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Termini R, Žihala D, Terpos E, Perez-Montaña A, Jelínek T, Raab M, Weinhold N, Mai EK, Grab AL, Corre J, Vergez F, Sacco A, Chiarini M, Giustini V, Tucci A, Rodriguez S, Moreno C, Perez C, Maia C, Martín-Sánchez E, Guerrero C, Botta C, Garces JJ, Lopez A, Tamariz-Amador LE, Prosper F, Bargay J, Cabezudo ME, Ocio EM, Hájek R, Martinez-Lopez J, Solano F, Iglesias R, Paiva A, Geraldes C, Vitoria H, Gomez C, De Arriba F, Ludwig H, Garcia-Guiñon A, Casanova M, Alegre A, Cabañas V, Sirvent M, Oriol A, de la Rubia J, Hernández-Rivas JÁ, Palomera L, Sarasa M, Rios P, Puig N, Mateos MV, Flores-Montero J, Orfao A, Goldschmidt H, Avet-Loiseau H, Roccaro AM, San-Miguel JF, Paiva B. Circulating Tumor and Immune Cells for Minimally Invasive Risk Stratification of Smoldering Multiple Myeloma. Clin Cancer Res 2022; 28:4771-4781. [PMID: 36074126 DOI: 10.1158/1078-0432.ccr-22-1594] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/01/2022] [Accepted: 09/06/2022] [Indexed: 01/24/2023]
Abstract
PURPOSE Early intervention in smoldering multiple myeloma (SMM) requires optimal risk stratification to avoid under- and overtreatment. We hypothesized that replacing bone marrow (BM) plasma cells (PC) for circulating tumor cells (CTC), and adding immune biomarkers in peripheral blood (PB) for the identification of patients at risk of progression due to lost immune surveillance, could improve the International Myeloma Working Group 20/2/20 model. EXPERIMENTAL DESIGN We report the outcomes of 150 patients with SMM enrolled in the iMMunocell study, in which serial assessment of tumor and immune cells in PB was performed every 6 months for a period of 3 years since enrollment. RESULTS Patients with >0.015% versus ≤0.015% CTCs at baseline had a median time-to-progression of 17 months versus not reached (HR, 4.9; P < 0.001). Presence of >20% BM PCs had no prognostic value in a multivariate analysis that included serum free light-chain ratio >20, >2 g/dL M-protein, and >0.015% CTCs. The 20/2/20 and 20/2/0.015 models yielded similar risk stratification (C-index of 0.76 and 0.78). The combination of the 20/2/0.015 model with an immune risk score based on the percentages of SLAN+ and SLAN- nonclassical monocytes, CD69+HLADR+ cytotoxic NK cells, and CD4+CXCR3+ stem central memory T cells, allowed patient' stratification into low, intermediate-low, intermediate-high, and high-risk disease with 0%, 20%, 39%, and 73% rates of progression at 2 years. CONCLUSIONS This study showed that CTCs outperform BM PCs for assessing tumor burden. Additional analysis in larger series are needed to define a consensus cutoff of CTCs for minimally invasive stratification of SMM.
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Affiliation(s)
- Rosalinda Termini
- Clinica Universidad de Navarra, Centro de Investigacion Medica Aplicada (CIMA), Instituto de Investigacion Sanitaria de Navarra (IDISNA), CCUN, CIBER-ONC numbers CB16/12/00369, CB16/12/00489, Pamplona, Spain
| | - David Žihala
- Department of Hematooncology, University Hospital Ostrava and University of Ostrava, Ostrava, Czech Republic
| | - Evangelos Terpos
- National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | | | - Tomáš Jelínek
- Department of Hematooncology, University Hospital Ostrava and University of Ostrava, Ostrava, Czech Republic
| | - Marc Raab
- Heidelberg University Clinic Hospital, Department of Internal Medicine V and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Niels Weinhold
- Heidelberg University Clinic Hospital, Department of Internal Medicine V and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Elias K Mai
- Heidelberg University Clinic Hospital, Department of Internal Medicine V and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Anna Luise Grab
- Heidelberg University Clinic Hospital, Department of Internal Medicine V and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Jill Corre
- Centre de Recherche en Cancérologie de Toulouse, Unité 1037, INSERM, Toulouse, France
| | - Francois Vergez
- Centre de Recherche en Cancérologie de Toulouse, Unité 1037, INSERM, Toulouse, France
| | | | | | | | | | - Sara Rodriguez
- Clinica Universidad de Navarra, Centro de Investigacion Medica Aplicada (CIMA), Instituto de Investigacion Sanitaria de Navarra (IDISNA), CCUN, CIBER-ONC numbers CB16/12/00369, CB16/12/00489, Pamplona, Spain
