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Razzouk R, Khattab N, Hoteit M, Kfoury H, Saleh M, Tanios B, El-Cheikh J, Mallat S. A rare case of IgA lambda multiple myeloma in a 32-year-old woman with t(14;16) translocation associated with kidney injury and non-albumin proteinuria. BMC Nephrol 2024; 25:165. [PMID: 38755555 PMCID: PMC11100155 DOI: 10.1186/s12882-024-03600-3] [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: 12/06/2023] [Accepted: 05/06/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Multiple myeloma (MM) is a malignant disorder characterized by monoclonal differentiated plasma cells. While it is more commonly diagnosed in elderly individuals, it can also affect younger populations, though with a lower incidence. CASE PRESENTATION Here, we present the case of a 32-year-old woman diagnosed with IgA lambda MM. She presented with fatigue, nausea, acute kidney injury (AKI) with a rapid increase in creatinine, and anemia. A kidney biopsy was done to rule out a rapidly progressive glomerular disease and a diagnosis was thus reached. A genetic workup revealed t(14;16) translocation and an extra copy of TP53. The patient received aggressive intravenous steroids and intravenous fluid resuscitation, resulting in an improvement in renal function. Treatment with daratumumab in combination with bortezomib, thalidomide, and dexamethasone was initiated and well tolerated. Despite the generally poor prognosis of IgA MM, our case emphasizes the importance of considering MM in young patients with unexplained kidney injury. CONCLUSION Early recognition and prompt intervention are essential in managing MM patients, especially in those with high-risk cytogenetic abnormalities. This case serves as a reminder for clinicians to maintain a high index of suspicion for MM, even in younger populations, when presented with unexplained kidney injury.
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Affiliation(s)
- Ranim Razzouk
- Department of Internal Medicine, Division of Nephrology and Hypertension, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nour Khattab
- Department of Internal Medicine, Division of Nephrology and Hypertension, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maysaa Hoteit
- Department of Internal Medicine, Division of Nephrology and Hypertension, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hala Kfoury
- Department of Pathology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mustafa Saleh
- Division of Hematology/Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Bassem Tanios
- Department of Internal Medicine, Division of Nephrology and Hypertension, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jean El-Cheikh
- Division of Hematology/Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Samir Mallat
- Department of Internal Medicine, Division of Nephrology and Hypertension, American University of Beirut Medical Center, Beirut, Lebanon.
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Xu L, Wu S. New diagnostic strategy for multiple myeloma: A review. Medicine (Baltimore) 2023; 102:e36660. [PMID: 38206744 PMCID: PMC10754592 DOI: 10.1097/md.0000000000036660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 11/22/2023] [Indexed: 01/13/2024] Open
Abstract
Multiple myeloma (MM) is the second most prevalent hematological malignancy and is distinguished by the aberrant proliferation of monoclonal plasma cells inside the bone marrow and production of M-protein. This condition frequently results in bone deterioration, acute kidney damage, anemia, and hypercalcemia. However, the clinical manifestations and accompanying symptoms of MM vary and may change as the condition evolves. Therefore, diagnosis of MM is difficult. At present, the confirmation of MM diagnosis necessitates the use of bone marrow biopsy, a procedure that is both invasive and challenging for assessing dynamic alterations in the disease. The integration of laboratory testing technologies with imaging technology has the potential to enhance the diagnostic effectiveness and provide a thorough evaluation of disease progression and prognosis in patients with MM. All the examination methods have advantages and disadvantages. Therefore, diagnosis is determined by the application of clinical characteristics, serological tests, and imaging investigations.
