renal pathological features is still unclear. METHODS A total of 148 patients with detectable serum M protein and biopsy-proven MGRS were recruited. The patients were categorized according to the heavy and light chain types of M protein in the serum. RESULTS Among 148 patients, the most common M protein was IgGλ, followed by IgAλ and IgGκ. According to the type of heavy chain, patients with IgM-MGRS were more likely to have renal dysfunction, anemia and hypocomplementemia than patients with IgG-MGRS and IgA-MGRS. The λ light chain was predominant in patients with IgG-MGRS and IgA-MGRS, whereas the κ light chain was predominant in patients with IgM-MGRS. The most common renal lesion was amyloidosis in patients with IgG-MGRS and IgA-MGRS, while it was cryoglobulinemic glomerulonephritis in patients with IgM-MGRS. According to the type of light chain, patients with κ light chain were more likely to be male and to have renal dysfunction, anemia and hypocomplementemia than those with λ light chain. The types of heavy chain and light chain of M protein were not associated with patient or renal survival. CONCLUSION The clinicopathological features were distinct in patients with different types of M protein. Integration of the types of M protein and renal pathologic findings may shed light on individual management of patients with MGRS.
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Affiliation(s)
- Dandan Liang
- National Clinical Research Center of Kidney Diseases, Jinling Clinical Medical College of Nanjing Medical University, 305 East Zhongshan Road, Nanjing, China
| | - Jing Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Shaoshan Liang
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Feng Xu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Zhen Cheng
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Xianghua Huang
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Caihong Zeng
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Zhihong Liu
- National Clinical Research Center of Kidney Diseases, Jinling Clinical Medical College of Nanjing Medical University, 305 East Zhongshan Road, Nanjing, China. .,National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.
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Evaluation of two serum free light chain quantitation methods, Freelite and Seralite, in the clinical laboratory with a view to switching immunoassay. Clin Chim Acta 2020; 510:235-241. [PMID: 32702434 DOI: 10.1016/j.cca.2020.07.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/14/2020] [Accepted: 07/16/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Serum free light chain (sFLC) quantitation is central for plasma cell dyscrasias. Several assays are available and switching sFLC methods may be advantageous in certain laboratories. This study performed Freelite and Seralite simultaneously for samples received by the clinical laboratory over a 10 month period and compared quantitation and its impact on interpretation of patient results. METHODS Patients (N = 189) included multiple myeloma (MM) and related plasma cell cancers, monoclonal gammopathy of unknown significance (MGUS), AL amyloidosis and renal impairment. sFLC quantitation and clinical agreement was assessed between methods. RESULTS Clinical agreement was substantial at diagnosis (κ = 0.647, p < .01) and moderate for monitoring (κ = 0.591, p < .01). Good concordance was seen for MM and related plasma disorders and MGUS, with poorer agreement seen for AL amyloidosis. Case studies illustrated agreement in pattern of myeloma disease activity. Bland-Atman plots showed small mean bias but increasing variation between methods with increasing FLC concentrations. Passing-Bablok analysis confirmed systematic differences in quantitation between methods. CONCLUSIONS Despite differences in quantitation, overall, agreement was seen between the different sFLC platforms in relation to the clinical interpretation. As a rapid test without the need for large and expensive analysers, Seralite may be highly applicable in certain laboratories to enable in-house testing.
