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Hu X, Dai X, Guo X, Jiang X, Li Y, Zhao H, Lu J, Li X, Jin M. Bone marrow fibrosis in newly diagnosed multiple myeloma and its correlation with clinicopathological factors. Diagn Pathol 2024; 19:99. [PMID: 39026319 PMCID: PMC11256401 DOI: 10.1186/s13000-024-01516-y] [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: 01/06/2024] [Accepted: 06/21/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Bone marrow fibrosis (BMF) severely impacts both the quality of life and the efficacy of diagnostic procedures. However, the correlation between BMF and clinicopathological features, cytogenetic changes, and prognosis of newly diagnosed multiple myeloma (NDMM) remains unclear. This study determined the incidence, patient characteristics, and clinical outcomes of patients with NDMM with BMF. METHODS The clinical data, histological features, and clinical outcomes of patients with NDMM were collected. Reticular fiber staining was performed on the enrolled cases, and the degree of reticular fiber overgrowth was graded. Patients with MF-2 and MF-3 were classified as the BMF+ group, and those with MF-0 and MF-1 were classified as the BMF- group, and BMF incidence was calculated. The differences in clinical data, histological features, and clinical outcomes between the BMF+ group and the BMF- group were compared. RESULTS A consecutive series of 146 patients with NDMM were included. The incidence of MF-0, MF-1, MF-2, and MF-3 was 7.53% (11/146), 34.93% (51/146), 51.37% (75/146), and 6.16% (9/146), respectively. The incidence of BMF-MF-2 and MF-3-was 57.53% (84/146). A significant correlation was identified between the pattern of infiltration and BMF (P < 0.001). In the BMF- group, the distribution of cases with interstitial, nodular, and diffuse infiltration of plasma cells was 16 (25.8%), 21 (33.9%), and 25 (40.3%), respectively. Conversely, in the BMF+ group, these values for interstitial, nodular, and diffuse tumor cells were 9 (10.7%), 15 (17.9%), and 60 (71.4%). Furthermore, BMF was associated with a diffuse infiltration pattern. The overall survival (OS) of the BMF+ group (39.1 months; 95% confidence interval [CI]: 34.0-44.3) was lower than that of the BMF- group (45.4 months; 95% CI: 39.5-51.3), but there was no significant difference between the two groups (P = 0.221). Univariate and multivariate analyses showed that the BMF+ status was not associated with OS in patients with NDMM (P = 0.381 and P = 0.748, respectively). CONCLUSIONS Our findings suggest that BMF is linked to a diffuse infiltration pattern, and its occurrence is not related to the prognosis of patients with NDMM, providing a basis for further exploring the BMF value in NDMM diagnosis and treatment.
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Affiliation(s)
- Xiumei Hu
- Department of Pathology, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Xiangyang Dai
- Department of Pathology, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Xinmeng Guo
- Department of Pathology, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Xingran Jiang
- Department of Pathology, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Yunlong Li
- Department of Pathology, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Hongying Zhao
- Department of Pathology, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Jun Lu
- Department of Pathology, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Xue Li
- Department of Pathology, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Mulan Jin
- Department of Pathology, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China.
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Murković M, Babarović E, Marijić B, Grohovac D, Hadžisejdić I. Association of pre-treatment bone marrow morphology and achievement of BCR-ABL1 transcript milestones in CML. Pathol Res Pract 2023; 246:154517. [PMID: 37182315 DOI: 10.1016/j.prp.2023.154517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 05/06/2023] [Indexed: 05/16/2023]
Abstract
Chronic myeloid leukemia (CML) is characterized by the fusion gene BCR-ABL1 which encodes aberrantly functioning tyrosine kinase. Treatment with tyrosine kinase inhibitors (TKI) is a landmark of CML management and the main goal is to achieve major molecular response (MMR) which is defined as BCR-ABL1IS ≤ 0.1 % at 12 months of therapy. The aim of this study is to analyze histologic features of bone marrow (BM) in CML patients at the time of diagnosis and compare it to the level of BCR-ABL1IS transcript at 3 (BCR-ABL1IS ≤10 % early molecular response; EMR) and 12 months (MMR) as well as to so called molecularly undetectable leukemia (MUL) to see weather bone marrow morphology can be of value in predicting achievement molecular response milestones. Thirty-two bone marrow biopsies of CML patients, prior TKI therapy, were re-evaluated and CD34 immunohistochemistry was performed to examine microvessel density (MVD) and microvessel area (MVA) and subsequently compared it to the level of BCR-ABL1IS transcript. This study showed statistically significant association between BM hypercellularity and EMR (p = 0.048) and MUL (p = 0.034), peri-trabecular adipocyte distribution and EMR and MUL (p = 0.027 and p = 0.011, respectively), MMR and bone marrow fibrosis (p = 0.029), loose megakaryocyte clustering and EMR and MUL (p = 0.004 and p = 0.018, respectively), absence of naked nuclei and MUL (p = 0.033) but there was no statistically significant association with vascular parameters. These results suggest that some bone marrow morphologic features prior TKI therapy might be indicators of favorable molecular response.