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Affiliation(s)
- Ligong Xu
- Department of Radiology, The First Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Shuang Wu
- Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
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3
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Gibson S, Thornton J, Sunderland K, Pham K, DeStefano C. Multiple Myeloma in Adolescent and Young Adults: An ASCO CancerLinQ and SEER Analysis. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2023; 23:e335-e340. [PMID: 37541820 DOI: 10.1016/j.clml.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/05/2023] [Accepted: 07/12/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND Multiple myeloma (MM) is exceedingly rare in adolescents and young adults (AYAs) < 45 years of age. METHODS Real-world data from ASCO's CancerLinQ DiscoveryⓇ (CLQD) MM dataset and SEER were utilized to characterize demographics and outcomes of AYA MM patients in the United States in the modern treatment era. Frequencies of SPMs, VTEs, and infections were assessed, as were OS and cause of death. RESULTS A total of 1946 AYA MM patients from SEER and 1334 from CancerLinQ were included. In terms of SPMs, AYAs were more likely to develop ALL (RR 2.6, P = .003) and AML (RR 1.7, P = .034), and less likely to develop nonmelanoma skin cancer (RR 0.2, P = .001) and prostate cancer (RR 0.1, P = .013) than MM patients ≥ 45. AYAs were at lower risk of VTE (RR 0.75, P = .002) and slightly higher risk of infections (RR 1.11, P = .002). Median OS among AYA MM patients was significantly longer than MM patients ≥ 45 in both datasets. In the SEER cohort, female sex (HR 0.74, P = .003), non-Hispanic ethnicity (HR 0.73, P = .005), and annual household income ≥ $65,000 per year (HR 0.67, P = .001) were associated with lower hazards of mortality. In the CLQD cohort, OS was significantly influenced by female sex (HR 0.6, P = .048). Race did not have a statistically significant impact OS in either cohort. Most AYAs died of MM (68.3%), other primary malignancy (7.5%, mostly leukemia), and cardiovascular events (5.2%). Infections accounted for 3.2% of deaths. CONCLUSION This analysis highlights some unique characteristics of AYA MM patients in the United States in the modern era.
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Affiliation(s)
- Steven Gibson
- Department of Hematology/Oncology, Walter Reed National Military Medical Center, Bethesda, MD
| | - Jennifer Thornton
- Clinical Investigation Facility, David Grant USAF Medical Center, Fairfield, CA; Ripple Effect, Rockville, MD
| | - Kevin Sunderland
- Clinical Investigation Facility, David Grant USAF Medical Center, Fairfield, CA; Ripple Effect, Rockville, MD
| | - Kevin Pham
- Clinical Investigation Facility, David Grant USAF Medical Center, Fairfield, CA
| | - Christin DeStefano
- Department of Hematology/Oncology, Walter Reed National Military Medical Center, Bethesda, MD.
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4
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Martínez-Cordero H, Peña C, Schutz NP, Bove V, Villano F, Beltran C, Donoso J, López-Vidal H, Roa Salinas MA, Soto P, Ochoa P, Duarte P, Remaggi G, Corzo A, Shanley C, Lopresti S, Orlando S, Verri V, Quiroga LD, Fantl D, Ramirez J, Ospina-Idárraga A, Idrobo H, Quintero G, Gomez R, Cantú-Martínez O, Gomez-Almaguer D, Ruiz-Arguelles GJ, Galvez-Cárdenas KM, Salazar LA, Novoa-Caicedo I, Fuentes-Lacouture MC, Spirko P, Arbeláez MI, Pereira M, Valdes J, Vasquez J, von Glasenapp A, Riva E. Patients Age 40 Years and Younger With Multiple Myeloma Have the Same Prognosis as Older Patients: An Analysis of Real-World Patients' Evidence From Latin America. JCO Glob Oncol 2023; 9:e2300182. [PMID: 38060975 PMCID: PMC10723854 DOI: 10.1200/go.23.00182] [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: 06/06/2023] [Accepted: 09/28/2023] [Indexed: 12/17/2023] Open
Abstract
PURPOSE Multiple myeloma (MM) is a highly heterogeneous, incurable disease most frequently diagnosed in the elderly. Therefore, data on clinical characteristics and outcomes in the very young population are scarce. PATIENTS AND METHODS We analyzed clinical characteristics, response to treatment, and survival in 103 patients with newly diagnosed MM age 40 years or younger compared with 256 patients age 41-50 years and 957 patients age 51 years or older. RESULTS There were no statistical differences in sex, isotype, International Scoring System, renal involvement, hypercalcemia, anemia, dialysis, bony lesions, extramedullary disease, and lactate dehydrogenase (LDH). The most used regimen in young patients was cyclophosphamide, bortezomib, dexamethasone, followed by cyclophosphamide, thalidomide, dexamethasone and bortezomib, thalidomide, dexamethasone. Of the patients age 40 years or younger, only 53% received autologous stem-cell transplant (ASCT) and 71.1% received maintenance. There were no differences in overall survival (OS) in the three patient cohorts. In the multivariate analysis, only high LDH, high cytogenetic risk, and ASCT were statistically associated with survival. CONCLUSION In conclusion, younger patients with MM in Latin America have similar clinical characteristics, responses, and OS compared with the elderly.