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Ramasamy I. A Single-Center Retrospective Study to Investigate the Follow-Up of Patients with Monoclonal Proteinemia by Community Physicians in the UK. J Blood Med 2020; 11:191-203. [PMID: 32607037 PMCID: PMC7295546 DOI: 10.2147/jbm.s255390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 05/14/2020] [Indexed: 11/23/2022] Open
Abstract
Background We determined the detection rate of monoclonal gammopathy of undetermined significance (MGUS) and follow-up of MGUS patients in a center that uses reflex testing at globulin levels outside the reference range as part of its routine service to detect monoclonal protein (M-protein). We recorded the natural history and follow-up of these patients. This is one of the first reports on the diagnosis and follow-up of MGUS patients within the UK. Patients and Methods A total of 163 patients diagnosed in 2006 and 393 patients with M-protein on long-term follow-up in 2006 were followed over a period of 10 years (y) by community physicians with laboratory support. Results In 2006, newly diagnosed patients with an M-protein and total number of patients as a percentage of the Worcestershire population were, respectively, 0.025%, 0.045% (at 45–49y); 0.1%, 0.25% (at 60–64y); and 0.26%, 1.12% (at 75–79y). Patients with M-protein had a survival of 35.5% at 10 y and 43.5% at >10y follow-up. Kaplan–Meier analysis of patients with an M-protein showed that lymphoplasma-cell proliferative disorders (LPD)-free survival was 91% for both 10y and >10y follow-up. LPD-free survival decreased to approximately 73% when competing causes (death due to unrelated causes, transient M-protein, loss to follow-up) were censored. Progression to LPD occurred at initial M-protein values of 3g/L at diagnosis. During follow-up, 38.3% died without evidence of LPD, 12% were diagnosed with transient M-protein, 8.7% developed LPD, 10.9% had stable M-protein, 4.9% showed increasing M-protein, and 25.2% were lost to follow-up. Survival curves showed that M-protein isotype contributed to LPD-free survival in the order IgG=IgM>IgA>biclonal M-protein. Conclusion Geographical variations in the diagnosis and follow-up of MGUS patients in the UK need investigation. From public health viewpoint, it is essential to determine MGUS follow-up to improve clinical care and individualise risk-based follow-up of patients.
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Affiliation(s)
- Indra Ramasamy
- Department of Blood Sciences, Worcester Royal Hospital, Worcester WR5 1DD, Worcestershire, UK
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Ravindran A, Lackore KA, Glasgow AE, Drake MT, Hobbs MA, Kourelis T, Kumar S, Kyle RA, Leung N, Muchtar E, Go RS. Monoclonal Gammopathy of Undetermined Significance: Indications for Prediagnostic Testing, Subsequent Diagnoses, and Follow-up Practice at Mayo Clinic. Mayo Clin Proc 2020; 95:944-954. [PMID: 32370855 DOI: 10.1016/j.mayocp.2019.12.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 12/13/2019] [Accepted: 12/23/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To determine the indications for prediagnostic testing, subsequent diagnoses found, and follow-up practices in patients who were incidentally diagnosed with monoclonal gammopathy of undetermined significance (MGUS). PATIENTS AND METHODS From our prospective MGUS database, we identified 329 patients residing in southeastern Minnesota who were diagnosed from January 1, 2011, through December 31, 2014, and followed up at Mayo Clinic. RESULTS Most test orders came from nonhematologists (n=310, 94.2%). The top 5 indications were neuropathy (n=65, 19.8%), renal disease (n=45, 13.7%), anemia (n=42, 12.8%), bone disorder or connective tissue pain (n=42, 12.8%), and cutaneous disease (n=19, 5.8%). Hypercalcemia was an infrequent indication (n=9, 2.7%). The final diagnosis for all neuropathy evaluations was sensory/motor neuropathy-not otherwise specified, with 18.7% having IgM MGUS. Chronic kidney disease-not otherwise specified, iron deficiency, and osteoporosis/osteopenia were the most common subsequent diagnoses for test indications of renal disease, anemia, and bone disorder or connective tissue pain, respectively. Most patients (n=213, 64.7%) had 1 or more follow-up visit during the study period. A minority were followed by hematologists (43.5%, n=143). Patients with low-risk MGUS comprised 45.0% (n=148) of the cohort. Male patients and younger patients were more likely to be followed up than their counterparts (P<.01). About one-third (n=27, 32.1%) of patients 80 years or older (n=84) continued to have regular follow-up visits. Hematologists were more likely to follow patients with MGUS more closely than nonhematologists (P<.001). However, the intensity of follow-up was not based on MGUS risk. CONCLUSION Monoclonal protein testing is commonly performed for signs and symptoms not typically associated with lymphoplasmacytic malignancies. There is a significant variation in MGUS follow-up between hematologists and nonhematologists (P<.001) that is not based on risk factors or clinical practice guidelines.