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Affiliation(s)
- Martina Murković
- Faculty of Medicine, University of Rijeka, Braće Branchetta 20, Rijeka, Croatia; Clinical Department of Pathology and Cytology, Clinical Hospital Center Rijeka, Krešimirova 42, Rijeka, Croatia
| | - Emina Babarović
- Faculty of Medicine, University of Rijeka, Braće Branchetta 20, Rijeka, Croatia; Clinical Department of Pathology and Cytology, Clinical Hospital Center Rijeka, Krešimirova 42, Rijeka, Croatia; Laboratory for Molecular Pathology, Clinical Hospital Center Rijeka, Krešimirova 42, Rijeka, Croatia
| | - Blažen Marijić
- Faculty of Medicine, University of Rijeka, Braće Branchetta 20, Rijeka, Croatia; Department of Otorhinolaryngology and Head and Neck Surgery, Clinical Hospital Center Rijeka, Krešimirova 42, Rijeka, Croatia
| | - Dragana Grohovac
- Faculty of Medicine, University of Rijeka, Braće Branchetta 20, Rijeka, Croatia; Department of Internal Medicine, Clinic for Hematology, Clinical Hospital Center Rijeka, Krešimirova 42, Rijeka, Croatia
| | - Ita Hadžisejdić
- Faculty of Medicine, University of Rijeka, Braće Branchetta 20, Rijeka, Croatia; Clinical Department of Pathology and Cytology, Clinical Hospital Center Rijeka, Krešimirova 42, Rijeka, Croatia; Laboratory for Molecular Pathology, Clinical Hospital Center Rijeka, Krešimirova 42, Rijeka, Croatia.
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Kikuchi H, Amofa E, Mcenery M, Schey SA, Ramasamy K, Farzaneh F, Calle Y. Inhibition of PI3K Class IA Kinases Using GDC-0941 Overcomes Cytoprotection of Multiple Myeloma Cells in the Osteoclastic Bone Marrow Microenvironment Enhancing the Efficacy of Current Clinical Therapeutics. Cancers (Basel) 2023; 15:462. [PMID: 36672411 PMCID: PMC9856454 DOI: 10.3390/cancers15020462] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/02/2023] [Accepted: 01/05/2023] [Indexed: 01/12/2023] Open
Abstract
Osteoclasts contribute to bone marrow (BM)-mediated drug resistance in multiple myeloma (MM) by providing cytoprotective cues. Additionally, 80% of patients develop osteolytic lesions, which is a major cause of morbidity in MM. Although targeting osteoclast function is critical to improve MM therapies, pre-clinical studies rarely consider overcoming osteoclast-mediated cytoprotection within the selection criteria of drug candidates. We have performed a drug screening and identified PI3K as a key regulator of a signalling node associated with resistance to dexamethasone lenalidomide, pomalidomide, and bortezomib mediated by osteoclasts and BM fibroblastic stromal cells, which was blocked by the pan-PI3K Class IA inhibitor GDC-0941. Additionally, GDC-0941 repressed the maturation of osteoclasts derived from MM patients and disrupted the organisation of the F-actin cytoskeleton in sealing zones required for bone degradation, correlating with decreased bone resorption by osteoclasts. In vivo, GDC-0941 improved the efficacy of dexamethasone against MM in the syngeneic GFP-5T33/C57-Rawji mouse model. Taken together, our results indicate that GDC-0941 in combination with currently used therapeutic agents could effectively kill MM cells in the presence of the cytoprotective BM microenvironment while inhibiting bone resorption by osteoclasts. These data support investigating GDC-0941 in combination with currently used therapeutic drugs for MM patients with active bone disease.
