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Lee DJ, O'Donnell EK, Raje N, Panaroni C, Redd R, Ligibel J, Sears DD, Nadeem O, Ghobrial IM, Marinac CR. Design and Rationale of Prolonged Nightly Fasting for Multiple Myeloma Prevention (PROFAST): Protocol for a Randomized Controlled Pilot Trial. JMIR Res Protoc 2024; 13:e51368. [PMID: 38466984 DOI: 10.2196/51368] [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: 07/31/2023] [Revised: 11/17/2023] [Accepted: 11/23/2023] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Obesity is an established, modifiable risk factor of multiple myeloma (MM); yet, no lifestyle interventions are routinely recommended for patients with overweight or obesity with MM precursor conditions. Prolonged nightly fasting is a simple, practical dietary regimen supported by research, suggesting that the synchronization of feeding-fasting timing with sleep-wake cycles favorably affects metabolic pathways implicated in MM. We describe the design and rationale of a randomized controlled pilot trial evaluating the efficacy of a regular, prolonged nighttime fasting schedule among individuals with overweight or obesity at high risk for developing MM or a related lymphoid malignancy. OBJECTIVE We aim to investigate the effects of 4-month prolonged nightly fasting on body composition and tumor biomarkers among individuals with overweight or obesity with monoclonal gammopathy of undetermined significance (MGUS), smoldering multiple myeloma (SMM), or smoldering Waldenström macroglobulinemia (SWM). METHODS Individuals with MGUS, SMM, or SWM aged ≥18 years and a BMI of ≥25 kg/m2 are randomized to either a 14-hour nighttime fasting intervention or a healthy lifestyle education control group. Participants' baseline diet and lifestyle patterns are characterized through two 24-hour dietary recalls: questionnaires querying demographic, comorbidity, lifestyle, and quality-of-life information; and wrist actigraphy measurements for 7 days. Fasting intervention participants are supported through one-on-one telephone counseling by a health coach and automated SMS text messaging to support fasting goals. Primary end points of body composition, including visceral and subcutaneous fat (by dual-energy x-ray absorptiometry); bone marrow adiposity (by bone marrow histology); and tumor biomarkers, specifically M-proteins and serum free light-chain concentrations (by gel-based and serum free light-chain assays), are assessed at baseline and after the 4-month study period; changes therein from baseline are evaluated using a repeated measures mixed-effects model that accounts for the correlation between baseline and follow-up measures and is generally robust to missing data. Feasibility is assessed as participant retention (percent dropout in each arm) and percentage of days participants achieved a ≥14-hour fast. RESULTS The PROlonged nightly FASTing (PROFAST) study was funded in June 2022. Participant recruitment commenced in April 2023. As of July 2023, six participants consented to the study. The study is expected to be completed by April 2024, and data analysis and results are expected to be published in the first quarter of 2025. CONCLUSIONS PROFAST serves as an important first step in exploring the premise that prolonged nightly fasting is a strategy to control obesity and obesity-related mechanisms of myelomagenesis. In evaluating the feasibility and impact of prolonged nightly fasting on body composition, bone marrow adipose tissue, and biomarkers of tumor burden, this pilot study may generate hypotheses regarding metabolic mechanisms underlying MM development and ultimately inform clinical and public health strategies for MM prevention. TRIAL REGISTRATION ClinicalTrials.gov NCT05565638; http://clinicaltrials.gov/ct2/show/NCT05565638. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/51368.
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Affiliation(s)
- David J Lee
- Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Elizabeth K O'Donnell
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Center for Early Detection and Interception of Blood Cancers, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Noopur Raje
- Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Cristina Panaroni
- Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Robert Redd
- Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Jennifer Ligibel
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Dorothy D Sears
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
| | - Omar Nadeem
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Center for Early Detection and Interception of Blood Cancers, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Irene M Ghobrial
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Center for Early Detection and Interception of Blood Cancers, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Catherine R Marinac
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Center for Early Detection and Interception of Blood Cancers, Dana-Farber Cancer Institute, Boston, MA, United States
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Goldsmith SR, Stockerl-Goldstein K. What Do the Elevated Protein Levels Mean in My Patients with Myeloma, Amyloidosis, and Related Disorders? Am J Med 2022; 135 Suppl 1:S24-S29. [PMID: 35081383 DOI: 10.1016/j.amjmed.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/14/2022] [Indexed: 11/26/2022]
Abstract
Multiple myeloma, light chain amyloidosis, and other plasma cell dyscrasias are characterized, in part, by abnormal production of paraproteins that are often responsible for the sequelae of those diseases. These paraproteins are whole or fragmented immunoglobulins produced by clonal antibody-secreting cells (usually plasma cells, but occasionally, B lymphocytes). Significant heterogeneity exists in the presentation of these diseases, ranging from incidental detection of a monoclonal protein in an asymptomatic patient, to life-threatening manifestations that require urgent diagnostic confirmation and intervention. Successful management of such scenarios requires a fundamental understanding of the laboratory assays at one's disposal, their role in the workup of paraproteinemias, and the interpretation thereof. This review broadly covers these assays and their roles in the diagnosis, prognosis, and management of these diseases.
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Affiliation(s)
- Scott R Goldsmith
- Division of Oncology, Washington University School of Medicine, St. Louis, Mo; The Judy and Bernard Briskin Center for Multiple Myeloma Research, City of Hope National Medical Center, Duarte, Calif.
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Single-cell profiling of tumour evolution in multiple myeloma - opportunities for precision medicine. Nat Rev Clin Oncol 2022; 19:223-236. [PMID: 35017721 DOI: 10.1038/s41571-021-00593-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2021] [Indexed: 11/08/2022]
Abstract
Multiple myeloma (MM) is a haematological malignancy of plasma cells characterized by substantial intraclonal genetic heterogeneity. Although therapeutic advances made in the past few years have led to improved outcomes and longer survival, MM remains largely incurable. Over the past decade, genomic analyses of patient samples have demonstrated that MM is not a single disease but rather a spectrum of haematological entities that all share similar clinical symptoms. Moreover, analyses of samples from monoclonal gammopathy of undetermined significance and smouldering MM have also shown the existence of genetic heterogeneity in precursor stages, in some cases remarkably similar to that of MM. This heterogeneity highlights the need for a greater dissection of underlying disease biology, especially the clonal diversity and molecular events underpinning MM at each stage to enable the stratification of individuals with a high risk of progression. Emerging single-cell sequencing technologies present a superlative solution to delineate the complexity of monoclonal gammopathy of undetermined significance, smouldering MM and MM. In this Review, we discuss how genomics has revealed novel insights into clonal evolution patterns of MM and provide examples from single-cell studies that are beginning to unravel the mutational and phenotypic characteristics of individual cells within the bone marrow tumour, immune microenvironment and peripheral blood. We also address future perspectives on clinical application, proposing that multi-omics single-cell profiling can guide early patient diagnosis, risk stratification and treatment strategies.