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Affiliation(s)
- Aishwarya Ravindran
- Division of Hematology, Mayo Clinic, Rochester, MN; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Kandace A Lackore
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Amy E Glasgow
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Matthew T Drake
- Division of Hematology, Mayo Clinic, Rochester, MN; Division of Endocrinology, Mayo Clinic, Rochester, MN
| | | | | | - Shaji Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | - Nelson Leung
- Division of Hematology, Mayo Clinic, Rochester, MN; Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Eli Muchtar
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Ronald S Go
- Division of Hematology, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
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Monoclonal Gammopathy of Undetermined Significance: Current Concepts and Future Prospects. Curr Hematol Malig Rep 2020; 15:45-55. [DOI: 10.1007/s11899-020-00569-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Analytical validation of new ELISAs for the quantitation of polyclonal free light chains and comparison to existing assays for healthy and patient samples. J Immunol Methods 2020; 478:112713. [DOI: 10.1016/j.jim.2019.112713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 11/05/2019] [Accepted: 11/25/2019] [Indexed: 01/13/2023]
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Ho M, Bianchi G, Anderson KC. Proteomics-inspired precision medicine for treating and understanding multiple myeloma. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2020; 5:67-85. [PMID: 34414281 DOI: 10.1080/23808993.2020.1732205] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction Remarkable progress in molecular characterization methods has led to significant improvements in how we manage multiple myeloma (MM). The introduction of novel therapies has led to significant improvements in overall survival over the past 10 years. However, MM remains incurable and treatment choice is largely based on outdated risk-adaptive strategies that do not factor in improved treatment outcomes in the context of modern therapies. Areas covered This review discusses current risk-adaptive strategies in MM and the clinical application of proteomics in the monitoring of treatment response, disease progression, and minimal residual disease (MRD). We also discuss promising biomarkers of disease progression, treatment response, and chemoresistance. Finally, we will discuss an immunomics-based approach to monoclonal antibody (mAb), vaccine, and CAR-T cell development. Expert opinion It is an exciting era in oncology with basic scientific knowledge translating in novel therapeutic approaches to improve patient outcomes. With the advent of effective immunotherapies and targeted therapies, it has become crucial to identify biomarkers to aid in the stratification of patients based on anticipated sensitivity to chemotherapy. As a paradigm of diseases highly dependent on protein homeostasis, multiple myeloma provides the perfect opportunity to investigate the use of proteomics to aid in precision medicine.
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Affiliation(s)
- Matthew Ho
- UCD School of Medicine, College of Health and Agricultural Sciences, University College Dublin, Dublin, Ireland
| | - Giada Bianchi
- LeBow Institute for Myeloma Therapeutics and Jerome Lipper Multiple Myeloma Center, Department of Medical Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Kenneth C Anderson
- LeBow Institute for Myeloma Therapeutics and Jerome Lipper Multiple Myeloma Center, Department of Medical Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
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Chang SH, Gumbel J, Luo S, Thomas TS, Sanfilippo KM, Luo J, Colditz GA, Carson KR. Post-MGUS Diagnosis Serum Monoclonal-Protein Velocity and the Progression of Monoclonal Gammopathy of Undetermined Significance to Multiple Myeloma. Cancer Epidemiol Biomarkers Prev 2019; 28:2055-2061. [PMID: 31501149 DOI: 10.1158/1055-9965.epi-19-0132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 06/05/2019] [Accepted: 09/03/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Multiple myeloma is a common hematologic malignancy consistently preceded by monoclonal gammopathy of undetermined significance (MGUS). Little is known about postdiagnosis clinical predictors of progression of MGUS to multiple myeloma to guide MGUS management. This study aimed to investigate whether the rate of rise in serum monoclonal protein concentration during the year after MGUS diagnosis-M-protein velocity-predicts progression of MGUS to multiple myeloma. METHODS Data from the U.S. Veterans Health Administration system were used. A retrospective cohort of patients with MGUS who progressed to multiple myeloma were matched on age at MGUS diagnosis and race in a 1:4 ratio to the patients with MGUS using incidence density sampling. Kaplan-Meier curves were plotted. Univariable and multivariable conditional logistic regression analyses were fitted from the matched risk sets. RESULTS A total of 128 cases and 490 matched controls were included. The case group contained a higher percentage of patients with M-protein velocity >0.1 g/dL/year than the control group (44.5% vs. 28.2%, P <0.0001). M-protein velocity of >0.1 g/dL during the year following MGUS diagnosis was positively associated with progression of MGUS to multiple myeloma (multivariable-adjusted odds ratio = 2.15; 95% confidence interval, 1.37-3.35). CONCLUSIONS Patients with a positive M-protein velocity during the year after MGUS diagnosis may be considered for more frequent monitoring for early detection and timely treatment of multiple myeloma. Future prevention studies could target these patients for intervention evaluation. IMPACT Our results suggest a new clinical predictor of progression to multiple myeloma following MGUS diagnosis, which has potential to identify high-risk patients for management and prevention.