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Affiliation(s)
- Humberto Martínez-Cordero
- Instituto Nacional de Cancerología de Colombia, Bogotá, Colombia
- Hospital Militar Central, Bogotá, Colombia
| | - Camila Peña
- Departamento de Hematología, Hospital Del Salvador, Santiago, Chile
| | | | | | | | | | | | | | | | - Pablo Soto
- Hospital Dr. Eduardo Schütz Schroeder, Puerto Montt, Chile
| | - Paola Ochoa
- Instituto Alexander Fleming, Munro, Argentina
| | | | | | - Ariel Corzo
- Hospital de Clínicas, Buenos Aires, Argentina
| | | | | | - Sergio Orlando
- Hospital Universitario Del Valle Evaristo García E.S.E, Cali, Colombia
| | | | | | - Dorotea Fantl
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | - Henry Idrobo
- Hospital Universitario Del Valle Evaristo García E.S.E, Cali, Colombia
| | | | | | - Omar Cantú-Martínez
- Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, México
| | | | | | | | | | | | | | - Paola Spirko
- Instituto Nacional de Cancerología de Colombia, Bogotá, Colombia
| | | | - Mario Pereira
- Instituto Nacional de Cancerología de Colombia, Bogotá, Colombia
| | - Jaime Valdes
- Instituto Nacional de Cancerología de Colombia, Bogotá, Colombia
| | - Jule Vasquez
- Instituto Nacional De Enfermedades Neoplásicas, Lima, Perú
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Pasvolsky O, Marcoux C, Milton DR, Tanner MR, Bashir Q, Srour S, Saini N, Lin P, Ramdial J, Nieto Y, Lee HC, Patel KK, Kebriaei P, Tewari P, Crawford-Suber L, Thomas SK, Weber DM, Orlowski RZ, Shpall EJ, Champlin RE, Qazilbash MH. Outcomes of young adults (aged ≤ 40 years) with newly diagnosed multiple myeloma after up-front autologous stem cell transplant. Br J Haematol 2023; 202:866-873. [PMID: 37376789 PMCID: PMC10527395 DOI: 10.1111/bjh.18944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/06/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023]
Abstract
Multiple myeloma (MM) primarily affects older patients. There are scarce data on the outcomes of young adults undergoing autologous transplantation (auto-HCT). In this single-centre analysis, we included 117 younger patients, with a median age of 37 years (range 22-40) at transplant. Seventeen (15%) patients had high-risk cytogenetics. Before transplant, 10% of patients achieved ≥CR and 44% achieved ≥VGPR. At best post-transplant response, 56% and 77% of patients achieved ≥CR and ≥VGPR respectively. With a median follow-up for survivors of 72.6 months (range 0.9-238.0), median PFS and OS were 43.1 months (95% CI 31.2-65.0) and 146.6 months (95% CI 100.0-208.1) respectively. Patients who underwent auto-HCT after 2010 had better median PFS (84.9 months vs. 28.2 months, p < 0.001) and OS (NR vs. 91.8 months, p < 0.001) compared with those transplanted earlier. In multi-variate analysis, achieving ≥CR as best post-transplant response was associated with improved PFS (HR [95% CI] 0.55 [0.32-0.95], p = 0.032), while achieving ≥VGPR was predictive of superior OS (0.32 [0.16-0.62], p < 0.001). Three patients (3%) developed a second primary malignancy. Younger MM patients had durable survival after auto-HCT, which further improved after the availability of novel anti-myeloma drugs in recent years. Depth of response following transplant remains a key predictor of survival.