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Faiman B, Richards T. Diagnosis and Treatment of AL and ATTR Amyloidosis. J Adv Pract Oncol 2021; 12:329-332. [PMID: 34084586 PMCID: PMC8087231 DOI: 10.6004/jadpro.2021.12.3.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
At JADPRO Live Virtual 2020, Beth Faiman, PhD, RN, MSN, APRN-BC, AOCN®, FAAN, and Tiffany Richards, PhD, ANP-BC, AOCNP®, differentiated between AL and ATTR amyloidosis, discussed key considerations in selecting therapy, and identified ways that advanced practitioners can manage the supportive care needs of this patient population.
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Affiliation(s)
- Beth Faiman
- Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio.,The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Tiffany Richards
- Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio.,The University of Texas MD Anderson Cancer Center, Houston, Texas
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Kaweme NM, Changwe GJ, Zhou F. Approaches and Challenges in the Management of Multiple Myeloma in the Very Old: Future Treatment Prospects. Front Med (Lausanne) 2021; 8:612696. [PMID: 33718400 PMCID: PMC7947319 DOI: 10.3389/fmed.2021.612696] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 02/03/2021] [Indexed: 12/14/2022] Open
Abstract
The increasing incidence of geriatric patients with multiple myeloma has elevated concerns in clinical practice. While the introduction of novel therapeutic agents has substantially improved outcomes in younger patients with myeloma, poorer outcomes remain in older patients. Managing older patients requires a multidisciplinary team approach to consider factors that may influence both treatment selection and outcomes. Aging is associated with remodeling of vital organs, physiological downregulations of basal metabolism, susceptibility to multiple comorbidities with ultimate frailty, thereby contributing to the underrepresentation and exclusion of very old patients from clinical trials. Therefore, timely confirmation of a precise diagnosis is crucial for prompt initiation of treatment if the desired outcome is to be achieved. Adequate and judicious assessment using comprehensive geriatric assessment tools minimizes toxicities and treatment discontinuation. Initiating treatment with combinational therapy requires knowledge of indications and anticipated outcomes, as well as individualized therapy with appropriate dose-adjustment. Individualized therapy based on good clinical acumen and best practices obverts unwanted polypharmacy, preventing iatrogenic harm. This review will therefore address the approaches and challenges faced in managing myeloma in geriatric patients aged 80 years and older, highlighting recommended therapeutic strategies and future prospective regimens.
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Affiliation(s)
| | | | - Fuling Zhou
- Department of Hematology, Zhongnan Hospital, Wuhan University, Wuhan, China
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6
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Yavorkovsky LL. Smoldering multiple myeloma 40 years later: a story of unintended disease. Expert Rev Hematol 2021; 14:149-153. [PMID: 33430658 DOI: 10.1080/17474086.2021.1875815] [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] [Indexed: 10/22/2022]
Abstract
Introduction: Smoldering multiple myeloma (SMM) is a clonal plasma cell (PC) disorder considered a prelude to MM due to its greater malignant potential compared to monoclonal gammopathy of undetermined significance (MGUS). Despite tectonic changes in the SMM landscape that occurred since it was first distinguished four decades ago, SMM continues to represent a complex and controversial entity causing a great deal of diagnostic and management turmoil.Areas covered: Author addresses increasingly complicated, ambiguous, as well as some overlooked and misjudged aspects of SMM such as the disease identity, relationship to its counterparts, MGUS and overt MM, its niche in the modern classification of monoclonal gammopathies and management. The PubMed search (1980-2020) was conducted and the current NCCN guidelines reviewed in reference to the diagnosis and treatment of smoldering multiple myeloma.Expert opinion: A plethora of clinical and biological evidence points to SMM as a source of the ongoing and expanding uncertainty of this condition and calls into question its authenticity as a discrete entity. Until comprehensive testing can predict the progression of pre-myeloma conditions with the utmost precision, attempts at preemptive treatments will fail to answer the basic question of who will benefit from the early treatment and who will not.
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Maura F, Landgren O, Morgan GJ. Designing Evolutionary-based Interception Strategies to Block the Transition from Precursor Phases to Multiple Myeloma. Clin Cancer Res 2021; 27:15-23. [PMID: 32759358 PMCID: PMC7785564 DOI: 10.1158/1078-0432.ccr-20-1395] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/17/2020] [Accepted: 07/31/2020] [Indexed: 11/16/2022]
Abstract
The development of next-generation sequencing technology has dramatically improved our understanding of the genetic landscape of multiple myeloma. Several new drivers and recurrent events have been reported and linked to a potential driver role. This complex landscape is enhanced by intraclonal mutational heterogeneity and variability introduced through the dimensions of time and space. The evolutionary history of multiple myeloma is driven by both the accumulation of different genomic drivers and by the activity of different mutational processes active overtime. In this review, we describe how these new findings and sequencing technologies have been progressively allowed to understand and reshape our knowledge of the complexity of multiple myeloma at each of its developmental stages: premalignant, at diagnosis, and in relapsed/refractory states. We discuss how these evolutionary concepts can be utilized in the clinic to alter evolutionary trajectories providing a framework for therapeutic intervention at early-disease stages.
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Affiliation(s)
- Francesco Maura
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Ola Landgren
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Gareth J Morgan
- Perlmutter Cancer Center, New York University Langone Health, New York, New York.
