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Wagner CB, Julian K, Bryan B, Steinbach MN, Shewan S, Maxwell L, Vigil M, Mohyuddin GR, Godara A, McClune B, Galarza Fortuna G, Sborov D. Novel chemotherapy combination of carfilzomib with dexamethasone, cyclophosphamide, etoposide and cisplatin (K-DCEP) for the treatment of relapsed/refractory aggressive plasma cell dyscrasias. Leuk Lymphoma 2024; 65:1362-1365. [PMID: 38824620 DOI: 10.1080/10428194.2024.2350670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/26/2024] [Accepted: 04/27/2024] [Indexed: 06/04/2024]
Affiliation(s)
- Charlotte B Wagner
- Department of Pharmacy, University of Utah Hospitals and Clinics, Huntsman Cancer Institute, UT, USA
| | - Kelley Julian
- Department of Pharmacy, University of Utah Hospitals and Clinics, Huntsman Cancer Institute, UT, USA
| | - Baylee Bryan
- Department of Pharmacy, University of Utah Hospitals and Clinics, Huntsman Cancer Institute, UT, USA
| | - Mary N Steinbach
- Internal Medicine, University of Utah Health Huntsman Cancer Institute, UT, USA
| | - Samuel Shewan
- Internal Medicine, University of Utah Health Huntsman Cancer Institute, UT, USA
| | - Lindsay Maxwell
- Internal Medicine, University of Utah Health Huntsman Cancer Institute, UT, USA
| | - Meghan Vigil
- Internal Medicine, University of Utah Health Huntsman Cancer Institute, UT, USA
| | | | - Amandeep Godara
- Internal Medicine, University of Utah Health Huntsman Cancer Institute, UT, USA
| | - Brian McClune
- Internal Medicine, University of Utah Health Huntsman Cancer Institute, UT, USA
| | | | - Douglas Sborov
- Internal Medicine, University of Utah Health Huntsman Cancer Institute, UT, USA
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Han X, Jiang X, He J, Zheng G, Xiong Y, Wen Y, Yang Y, He D, Chen Q, Zhao Y, Li Y, Wu W, Cai Z. Clinical outcomes of pomalidomide-based and daratumumab-based therapies in patients with relapsed/refractory multiple myeloma: A real-world cohort study in China. Cancer Med 2024; 13:e7232. [PMID: 38698679 PMCID: PMC11066492 DOI: 10.1002/cam4.7232] [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: 01/18/2024] [Revised: 04/14/2024] [Accepted: 04/18/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Comparative investigations evaluating the efficacy of pomalidomide-based (Pom-based) versus daratumumab-based (Dara-based) therapies in patients with relapsed/refractory multiple myeloma (RRMM) remain scarce, both in randomized controlled trials and real-world studies. METHODS This retrospective cohort study included 140 RRMM patients treated with Pom-based or Dara-based or a combination of pomalidomide and daratumumab (DPd) regimens in a Chinese tertiary hospital between December 2018 and July 2023. RESULTS The overall response rates (ORR) for Pom-based (n = 48), Dara-based (n = 68), and DPd (n = 24) groups were 57.8%, 84.6%, and 75.0%, respectively (p = 0.007). At data cutoff on August 1, 2023, the median progression-free survival (PFS) was 5.7 months (95% CI: 5.0-6.5) for the Pom-based group, 10.5 months (5.2-15.8) for the Dara-based group, and 6.7 months (4.0-9.3) for the DPd group (p = 0.056). Multivariate analysis identified treatment regimens (Dara-based vs. Pom-based, DPd vs. Pom-based) and Eastern Cooperative Oncology Group performance status (ECOG PS) as independent prognostic factors for PFS. In the subgroups of patients aged >65 years, with ECOG PS ≥2, lines of therapy ≥2, extramedullary disease or double-refractory disease (refractory to both lenalidomide and proteasome inhibitors), the superiority of Dara-based regimens over Pom-based regimens was not evident. A higher incidence of infections was observed in patients receiving Dara-based and DPd regimens (Pom-based 39.6% vs. Dara-based 64.7% vs. DPd 70.8%, p = 0.009). CONCLUSIONS In real-world settings, Pom-based, Dara-based, and DPd therapies exhibited favorable efficacy in patients with RRMM. Dara-based therapy yielded superior clinical response and PFS compared to Pom-based therapy.