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Affiliation(s)
- Hugh Kikuchi
- Department of Haemato-Oncology, King’s College London, London SE5 9NU, UK
| | - Eunice Amofa
- Department of Haemato-Oncology, King’s College London, London SE5 9NU, UK
| | - Maeve Mcenery
- Department of Haemato-Oncology, King’s College London, London SE5 9NU, UK
| | - Steve Arthur Schey
- Department of Haemato-Oncology, King’s College London, London SE5 9NU, UK
- Department of Haematology, Guys Hospital, Guys and St. Thomas’ NHS Foundation Trust, London SE5 9RS, UK
| | - Karthik Ramasamy
- Royal Berkshire Hospital, Oxford University Hospitals, Oxford OX3 7LE, UK
| | - Farzin Farzaneh
- Department of Haemato-Oncology, King’s College London, London SE5 9NU, UK
| | - Yolanda Calle
- School of Life Sciences and Health, University of Roehampton, London SW15 4JD, UK
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Kannan N, Dass J, Dangudubiyyam S, Viswanathan GK, Aggarwal M, Kumar P, Dhawan R, Seth T, Mahapatra M. Clinico-pathological profile of patients with plasma cell neoplasms with special reference to bone marrow fibrosis and amyloid deposition. J Clin Exp Hematop 2023; 63:214-218. [PMID: 38148011 PMCID: PMC10861367 DOI: 10.3960/jslrt.23029] [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: 07/21/2023] [Revised: 08/26/2023] [Accepted: 09/04/2023] [Indexed: 12/28/2023] Open
Abstract
To clarify the significance of bone marrow fibrosis and amyloid deposition in plasma cell neoplasm, a retrospective cross-sectional study for a period of 3 years was conducted. Patients who underwent bone marrow aspiration and biopsy with suspicion of plasma cell neoplasms were included in the study. The bone marrow findings were correlated with clinical profile of the patient along with biochemical parameters, cytogenetics, Fluorescent in situ hybridization (FISH) wherever available. A total of 273 bone marrow aspirates and biopsies of patients with suspected plasma cell neoplasms were analyzed. There were 181 male patients and 92 female patients (Male: Female = 1.96: 1). There were 245 cases of multiple myeloma (89.7%), 8 cases of primary amyloidosis (2.9%) and 6 monoclonal gammopathy of undetermined significance (MGUS) (2.1%), 5 cases of plasmacytoma (1.8%) and 4 cases of smouldering myeloma (1.4%), 5 cases of POEMS syndrome (1.8%). Bone marrow fibrosis was noted in 12 patients at diagnosis (4.3%). Among the parameters studied, only the mean Hemoglobin was significantly low in patients with marrow fibrosis. Amyloid deposition in various organs including bone marrow, kidney, liver etc., were noted in 17 patients overall (6.2%). In conclusion, the incidence of fibrosis (4.3%) and amyloidosis (6.2%) associated with plasma cell neoplasms were much lower in our study as compared to published studies.