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Affiliation(s)
- Su-Hsin Chang
- Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, Missouri.
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Jason Gumbel
- Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, Missouri
| | - Suhong Luo
- Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, Missouri
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Theodore S Thomas
- Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, Missouri
| | - Kristen M Sanfilippo
- Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, Missouri
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Jingqin Luo
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Kenneth R Carson
- Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, Missouri
- Flatiron Health, New York, New York
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Landgren O, Hofmann JN, McShane CM, Santo L, Hultcrantz M, Korde N, Mailankody S, Kazandjian D, Murata K, Thoren K, Ramanathan L, Dogan A, Rustad E, Lu SX, Akhlaghi T, Kristinsson SY, Björkholm M, Devlin S, Purdue MP, Pfeiffer RM, Turesson I. Association of Immune Marker Changes With Progression of Monoclonal Gammopathy of Undetermined Significance to Multiple Myeloma. JAMA Oncol 2019; 5:1293-1301. [PMID: 31318385 PMCID: PMC6646992 DOI: 10.1001/jamaoncol.2019.1568] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 03/15/2019] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Multiple myeloma is consistently preceded by monoclonal gammopathy of undetermined significance (MGUS). Risk models that estimate the risk of progression from MGUS to multiple myeloma use data from a single time point, usually the initial workup. OBJECTIVE To longitudinally investigate the alterations of serum immune markers with stable vs progressive MGUS. DESIGN, SETTING, AND PARTICIPANTS This prospective cross-sectional cohort study included 77 469 adult participants aged 55 to 74 years in the screening arm of the National Cancer Institute Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial who had a diagnosis of progressing MGUS (n = 187) or stable MGUS (n = 498), including light-chain subtype, from November 1993, through December 2011. For each participant, all available serially stored prediagnostic serum samples (N = 3266) were obtained. Data analysis was performed from April 2018, to December 2018. MAIN OUTCOMES AND MEASURES Serum protein and monoclonal immunoglobulin levels, serum free light chains, and serum light chains within each immunoglobulin class were measured. RESULTS Of 685 individuals included in the study, 461 (67.3%) were men; the mean (SD) age was 69.1 (5.6) years. In cross-sectional modeling, risk factors associated with progressive MGUS were IgA isotype (adjusted odds ratio [OR], 1.80; 95% CI, 1.03-3.13; P = .04), 15 g/L or more monoclonal spike (adjusted OR, 23.5; 95% CI, 8.9-61.9; P < .001), skewed (<0.1 or >10) serum free light chains ratio (adjusted OR, 46.4; 95% CI, 18.4-117.0; P < .001), and severe immunoparesis (≥2 suppressed uninvolved immunoglobulins) (adjusted OR, 19.1; 95% Cl, 7.5-48.3; P < .001). Risk factors associated with progressive light-chain MGUS were skewed serum free light chains ratio (adjusted OR, 44.0; 95% CI, 14.2-136.3; P < .001) and severe immunoparesis (adjusted OR, 48.6; 95% CI, 9.5-248.2; P < .001). In longitudinal analysis of participants with serial samples prior to progression, 23 of 43 participants (53%) had high-risk MGUS before progression; 16 of these 23 (70%) experienced conversion from low-risk or intermediate-risk MGUS within 5 years. Similar results were found for light-chain MGUS. CONCLUSIONS AND RELEVANCE The findings of evolving risk patterns support annual blood testing and risk assessment for patients with MGUS or light-chain MGUS.