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Affiliation(s)
- Xiaoyan Han
- Department of Hematology and Bone Marrow Transplantation CenterThe First Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhouZhejiangChina
| | - Xincheng Jiang
- Department of Hematology and Bone Marrow Transplantation CenterThe First Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhouZhejiangChina
| | - Jingsong He
- Department of Hematology and Bone Marrow Transplantation CenterThe First Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhouZhejiangChina
| | - Gaofeng Zheng
- Department of Hematology and Bone Marrow Transplantation CenterThe First Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhouZhejiangChina
| | - Yaqin Xiong
- Department of Hematology and Bone Marrow Transplantation CenterThe First Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhouZhejiangChina
| | - Yanling Wen
- Department of Hematology and Bone Marrow Transplantation CenterThe First Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhouZhejiangChina
| | - Yang Yang
- Department of Hematology and Bone Marrow Transplantation CenterThe First Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhouZhejiangChina
| | - Donghua He
- Department of Hematology and Bone Marrow Transplantation CenterThe First Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhouZhejiangChina
| | - Qingxiao Chen
- Department of Hematology and Bone Marrow Transplantation CenterThe First Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhouZhejiangChina
| | - Yi Zhao
- Department of Hematology and Bone Marrow Transplantation CenterThe First Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhouZhejiangChina
| | - Yi Li
- Department of Hematology and Bone Marrow Transplantation CenterThe First Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhouZhejiangChina
| | - Wenjun Wu
- Department of Hematology and Bone Marrow Transplantation CenterThe First Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhouZhejiangChina
| | - Zhen Cai
- Department of Hematology and Bone Marrow Transplantation CenterThe First Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhouZhejiangChina
- Institute of Hematology, Zhejiang UniversityHangzhouZhejiangChina
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Wadhera S, Jain A, Mitra S, Malhotra P. Extramedullary relapse of multiple myeloma presenting as space-occupying lesion in liver treated with daratumumab, pomalidomide, dexamethasone and bendamustine. BMJ Case Rep 2024; 17:e257346. [PMID: 38627054 PMCID: PMC11029303 DOI: 10.1136/bcr-2023-257346] [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] [Indexed: 04/19/2024] Open
Abstract
Extramedullary relapse in patients with multiple myeloma (MM) is often associated with loss of biochemical response and the appearance of measurable residual disease in the bone marrow. Fever is an unusual presenting manifestation of MM. Treatment of extramedullary relapse in patients progressing on proteasome inhibitors, anti-CD38 monoclonal antibodies and immunomodulatory drugs is challenging, as access to chimeric antigen receptor T-cells and bispecific antibodies is limited. We report a case of relapsed MM who presented with fever and hepatic space-occupying lesion mimicking hepatocellular carcinoma. In this case report, we also present our experience of using a novel combination regimen comprising Dara-Pom-Benda-Dexa (daratumumab, pomalidomide, dexamethasone and bendamustine) for relapsed MM.
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Affiliation(s)
- Sarthak Wadhera
- Clinical Hematology and Medical Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Arihant Jain
- Clinical Hematology and Medical Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Suvradeep Mitra
- Pathology(Histopathology), Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Malhotra
- Clinical Hematology and Medical Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Zhang H, Liu Y, Liu J, Chen J, Wang J, Hua H, Jiang Y. cAMP-PKA/EPAC signaling and cancer: the interplay in tumor microenvironment. J Hematol Oncol 2024; 17:5. [PMID: 38233872 PMCID: PMC10792844 DOI: 10.1186/s13045-024-01524-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/02/2024] [Indexed: 01/19/2024] Open
Abstract
Cancer is a complex disease resulting from abnormal cell growth that is induced by a number of genetic and environmental factors. The tumor microenvironment (TME), which involves extracellular matrix, cancer-associated fibroblasts (CAF), tumor-infiltrating immune cells and angiogenesis, plays a critical role in tumor progression. Cyclic adenosine monophosphate (cAMP) is a second messenger that has pleiotropic effects on the TME. The downstream effectors of cAMP include cAMP-dependent protein kinase (PKA), exchange protein activated by cAMP (EPAC) and ion channels. While cAMP can activate PKA or EPAC and promote cancer cell growth, it can also inhibit cell proliferation and survival in context- and cancer type-dependent manner. Tumor-associated stromal cells, such as CAF and immune cells, can release cytokines and growth factors that either stimulate or inhibit cAMP production within the TME. Recent studies have shown that targeting cAMP signaling in the TME has therapeutic benefits in cancer. Small-molecule agents that inhibit adenylate cyclase and PKA have been shown to inhibit tumor growth. In addition, cAMP-elevating agents, such as forskolin, can not only induce cancer cell death, but also directly inhibit cell proliferation in some cancer types. In this review, we summarize current understanding of cAMP signaling in cancer biology and immunology and discuss the basis for its context-dependent dual role in oncogenesis. Understanding the precise mechanisms by which cAMP and the TME interact in cancer will be critical for the development of effective therapies. Future studies aimed at investigating the cAMP-cancer axis and its regulation in the TME may provide new insights into the underlying mechanisms of tumorigenesis and lead to the development of novel therapeutic strategies.