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Koshiishi M, Kawashima I, Hyuga H, Nakadate A, Matsuura M, Hosokawa E, Sakamoto Y, Suzuki J, Suzuki M, Kumagai T, Yamamoto T, Nakajima K, Tanaka M, Kirito K. Presence of bone marrow fibrosis in multiple myeloma may predict extramedullary disease. Int J Hematol 2022; 116:544-552. [PMID: 35538304 DOI: 10.1007/s12185-022-03373-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 04/20/2022] [Accepted: 04/20/2022] [Indexed: 11/25/2022]
Abstract
We analyzed the incidence of bone marrow fibrosis in 91 newly diagnosed Japanese multiple myeloma (MM) patients and evaluated the impact of fibrosis on clinical characteristics and therapeutic outcomes. Thirty-four (37%) patients had greater than grade 1 bone marrow fibrosis. The presence of bone marrow fibrosis did not affect laboratory data, the percentage of plasma cells in bone marrow or cytogenetic findings. It also had no significant effect on response to initial treatment, engraftment after autologous hematopoietic stem cell transplantation or overall survival. Interestingly, the incidence of extramedullary disease at diagnosis was significantly higher in patients with bone marrow fibrosis (p = 0.006). Analysis of biological characteristics of MM cells revealed that expression of CD49e, an alpha5/beta1 integrin, was downregulated in MM cells derived from patients with bone marrow fibrosis (p = 0.026). When seven of the original 34 patients were re-evaluated for fibrosis grading after treatment, five (71%) showed a reduction in fibrosis. Our present findings suggest that the presence of bone marrow fibrosis may predict development of extramedullary disease in MM.
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Affiliation(s)
- Megumi Koshiishi
- Department of Hematology/Oncology, University of Yamanashi, 1110, Shimokato, Chuo City, Yamanashi-ken, 409-3898, Japan
| | - Ichiro Kawashima
- Department of Hematology/Oncology, University of Yamanashi, 1110, Shimokato, Chuo City, Yamanashi-ken, 409-3898, Japan
| | - Hideto Hyuga
- Department of Hematology/Oncology, University of Yamanashi, 1110, Shimokato, Chuo City, Yamanashi-ken, 409-3898, Japan
| | - Ayato Nakadate
- Department of Hematology/Oncology, University of Yamanashi, 1110, Shimokato, Chuo City, Yamanashi-ken, 409-3898, Japan
| | - Minori Matsuura
- Department of Hematology/Oncology, University of Yamanashi, 1110, Shimokato, Chuo City, Yamanashi-ken, 409-3898, Japan
| | - Eriko Hosokawa
- Department of Hematology/Oncology, University of Yamanashi, 1110, Shimokato, Chuo City, Yamanashi-ken, 409-3898, Japan
| | - Yuma Sakamoto
- Department of Hematology/Oncology, University of Yamanashi, 1110, Shimokato, Chuo City, Yamanashi-ken, 409-3898, Japan
| | - Jun Suzuki
- Department of Hematology/Oncology, University of Yamanashi, 1110, Shimokato, Chuo City, Yamanashi-ken, 409-3898, Japan
| | - Megumi Suzuki
- Department of Hematology/Oncology, University of Yamanashi, 1110, Shimokato, Chuo City, Yamanashi-ken, 409-3898, Japan
| | - Takuma Kumagai
- Department of Hematology/Oncology, University of Yamanashi, 1110, Shimokato, Chuo City, Yamanashi-ken, 409-3898, Japan
| | - Takeo Yamamoto
- Department of Hematology/Oncology, University of Yamanashi, 1110, Shimokato, Chuo City, Yamanashi-ken, 409-3898, Japan
| | - Kei Nakajima
- Department of Hematology/Oncology, University of Yamanashi, 1110, Shimokato, Chuo City, Yamanashi-ken, 409-3898, Japan
| | - Masaru Tanaka
- Department of Hematology/Oncology, University of Yamanashi, 1110, Shimokato, Chuo City, Yamanashi-ken, 409-3898, Japan
| | - Keita Kirito
- Department of Hematology/Oncology, University of Yamanashi, 1110, Shimokato, Chuo City, Yamanashi-ken, 409-3898, Japan.