| | - Cristina Moreno
- Clinica Universidad de Navarra, Centro de Investigacion Medica Aplicada (CIMA), Instituto de Investigacion Sanitaria de Navarra (IDISNA), CCUN, CIBER-ONC numbers CB16/12/00369, CB16/12/00489, Pamplona, Spain
| | - Cristina Perez
- Clinica Universidad de Navarra, Centro de Investigacion Medica Aplicada (CIMA), Instituto de Investigacion Sanitaria de Navarra (IDISNA), CCUN, CIBER-ONC numbers CB16/12/00369, CB16/12/00489, Pamplona, Spain
| | - Catarina Maia
- Clinica Universidad de Navarra, Centro de Investigacion Medica Aplicada (CIMA), Instituto de Investigacion Sanitaria de Navarra (IDISNA), CCUN, CIBER-ONC numbers CB16/12/00369, CB16/12/00489, Pamplona, Spain
| | - Esperanza Martín-Sánchez
- Clinica Universidad de Navarra, Centro de Investigacion Medica Aplicada (CIMA), Instituto de Investigacion Sanitaria de Navarra (IDISNA), CCUN, CIBER-ONC numbers CB16/12/00369, CB16/12/00489, Pamplona, Spain
| | - Camilla Guerrero
- Clinica Universidad de Navarra, Centro de Investigacion Medica Aplicada (CIMA), Instituto de Investigacion Sanitaria de Navarra (IDISNA), CCUN, CIBER-ONC numbers CB16/12/00369, CB16/12/00489, Pamplona, Spain
| | - Cirino Botta
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Juan-Jose Garces
- Clinica Universidad de Navarra, Centro de Investigacion Medica Aplicada (CIMA), Instituto de Investigacion Sanitaria de Navarra (IDISNA), CCUN, CIBER-ONC numbers CB16/12/00369, CB16/12/00489, Pamplona, Spain
| | - Aitziber Lopez
- Clinica Universidad de Navarra, Centro de Investigacion Medica Aplicada (CIMA), Instituto de Investigacion Sanitaria de Navarra (IDISNA), CCUN, CIBER-ONC numbers CB16/12/00369, CB16/12/00489, Pamplona, Spain
| | | | - Felipe Prosper
- Clinica Universidad de Navarra, Centro de Investigacion Medica Aplicada (CIMA), Instituto de Investigacion Sanitaria de Navarra (IDISNA), CCUN, CIBER-ONC numbers CB16/12/00369, CB16/12/00489, Pamplona, Spain
| | - Joan Bargay
- Hospital Sont LLatzer, Palma de Mallorca, Spain
| | | | - Enrique M Ocio
- Hospital Universitario Marqués de Valdecilla (IDIVAL), Universidad de Cantabria, Santander, Spain
| | - Roman Hájek
- Department of Hematooncology, University Hospital Ostrava and University of Ostrava, Ostrava, Czech Republic
| | | | | | | | - Artur Paiva
- Flow Cytometry Unit (UGOC), Department of Clinical Pathology, Centro Hospitalare Universitário de Coimbra (CHUC), Coimbra, Portugal
| | - Catarina Geraldes
- Flow Cytometry Unit (UGOC), Department of Clinical Pathology, Centro Hospitalare Universitário de Coimbra (CHUC), Coimbra, Portugal
| | - Helena Vitoria
- Centro Hospitalare Universitário de Coimbra (CHUC), Coimbra, Portugal
| | | | - Felipe De Arriba
- Hospital Morales Meseguer, IMIB-Arrixaca, Universidad de Murcia, Murcia, Spain
| | - Heinz Ludwig
- Wilhelminen Cancer Research Institute, Clinic Ottakring, Vienna, Austria
| | | | | | | | - Valentin Cabañas
- Hospital Virgen de la Arrixaca de Murcia, IMIB Arrixaca, Universidad de Murcia, Murcia, Spain
| | | | - Albert Oriol
- Institut Català d'Oncologia Institut Josep Carreras, Badalona, Spain
| | - Javier de la Rubia
- University Hospital de La Fe, School of Medicine and Dentistry, Catholic University of Valencia, CIBERONC CB16/12/00284, Valencia, Spain
| | | | - Luis Palomera
- Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain
| | | | - Pablo Rios
- Hospital Nuestra Señora de la Candelara, Santa Cruz de Tenerife, Spain
| | - Noemi Puig
- Hospital Universitario de Salamanca, Instituto de Investigacion Biomedica de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | - Maria-Victoria Mateos
- Hospital Universitario de Salamanca, Instituto de Investigacion Biomedica de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | - Juan Flores-Montero
- Translational and Clinical Research Program, Centro de Investigación del Cancer (IBMCC-USAL, CSIC), Department of Medicine, Cytometry Service, Instituto de Investigación Biosanitaria de Salamanca (IBSAL) and CIBER-ONC (number CB16/12/00400), University of Salamanca, Salamanca, Spain
| | - Alberto Orfao
- Translational and Clinical Research Program, Centro de Investigación del Cancer (IBMCC-USAL, CSIC), Department of Medicine, Cytometry Service, Instituto de Investigación Biosanitaria de Salamanca (IBSAL) and CIBER-ONC (number CB16/12/00400), University of Salamanca, Salamanca, Spain
| | - Hartmut Goldschmidt