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Lonial S, Jacobus S, Fonseca R, Weiss M, Kumar S, Orlowski RZ, Kaufman JL, Yacoub AM, Buadi FK, O’Brien T, Matous JV, Anderson DM, Emmons RV, Mahindra A, Wagner LI, Dhodapkar MV, Rajkumar SV. Randomized Trial of Lenalidomide Versus Observation in Smoldering Multiple Myeloma. J Clin Oncol 2020; 38:1126-1137. [PMID: 31652094 PMCID: PMC7145586 DOI: 10.1200/jco.19.01740] [Citation(s) in RCA: 158] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2019] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Observation is the current standard of care for smoldering multiple myeloma. We hypothesized that early intervention with lenalidomide could delay progression to symptomatic multiple myeloma. METHODS We conducted a randomized trial that assessed the efficacy of single-agent lenalidomide compared with observation in patients with intermediate- or high-risk smoldering multiple myeloma. Lenalidomide was administered orally at a dose of 25 mg on days 1 to 21 of a 28-day cycle. The primary end point was progression-free survival, with disease progression requiring the development of end-organ damage attributable to multiple myeloma and biochemical progression. RESULTS One hundred eighty-two patients were randomly assigned-92 patients to the lenalidomide arm and 90 to the observation arm. Median follow-up is 35 months. Response to therapy was observed in 50% (95% CI, 39% to 61%) of patients in the lenalidomide arm, with no responses in the observation arm. Progression-free survival was significantly longer with lenalidomide compared with observation (hazard ratio, 0.28; 95% CI, 0.12 to 0.62; P = .002). One-, 2-, and 3-year progression-free survival was 98%, 93%, and 91% for the lenalidomide arm versus 89%, 76%, and 66% for the observation arm, respectively. Only six deaths have been reported, two in the lenalidomide arm versus four in the observation arm (hazard ratio for death, 0.46; 95% CI, 0.08 to 2.53). Grade 3 or 4 nonhematologic adverse events occurred in 25 patients (28%) on lenalidomide. CONCLUSION Early intervention with lenalidomide in smoldering multiple myeloma significantly delays progression to symptomatic multiple myeloma and the development of end-organ damage.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Jeffrey V. Matous
- Colorado Blood Cancer Institute and Sarah Cannon Research Institute, Denver, CO
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Hernández-Rivas JÁ, Gironella Mesa M. La realidad asistencial del tratamiento del mieloma múltiple de alto riesgo en España. Med Clin (Barc) 2020; 154:315-319. [DOI: 10.1016/j.medcli.2019.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/03/2019] [Accepted: 10/08/2019] [Indexed: 11/26/2022]
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10
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Piraud M, Wennmann M, Kintzelé L, Hillengass J, Keller U, Langs G, Weber MA, Menze BH. Towards quantitative imaging biomarkers of tumor dissemination: A multi-scale parametric modeling of multiple myeloma. Med Image Anal 2019; 57:214-225. [PMID: 31349146 DOI: 10.1016/j.media.2019.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 06/20/2019] [Accepted: 07/02/2019] [Indexed: 12/11/2022]
Abstract
The advent of medical imaging and automatic image analysis is bringing the full quantitative assessment of lesions and tumor burden at every clinical examination within reach. This opens avenues for the development and testing of functional disease models, as well as their use in the clinical practice for personalized medicine. In this paper, we introduce a Bayesian statistical framework, based on mixed-effects models, to quantitatively test and learn functional disease models at different scales, on population longitudinal data. We also derive an effective mathematical model for the crossover between initially detected lesions and tumor dissemination, based on the Iwata-Kawasaki-Shigesada model. We finally propose to leverage this descriptive disease progression model into model-aware biomarkers for personalized risk-assessment, taking all available examinations and relevant covariates into account. As a use case, we study Multiple Myeloma, a disseminated plasma cell cancer, in which proper diagnostics is essential, to differentiate frequent precursor state without end-organ damage from the rapidly developing disease requiring therapy. After learning the best biological models for local lesion growth and global tumor burden evolution on clinical data, and computing corresponding population priors, we use individual model parameters as biomarkers, and can study them systematically for correlation with external covariates, such as sex or location of the lesion. On our cohort of 63 patients with smoldering Multiple Myeloma, we show that they perform substantially better than other radiological criteria, to predict progression into symptomatic Multiple Myeloma. Our study paves the way for modeling disease progression patterns for Multiple Myeloma, but also for other metastatic and disseminated tumor growth processes, and for analyzing large longitudinal image data sets acquired in oncological imaging. It shows the unprecedented potential of model-based biomarkers for better and more personalized treatment decisions and deserves being validated on larger cohorts to establish its role in clinical decision making.
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Affiliation(s)
- Marie Piraud
- Department of Computer Science, Technical University of Munich, Munich, Germany; Center for Translational Cancer Research (Translatum), Klinikum rechts der Isar, Technical University of Munich, Germany.