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Seyhanlı A, Yavuz B, Akşit Z, Yüce Z, Özkal S, Altungöz O, Demirkan F, Alacacıoğlu İ, Özsan GH. Assessment of Bone Marrow Biopsy and Cytogenetic Findings in Patients with Multiple Myeloma. Turk J Haematol 2021; 39:109-116. [PMID: 34823323 PMCID: PMC9160703 DOI: 10.4274/tjh.galenos.2021.2021.0325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective Multiple myeloma (MM) is a malignant condition that is characterized by the accumulation of malignant plasma cells. Although MM remains incurable, the survival of MM patients has improved considerably due to applied autologous stem cell transplantation (ASCT), novel agents, and treatment strategies. This study aimed to determine the cytogenetic characterization and bone marrow features of Turkish patients with MM. Materials and Methods Eighty-five MM patients were admitted to the 9 Eylul University Hospital in Turkey. Bone marrow (BM) samples MM patients were subject to cytogenetic analyses on diagnosis and during therapy as part of therapeutical and clinical evaluation. A complete cytogenetic study was performed using the G-banding technique. The Fluorescent in situ hybridization (FISH) analysis was performed using cytoplasmic immunoglobulin (cIg)-FISH. The degree of bone marrow fibrosis was determined using the histochemical stain of reticulin. We determined the percentage of bone marrow plasma cells based on the extent of CD38 staining. Results Eighty-five MM patients were retrospectively identified between 2015 and 2021. The median age was 63 (38-90) years. Of the 85 patients, 60 (70.6%) were male, and 25 (29.4%) were female. Seventy-two (84.7%) cases had bone marrow fibrosis at the time of diagnosis. The most common was grade-2 fibrosis, recorded in 35 patients (41.2%). About 72.9% of the patients showed more than 50% plasma cells. The FISH analysis indicated the presence of abnormal chromosomes in 37% (32/85) of the patients. The most frequent abnormality was IGH translocation (21.3%). Conclusion Subgroup analysis of IGH mutations is crucial in the identification of high-risk MM patients. We believe that our study will contribute to the determination of bone marrow biopsy and cytogenetic features of MM patients in our country.
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Affiliation(s)
- Ahmet Seyhanlı
- Sivas Numune Hospital, Department of Hematology, Sivas, Turkey
| | - Boran Yavuz
- Dokuz Eylül University Faculty of Medicine, Department of Hematology, İzmir, Turkey
| | - Zehra Akşit
- Dokuz Eylül University Faculty of Medicine, Department of Internal Medicine, İzmir, Turkey
| | - Zeynep Yüce
- Dokuz Eylül University Faculty of Medicine, Department of Medical Biology, İzmir, Turkey
| | - Sermin Özkal
- Dokuz Eylül University Faculty of Medicine, Department of Pathology, İzmir, Turkey
| | - Oğuz Altungöz
- Dokuz Eylül University Faculty of Medicine, Department of Medical Biology, İzmir, Turkey
| | - Fatih Demirkan
- Dokuz Eylül University Faculty of Medicine, Department of Hematology, İzmir, Turkey
| | - İnci Alacacıoğlu
- Dokuz Eylül University Faculty of Medicine, Department of Hematology, İzmir, Turkey
| | - Güner Hayri Özsan
- Dokuz Eylül University Faculty of Medicine, Department of Hematology, İzmir, Turkey
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Paul B, Zhao Y, Loitsch G, Feinberg D, Mathews P, Barak I, Dupuis M, Li Z, Rein L, Wang E, Kang Y. The impact of bone marrow fibrosis and JAK2 expression on clinical outcomes in patients with newly diagnosed multiple myeloma treated with immunomodulatory agents and/or proteasome inhibitors. Cancer Med 2020; 9:5869-5880. [PMID: 32628819 PMCID: PMC7433821 DOI: 10.1002/cam4.3265] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 06/09/2020] [Accepted: 06/10/2020] [Indexed: 01/11/2023] Open
Abstract
We determined the impact of bone marrow fibrosis (BMF) on the clinical outcomes of newly diagnosed multiple myeloma (NDMM) patients in the current era of myeloma therapy. A total of 393 MM patients were included in the final analysis. The median followup was 83 months (range: 3.9 to 212 months). BMF was noted in 122 (48.2%) evaluable patients. Median progression free survival (PFS) in patients without BMF was 30.2 (95% CI: 24.7-38.0) months, and 21.1 (95% CI: 18.8-27.5) months in patients with BMF present (P = .024). Median overall survival (OS) was 61.2 (95% CI: 51.5-81.2) months in patients without BMF, and 45.1 (95% CI: 38.7-57.0) months in patients with BMF (P = .0048). A subset of 99 patients had their bone marrow biopsies stained for JAK1 and JAK2 by immunohistochemistry. Of these samples 67 (67.7%) patients had detectable JAK2 expression predominantly noted on bone marrow megakaryocytes. JAK2 expression correlated with myeloma disease stage (P = .0071). Our study represents the largest dataset to date examining the association of BMF with prognosis in the era of novel therapies and widespread use of hematopoietic stem cell transplant (HSCT). Our data suggest that MM patients with BMF (particularly those with extensive BMF) have a poorer prognosis even when treated with immunomodulatory agents and proteasome inhibitors.