- Heidelberg University Clinic Hospital, Department of Internal Medicine V and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Hervé Avet-Loiseau
- Centre de Recherche en Cancérologie de Toulouse, Unité 1037, INSERM, Toulouse, France
| | | | - Jesus F San-Miguel
- Clinica Universidad de Navarra, Centro de Investigacion Medica Aplicada (CIMA), Instituto de Investigacion Sanitaria de Navarra (IDISNA), CCUN, CIBER-ONC numbers CB16/12/00369, CB16/12/00489, Pamplona, Spain
| | - Bruno Paiva
- Clinica Universidad de Navarra, Centro de Investigacion Medica Aplicada (CIMA), Instituto de Investigacion Sanitaria de Navarra (IDISNA), CCUN, CIBER-ONC numbers CB16/12/00369, CB16/12/00489, Pamplona, Spain
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Rajkumar SV, Kumar S, Lonial S, Mateos MV. Smoldering multiple myeloma current treatment algorithms. Blood Cancer J 2022; 12:129. [PMID: 36064707 PMCID: PMC9445066 DOI: 10.1038/s41408-022-00719-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/03/2022] [Accepted: 08/10/2022] [Indexed: 11/30/2022] Open
Abstract
Smoldering multiple myeloma (SMM) is an asymptomatic condition that occupies a space between monoclonal gammopathy of undetermined significance (MGUS) and multiple myeloma (MM) along the spectrum of clonal plasma cell proliferative disorders. It is not a biologic intermediate stage between MGUS and MM, but rather represents a heterogeneous clinically defined condition in which some patients (approximately two-thirds) have MGUS (pre-malignancy), and some (approximately one-third) have MM (biologic malignancy). Unfortunately, no single pathologic or molecular feature can reliably distinguish these two groups of patients. For purposes of practice and clinical trials, specific risk factors are used to identify patients with SMM in whom malignant transformation has already likely occurred (high risk SMM). Patients with newly diagnosed high risk SMM should be offered therapy with lenalidomide or lenalidomide plus dexamethasone (Rd) for 2 years, or enrollment in clinical trials. Patients with low risk SMM should be observed without therapy every 3-4 months.
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Affiliation(s)
| | - Shaji Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Sagar Lonial
- Department of Hematology and Medical Oncology, Emory University School of Medicine Atlanta, Atlanta, GA, USA
| | - Maria Victoria Mateos
- Department of Hematology, and Center for Cancer Research, University Hospital of Salamanca, Salamanca, Spain
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Zhao Y, Niu D, Ye E, Huang J, Wang J, Hou X, Wu J. Secular Trends in the Burden of Multiple Myeloma From 1990 to 2019 and Its Projection Until 2044 in China. Front Public Health 2022; 10:938770. [PMID: 35875035 PMCID: PMC9304978 DOI: 10.3389/fpubh.2022.938770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 06/17/2022] [Indexed: 12/20/2022] Open
Abstract
Objective Multiple myeloma (MM) imposes a heavy burden in China. Understanding the secular trend of MM burden and projecting its future trend could facilitate appropriate public health planning and improve the management of MM. Methods Sex-specific incidence and mortality rates of MM in China from 1990 to 2019 were collected from the Global Burden of Disease 2019 study. The secular trend of MM burden was analyzed by joinpoint regression. Age–period–cohort model was used to analyze the effects of age, period, and birth cohort on MM burden and project future trends up to 2044. Results From 1990 to 2019, the age-standardized incidence and mortality rates of MM continued to increase in males. For females, the age-standardized rates were stable in MM incidence and decreased in MM mortality. Males had a higher disease burden of MM than females. Age effects were the most significant risk factor for MM incidence and mortality. Moreover, the risk of MM incidence and mortality increased with increasing time period but decreased with birth cohort in males and females. The age-standardized incidence and mortality rates of MM in China is predicted to be continuously increasing over the next 25 years. Conclusion The burden of MM in China is expected to continue to increase in the future, with significant sex difference. A comprehensive understanding of the risk characteristics and disease pattern of MM could help develop timely intervention measures to effectively reduce its burden.