| | - Markus Wennmann
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Laurent Kintzelé
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Jens Hillengass
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Ulrich Keller
- Hematology and Oncology, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany; Medical Department, Technical University of Munich, Munich, Germany
| | - Georg Langs
- Department of Biomedical Imaging and Image-Guided Therapy, Computational Imaging Research Laboratory, Medical University of Vienna, Vienna, Austria
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany
| | - Björn H Menze
- Department of Computer Science, Technical University of Munich, Munich, Germany; Center for Translational Cancer Research (Translatum), Klinikum rechts der Isar, Technical University of Munich, Germany
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Qiu Y, Jiang XY, Luo YP, Li J, Zhou DB, Cao XX. [A 55-year-old male with anemia and monoclonal gammopathy]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2019; 40:783-785. [PMID: 31648486 PMCID: PMC7342450 DOI: 10.3760/cma.j.issn.0253-2727.2019.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Y Qiu
- Department of Hematology, Peking Union Medical College Hospital, CAMS & PUMC, Beijing 100730, China
| | - X Y Jiang
- Department of Hematology, Peking Union Medical College Hospital, CAMS & PUMC, Beijing 100730, China
| | - Y P Luo
- Department of Nuclear Medicine, Peking Union Medical College Hospital, CAMS & PUMC, Beijing 100730, China
| | - J Li
- Department of Hematology, Peking Union Medical College Hospital, CAMS & PUMC, Beijing 100730, China
| | - D B Zhou
- Department of Hematology, Peking Union Medical College Hospital, CAMS & PUMC, Beijing 100730, China
| | - X X Cao
- Department of Hematology, Peking Union Medical College Hospital, CAMS & PUMC, Beijing 100730, China
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Mayerhoefer ME, Archibald SJ, Messiou C, Staudenherz A, Berzaczy D, Schöder H. MRI and PET/MRI in hematologic malignancies. J Magn Reson Imaging 2019; 51:1325-1335. [PMID: 31260155 PMCID: PMC7217155 DOI: 10.1002/jmri.26848] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 06/17/2019] [Indexed: 12/12/2022] Open
Abstract
The role of MRI differs considerably between the three main groups of hematological malignancies: lymphoma, leukemia, and myeloma. In myeloma, whole‐body MRI (WB‐MRI) is recognized as a highly sensitive test for the assessment of myeloma, and is also endorsed by clinical guidelines, especially for detection and staging. In lymphoma, WB‐MRI is presently not recommended, and merely serves as an alternative technique to the current standard imaging test, [18F]FDG‐PET/CT, especially in pediatric patients. Even for lymphomas with variable FDG avidity, such as extranodal mucosa‐associated lymphoid tissue lymphoma (MALT), contrast‐enhanced computed tomography (CT), but not WB‐MRI, is presently recommended, despite the high sensitivity of diffusion‐weighted MRI and its ability to capture treatment response that has been reported in the literature. In leukemia, neither MRI nor any other cross‐sectional imaging test (including positron emission tomography [PET]) is currently recommended outside of clinical trials. This review article discusses current clinical applications as well as the main research topics for MRI, as well as PET/MRI, in the field of hematological malignancies, with a focus on functional MRI techniques such as diffusion‐weighted imaging and dynamic contrast‐enhanced MRI, on the one hand, and novel, non‐FDG PET imaging probes such as the CXCR4 radiotracer [68Ga]Ga‐Pentixafor and the amino acid radiotracer [11C]methionine, on the other hand. Level of Evidence: 5 Technical Efficacy Stage: 3 J. Magn. Reson. Imaging 2020;51:1325–1335.
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Affiliation(s)
- Marius E Mayerhoefer
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Austria.,Department of Radiology, Memorial Sloan Kettering Cancer Center New York, New York, USA
| | | | - Christina Messiou
- Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, Sutton, UK
| | - Anton Staudenherz
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Austria
| | - Dominik Berzaczy
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Austria
| | - Heiko Schöder
- Department of Radiology, Memorial Sloan Kettering Cancer Center New York, New York, USA
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Baron M, Simon L, Poulain S, Leblond V. How Recent Advances in Biology of Waldenström's Macroglobulinemia May Affect Therapy Strategy. Curr Oncol Rep 2019; 21:27. [PMID: 30806816 DOI: 10.1007/s11912-019-0768-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Waldenström macroglobulinemia (WM) is a rare lymphoproliferative disorder. Up to now, therapeutic choice was not influenced by the biological characteristics of the disease. Here, we will review how recent advances in biology in WM may affect therapy strategy. RECENT FINDINGS Recently, WM has been described as a new oncogenic model. MyD88 mutation has been described as a key driver mutation and has functional consequences which could be targeted. Other mutations, such as CXCR4 or TP53, have been reported. These mutations are associated with different clinical presentation, prognosis, and treatment response. Mutational status may influence therapeutic choice in some patients but additional data are required. New targeted therapies are on development.
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Affiliation(s)
- Marine Baron
- Department of Hematology, Pitié-Salpétrière Hospital APHP, Sorbonne Université, Boulevard de l'hôpital, 75013, Paris, France.
| | - Laurence Simon
- Department of Hematology, Centre-Hospitalier Sud-Francilien, Corbeil-Essonnes, France
| | - Stéphanie Poulain
- Department of Cellular Hematology, CHU de Lille, Lille, France.,INSERM UMRX 1172, IRCL, Lille, France
| | - Véronique Leblond
- Department of Hematology, Pitié-Salpétrière Hospital APHP, Sorbonne Université, Boulevard de l'hôpital, 75013, Paris, France
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Fonseca GSD, Machado JR, Zago LBR, Reis MAD, Monteiro MLGDR, Vito FBD. Monoclonal gammopathy of renal significance: case report. Hematol Transfus Cell Ther 2018; 40:86-89. [PMID: 30057977 PMCID: PMC6001933 DOI: 10.1016/j.htct.2017.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 11/23/2017] [Indexed: 12/03/2022] Open
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Frerichs KA, Nagy NA, Lindenbergh PL, Bosman P, Marin Soto J, Broekmans M, Groen RWJ, Themeli M, Nieuwenhuis L, Stege C, Nijhof IS, Mutis T, Zweegman S, Lokhorst HM, van de Donk NWCJ. CD38-targeting antibodies in multiple myeloma: mechanisms of action and clinical experience. Expert Rev Clin Immunol 2018; 14:197-206. [PMID: 29465271 DOI: 10.1080/1744666x.2018.1443809] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Multiple myeloma (MM) is generally an incurable hematological malignancy with heterogeneous overall survival rates ranging from a few months to more than 10 years. Survival is especially poor for patients who developed disease that is refractory to immunomodulatory drugs and proteasome inhibitors. Areas covered: This review will discuss the importance of CD38-targeting antibodies for the treatment of MM patients to improve their outcome. Expert commentary: Intense immuno-oncological laboratory research has resulted in the development of functionally active monoclonal antibodies against cell surface markers present on MM cells. In this respect, CD38-targeting antibodies such as daratumumab, MOR202, and isatuximab, have high single agent activity in heavily pretreated MM patients by virtue of their pleiotropic mechanisms of action including Fc-dependent effector mechanisms and immunomodulatory activities. Importantly, CD38-targeting antibodies are well tolerated, with infusion reactions as most frequent adverse event. Altogether, this makes them attractive combination partners with other anti-MM agents. Daratumumab is already approved as monotherapy and in combination with lenalidomide-dexamethasone as well as bortezomib-dexamethasone in pretreated MM patients. Furthermore, results from studies evaluating CD38-targeting antibodies in newly diagnosed MM patients are also promising, indicating that CD38-targeting antibodies will be broadly used in MM, resulting in further improvements in survival.