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Affiliation(s)
- Oren Pasvolsky
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Curtis Marcoux
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Denái R. Milton
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mark R. Tanner
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Qaiser Bashir
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Samer Srour
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Neeraj Saini
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Paul Lin
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeremy Ramdial
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yago Nieto
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hans C. Lee
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Krina K. Patel
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Partow Kebriaei
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Priti Tewari
- Department of Pediatrics Patient Care, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lindsay Crawford-Suber
- Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas
| | - Sheeba K. Thomas
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Donna M. Weber
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Robert Z. Orlowski
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Elizabeth J. Shpall
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Richard E. Champlin
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Muzaffar H. Qazilbash
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Oriol A, Abril L, Ibarra G. First-line treatment of multiple myeloma in both transplant and non-transplant candidates. Expert Rev Anticancer Ther 2023; 23:685-698. [PMID: 37194283 DOI: 10.1080/14737140.2023.2213891] [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: 02/21/2023] [Accepted: 05/10/2023] [Indexed: 05/18/2023]
Abstract
INTRODUCTION The last decade's progress in the treatment of newly diagnosed multiple myeloma has relied on the synergistic combination of agents with different mechanisms of action, basically proteasome inhibitors, immunomodulatory agents, and monoclonal antibodies, in order to achieve the deepest possible response early in the course of treatment. Following induction, several therapeutic strategies aim to improve and maintain response. AREAS COVERED The manuscript reviews available data for the treatment of newly diagnosed multiple myeloma patients with a focus on most recent induction and maintenance combinations and the still important role of autologous stem transplantation. Future perspectives in the light of initial results from ongoing clinical trials are also addressed. EXPERT OPINION Remarkable progress has been made in myeloma treatment due to the integration of immunomodulators, proteasome inhibitors, monoclonal antibodies, and high dose therapy in the frontline setting. Upfront therapy may be further improved intensifying induction combinations, adapting high dose therapy and consolidation strategies to the patient's profile, improving maintenance in high-risk individuals, or limiting maintenance duration in those with a better prognosis. Evidence needs to be reviewed, taking into account the therapeutic objectives at each treatment stage and patient specific risk factors.
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Affiliation(s)
- Albert Oriol
- Institut Català d'Oncologia and Institut Josep Carreras. Hospital Germans Trias i Pujol, Carretera del Canyet, Barcelona, Spain
| | - Laura Abril
- Institut Català d'Oncologia and Institut Josep Carreras. Hospital Germans Trias i Pujol, Carretera del Canyet, Barcelona, Spain
| | - Gladys Ibarra
- Institut Català d'Oncologia and Institut Josep Carreras. Hospital Germans Trias i Pujol, Carretera del Canyet, Barcelona, Spain
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Tanguay M, Dagenais C, LeBlanc R, Ahmad I, Claveau JS, Roy J. Young Myeloma Patients: A Systematic Review of Manifestations and Outcomes. Curr Oncol 2023; 30:5214-5226. [PMID: 37366879 DOI: 10.3390/curroncol30060396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/15/2023] [Accepted: 05/18/2023] [Indexed: 06/28/2023] Open
Abstract
Multiple myeloma usually affects older adults. However, younger patients constitute a significant subset as approximately 10% of cases occur in subjects younger than 50 years old. Young patients, who are underrepresented in the literature, are diagnosed during their most productive years of life, urging the need for tailored treatment approaches. This literature review aims to report recent studies specifically addressing young patients with a focus on characteristics at diagnosis, cytogenetics, treatments, and outcomes. We searched PubMed for studies involving young patients with multiple myeloma ≤50 years old. The time span of our literature review search was from 1 January 2010 to 31 December 2022. Overall, 16 retrospective studies were analyzed for this review. Young patients with multiple myeloma tend to have less advanced disease, more frequent light chain subtypes, and survive longer compared to their older counterparts. However, available studies included a limited number of patients; the newest revised international staging system was not used to stratify patients, cytogenetics varied from one cohort to another, and most patients did not receive contemporary triplet/quadruplet treatments. This review emphasizes the need to perform contemporary, large-scale retrospective studies to improve knowledge regarding the presentation and outcomes of young myeloma patients in the era of modern treatments.