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Affiliation(s)
- Yumei Zhao
- Clinical Research Service Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
- Guangdong Engineering Research Center of Collaborative Innovation Technology of Clinical Medical Big Data Cloud Service in Medical Consortium of West Guangdong Province, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Dongdong Niu
- Clinical Research Service Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Enlin Ye
- Clinical Research Service Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Jiasheng Huang
- Clinical Research Service Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Jia Wang
- Clinical Research Service Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Xuefei Hou
- Clinical Research Service Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
- Guangdong Engineering Research Center of Collaborative Innovation Technology of Clinical Medical Big Data Cloud Service in Medical Consortium of West Guangdong Province, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Jiayuan Wu
- Clinical Research Service Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
- Guangdong Engineering Research Center of Collaborative Innovation Technology of Clinical Medical Big Data Cloud Service in Medical Consortium of West Guangdong Province, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
- *Correspondence: Jiayuan Wu
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Visram A, Cook J, Warsame R. Smoldering multiple myeloma: evolving diagnostic criteria and treatment strategies. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2021; 2021:673-681. [PMID: 34889380 PMCID: PMC8791169 DOI: 10.1182/hematology.2021000304] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The adage for smoldering myeloma (SMM) has been to observe without treatment, until criteria for active multiple myeloma were satisfied. Definitions and risk stratification models have become more sophisticated, with prognostication tailored to include high-risk cytogenetics as per the most recent International Myeloma Working Group 2020 risk model. Moreover, progress in defining genomic evolution and changes in the bone marrow microenvironment through the monoclonal continuum have given insight into the complexities underlying the different patterns of progression observed in SMM. Given recent data showing improved progression-free survival with early intervention in high-risk SMM, the current dilemma is focused on how these patients should be treated. This case-based article maps the significant advancements made in the diagnosis and risk stratification of SMM. Data from landmark clinical trials will also be discussed, and ongoing trials are summarized. Ultimately, we outline our approach to SMM and hope to impart to the reader a sound concept of the current clinical management of SMM.
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Affiliation(s)
- Alissa Visram
- Division of Hematology, The Ottawa Hospital, Ottawa, ON, Canada
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Joselle Cook
- Division of Hematology, The Ottawa Hospital, Ottawa, ON, Canada
| | - Rahma Warsame
- Division of Hematology, The Ottawa Hospital, Ottawa, ON, Canada
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Aksenova AY, Zhuk AS, Lada AG, Zotova IV, Stepchenkova EI, Kostroma II, Gritsaev SV, Pavlov YI. Genome Instability in Multiple Myeloma: Facts and Factors. Cancers (Basel) 2021; 13:5949. [PMID: 34885058 PMCID: PMC8656811 DOI: 10.3390/cancers13235949] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/20/2021] [Accepted: 11/22/2021] [Indexed: 02/06/2023] Open
Abstract
Multiple myeloma (MM) is a malignant neoplasm of terminally differentiated immunoglobulin-producing B lymphocytes called plasma cells. MM is the second most common hematologic malignancy, and it poses a heavy economic and social burden because it remains incurable and confers a profound disability to patients. Despite current progress in MM treatment, the disease invariably recurs, even after the transplantation of autologous hematopoietic stem cells (ASCT). Biological processes leading to a pathological myeloma clone and the mechanisms of further evolution of the disease are far from complete understanding. Genetically, MM is a complex disease that demonstrates a high level of heterogeneity. Myeloma genomes carry numerous genetic changes, including structural genome variations and chromosomal gains and losses, and these changes occur in combinations with point mutations affecting various cellular pathways, including genome maintenance. MM genome instability in its extreme is manifested in mutation kataegis and complex genomic rearrangements: chromothripsis, templated insertions, and chromoplexy. Chemotherapeutic agents used to treat MM add another level of complexity because many of them exacerbate genome instability. Genome abnormalities are driver events and deciphering their mechanisms will help understand the causes of MM and play a pivotal role in developing new therapies.