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Affiliation(s)
- Kristine A Frerichs
- a Department of Hematology , VU University Medical Center , Amsterdam , The Netherlands
| | - Noemi Anna Nagy
- a Department of Hematology , VU University Medical Center , Amsterdam , The Netherlands
| | - Pieter L Lindenbergh
- a Department of Hematology , VU University Medical Center , Amsterdam , The Netherlands
| | - Patty Bosman
- a Department of Hematology , VU University Medical Center , Amsterdam , The Netherlands
| | - Jhon Marin Soto
- a Department of Hematology , VU University Medical Center , Amsterdam , The Netherlands
| | - Marloes Broekmans
- a Department of Hematology , VU University Medical Center , Amsterdam , The Netherlands
| | - Richard W J Groen
- a Department of Hematology , VU University Medical Center , Amsterdam , The Netherlands
| | - Maria Themeli
- a Department of Hematology , VU University Medical Center , Amsterdam , The Netherlands
| | - Louise Nieuwenhuis
- a Department of Hematology , VU University Medical Center , Amsterdam , The Netherlands
| | - Claudia Stege
- a Department of Hematology , VU University Medical Center , Amsterdam , The Netherlands
| | - Inger S Nijhof
- a Department of Hematology , VU University Medical Center , Amsterdam , The Netherlands
| | - Tuna Mutis
- a Department of Hematology , VU University Medical Center , Amsterdam , The Netherlands
| | - Sonja Zweegman
- a Department of Hematology , VU University Medical Center , Amsterdam , The Netherlands
| | - Henk M Lokhorst
- a Department of Hematology , VU University Medical Center , Amsterdam , The Netherlands
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16
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Ghobrial IM, Detappe A, Anderson KC, Steensma DP. The bone-marrow niche in MDS and MGUS: implications for AML and MM. Nat Rev Clin Oncol 2018; 15:219-233. [PMID: 29311715 DOI: 10.1038/nrclinonc.2017.197] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Several haematological malignancies, including multiple myeloma (MM) and acute myeloid leukaemia (AML), have well-defined precursor states that precede the development of overt cancer. MM is almost always preceded by monoclonal gammopathy of undetermined significance (MGUS), and at least a quarter of all patients with myelodysplastic syndromes (MDS) have disease that evolves into AML. In turn, MDS are frequently anteceded by clonal haematopoiesis of indeterminate potential (CHIP). The acquisition of additional genetic and epigenetic alterations over time clearly influences the increasingly unstable and aggressive behaviour of neoplastic haematopoietic clones; however, perturbations in the bone-marrow microenvironment are increasingly recognized to have key roles in initiating and supporting oncogenesis. In this Review, we focus on the concept that the haematopoietic neoplasia-microenvironment relationship is an intimate rapport between two partners, provide an overview of the evidence supporting a role for the bone-marrow niche in promoting neoplasia, and discuss the potential for niche-specific therapeutic targets.
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Affiliation(s)
- Irene M Ghobrial
- Division of Hematological Malignancies, Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, Massachusetts 02115, USA
| | - Alexandre Detappe
- Division of Hematological Malignancies, Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, Massachusetts 02115, USA
| | - Kenneth C Anderson
- Division of Hematological Malignancies, Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, Massachusetts 02115, USA
| | - David P Steensma
- Division of Hematological Malignancies, Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, Massachusetts 02115, USA
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17
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Foulk B, Schaffer M, Gross S, Rao C, Smirnov D, Connelly MC, Chaturvedi S, Reddy M, Brittingham G, Mata M, Repollet M, Rojas C, Auclair D, DeRome M, Weiss B, Sasser AK. Enumeration and characterization of circulating multiple myeloma cells in patients with plasma cell disorders. Br J Haematol 2017; 180:71-81. [DOI: 10.1111/bjh.15003] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 09/01/2017] [Indexed: 02/06/2023]
Affiliation(s)
- Brad Foulk
- Janssen Research & Development, LLC; Spring House PA USA
| | - Mike Schaffer
- Janssen Research & Development, LLC; Spring House PA USA
| | - Steve Gross
- Menarini Silicon Biosystems; Huntingdon Valley PA USA
| | - Chandra Rao
- Janssen Research & Development, LLC; Spring House PA USA
| | - Denis Smirnov
- Janssen Research & Development, LLC; Spring House PA USA
| | | | | | - Manjula Reddy
- Janssen Research & Development, LLC; Spring House PA USA
| | | | - Marielena Mata
- Janssen Research & Development, LLC; Spring House PA USA
| | | | - Claudia Rojas
- Menarini Silicon Biosystems; Huntingdon Valley PA USA
| | | | - Mary DeRome
- Multiple Myeloma Research Foundation; Norwalk CT USA
| | - Brendan Weiss
- Abramson Cancer Center and Perelman School of Medicine; University of Pennsylvania; Philadelphia PA USA
| | - Amy K. Sasser
- Janssen Research & Development, LLC; Spring House PA USA
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18
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Mailankody S, Kazandjian D, Korde N, Roschewski M, Manasanch E, Bhutani M, Tageja N, Kwok M, Zhang Y, Zingone A, Lamy L, Costello R, Morrison C, Hultcrantz M, Christofferson A, Washington M, Boateng M, Steinberg SM, Stetler-Stevenson M, Figg WD, Papaemmanuil E, Wilson WH, Keats JJ, Landgren O. Baseline mutational patterns and sustained MRD negativity in patients with high-risk smoldering myeloma. Blood Adv 2017; 1:1911-1918. [PMID: 29296837 PMCID: PMC5728141 DOI: 10.1182/bloodadvances.2017005934] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 08/14/2017] [Indexed: 02/07/2023] Open
Abstract
Early results of a prospective phase 2 clinical trial of carfilzomib, lenalidomide, and dexamethasone followed by lenalidomide maintenance in high-risk smoldering myeloma showed promising results that were previously published. Here, we provide novel insights into the genetic landscape of high-risk smoldering myeloma and information on sustained minimal residual disease (MRD) negativity with an expanded cohort of patients. Eighteen patients with high-risk smoldering myeloma were enrolled between 29 May 2012, and 14 January 2014. We included patients with newly diagnosed multiple myeloma enrolled in a parallel trial who received the same therapy (reference group). The overall response rate was 100%. With median potential follow-up of 43.3 months, 10 (63%) remain in MRD negativity, and the estimated 4-year progression-free and overall survival rates are 71% and 100%, respectively. Importantly, we report differences in mutational patterns in patients with high-risk smoldering myeloma and newly diagnosed multiple myeloma, reflected in a lower frequency of mutations in significant myeloma genes (6.6% vs 45%) and NFKB pathway genes (6.6% vs 25%). Treatment with carfilzomib, lenalidomide, and dexamethasone followed by lenalidomide maintenance was associated with a 100% response rate and 63% MRD negativity with a safety profile consistent with previous reports for this regimen. This study had a small numbers of participants, but there seemed to be important differences in the genetic landscape of patients with high-risk smoldering myeloma and those with newly diagnosed multiple myeloma, suggestive of a more treatment-responsive biology in early disease.