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Affiliation(s)
- Barry Paul
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Yue Zhao
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Gavin Loitsch
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Daniel Feinberg
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Parker Mathews
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Ian Barak
- Biostatistics Shared Resource, Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - Megan Dupuis
- Hematology/Oncology Fellowship Program, MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Zhiguo Li
- Biostatistics Shared Resource, Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - Lindsay Rein
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Endi Wang
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Yubin Kang
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
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Della-Torre E, Rigamonti E, Perugino C, Baghai-Sain S, Sun N, Kaneko N, Maehara T, Rovati L, Ponzoni M, Milani R, Lanzillotta M, Mahajan V, Mattoo H, Molineris I, Deshpande V, Stone JH, Falconi M, Manfredi AA, Pillai S. B lymphocytes directly contribute to tissue fibrosis in patients with IgG 4-related disease. J Allergy Clin Immunol 2019; 145:968-981.e14. [PMID: 31319101 DOI: 10.1016/j.jaci.2019.07.004] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 05/31/2019] [Accepted: 07/09/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND IgG4-related disease (IgG4-RD) is a fibroinflammatory condition marked by rapid clinical improvement after selective depletion of B lymphocytes with rituximab. This feature suggests that B cells might participate in fibrogenesis and wound healing. OBJECTIVE In the present work we aimed to demonstrate that B lymphocytes contribute directly to tissue fibrosis in patients with IgG4-RD. METHODS Total circulating CD19+ B lymphocytes, naive B cells, memory B cells, or plasmablasts from patients with IgG4-RD were cultivated with human fibroblasts. Profibrotic soluble factors and collagen production in cocultures were assessed by using ELISAs and Luminex assays. RNA sequencing and quantitative RT-PCR were used to assess fibroblast activation in the presence of B cells, as well as induction of profibrotic pathways in B-cell subsets. Relevant profibrotic and inflammatory molecules were confirmed in vitro by using functional experiments and on IgG4-RD tissue sections by using multicolor immunofluorescence studies. RESULTS B cells from patients with IgG4-RD (1) produced the profibrotic molecule platelet-derived growth factor B and stimulated collagen production by fibroblasts; (2) expressed enzymes implicated in extracellular matrix remodeling, such as lysyl oxidase homolog 2; (3) produced the chemotactic factors CCL4, CCL5, and CCL11; and (4) induced production of these same chemokines by activated fibroblasts. Plasmablasts expressed sets of genes implicated in fibroblast activation and proliferation and therefore represent cells with intrinsic profibrotic properties. CONCLUSION We have demonstrated that B cells contribute directly to tissue fibrosis in patients with IgG4-RD. These unanticipated profibrotic properties of B lymphocytes, particularly plasmablasts, might be relevant for fibrogenesis in patients with other fibroinflammatory disorders and for wound-healing processes in physiologic conditions.