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Affiliation(s)
- Anna Y. Aksenova
- Laboratory of Amyloid Biology, St. Petersburg State University, 199034 St. Petersburg, Russia
| | - Anna S. Zhuk
- International Laboratory “Computer Technologies”, ITMO University, 197101 St. Petersburg, Russia;
| | - Artem G. Lada
- Department of Microbiology and Molecular Genetics, University of California, Davis, CA 95616, USA;
| | - Irina V. Zotova
- Department of Genetics and Biotechnology, St. Petersburg State University, 199034 St. Petersburg, Russia; (I.V.Z.); (E.I.S.)
- Vavilov Institute of General Genetics, St. Petersburg Branch, Russian Academy of Sciences, 199034 St. Petersburg, Russia
| | - Elena I. Stepchenkova
- Department of Genetics and Biotechnology, St. Petersburg State University, 199034 St. Petersburg, Russia; (I.V.Z.); (E.I.S.)
- Vavilov Institute of General Genetics, St. Petersburg Branch, Russian Academy of Sciences, 199034 St. Petersburg, Russia
| | - Ivan I. Kostroma
- Russian Research Institute of Hematology and Transfusiology, 191024 St. Petersburg, Russia; (I.I.K.); (S.V.G.)
| | - Sergey V. Gritsaev
- Russian Research Institute of Hematology and Transfusiology, 191024 St. Petersburg, Russia; (I.I.K.); (S.V.G.)
| | - Youri I. Pavlov
- Eppley Institute for Research in Cancer, Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE 68198, USA
- Departments of Biochemistry and Molecular Biology, Microbiology and Pathology, Genetics Cell Biology and Anatomy, University of Nebraska Medical Center, Omaha, NE 68198, USA
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Musto P, Engelhardt M, Caers J, Bolli N, Kaiser M, Van de Donk N, Terpos E, Broijl A, De Larrea CF, Gay F, Goldschmidt H, Hajek R, Vangsted AJ, Zamagni E, Zweegman S, Cavo M, Dimopoulos M, Einsele H, Ludwig H, Barosi G, Boccadoro M, Mateos MV, Sonneveld P, Miguel JS. 2021 European Myeloma Network review and consensus statement on smoldering multiple myeloma: how to distinguish (and manage) Dr. Jekyll and Mr. Hyde. Haematologica 2021; 106:2799-2812. [PMID: 34261295 PMCID: PMC8561280 DOI: 10.3324/haematol.2021.278519] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 06/15/2021] [Indexed: 11/09/2022] Open
Abstract
According to the updated International Myeloma Working Group criteria, smoldering multiple myeloma (SMM) is an asymptomatic plasma cell disorder characterized by an M-component >3 g/dL, bone marrow plasma cell infiltration >10% and <60%, and absence of any myeloma-defining event. Active multiple myeloma is preceded by SMM, with a median time to progression of approximately 5 years. Cases of SMM range from the extremes of "monoclonal gammopathy of undetermined significance-like", in which patients never progress during their lifetimes, to "early multiple myeloma", in which transformation into symptomatic disease, based on genomic evolution, may be rapid and devastating. Such a "split personality" makes the prognosis and management of individual patients challenging, particularly with regard to the identification and possible early treatment of high-risk SMM. Outside of clinical trials, the conventional approach to SMM generally remains close observation until progression to active multiple myeloma. However, two prospective, randomized trials have recently demonstrated a significant clinical benefit in terms of time to progression, and of overall survival in one of the two studies, for some patients with higher-risk SMM treated with lenalidomide ± dexamethasone, raising the question of whether such an approach should be considered a new standard of care. In this paper, experts from the European Myeloma Network describe current biological and clinical knowledge on SMM, focusing on novel insights into its molecular pathogenesis, new prognostic scoring systems proposed to identify SMM patients at higher risk of early transformation, and updated results of completed or ongoing clinical trials. Finally, some practical recommendations for the real-life management of these patients, based on Delphi consensus methodology, are provided.
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Affiliation(s)
- Pellegrino Musto
- "Aldo Moro" University School of Medicine, Unit of Hematology and Stem Cell Transplantation, AOUC Policlinico, Bari.