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Affiliation(s)
- Sham Mailankody
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Dickran Kazandjian
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Neha Korde
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mark Roschewski
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Elisabet Manasanch
- Department of Lymphoma and Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Manisha Bhutani
- Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC
| | - Nishant Tageja
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Mary Kwok
- Hematology/Oncology Department, John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, MD
| | - Yong Zhang
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Adriana Zingone
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Laurence Lamy
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Rene Costello
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Candis Morrison
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Malin Hultcrantz
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Division of Hematology, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
| | | | - Megan Washington
- Integrated Cancer Genomics, Translational Genomics Research Institute, Phoenix, AZ
| | - Martin Boateng
- Integrated Cancer Genomics, Translational Genomics Research Institute, Phoenix, AZ
| | - Seth M Steinberg
- Biostatistics and Data Management Section, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD; and
| | | | - William D Figg
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Elli Papaemmanuil
- Computational Oncology, Epidemiology and Biostatics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Wyndham H Wilson
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Jonathan J Keats
- Integrated Cancer Genomics, Translational Genomics Research Institute, Phoenix, AZ
| | - Ola Landgren
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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19
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Dosani T, Mailankody S, Korde N, Manasanch E, Bhutani M, Tageja N, Roschewski M, Kwok M, Kazandjian D, Costello R, Burton D, Zhang Y, Liewehr D, Steinberg SM, Maric I, Landgren O. Host-related immunodeficiency in the development of multiple myeloma. Leuk Lymphoma 2017; 59:1127-1132. [PMID: 28792255 DOI: 10.1080/10428194.2017.1361026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Host-related immunodeficiency is known to play a role in the development of multiple myeloma (MM) from its precursor conditions (monoclonal gammopathy of undetermined significance, MGUS, smoldering multiple myeloma, SMM). In order to understand the underlying immune changes in this process, we characterized immune patterns from MGUS to SMM to MM. We further sought to identify potential novel immune biomarkers that may predict progression of SMM to MM. We characterized patterns of circulating lymphocytes in 181 patients using multiparametric flow cytometry. We found decreased B- (p = .0003), increased T- (p = .037) and unaltered NK cell proportions from MGUS to SMM to MM. To gain insights into functional variability, we further characterized immunophenotypic lymphocyte subsets, which uncovered differences in CD57 subsets. Specifically, we found that SMM patients who eventually progressed to MM showed decreased proportions of CD57-CD56 + (p = .0061) and CD57-CD16 + (p = .035) lymphocyte subsets. We thus report novel data characterizing the nature of host-related immunodeficiency in the development of MM. We show sequential changes in lymphocyte subsets from MGUS to SMM to MM. We further suggest that CD57 subsets may serve as potential markers of progression from SMM to MM. Our findings support the study of lymphocyte subsets in the search for immune biomarkers. Such markers could provide clinical guidance in managing myeloma precursor disease.
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Affiliation(s)
- Talib Dosani
- a Department of Medicine , University Hospitals Case Medical Center , Cleveland , OH, USA
| | - Sham Mailankody
- b Myeloma Service, Department of Medicine , Memorial Sloan-Kettering Cancer Center , New York , NY, USA
| | - Neha Korde
- b Myeloma Service, Department of Medicine , Memorial Sloan-Kettering Cancer Center , New York , NY, USA
| | - Elisabet Manasanch
- c Department of Lymphoma and Myeloma , University of Texas MD Anderson Cancer Center , Houston , TX, USA
| | - Manisha Bhutani
- d Lymphoid Malignancies Branch , Center for Cancer Research, National Cancer Institute, National Institutes of Health , Bethesda , MD, USA
| | - Nishant Tageja
- d Lymphoid Malignancies Branch , Center for Cancer Research, National Cancer Institute, National Institutes of Health , Bethesda , MD, USA
| | - Mark Roschewski
- d Lymphoid Malignancies Branch , Center for Cancer Research, National Cancer Institute, National Institutes of Health , Bethesda , MD, USA
| | - Mary Kwok
- d Lymphoid Malignancies Branch , Center for Cancer Research, National Cancer Institute, National Institutes of Health , Bethesda , MD, USA
| | - Dickran Kazandjian
- d Lymphoid Malignancies Branch , Center for Cancer Research, National Cancer Institute, National Institutes of Health , Bethesda , MD, USA
| | - Rene Costello
- d Lymphoid Malignancies Branch , Center for Cancer Research, National Cancer Institute, National Institutes of Health , Bethesda , MD, USA
| | - Debra Burton
- d Lymphoid Malignancies Branch , Center for Cancer Research, National Cancer Institute, National Institutes of Health , Bethesda , MD, USA
| | - Yong Zhang
- d Lymphoid Malignancies Branch , Center for Cancer Research, National Cancer Institute, National Institutes of Health , Bethesda , MD, USA
| | - David Liewehr
- e Biostatistics and Data Management Section , Center for Cancer Research, National Cancer Institute, National Institutes of Health , Bethesda , MD, USA
| | - Seth M Steinberg
- e Biostatistics and Data Management Section , Center for Cancer Research, National Cancer Institute, National Institutes of Health , Bethesda , MD, USA
| | - Irina Maric
- f Hematology Section, Department of Laboratory Medicine , Clinical Center, National Institutes of Health , Bethesda , MD, USA
| | - Ola Landgren
- b Myeloma Service, Department of Medicine , Memorial Sloan-Kettering Cancer Center , New York , NY, USA
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20
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Olaptesed pegol, an anti-CXCL12/SDF-1 Spiegelmer, alone and with bortezomib-dexamethasone in relapsed/refractory multiple myeloma: a Phase IIa Study. Leukemia 2017; 31:997-1000. [PMID: 28074071 PMCID: PMC5383929 DOI: 10.1038/leu.2017.5] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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21