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Affiliation(s)
- Mégane Tanguay
- Institut Universitaire d'Hémato-Oncologie et de Thérapie Cellulaire, Hôpital Maisonneuve-Rosemont, 5415 de l'Assomption, Montreal, QC H1T 2M4, Canada
- Departement of Medicine, Université de Montréal, 2900 Édouard-Montpetit, Montreal, QC H3T 1J4, Canada
| | - Christophe Dagenais
- Departement of Medicine, Université de Montréal, 2900 Édouard-Montpetit, Montreal, QC H3T 1J4, Canada
- Service de Médecine Interne, Hôpital Notre-Dame, 1560 Sherbrooke Est, Montreal, QC H2L 4M1, Canada
| | - Richard LeBlanc
- Institut Universitaire d'Hémato-Oncologie et de Thérapie Cellulaire, Hôpital Maisonneuve-Rosemont, 5415 de l'Assomption, Montreal, QC H1T 2M4, Canada
- Departement of Medicine, Université de Montréal, 2900 Édouard-Montpetit, Montreal, QC H3T 1J4, Canada
| | - Imran Ahmad
- Institut Universitaire d'Hémato-Oncologie et de Thérapie Cellulaire, Hôpital Maisonneuve-Rosemont, 5415 de l'Assomption, Montreal, QC H1T 2M4, Canada
- Departement of Medicine, Université de Montréal, 2900 Édouard-Montpetit, Montreal, QC H3T 1J4, Canada
| | - Jean-Sébastien Claveau
- Institut Universitaire d'Hémato-Oncologie et de Thérapie Cellulaire, Hôpital Maisonneuve-Rosemont, 5415 de l'Assomption, Montreal, QC H1T 2M4, Canada
- Departement of Medicine, Université de Montréal, 2900 Édouard-Montpetit, Montreal, QC H3T 1J4, Canada
| | - Jean Roy
- Institut Universitaire d'Hémato-Oncologie et de Thérapie Cellulaire, Hôpital Maisonneuve-Rosemont, 5415 de l'Assomption, Montreal, QC H1T 2M4, Canada
- Departement of Medicine, Université de Montréal, 2900 Édouard-Montpetit, Montreal, QC H3T 1J4, Canada
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8
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Hajji M, Barbouch S, Goucha R, Abderrahim E. Multiple Myeloma in a Young Adult with Renal Involvement. Clin Case Rep 2023; 11:e6986. [PMID: 36852120 PMCID: PMC9957701 DOI: 10.1002/ccr3.6986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 04/06/2022] [Accepted: 01/23/2023] [Indexed: 02/27/2023] Open
Abstract
Multiple myeloma (MM) results from malignant plasma cell disorder. It represents approximately 10% of hematological malignancies and it is typically diagnosed in the elderly with a median age of 70 years and has a steep increase in incidence with advancing age. N Engl J Med. 2004, 1860; Clin Interv Aging. 2020, 619. The incidence of MM has been increasing over time, mostly due to population aging. Mayo Clin Proc. 2010, 225 However, certain MMs are diagnosed at young age even under 40 years old (2%). Leuk Lymphoma. 1998, 493; Blood. 2010, 5501. We report a case of a MM in a thirty-four-year-old woman whose circumstance of discovery was acute kidney failure.