| | - Monika Engelhardt
- Department of Medicine I, Medical Center - University of Freiburg, Freiburg, Faculty of Medicine, University of Freiburg
| | - Jo Caers
- Department of Clinical Hematology, CHU of Liège, Liège, Belgium; Laboratory of Hematology, GIGA-I3, University of Liège, Liège
| | - Niccolo' Bolli
- Division of Hematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy; Department of Oncology and Onco-Hematology, University of Milan, Milano
| | - Martin Kaiser
- The Institute of Cancer Research, Division of Molecular Pathology, London, UK; The Royal Marsden Hospital, Department of Haematology, London
| | - Niels Van de Donk
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Hematology, Cancer Center Amsterdam, Amsterdam
| | - Evangelos Terpos
- Stem Cell Transplantation Unit, Plasma Cell Dyscrasias Unit, Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens
| | - Annemiek Broijl
- Erasmus MC Cancer Institute and Erasmus University of Rotterdam, Rotterdam
| | - Carlos Fernández De Larrea
- Amyloidosis and Myeloma Unit, Department of Hematology, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona
| | - Francesca Gay
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Torino
| | - Hartmut Goldschmidt
- University Hospital Heidelberg Internal Medicine V and National Center for Tumor Diseases (NCT), Heidelberg
| | - Roman Hajek
- Department of Hemato-oncology, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | | | - Elena Zamagni
- Seràgnoli Institute of Hematology, Bologna University School of Medicine, Bologna
| | - Sonja Zweegman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Hematology, Cancer Center Amsterdam, Amsterdam
| | - Michele Cavo
- Seràgnoli Institute of Hematology, Bologna University School of Medicine, Bologna
| | - Meletios Dimopoulos
- National and Kapodistrian University of Athens, School of Medicine, Department of Clinical Therapeutics, Athens
| | - Hermann Einsele
- University Hospital Würzburg, Internal Medicine II, Würzburg
| | - Heinz Ludwig
- Wilhelminen Cancer Research Institute, 1st Department of Medicine, Center for Oncology, Hematology and Palliative Care, Wilhelminenspital, Vienna
| | | | - Mario Boccadoro
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Torino
| | | | - Pieter Sonneveld
- Erasmus MC Cancer Institute and Erasmus University of Rotterdam, Rotterdam
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Reale A, Khong T, Mithraprabhu S, Spencer A. Translational Potential of RNA Derived From Extracellular Vesicles in Multiple Myeloma. Front Oncol 2021; 11:718502. [PMID: 34513695 PMCID: PMC8429596 DOI: 10.3389/fonc.2021.718502] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/04/2021] [Indexed: 12/20/2022] Open
Abstract
The cross-talk between tumour cells and stromal cells is a hallmark of multiple myeloma (MM), a blood cancer that still remains incurable despite increased knowledge of its biology and advances in its treatment. Extracellular vesicles (EVs) derived from both tumour and stromal cells have been shown to play an important role in mediating this cross-talk ultimately favouring MM progression and drug resistance. Furthermore, EVs and their content including RNA (EV-RNA) have been successfully isolated from blood and are being explored as liquid biomarkers in MM with the potential to improve diagnosis and monitoring modalities with a minimally-invasive and repeatable analysis, i.e. liquid biopsy. In this review, we describe both the role of EV-RNA in defining the biological features of MM and their potential translational relevance as liquid biomarkers, therapeutic targets and delivery systems. We also discuss the limitations and technical challenges related to the isolation and characterization of EVs and provide a perspective on the future of MM-derived EV-RNA in translational research.
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Affiliation(s)
- Antonia Reale
- Myeloma Research Group, Australian Centre for Blood Diseases, Central Clinical School, Monash University/Alfred Health, Melbourne, VIC, Australia
| | - Tiffany Khong
- Myeloma Research Group, Australian Centre for Blood Diseases, Central Clinical School, Monash University/Alfred Health, Melbourne, VIC, Australia
| | - Sridurga Mithraprabhu
- Myeloma Research Group, Australian Centre for Blood Diseases, Central Clinical School, Monash University/Alfred Health, Melbourne, VIC, Australia
| | - Andrew Spencer
- Myeloma Research Group, Australian Centre for Blood Diseases, Central Clinical School, Monash University/Alfred Health, Melbourne, VIC, Australia.,Malignant Haematology and Stem Cell Transplantation, The Alfred Hospital, and Department of Clinical Haematology, Monash University, Melbourne, VIC, Australia
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Reale A, Carmichael I, Xu R, Mithraprabhu S, Khong T, Chen M, Fang H, Savvidou I, Ramachandran M, Bingham N, Simpson RJ, Greening DW, Spencer A. Human myeloma cell- and plasma-derived extracellular vesicles contribute to functional regulation of stromal cells. Proteomics 2021; 21:e2000119. [PMID: 33580572 DOI: 10.1002/pmic.202000119] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 02/04/2021] [Accepted: 02/08/2021] [Indexed: 02/06/2023]
Abstract
Circulating small extracellular vesicles (sEV) represent promising non-invasive biomarkers that may aid in the diagnosis and risk-stratification of multiple myeloma (MM), an incurable blood cancer. Here, we comprehensively isolated and characterized sEV from human MM cell lines (HMCL) and patient-derived plasma (psEV) by specific EV-marker enrichment and morphology. Importantly, we demonstrate that HMCL-sEV are readily internalised by stromal cells to functionally modulate proliferation. psEV were isolated using various commercial approaches and pre-analytical conditions (collection tube types, storage conditions) assessed for sEV yield and marker enrichment. Functionally, MM-psEV was shown to regulate stromal cell proliferation and migration. In turn, pre-educated stromal cells favour HMCL adhesion. psEV isolated from patients with both pre-malignant plasma cell disorders (monoclonal gammopathy of undetermined significance [MGUS]; smouldering MM [SMM]) and MM have a similar ability to promote cell migration and adhesion, suggesting a role for both malignant and pre-malignant sEV in disease progression. Proteomic profiling of MM-psEV (305 proteins) revealed enrichment of oncogenic factors implicated in cell migration and adhesion, in comparison to non-disease psEV. This study describes a protocol to generate morphologically-intact and biologically functional sEV capable of mediating the regulation of stromal cells, and a model for the characterization of tumour-stromal cross-talk by sEV in MM.