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Affiliation(s)
- Ola Landgren
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jonathan N. Hofmann
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Charlene M. McShane
- Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen’s University, Belfast, Northern Ireland, United Kingdom
| | - Loredana Santo
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Malin Hultcrantz
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Division of Hematology, Department of Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Neha Korde
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sham Mailankody
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Kazunori Murata
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Katie Thoren
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lakshmi Ramanathan
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ahmet Dogan
- Department of Hematopathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Even Rustad
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sydney X. Lu
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Theresia Akhlaghi
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sigurdur Y. Kristinsson
- Division of Hematology, Department of Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Magnus Björkholm
- Division of Hematology, Department of Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Sean Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mark P. Purdue
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Ruth M. Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Ingemar Turesson
- Myeloma Section, Department of Medicine, University Hospital of Malmo, Malmo, Sweden
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Heaney JLJ, Richter A, Bowcock S, Pratt G, Child JA, Jackson G, Morgan G, Turesson I, Drayson MT. Excluding myeloma diagnosis using revised thresholds for serum free light chain ratios and M-protein levels. Haematologica 2019; 105:e169-e171. [PMID: 31399530 DOI: 10.3324/haematol.2019.224360] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Jennifer L J Heaney
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Alex Richter
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | | | - Guy Pratt
- University Hospitals Birmingham NHS Trust, Birmingham, UK
| | | | | | | | | | - Mark T Drayson
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
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McShane CM, Murphy B, Santin O, Anderson LA. Low knowledge and awareness of monoclonal gammopathy of undetermined significance (MGUS) among general practitioners. BMC FAMILY PRACTICE 2019; 20:61. [PMID: 31088396 PMCID: PMC6518797 DOI: 10.1186/s12875-019-0944-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 04/10/2019] [Indexed: 12/24/2022]
Abstract
INTRODUCTION While multiple myeloma (MM) is a rare diagnosis within primary care, its precursor MGUS (monoclonal gammopathy of undetermined significance) is more common, particularly among older populations. Upon first detection, the majority of MGUS patients will be under the care of their General Practitioner (GP)/Family Doctor who is also often the first healthcare professional that patients report symptoms of progression to. However, our previous work with MGUS patients and haematology healthcare professionals has suggested that knowledge and awareness of MGUS is low among GPs. METHODS An online survey was undertaken to investigate knowledge and awareness of MGUS and services needed by GPs/GP trainees to support these patients. The survey was promoted at a large European primary care conference and via social media. Descriptive statistics were utilised to compare participant responses. RESULTS In total 58 GPs (n = 35 GPs and n = 23 GP trainees) from 24 countries responded. Overall, self-reported familiarity with the term MGUS was low (mean score: 2.21/5, standard deviation (SD): 1.09), but higher among GPs who reported having at least one MGUS patient (mean score: 2.83/5, SD 0.99). The majority (88.2%) of GPs/GP trainees stated they would feel uncomfortable discussing MGUS with patients. The increased risk of haematological malignancies was identified by 62.1% of GPs/GP trainees with MM, lymphoma and myelodysplastic syndromes the most commonly reported cancers associated with MGUS. The majority (81.6%) of GPs/GP trainees were supportive of patient follow-up via telephone clinics (phlebotomy performed in GP practice with patient management maintained by haematology) but only 27.1% stated they would be happy to solely manage all low/low-intermediate risk MGUS patients. A laboratory report alerting to the possibility of MGUS or a haematological malignancy was reported as the most useful service which could be implemented to help GPs manage MGUS patients. The need for MGUS focused information and education resources for GPs was also highlighted. CONCLUSIONS The findings of this study highlight a lack of knowledge and awareness of MGUS among GPs/ GP trainees. The majority of GPs/GP trainees are happy to support haematology in managing these patients but require assistance and support in providing these services.