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Affiliation(s)
- Hongying Zhang
- Cancer Center, Laboratory of Oncogene, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yongliang Liu
- Cancer Center, Laboratory of Oncogene, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Jieya Liu
- Cancer Center, Laboratory of Oncogene, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Jinzhu Chen
- Cancer Center, Laboratory of Oncogene, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Jiao Wang
- School of Basic Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
| | - Hui Hua
- Laboratory of Stem Cell Biology, West China Hospital, Sichuan University, Chengdu, 610041, China.
| | - Yangfu Jiang
- Cancer Center, Laboratory of Oncogene, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, China.
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[Consensus for the diagnosis and management of extramedullary plasmacytoma in China(2024)]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2024; 45:8-17. [PMID: 38527832 PMCID: PMC10951115 DOI: 10.3760/cma.j.cn121090-20231107-00253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Indexed: 03/27/2024]
Abstract
Extramedullary plasmacytoma (EMP) is a special type of malignant plasmacytosis, which is complex and heterogeneous. Most EMP patients have poor prognosis and lack a stratified prognostic system or ideal treatment strategy supported by evidence-based medical evidence, which cannot meet clinical needs. In order to improve the understanding of this disease entity, Plasma Cell Disease Group, Chinese Society of Hematology, Chinese Medical Association and Chinese Myeloma Committee-Chinese Hematology Association developed the "Chinese Expert Consensus on the diagnosis and treatment of extramedullary plasmacytoma", which aims to standardize the clinical diagnosis and treatment of EMP and ultimately improve the overall survival of patients with plasmacytoma.
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Tekinalp A, Gedük A, Akdeniz A, Terzi Demirsoy E, Gürsoy V, Aslaner Ak M, Bağcı M, Seçilmiş S, Keklik Karadağ F, Oruç Uysal A, Doğan A, Demircioğlu S, Erol HA, Aslan C, Özkalemkaş F, Ertop Ş, Dağlı M, Dal MS, Saydam G, Merter M, Ural C, Çeneli Ö. Experience of Daratumumab in Relapsed/Refractory Multiple Myeloma: A Multicenter Study from Türkiye. Turk J Haematol 2023; 40:242-250. [PMID: 37961952 PMCID: PMC10701322 DOI: 10.4274/tjh.galenos.2023.2023.0029] [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: 01/18/2023] [Accepted: 11/13/2023] [Indexed: 11/15/2023] Open
Abstract
Objective This study aimed to evaluate patients with relapsed/refractory multiple myeloma (RRMM) who underwent daratumumab (DARA) therapy. Materials and Methods This multicenter retrospective study included 134 patients who underwent at least two courses of DARA from February 1, 2018, to April 15, 2022. Epidemiological, disease, and treatment characteristics of patients and treatment-related side effects were evaluated. Survival analysis was performed. Results The median age at the start of DARA was 60 (range: 35-88), with 56 patients (41.8%) being female and 48 (58.2%) being male. The median time to initiation of DARA and the median follow-up time were 41.2 (5.1-223) and 5.7 (2.1-24.1) months, respectively. The overall response rate after DARA therapy was 75 (55.9%), and very good partial response or better was observed in 48 (35.8%) patients. Overall survival (OS) and progression-free survival (PFS) for all patients were 11.6 (7.8-15.5) and 8.0 (5.1-10.9) months, respectively. OS was higher for patients undergoing treatment with DARA and bortezomib-dexamethasone (DARA-Vd) compared to those undergoing treatment with DARA and lenalidomide-dexamethasone (DARA-Rd) (16.9 vs. 8.3 months; p=0.014). Among patients undergoing DARA-Rd, PFS was higher in those without extramedullary disease compared to those with extramedullary disease (not achieved vs. 3.7 months; odds ratio: 3.4; p<0.001). The median number of prior therapies was 3 (1-8). Initiation of DARA therapy in the early period provided an advantage for OS and PFS, although it was statistically insignificant. Infusion-related reactions were observed in 18 (13.4%) patients. All reactions occurred during the first infusion and most reactions were of grade 1 or 2 (94.5%). The frequency of neutropenia and thrombocytopenia was higher in the DARA-Rd group (61.9% vs. 24.7%, p<0.001 and 42.9% vs. 15.7%, p<0.001). Conclusion Our study provides real-life data in terms of DARA therapy for patients with RRMM and supports the early initiation of DARA therapy.