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Affiliation(s)
- Antonia Reale
- Myeloma Research Group, Australian Centre for Blood Diseases, Monash University/Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Irena Carmichael
- Monash Micro Imaging-AMREP, Monash University, Melbourne, Victoria, Australia
| | - Rong Xu
- Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Nanobiotechnology Laboratory, Australian Centre for Blood Diseases, Monash University/Alfred Health, Melbourne, Victoria, Australia.,Department of Biochemistry and Genetics, La Trobe Institute for Molecular Science, La Trobe University, Melbourne, Victoria, Australia
| | - Sridurga Mithraprabhu
- Myeloma Research Group, Australian Centre for Blood Diseases, Monash University/Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Tiffany Khong
- Myeloma Research Group, Australian Centre for Blood Diseases, Monash University/Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Maoshan Chen
- Myeloma Research Group, Australian Centre for Blood Diseases, Monash University/Alfred Health, Melbourne, Victoria, Australia
| | - Haoyun Fang
- Molecular Proteomics, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Ioanna Savvidou
- Myeloma Research Group, Australian Centre for Blood Diseases, Monash University/Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Malarmathy Ramachandran
- Myeloma Research Group, Australian Centre for Blood Diseases, Monash University/Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Nicholas Bingham
- Myeloma Research Group, Australian Centre for Blood Diseases, Monash University/Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Richard J Simpson
- Department of Biochemistry and Genetics, La Trobe Institute for Molecular Science, La Trobe University, Melbourne, Victoria, Australia
| | - David W Greening
- Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Biochemistry and Genetics, La Trobe Institute for Molecular Science, La Trobe University, Melbourne, Victoria, Australia.,Molecular Proteomics, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Andrew Spencer
- Myeloma Research Group, Australian Centre for Blood Diseases, Monash University/Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Malignant Haematology and Stem Cell Transplantation, The Alfred Hospital, and Department of Clinical Haematology, Monash University, Melbourne, Victoria, Australia
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9
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Bolli N, Sgherza N, Curci P, Rizzi R, Strafella V, Delia M, Gagliardi VP, Neri A, Baldini L, Albano F, Musto P. What Is New in the Treatment of Smoldering Multiple Myeloma? J Clin Med 2021; 10:421. [PMID: 33499196 PMCID: PMC7865294 DOI: 10.3390/jcm10030421] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 01/15/2021] [Accepted: 01/18/2021] [Indexed: 12/13/2022] Open
Abstract
Smoldering multiple myeloma (SMM), an asymptomatic plasma cell neoplasm, is currently diagnosed according to the updated IMWG criteria, which reflect an intermediate tumor mass between monoclonal gammopathy of undetermined significance (MGUS) and active MM. However, SMM is a heterogeneous entity and individual case may go from an "MGUS-like" behavior to "early MM" with rapid transformation into symptomatic disease. This wide range of clinical outcomes poses challenges for prognostication and management of individual patients. However, initial studies showed a benefit in terms of progression or even survival for early treatment of high-risk SMM patients. While outside of clinical trials the conventional approach to SMM generally remains that of close observation, these studies raised the question of whether early treatment should be offered in high-risk patients, prompting evaluation of several different therapeutic approaches with different goals. While delay of progression to MM with a non-toxic treatment is clearly achievable by early treatment, a convincing survival benefit still needs to be proven by independent studies. Furthermore, if SMM is to be considered less biologically complex than MM, early treatment may offer the chance of cure that is currently not within reach of any active MM treatment. In this paper, we present updated results of completed or ongoing clinical trials in SMM treatment, highlighting areas of uncertainty and critical issues that will need to be addressed in the near future before the "watch and wait" paradigm in SMM is abandoned in favor of early treatment.