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Affiliation(s)
- Emanuel Della-Torre
- Università Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy; Ragon Institute of MGH, MIT, and Harvard, Massachusetts General Hospital, Harvard Medical School, Boston, Mass; Unit of Immunology, Rheumatology, Allergy, and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Elena Rigamonti
- Università Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Cory Perugino
- Ragon Institute of MGH, MIT, and Harvard, Massachusetts General Hospital, Harvard Medical School, Boston, Mass; Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Simona Baghai-Sain
- Center for Translational Genomics and Bioinformatics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Na Sun
- Ragon Institute of MGH, MIT, and Harvard, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Naoki Kaneko
- Ragon Institute of MGH, MIT, and Harvard, Massachusetts General Hospital, Harvard Medical School, Boston, Mass; Section of Oral and Maxillofacial Oncology, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Takashi Maehara
- Ragon Institute of MGH, MIT, and Harvard, Massachusetts General Hospital, Harvard Medical School, Boston, Mass; Section of Oral and Maxillofacial Oncology, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Lucrezia Rovati
- Università Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy; Ragon Institute of MGH, MIT, and Harvard, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Maurilio Ponzoni
- Università Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pathology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Raffaella Milani
- Immunohematology and Transfusion Medicine Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Lanzillotta
- Università Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vinay Mahajan
- Ragon Institute of MGH, MIT, and Harvard, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Hamid Mattoo
- Immunology and Inflammation Therapeutic Area, Sanofi, Cambridge, Mass
| | - Ivan Molineris
- Center for Translational Genomics and Bioinformatics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vikram Deshpande
- Department of Pathology, Massachusetts General Hospital, Boston, Mass
| | - John H Stone
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Massimo Falconi
- Università Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy; Division of Pancreatic Surgery, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Angelo A Manfredi
- Università Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy; Unit of Immunology, Rheumatology, Allergy, and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Shiv Pillai
- Ragon Institute of MGH, MIT, and Harvard, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
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9
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Profile of fibrosis-related gene transcripts and megakaryocytic changes in the bone marrow of myelodysplastic syndromes with fibrosis. Ann Hematol 2018; 97:2099-2106. [DOI: 10.1007/s00277-018-3411-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 06/21/2018] [Indexed: 11/26/2022]
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10
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Jaime-Pérez J, Villarreal-Villarreal C, Alvarado-Bernal Y, Padilla-Medina J, Fernández L, Gómez-Almaguer D. Bone marrow architecture reconstitution after hematopoietic grafting: A cross-sectional study. MEDICINA UNIVERSITARIA 2017. [DOI: 10.1016/j.rmu.2017.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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11
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Lee N, Lee H, Moon SY, Sohn JY, Hwang SM, Yoon OJ, Youn HS, Eom HS, Kong SY. Adverse prognostic impact of bone marrow microvessel density in multiple myeloma. Ann Lab Med 2016; 35:563-9. [PMID: 26354343 PMCID: PMC4579099 DOI: 10.3343/alm.2015.35.6.563] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 04/20/2015] [Accepted: 08/09/2015] [Indexed: 12/12/2022] Open
Abstract
Background Angiogenesis is important for the proliferation and survival of multiple myeloma (MM) cells. Bone marrow (BM) microvessel density (MVD) is a useful marker of angiogenesis and is determined by immunohistochemical staining with anti-CD34 antibody. This study investigated the prognostic impact of MVD and demonstrated the relationship between MVD and previously mentioned prognostic factors in patients with MM. Methods The study included 107 patients with MM. MVD was assessed at initial diagnosis in a blinded manner by two hematopathologists who examined three CD34-positive hot spots per patient and counted the number of vessels in BM samples. Patients were divided into three groups according to MVD tertiles. Cumulative progression-free survival (PFS) and overall survival (OS) curves, calculated by using Kaplan-Meier method, were compared among the three groups. Prognostic impact of MVD was assessed by calculating Cox proportional hazard ratio (HR). Results Median MVDs in the three groups were 16.8, 33.9, and 54.7. MVDs were correlated with other prognostic factors, including β2-microglobulin concentration, plasma cell percentage in the BM, and cancer stage according to the International Staging System. Multivariate Cox regression analysis showed that high MVD was an independent predictor of PFS (HR=2.57; 95% confidence interval, 1.22-5.42; P=0.013). PFS was significantly lower in the high MVD group than in the low MVD group (P=0.025). However, no difference was observed in the OS (P=0.428). Conclusions Increased BM MVD is a marker of poor prognosis in patients newly diagnosed with MM. BM MVD should be assessed at the initial diagnosis of MM.