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Sarı M, Sarı S, Nalçacı M. The Effect of Suppressed Levels of Uninvolved Immunoglobulins on the Prognosis of Symptomatic Multiple Myeloma. Turk J Haematol 2016; 34:131-136. [PMID: 27795224 PMCID: PMC5440864 DOI: 10.4274/tjh.2016.0161] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: The majority of multiple myeloma (MM) patients have high levels of monoclonal immunoglobulin in the serum and/or urine and suppressed levels of the uninvolved immunoglobulins. The prognostic significance of this phenomenon has not been assessed sufficiently. In this study, our aim is to evaluate the prognostic significance of uninvolved immunoglobulin suppression measured by nephelometry in patients with new symptomatic MM and the association with other features of the disease. Materials and Methods: Between August 2003 and February 2015, 137 patients who were referred for the treatment of newly diagnosed symptomatic myeloma to the Hematology Department polyclinics of the İstanbul University İstanbul Faculty of Medicine were prospectively included and had available pretreatment immunoglobulin levels measured by nephelometry. Results: Suppression of at least one uninvolved immunoglobulin was observed in 87% of patients and this situation was slightly more common in patients with immunoglobulin A myeloma but had no statistical significance (p>0.05). Uninvolved immunoglobulin suppression was also more common among patients who had bone marrow plasma cell infiltration of ≥40% and presented with anemia and hypercalcemia (p<0.05). The overall survival time was shorter in patients with positive calcium-renal-anemia-bone criteria and International Staging System stage 3 compared with others (p<0.05). Factors that were independently associated with inferior survival in the multivariate analysis included patients with estimated glomerular filtration rate of <60 mL/min, age of >65 years, lactate dehydrogenase of >300 IU/L, bone marrow plasma cells of ≥40%, and β2-microglobulin of >3.5 mg/dL (p<0.05). Conclusion: In this study, 13.1% of MM patients had preserved levels of uninvolved immunoglobulins. We observed that patients who had preserved uninvolved immunoglobulin levels had better treatment responses and better pathologic signs, but statistical significance could not be shown. Conversely, patients with suppression of even one of the uninvolved immunoglobulins had a shorter survival, but similarly, statistical significance could not be shown.
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Affiliation(s)
- Murat Sarı
- İstanbul University İstanbul Faculty of Medicine, Department of Internal Medicine, İstanbul, Turkey Phone: +90 543 338 93 39 E-mail:
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22
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Princic N, Gregory C, Willson T, Mahue M, Felici D, Werther W, Lenhart G, Foley KA. Development and Validation of an Algorithm to Identify Patients with Multiple Myeloma Using Administrative Claims Data. Front Oncol 2016; 6:224. [PMID: 27833899 PMCID: PMC5081355 DOI: 10.3389/fonc.2016.00224] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 10/10/2016] [Indexed: 11/13/2022] Open
Abstract
PURPOSE The objective was to expand on prior work by developing and validating a new algorithm to identify multiple myeloma (MM) patients in administrative claims. METHODS Two files were constructed to select MM cases from MarketScan Oncology Electronic Medical Records (EMR) and controls from the MarketScan Primary Care EMR during January 1, 2000-March 31, 2014. Patients were linked to MarketScan claims databases, and files were merged. Eligible cases were age ≥18, had a diagnosis and visit for MM in the Oncology EMR, and were continuously enrolled in claims for ≥90 days preceding and ≥30 days after diagnosis. Controls were age ≥18, had ≥12 months of overlap in claims enrollment (observation period) in the Primary Care EMR and ≥1 claim with an ICD-9-CM diagnosis code of MM (203.0×) during that time. Controls were excluded if they had chemotherapy; stem cell transplant; or text documentation of MM in the EMR during the observation period. A split sample was used to develop and validate algorithms. A maximum of 180 days prior to and following each MM diagnosis was used to identify events in the diagnostic process. Of 20 algorithms explored, the baseline algorithm of 2 MM diagnoses and the 3 best performing were validated. Values for sensitivity, specificity, and positive predictive value (PPV) were calculated. CONCLUSION Three claims-based algorithms were validated with ~10% improvement in PPV (87-94%) over prior work (81%) and the baseline algorithm (76%) and can be considered for future research. Consistent with prior work, it was found that MM diagnoses before and after tests were needed.
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Affiliation(s)
| | | | | | - Maya Mahue
- Onyx Pharmaceuticals Inc., An Amgen Subsidiary , San Francisco, CA , USA
| | - Diana Felici
- Onyx Pharmaceuticals Inc., An Amgen Subsidiary , San Francisco, CA , USA
| | - Winifred Werther
- Onyx Pharmaceuticals Inc., An Amgen Subsidiary , San Francisco, CA , USA
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23
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Hong J, Lee JH. Recent advances in multiple myeloma: a Korean perspective. Korean J Intern Med 2016; 31:820-34. [PMID: 27604794 PMCID: PMC5016289 DOI: 10.3904/kjim.2015.408] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 08/22/2016] [Indexed: 12/22/2022] Open
Abstract
Epidemiologically, multiple myeloma (MM) is a malignant disorder of plasma cells with a higher incidence among Western populations than among Asians. However, there is growing evidence of a recent increase in the age-standardized incidence rate (ASR) of MM in Asian countries, particularly Korea. Application of novel agents has resulted in significant improvement of treatment outcomes, and the advances are ongoing with the recent introduction and U.S. Food and Drug Administration's approval of newer agents, including carfilzomib, ixazomib, elotuzumab, and daratumumab. In concert with the technical advances in the cytogenetic and molecular diagnostics of MM, modifications of its diagnosis and staging system have been attempted for better risk stratification. The modified diagnostic criteria from the International Myeloma Working Group in 2014 enabled a strategy of more active treatment for some patients with smoldering MM, with an ultra-high risk of progression, and fine-tuned the definition of end-organ damage, known as CRAB (hypercalcemia, renal insufficiency, anemia, and bone lesions). Considering Korea's trend of aging at an unprecedented rate, we can expect that the ASR of MM will maintain a gradual increase for many years to come; therefore, MM will be a cancer of critical importance from both medical and socioeconomic perspectives in Korea.