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Affiliation(s)
- Atakan Tekinalp
- Necmettin Erbakan University Meram Faculty of Medicine, Department of Hematology, Division of Internal Medicine, Konya, Türkiye
| | - Ayfer Gedük
- Kocaeli University Faculty of Medicine, Department of Hematology, Division of Internal Medicine, Kocaeli, Türkiye
| | - Aydan Akdeniz
- Mersin University Faculty of Medicine, Department of Hematology, Division of Internal Medicine, Mersin, Türkiye
| | - Esra Terzi Demirsoy
- University of Health Sciences Türkiye, Derince Training and Research Hospital, Clinic of Hematology, Kocaeli, Türkiye
| | - Vildan Gürsoy
- Bursa City Hospital, Clinic of Hematology, Bursa, Türkiye
| | - Müzeyyen Aslaner Ak
- Bülent Ecevit University Faculty of Medicine, Department of Hematology, Division of Internal Medicine, Zonguldak, Türkiye
| | - Metin Bağcı
- Selçuk University Faculty of Medicine, Department of Hematology, Division of Internal Medicine, Konya, Türkiye
| | - Sema Seçilmiş
- Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Clinic of Hematology, Ankara, Türkiye
| | - Fatma Keklik Karadağ
- Ege University Faculty of Medicine, Department of Hematology, Division of Internal Medicine, İzmir, Türkiye
| | - Ayşe Oruç Uysal
- Fırat University Faculty of Medicine, Department of Hematology, Division of Internal Medicine, Elazığ, Türkiye
| | - Ali Doğan
- Van Yüzüncü Yıl University Faculty of Medicine, Department of Hematology, Division of Internal Medicine, Van, Türkiye
| | - Sinan Demircioğlu
- Necmettin Erbakan University Meram Faculty of Medicine, Department of Hematology, Division of Internal Medicine, Konya, Türkiye
| | - Haşim Atakan Erol
- Kocaeli University Faculty of Medicine, Department of Hematology, Division of Internal Medicine, Kocaeli, Türkiye
| | - Ceyda Aslan
- University of Health Sciences Türkiye, Derince Training and Research Hospital, Clinic of Hematology, Kocaeli, Türkiye
| | - Fahir Özkalemkaş
- Bursa Uludağ University Faculty of Medicine, Department of Hematology, Division of Internal Medicine, Bursa, Türkiye
| | - Şehmus Ertop
- Bülent Ecevit University Faculty of Medicine, Department of Hematology, Division of Internal Medicine, Zonguldak, Türkiye
| | - Mehmet Dağlı
- Selçuk University Faculty of Medicine, Department of Hematology, Division of Internal Medicine, Konya, Türkiye
| | - Mehmet Sinan Dal
- Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Clinic of Hematology, Ankara, Türkiye
| | - Güray Saydam
- Ege University Faculty of Medicine, Department of Hematology, Division of Internal Medicine, İzmir, Türkiye
| | - Mustafa Merter
- Fırat University Faculty of Medicine, Department of Hematology, Division of Internal Medicine, Elazığ, Türkiye
| | - Cihan Ural
- Van Yüzüncü Yıl University Faculty of Medicine, Department of Hematology, Division of Internal Medicine, Van, Türkiye
| | - Özcan Çeneli
- Necmettin Erbakan University Meram Faculty of Medicine, Department of Hematology, Division of Internal Medicine, Konya, Türkiye
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Stork M, Spicka I, Radocha J, Minarik J, Jelinek T, Jungova A, Pavlicek P, Pospisilova L, Sedlak F, Straub J, Pika T, Knechtova Z, Fidrichova A, Boichuk I, Sevcikova S, Maisnar V, Hajek R, Pour L. Daratumumab with lenalidomide and dexamethasone in relapsed or refractory multiple myeloma patients - real world evidence analysis. Ann Hematol 2023; 102:1501-1511. [PMID: 37088816 PMCID: PMC10182121 DOI: 10.1007/s00277-023-05188-4] [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: 02/14/2023] [Accepted: 03/16/2023] [Indexed: 04/25/2023]
Abstract