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Affiliation(s)
- Meriam. Hajji
- Department of Medecine ACharles Nicolle HospitalTunisTunisia,Laboratory of renal pathology LR00SP01TunisTunisia,Faculty of Medecine of TunisTunis El Manar UniversityTunisTunisia
| | - Samia. Barbouch
- Department of Medecine ACharles Nicolle HospitalTunisTunisia,Laboratory of renal pathology LR00SP01TunisTunisia,Faculty of Medecine of TunisTunis El Manar UniversityTunisTunisia
| | - Rim. Goucha
- Laboratory of renal pathology LR00SP01TunisTunisia,Faculty of Medecine of TunisTunis El Manar UniversityTunisTunisia
| | - Ezzeddine. Abderrahim
- Department of Medecine ACharles Nicolle HospitalTunisTunisia,Laboratory of renal pathology LR00SP01TunisTunisia,Faculty of Medecine of TunisTunis El Manar UniversityTunisTunisia
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9
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Mehta PH, Fiorenza S, Koldej RM, Jaworowski A, Ritchie DS, Quinn KM. T Cell Fitness and Autologous CAR T Cell Therapy in Haematologic Malignancy. Front Immunol 2021; 12:780442. [PMID: 34899742 PMCID: PMC8658247 DOI: 10.3389/fimmu.2021.780442] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/05/2021] [Indexed: 12/14/2022] Open
Abstract
A range of emerging therapeutic approaches for the treatment of cancer aim to induce or augment endogenous T cell responses. Chimeric antigen receptor (CAR) T cell therapy (CTT) is one such approach that utilises the patient’s own T cells, engineered ex vivo to target cell surface antigens, to eliminate haematological malignancies. Despite mediating high rates of responses in some clinical trials, this approach can be limited by dysfunctional T cells if they are present at high frequencies either in the starting material from the patient or the CAR T cell product. The fitness of an individual’s T cells, driven by age, chronic infection, disease burden and cancer treatment, is therefore likely to be a crucial limiting factor of CTT. Currently, T cell dysfunction and its impact on CTT is not specifically quantified when patients are considering the therapy. Here, we review our current understanding of T cell fitness for CTT, how fitness may be impacted by age, chronic infection, malignancy, and treatment. Finally, we explore options to specifically tailor clinical decision-making and the CTT protocol for patients with more extensive dysfunction to improve treatment efficacy. A greater understanding of T cell fitness throughout a patient’s treatment course could ultimately be used to identify patients likely to achieve favourable CTT outcomes and improve methods for T cell collection and CTT delivery.
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Affiliation(s)
- Palak H Mehta
- School of Health and Biomedical Sciences, Royal Melbourne Institute of Technology (RMIT) University, Bundoora, VIC, Australia
| | - Salvatore Fiorenza
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Rachel M Koldej
- Australian Cancer Research Foundation (ACRF) Translational Laboratory, Royal Melbourne Hospital, Melbourne, VIC, Australia.,Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Anthony Jaworowski
- School of Health and Biomedical Sciences, Royal Melbourne Institute of Technology (RMIT) University, Bundoora, VIC, Australia
| | - David S Ritchie
- Australian Cancer Research Foundation (ACRF) Translational Laboratory, Royal Melbourne Hospital, Melbourne, VIC, Australia.,Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Kylie M Quinn
- School of Health and Biomedical Sciences, Royal Melbourne Institute of Technology (RMIT) University, Bundoora, VIC, Australia.,Department of Biochemistry, Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia
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10
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LeBlanc R, Ahmad I, Terra R, Boudreault JS, Ogez D, Lamore K, Delisle JS, Bambace N, Bernard L, Cohen S, Kiss T, Lachance S, Landais S, Lemieux-Blanchard É, Sauvageau G, Sebag M, Roy DC, Roy J. Outcomes in newly diagnosed young or high-risk myeloma patients receiving tandem autologous/allogeneic transplant followed by bortezomib maintenance: a phase II study. Bone Marrow Transplant 2021; 57:252-260. [PMID: 34845367 DOI: 10.1038/s41409-021-01532-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 10/29/2021] [Accepted: 11/15/2021] [Indexed: 01/14/2023]
Abstract
Despite novel drugs and autologous HCT, MM remains incurable, with short survival in patients with poor biological characteristics. Allo HCT may be curative in some patients but is hampered by high rates of toxicity and relapse. We hypothesized that bortezomib (BTZ), with its anti-myeloma and immunologic properties, could improve PFS and cGVHD after allo HCT in newly diagnosed MM patients. In this prospective phase II study, we included 39 young (≤50 years) and high-risk patients who received a tandem auto-allo HCT followed by BTZ. Patients had prospective minimal residual disease (MRD) evaluations using Next-Generation Flow cytometry prior to allo HCT, prior BTZ and every 3 months for 2 years. With a median follow-up of 48 months, we report PFS and OS at 5 years of 41% and 80%, with a non-relapse mortality of 12%. Incidences of grade II-IV aGVHD at 12 months and moderate/severe cGVHD at 2 years were 26% and 57%. In a multivariate analysis model including cytogenetics, ISS and MRD status, MRD positivity prior to allo HCT (HR 3.75, p = 0.037), prior BTZ (HR 11.3, p = 0.018) and 3 months post-BTZ initiation (HR 9.7, p = 0.001) was highly predictive of progression. Peritransplant MRD assessment thus strongly predicts disease progression.