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Affiliation(s)
- Charlene M. McShane
- Cancer Epidemiology Research Group, Centre for Public Health, Queen’s University Belfast, Grosvenor Road, Belfast, BT12 6BJ Northern Ireland
| | - Blain Murphy
- Cancer Epidemiology Research Group, Centre for Public Health, Queen’s University Belfast, Grosvenor Road, Belfast, BT12 6BJ Northern Ireland
| | - Olinda Santin
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, Northern Ireland
| | - Lesley A. Anderson
- Cancer Epidemiology Research Group, Centre for Public Health, Queen’s University Belfast, Grosvenor Road, Belfast, BT12 6BJ Northern Ireland
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Martellosio JP, Leleu X, Roblot P, Martin M, Puyade M. Dosage des chaînes légères libres : indications et méthodes. Rev Med Interne 2019; 40:297-305. [DOI: 10.1016/j.revmed.2019.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 01/04/2019] [Accepted: 01/20/2019] [Indexed: 12/18/2022]
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Schüssler-Fiorenza Rose SM, Contrepois K, Moneghetti KJ, Zhou W, Mishra T, Mataraso S, Dagan-Rosenfeld O, Ganz AB, Dunn J, Hornburg D, Rego S, Perelman D, Ahadi S, Sailani MR, Zhou Y, Leopold SR, Chen J, Ashland M, Christle JW, Avina M, Limcaoco P, Ruiz C, Tan M, Butte AJ, Weinstock GM, Slavich GM, Sodergren E, McLaughlin TL, Haddad F, Snyder MP. A longitudinal big data approach for precision health. Nat Med 2019; 25:792-804. [PMID: 31068711 PMCID: PMC6713274 DOI: 10.1038/s41591-019-0414-6] [Citation(s) in RCA: 234] [Impact Index Per Article: 46.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 03/06/2019] [Indexed: 12/31/2022]
Abstract
Precision health relies on the ability to assess disease risk at an individual level, detect early preclinical conditions and initiate preventive strategies. Recent technological advances in omics and wearable monitoring enable deep molecular and physiological profiling and may provide important tools for precision health. We explored the ability of deep longitudinal profiling to make health-related discoveries, identify clinically relevant molecular pathways and affect behavior in a prospective longitudinal cohort (n = 109) enriched for risk of type 2 diabetes mellitus. The cohort underwent integrative personalized omics profiling from samples collected quarterly for up to 8 years (median, 2.8 years) using clinical measures and emerging technologies including genome, immunome, transcriptome, proteome, metabolome, microbiome and wearable monitoring. We discovered more than 67 clinically actionable health discoveries and identified multiple molecular pathways associated with metabolic, cardiovascular and oncologic pathophysiology. We developed prediction models for insulin resistance by using omics measurements, illustrating their potential to replace burdensome tests. Finally, study participation led the majority of participants to implement diet and exercise changes. Altogether, we conclude that deep longitudinal profiling can lead to actionable health discoveries and provide relevant information for precision health.
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Affiliation(s)
- Sophia Miryam Schüssler-Fiorenza Rose
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
- Spinal Cord Injury Service, Veteran Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Kévin Contrepois
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Kegan J Moneghetti
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Medicine, St Vincent's Hospital, University of Melbourne, Melbourne, Australia
| | - Wenyu Zhou
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Tejaswini Mishra
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Samson Mataraso
- Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, Berkeley, CA, USA
- Department of Bioengineering, University of California, Berkeley, Berkeley, CA, USA
| | - Orit Dagan-Rosenfeld
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Ariel B Ganz
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Jessilyn Dunn
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
- Mobilize Center, Stanford University, Stanford, CA, USA
| | - Daniel Hornburg
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Shannon Rego
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Dalia Perelman
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Sara Ahadi
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - M Reza Sailani
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Yanjiao Zhou
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
- Department of Medicine, University of Connecticut Health, Farmington, CT, USA
| | - Shana R Leopold
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | - Jieming Chen
- Bakar Computational Health Sciences Institute and Department of Pediatrics, University of California, San Francisco, CA, USA
| | - Melanie Ashland
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Jeffrey W Christle
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Monika Avina
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Patricia Limcaoco
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Camilo Ruiz
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Marilyn Tan
- Division of Endocrinology, Stanford University School of Medicine, Stanford, CA, USA
| | - Atul J Butte
- Bakar Computational Health Sciences Institute and Department of Pediatrics, University of California, San Francisco, CA, USA
| | | | - George M Slavich
- Cousins Center for Psychoneuroimmunology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Erica Sodergren
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | - Tracey L McLaughlin
- Division of Endocrinology, Stanford University School of Medicine, Stanford, CA, USA
| | - Francois Haddad
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA.