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Affiliation(s)
- Niccolo’ Bolli
- Division of Hematology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy; (N.B.); (A.N.); (L.B.)
- Department of Oncology and Onco-Hematology, University of Milan, 20122 Milan, Italy
| | - Nicola Sgherza
- Unit of Hematology and Stem Cell Transplantation, AOUC Policlinico, 70124 Bari, Italy; (N.S.); (P.C.); (R.R.); (M.D.); (V.P.G.); (F.A.)
| | - Paola Curci
- Unit of Hematology and Stem Cell Transplantation, AOUC Policlinico, 70124 Bari, Italy; (N.S.); (P.C.); (R.R.); (M.D.); (V.P.G.); (F.A.)
| | - Rita Rizzi
- Unit of Hematology and Stem Cell Transplantation, AOUC Policlinico, 70124 Bari, Italy; (N.S.); (P.C.); (R.R.); (M.D.); (V.P.G.); (F.A.)
- Department of Emergency and Organ Transplantation, “Aldo Moro” University School of Medicine, 70124 Bari, Italy;
| | - Vanda Strafella
- Department of Emergency and Organ Transplantation, “Aldo Moro” University School of Medicine, 70124 Bari, Italy;
| | - Mario Delia
- Unit of Hematology and Stem Cell Transplantation, AOUC Policlinico, 70124 Bari, Italy; (N.S.); (P.C.); (R.R.); (M.D.); (V.P.G.); (F.A.)
| | - Vito Pier Gagliardi
- Unit of Hematology and Stem Cell Transplantation, AOUC Policlinico, 70124 Bari, Italy; (N.S.); (P.C.); (R.R.); (M.D.); (V.P.G.); (F.A.)
| | - Antonino Neri
- Division of Hematology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy; (N.B.); (A.N.); (L.B.)
- Department of Oncology and Onco-Hematology, University of Milan, 20122 Milan, Italy
| | - Luca Baldini
- Division of Hematology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy; (N.B.); (A.N.); (L.B.)
- Department of Oncology and Onco-Hematology, University of Milan, 20122 Milan, Italy
| | - Francesco Albano
- Unit of Hematology and Stem Cell Transplantation, AOUC Policlinico, 70124 Bari, Italy; (N.S.); (P.C.); (R.R.); (M.D.); (V.P.G.); (F.A.)
- Department of Emergency and Organ Transplantation, “Aldo Moro” University School of Medicine, 70124 Bari, Italy;
| | - Pellegrino Musto
- Unit of Hematology and Stem Cell Transplantation, AOUC Policlinico, 70124 Bari, Italy; (N.S.); (P.C.); (R.R.); (M.D.); (V.P.G.); (F.A.)
- Department of Emergency and Organ Transplantation, “Aldo Moro” University School of Medicine, 70124 Bari, Italy;
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10
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Rajkumar SV, Kumar S. Multiple myeloma current treatment algorithms. Blood Cancer J 2020; 10:94. [PMID: 32989217 PMCID: PMC7523011 DOI: 10.1038/s41408-020-00359-2] [Citation(s) in RCA: 178] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/11/2020] [Accepted: 08/20/2020] [Indexed: 12/22/2022] Open
Abstract
The treatment of multiple myeloma (MM) continues to evolve rapidly with arrival of multiple new drugs, and emerging data from randomized trials to guide therapy. Along the disease course, the choice of specific therapy is affected by many variables including age, performance status, comorbidities, and eligibility for stem cell transplantation. In addition, another key variable that affects treatment strategy is risk stratification of patients into standard and high-risk MM. High-risk MM is defined by the presence of t(4;14), t(14;16), t(14;20), gain 1q, del(17p), or p53 mutation. In this paper, we provide algorithms for the treatment of newly diagnosed and relapsed MM based on the best available evidence. We have relied on data from randomized controlled trials whenever possible, and when appropriate trials to guide therapy are not available, our recommendations reflect best practices based on non-randomized data, and expert opinion. Each algorithm has been designed to facilitate easy decision-making for practicing clinicians. In all patients, clinical trials should be considered first, prior to resorting to the standard of care algorithms we outline.
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Affiliation(s)
| | - Shaji Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
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