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Affiliation(s)
| | - Jae Hoon Lee
- Correspondence to Jae Hoon Lee, M.D. Department of Internal Medicine, Gachon University Gil Medical Center, 21 Namdong-daero 774beon-gil, Namdong-gu, Incheon 21565, Korea Tel: +82-32-460-2186 Fax: +82-32-460-3233 E-mail:
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24
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van de Donk NWCJ, Mutis T, Poddighe PJ, Lokhorst HM, Zweegman S. Diagnosis, risk stratification and management of monoclonal gammopathy of undetermined significance and smoldering multiple myeloma. Int J Lab Hematol 2016; 38 Suppl 1:110-22. [DOI: 10.1111/ijlh.12504] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2016] [Indexed: 11/28/2022]
Affiliation(s)
| | - T. Mutis
- Department of Hematology; VU University Medical Center; Amsterdam The Netherlands
| | - P. J. Poddighe
- Department of Clinical Genetics; VU University Medical Center; Amsterdam The Netherlands
| | - H. M. Lokhorst
- Department of Hematology; VU University Medical Center; Amsterdam The Netherlands
| | - S. Zweegman
- Department of Hematology; VU University Medical Center; Amsterdam The Netherlands
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25
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Castillo JJ. Risk factors for progression from smoldering into active myeloma: additional insights from a population-based study. Eur J Haematol 2016; 97:217-8. [PMID: 26918423 DOI: 10.1111/ejh.12750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Jorge J Castillo
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
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26
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Manier S, Salem KZ, Liu D, Ghobrial IM. Future Directions in the Evaluation and Treatment of Precursor Plasma Cell Disorders. Am Soc Clin Oncol Educ Book 2016; 35:e400-e406. [PMID: 27249747 DOI: 10.1200/edbk_159010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Multiple myeloma (MM) is an incurable disease that progresses from a premalignant stage termed monoclonal gammopathy of undetermined significance (MGUS) and an intermediate stage of smoldering multiple myeloma (SMM). Recent major advances in therapy with more effective and less toxic treatments have brought reconsideration of early therapeutic intervention in management of SMM, with the goal of reducing progression of the disease before the occurrence of end-organ damage to MM and improving survival. Key to this effort is accurate identification of patients at high risk of progression who would truly benefit from early intervention. In this review, we discuss the current definitions, risk factors, risk stratification, prognosis, and management of MGUS and SMM, as well as new emerging therapeutic options under active investigation.
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Affiliation(s)
- Salomon Manier
- From the Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Karma Z Salem
- From the Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - David Liu
- From the Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Irene M Ghobrial
- From the Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
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27
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Zamagni E, Nanni C, Gay F, Pezzi A, Patriarca F, Bellò M, Rambaldi I, Tacchetti P, Hillengass J, Gamberi B, Pantani L, Magarotto V, Versari A, Offidani M, Zannetti B, Carobolante F, Balma M, Musto P, Rensi M, Mancuso K, Dimitrakopoulou-Strauss A, Chauviè S, Rocchi S, Fard N, Marzocchi G, Storto G, Ghedini P, Palumbo A, Fanti S, Cavo M. 18F-FDG PET/CT focal, but not osteolytic, lesions predict the progression of smoldering myeloma to active disease. Leukemia 2015; 30:417-22. [DOI: 10.1038/leu.2015.291] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 09/17/2015] [Accepted: 09/29/2015] [Indexed: 12/29/2022]
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28
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Shay G, Hazlehurst L, Lynch CC. Dissecting the multiple myeloma-bone microenvironment reveals new therapeutic opportunities. J Mol Med (Berl) 2015; 94:21-35. [PMID: 26423531 DOI: 10.1007/s00109-015-1345-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 09/13/2015] [Accepted: 09/17/2015] [Indexed: 12/19/2022]
Abstract
Multiple myeloma is a plasma cell skeletal malignancy. While therapeutic agents such as bortezomib and lenalidomide have significantly improved overall survival, the disease is currently incurable with the emergence of drug resistance limiting the efficacy of chemotherapeutic strategies. Failure to cure the disease is in part due to the underlying genetic heterogeneity of the cancer. Myeloma progression is critically dependent on the surrounding microenvironment. Defining the interactions between myeloma cells and the more genetically stable hematopoietic and mesenchymal components of the bone microenvironment is critical for the development of new therapeutic targets. In this review, we discuss recent advances in our understanding of how microenvironmental elements contribute to myeloma progression and, therapeutically, how those elements can or are currently being targeted in a bid to eradicate the disease.
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Affiliation(s)
- G Shay
- Tumor Biology Department, SRB-3, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Blvd, Tampa, FL, 33612, USA
| | - L Hazlehurst
- Department of Pharmaceutical Sciences and The Alexander B. Osborn Hematopoietic Malignancy and Transplantation Program, West Virginia University, Morgantown, WV, 26506, USA
| | - C C Lynch
- Tumor Biology Department, SRB-3, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Blvd, Tampa, FL, 33612, USA.
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29
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Furukawa Y, Kikuchi J. Molecular pathogenesis of multiple myeloma. Int J Clin Oncol 2015; 20:413-22. [DOI: 10.1007/s10147-015-0837-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 04/21/2015] [Indexed: 12/31/2022]
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30
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Abstract
INTRODUCTION Smoldering multiple myeloma (SMM) is a heterogeneous clinical entity that defines patients in the spectrum of disease progression from monoclonal gammopathy of undetermined significance to multiple myeloma (MM). Current standard of care is observation until end organ damage occurs. In spite of this, the scientific community has begun to question whether the strategy of watchful waiting should be replaced with earlier therapeutic intervention with the ultimate goal of preventing clonal heterogeneity and end organ damage. AREAS COVERED In this review, we challenge the concept of observation as the best option of therapy in SMM. We present current data on diagnosis, prognostic factors of disease progression and studies that have been conducted to date to determine whether earlier therapeutic interventions will lead to an improvement in overall survival of patients with MM. EXPERT OPINION If the recommendations of treatment of SMM were to change, the scientific body of evidence would have to overcome four major hurdles: to demonstrate that early intervention leads to prolonged survival and delay in development of end organ damage, that it does not have long-term toxicities, that it is implemented in patients with a high-likelihood of developing myeloma and that it does not lead to the outgrowth of more resistant clones. Only well-designed clinical trials will determine whether cure can be achieved with earlier interventions.
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