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
| | - Michael P Snyder
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA.
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA.
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Bensalah M, Lamrabat S, Lyagoubi A, Aarab A, Bouayadi O, Seddik R. A Rare Case of Non-Secretory Multiple Myeloma: A Case Report and Literature Review. EJIFCC 2019; 30:88-94. [PMID: 30881278 PMCID: PMC6416810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Non-secretory myeloma (NSM) is a rare form of myeloma. It is defined as monoclonal plasmocytic proliferation of the bone marrow with the same clinical and radiological manifestations of myeloma. However, plasma cells are unable to secrete immunoglobulin (serum and urinary electrophoresis are negative and free light chain measurement is unquantifiable). This variant of multiple myeloma (MM) usually poses a diagnostic challenge to the biologist and clinician. We report a rare case of non-secretory myeloma in a 76-year-old patient who was diagnosed at the Mohammed V University Hospital Center in Oujda, Morocco.
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Affiliation(s)
- Mohammed Bensalah
- Hematology Laboratory, Mohammed VI University Hospital, Oujda, Morocco, Faculty of Medicine and Pharmacy, Mohammed the First University, Oujda, Morocco,Corresponding author: Mohammed Bensalah Boulvard Zaid Ben Soltan Quartier Ben Khaldoune Rue: N, Numéro: 29 Oujda Morocco E-mail:
| | - Somiya Lamrabat
- Hematology Laboratory, Mohammed VI University Hospital, Oujda, Morocco, Faculty of Medicine and Pharmacy, Mohammed the First University, Oujda, Morocco
| | - Amina Lyagoubi
- Hematology Laboratory, Mohammed VI University Hospital, Oujda, Morocco, Faculty of Medicine and Pharmacy, Mohammed the First University, Oujda, Morocco
| | - Adnane Aarab
- Hematology Laboratory, Mohammed VI University Hospital, Oujda, Morocco, Faculty of Medicine and Pharmacy, Mohammed the First University, Oujda, Morocco
| | - Ouardia Bouayadi
- Hematology Laboratory, Mohammed VI University Hospital, Oujda, Morocco, Faculty of Medicine and Pharmacy, Mohammed the First University, Oujda, Morocco
| | - Rachid Seddik
- Hematology Laboratory, Mohammed VI University Hospital, Oujda, Morocco, Faculty of Medicine and Pharmacy, Mohammed the First University, Oujda, Morocco
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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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Characteristics and prognosis of patients with non-immunoglobulin-M monoclonal gammopathy of undetermined significance: a retrospective study. Int J Hematol 2018; 109:154-161. [PMID: 30406907 DOI: 10.1007/s12185-018-2555-7] [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] [Received: 07/18/2018] [Revised: 10/24/2018] [Accepted: 10/30/2018] [Indexed: 12/18/2022]
Abstract
Non-immunoglobulin (Ig)-M monoclonal gammopathy of undetermined significance (MGUS) is a precursor lesion with the potential to evolve into a malignant plasma cell neoplasm. The prevalence of MGUS differs by ethnicity and is lower in the Japanese population than in the Western population. However, there is limited evidence about the clinical course of MGUS in Asian races. The present study aims at elucidating the clinical course and prognosis of Japanese patients with non-IgM MGUS in the clinical setting. We retrospectively examined 1009 patients with non-IgM MGUS identified by screening procedures. The median overall survival of these patients was > 20 years, and only one-fifth patients died of plasma cell neoplasms. The cumulative incidence of plasma cell neoplasms requiring treatment was 19%. Multivariate analysis revealed that immunoparesis and female gender were independent factors affecting treatment requirement. Although the characteristics and clinical course of patients with non-IgM MGUS obtained in this study were found to be essentially similar to those of previous studies, we report here for the first time that female gender is a significant independent factor for requiring treatment.