We performed real world evidence (RWE) analysis of daratumumab, lenalidomide and dexamethasone (Dara-Rd) versus lenalidomide and dexamethasone (Rd) treatment in relapsed/refractory multiple myeloma patients (RRMM). In total, 240 RRMM patients were treated with Dara-Rd from 2016 to 2022 outside of clinical trials in all major Czech hematology centers. As a reference, 531 RRMM patients treated with Rd were evaluated. Patients' data were recorded in the Czech Registry of Monoclonal Gammopathies (RMG). Partial response (PR) or better response (ORR) was achieved in significantly more patients in Dara-Rd than in Rd group (91.2% vs. 69.9%; p < 0.001). The median progression free survival (PFS) was 26.9 months in the Dara-Rd and 12.8 months in the Rd group (p < 0.001). Median overall survival (OS) was not reached in the Dara-Rd compared to 27.2 months in the Rd group (p = 0.023). In patients with 1-3 previous treatment lines, there was significant PFS benefit of Dara-Rd compared to Rd (median PFS not reached vs. 13.2 months; p < 0.001). In patients with > 3 previous treatment lines, there was no significant PFS benefit of Dara-Rd treatment (7.8 months vs. 9.9 months; p = 0.874), similarly in patients refractory to PI + IMIDs (11.5 months vs. 9.2 months; p = 0.376). In RWE conditions, the median PFS in RRMM patients treated with Dara-Rd is shorter when compared to clinical trials. In heavily pretreated RRMM patients, efficacy of Dara-Rd treatment is limited; best possible outcomes of Dara-Rd are achieved in minimally pretreated patients.
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Affiliation(s)
- Martin Stork
- Department of Internal Medicine, Hematology and Oncology, Faculty of Medicine, University Hospital Brno, Masaryk University, Brno, Czech Republic
| | - Ivan Spicka
- 1st Medical Department - Clinical Department of Hematology of the First Faculty of Medicine, General Teaching Hospital Charles University, Prague, Czech Republic
| | - Jakub Radocha
- 4th Department of Medicine - Hematology, Faculty of Medicine, Charles University Hospital, Hradec Kralove, Czech Republic
| | - Jiri Minarik
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, University Hospital Olomouc, Palacky University Olomouc, Olomouc, Czech Republic
| | - Tomas Jelinek
- Department of Hematooncology, Faculty of Medicine, University Hospital Ostrava, University of Ostrava, Ostrava, Czech Republic
| | - Alexandra Jungova
- Hematology and Oncology Department, Charles University Hospital, Pilsen, Czech Republic
| | - Petr Pavlicek
- Department of Internal Medicine and Hematology, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | | | - Frantisek Sedlak
- 1st Medical Department - Clinical Department of Hematology of the First Faculty of Medicine, General Teaching Hospital Charles University, Prague, Czech Republic
| | - Jan Straub
- 1st Medical Department - Clinical Department of Hematology of the First Faculty of Medicine, General Teaching Hospital Charles University, Prague, Czech Republic
| | - Tomas Pika
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, University Hospital Olomouc, Palacky University Olomouc, Olomouc, Czech Republic
| | - Zdenka Knechtova
- Department of Internal Medicine, Hematology and Oncology, Faculty of Medicine, University Hospital Brno, Masaryk University, Brno, Czech Republic
| | - Anna Fidrichova
- Department of Internal Medicine, Hematology and Oncology, Faculty of Medicine, University Hospital Brno, Masaryk University, Brno, Czech Republic
| | - Ivanna Boichuk
- Department of Internal Medicine, Hematology and Oncology, Faculty of Medicine, University Hospital Brno, Masaryk University, Brno, Czech Republic
| | - Sabina Sevcikova
- Babak Myeloma Group, Department of Pathophysiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Vladimir Maisnar
- 4th Department of Medicine - Hematology, Faculty of Medicine, Charles University Hospital, Hradec Kralove, Czech Republic
| | - Roman Hajek
- Department of Hematooncology, Faculty of Medicine, University Hospital Ostrava, University of Ostrava, Ostrava, Czech Republic
| | - Ludek Pour
- Department of Internal Medicine, Hematology and Oncology, Faculty of Medicine, University Hospital Brno, Masaryk University, Brno, Czech Republic.
- Babak Myeloma Group, Department of Pathophysiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
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