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Affiliation(s)
- Richard LeBlanc
- Division of Hematology, Oncology and Transplantation, Hôpital Maisonneuve-Rosemont, Department of Medicine/Université de Montréal, Montreal, QC, Canada.
| | - Imran Ahmad
- Division of Hematology, Oncology and Transplantation, Hôpital Maisonneuve-Rosemont, Department of Medicine/Université de Montréal, Montreal, QC, Canada
| | - Rafik Terra
- Division of Hematology, Oncology and Transplantation, Hôpital Maisonneuve-Rosemont, Montreal, QC, Canada
| | - Jean-Samuel Boudreault
- Division of Hematology and Oncology, Hôpital du Sacré-Coeur, Department of Medicine/Université de Montréal, Montreal, QC, Canada
| | - David Ogez
- Chronic Pain Clinic, Hôpital Maisonneuve-Rosemont, Department of Anesthesiology and Pain Medicine/Université de Montréal, Montreal, QC, Canada
| | - Kristopher Lamore
- Laboratoire de psychopathologie et processus de santé, Université de Paris, Paris, Boulogne-Billancourt, France
| | - Jean-Sébastien Delisle
- Division of Hematology, Oncology and Transplantation, Hôpital Maisonneuve-Rosemont, Department of Medicine/Université de Montréal, Montreal, QC, Canada
| | - Nadia Bambace
- Division of Hematology, Oncology and Transplantation, Hôpital Maisonneuve-Rosemont, Department of Medicine/Université de Montréal, Montreal, QC, Canada
| | - Léa Bernard
- Division of Hematology, Oncology and Transplantation, Hôpital Maisonneuve-Rosemont, Department of Medicine/Université de Montréal, Montreal, QC, Canada
| | - Sandra Cohen
- Division of Hematology, Oncology and Transplantation, Hôpital Maisonneuve-Rosemont, Department of Medicine/Université de Montréal, Montreal, QC, Canada
| | - Thomas Kiss
- Division of Hematology, Oncology and Transplantation, Hôpital Maisonneuve-Rosemont, Department of Medicine/Université de Montréal, Montreal, QC, Canada
| | - Silvy Lachance
- Division of Hematology, Oncology and Transplantation, Hôpital Maisonneuve-Rosemont, Department of Medicine/Université de Montréal, Montreal, QC, Canada
| | - Séverine Landais
- Division of Hematology, Oncology and Transplantation, Hôpital Maisonneuve-Rosemont, Montreal, QC, Canada
| | - Émilie Lemieux-Blanchard
- Division of Hematology and Oncology, Centre Hospitalier de l'Université de Montréal, Department of Medicine/Université de Montréal, Montreal, QC, Canada
| | - Guy Sauvageau
- Division of Hematology, Oncology and Transplantation, Hôpital Maisonneuve-Rosemont, Department of Medicine/Université de Montréal, Montreal, QC, Canada
| | - Michael Sebag
- Division of Hematology, McGill University Health Center, Department of Medicine/McGill University, Montreal, QC, Canada
| | - Denis Claude Roy
- Division of Hematology, Oncology and Transplantation, Hôpital Maisonneuve-Rosemont, Department of Medicine/Université de Montréal, Montreal, QC, Canada
| | - Jean Roy
- Division of Hematology, Oncology and Transplantation, Hôpital Maisonneuve-Rosemont, Department of Medicine/Université de Montréal, Montreal, QC, Canada
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