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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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Wang L, Kumar M, Deng Q, Wang X, Liu M, Gong Z, Zhang S, Ma X, Xu-Monette ZY, Xiao M, Yi Q, Young KH, Ramos KS, Li Y. 2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD) induces peripheral blood abnormalities and plasma cell neoplasms resembling multiple myeloma in mice. Cancer Lett 2018; 440-441:135-144. [PMID: 30343114 DOI: 10.1016/j.canlet.2018.10.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 09/11/2018] [Accepted: 10/09/2018] [Indexed: 01/18/2023]
Abstract
Although epidemiologic studies have suggested a possible association between occupational exposures to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) and the risk of development of multiple myeloma, definitive evidence in support of this association is lacking. In the present study, we employed the Vk*Myc mouse model of multiple myeloma to assess the impact of TCDD exposure on multiple myeloma pathogenesis. TCDD induced splenomegaly and multiple peripheral blood abnormalities, including anemia and high serum IgG levels. In addition, TCDD triggered bone lytic lesions, as well as renal tubular casts, a phenomenon associated with human myeloma kidney disease. Even in wild-type C57BL/6 mice, TCDD increased serum IgG levels, induced anemia, and increased plasma cell presence in the spleen and bone marrow, hallmarks of benign monoclonal gammopathy. Lastly, TCDD induced AKT activation and the DNA damage response, key pathogenic events in myeloma pathogenesis, in animal spleen and/or bone marrow. These data indicate that TCDD accelerates monoclonal gammopathy development and promotes progression to multiple myeloma in genetically-predisposed mice. This work offers the first direct experimental evidence establishing TCDD as an environmental risk factor for monoclonal gammopathy of undetermined significance and multiple myeloma.
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Affiliation(s)
- Lei Wang
- Institute for Brain Research and Rehabilitation, South China Normal University, Guangzhou, China; Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Munish Kumar
- Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA; Raman Fellow (UGC), Department of Biochemistry, University of Allahabad, Allahabad, India
| | - Qipan Deng
- Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Xu Wang
- Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ming Liu
- Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA; State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Zhaojian Gong
- Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shanshan Zhang
- Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Stomatology, Xiangya Hospital, Central South University, Changsha, China
| | - Xiaodong Ma
- Institute for Brain Research and Rehabilitation, South China Normal University, Guangzhou, China; Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Zijun Y Xu-Monette
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Min Xiao
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Qing Yi
- Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ken H Young
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kenneth S Ramos
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Yong Li
- Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
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50
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Heaney JLJ, Campbell JP, Iqbal G, Cairns D, Richter A, Child JA, Gregory W, Jackson G, Kaiser M, Owen R, Davies F, Morgan G, Dunn J, Drayson MT. Characterisation of immunoparesis in newly diagnosed myeloma and its impact on progression-free and overall survival in both old and recent myeloma trials. Leukemia 2018; 32:1727-1738. [PMID: 29925902 PMCID: PMC6087716 DOI: 10.1038/s41375-018-0163-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 03/27/2018] [Accepted: 04/27/2018] [Indexed: 12/13/2022]
Abstract
We measured immunosuppression at myeloma diagnosis and assessed the impact on survival in 5826 UK myeloma trial patients. Polyclonal immunoglobulin levels were below normal in 85% of patients and above normal in only 0.4% of cases for IgA, 0.2% for IgM and no cases for IgG. Immunoparesis had a greater impact in recent trials: median overall survival (OS) was up to 3 years longer for patients without immunoparesis compared to the old trials, less than 1 year longer. Median progression-free survival (PFS) was 39%, 36% and 57% longer for patients with normal IgG, IgA and IgM levels, respectively. The depth of IgM suppression, but not the depth of IgG or IgA suppression, was prognostic for survival: the most severely suppressed IgM tertile of patients OS was 0.9 years shorter than those in the top tertile, and 2.6 years shorter than OS of those with normal IgM levels (p = .007). The degree of suppression of polyclonal IgM levels below normal was associated with worse PFS (p = .0002). Infection does not appear to be the main mechanism through which immunoparesis affects survival. We hypothesise that IgM immunoparesis impacts through a combination of being associated with more aggressive disease and reduced immune surveillance against relapse.
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Affiliation(s)
- Jennifer L J Heaney
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - John P Campbell
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.,University of Bath, Bath, UK
| | | | | | - Alex Richter
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | | | | | | | | | - Roger Owen
- St James's University Hospital, Leeds, UK
| | - Faith Davies
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Gareth Morgan
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | - Mark T Drayson
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.
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