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Affiliation(s)
- Nuri Lee
- Department of Laboratory Medicine, Center for Diagnostic Oncology, Hospital and Research Institute, National Cancer Center, Goyang, Korea.,Department of Laboratory Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyewon Lee
- Hematologic Oncology Clinic, Center for Specific Organs Cancer, Hospital and Research Institute, National Cancer Center, Goyang, Korea
| | - Soo Young Moon
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul, Korea
| | - Ji Yeon Sohn
- Department of Laboratory Medicine, Center for Diagnostic Oncology, Hospital and Research Institute, National Cancer Center, Goyang, Korea
| | - Sang Mee Hwang
- Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ok Jin Yoon
- Department of Laboratory Medicine, Center for Diagnostic Oncology, Hospital and Research Institute, National Cancer Center, Goyang, Korea
| | - Hye Sun Youn
- Department of Laboratory Medicine, Center for Diagnostic Oncology, Hospital and Research Institute, National Cancer Center, Goyang, Korea
| | - Hyeon Seok Eom
- Hematologic Oncology Clinic, Center for Specific Organs Cancer, Hospital and Research Institute, National Cancer Center, Goyang, Korea.
| | - Sun Young Kong
- Research Institute, Translational Epidemiology Branch, National Cancer Center, Goyang, Korea.,Department of Laboratory Medicine, Center for Diagnostic Oncology, Hospital and Research Institute, National Cancer Center, Goyang, Korea.
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12
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Babarović E, Valković T, Budisavljević I, Balen I, Štifter S, Duletić-Načinović A, Lučin K, Jonjić N. The expression of osteopontin and vascular endothelial growth factor in correlation with angiogenesis in monoclonal gammopathy of undetermined significance and multiple myeloma. Pathol Res Pract 2016; 212:509-16. [DOI: 10.1016/j.prp.2015.11.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Revised: 10/24/2015] [Accepted: 11/23/2015] [Indexed: 01/24/2023]
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13
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Plasma Levels of Monocyte Chemotactic Protein-1 Are Associated with Clinical Features and Angiogenesis in Patients with Multiple Myeloma. BIOMED RESEARCH INTERNATIONAL 2016; 2016:7870590. [PMID: 26925413 PMCID: PMC4748063 DOI: 10.1155/2016/7870590] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 11/26/2015] [Accepted: 12/08/2015] [Indexed: 02/07/2023]
Abstract
The aim of this pilot study was to determine the plasma levels of monocyte chemotactic protein-1 (MCP-1) and possible associations with angiogenesis and the main clinical features of untreated patients with multiple myeloma (MM). ELISA was used to determine plasma MCP-1 levels in 45 newly diagnosed MM patients and 24 healthy controls. The blood vessels were highlighted by immunohistochemical staining, and computer-assisted image analysis was used for more objective and accurate determination of two parameters of angiogenesis: microvessel density (MVD) and total vascular area (TVA). The plasma levels of MCP-1 were compared to these parameters and the presence of anemia, renal dysfunction, and bone lesions. A significant positive correlation was found between plasma MCP-1 concentrations and TVA (p = 0.02). The MCP-1 levels were significantly higher in MM patients with evident bone lesions (p = 0.01), renal dysfunction (p = 0.02), or anemia (p = 0.04). Therefore, our preliminary results found a positive association between plasma MCP-1 levels, angiogenesis (expressed as TVA), and clinical features in patients with MM. However, additional prospective studies with a respectable number of patients should be performed to authenticate these results and establish MCP-1 as a possible target of active treatment.
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14
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AbdElAal Asmaa A, Afify RAA, Zaher AE, ElGammal MM, Atef AM. Study of prognostic significance of marrow angiogenesis assessment in patients with de novo acute leukemia. ACTA ACUST UNITED AC 2015; 20:504-10. [PMID: 25885121 DOI: 10.1179/1607845415y.0000000012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Angiogenesis is the highly ordered formation of new blood vessels from pre-existing vessels. It is seen throughout growth, in wound healing, menses, and is important in cancer, where pro- and antiangiogenic signals can be released by cancer cells, endothelial cells, stromal cells, blood, and the extracellular matrix. Aim of the study is to use standardized method for counting blood vessels to verify the significance and prognostic value of assessing marrow angiogenesis at diagnosis of de novo acute leukemia. SUBJECTS AND METHODS The study included 70 newly diagnosed acute leukemia cases and a control group composed of 35 bone marrow biopsy sections obtained from breast cancer patients. Examination of CD34 immunohistochemically stained sections for the assessment of marrow angiogenesis by quantification of its microvessel density (MVD). RESULTS MVD was significantly increased in acute leukemia patients in comparison to control group (P-value <0.001). Increased MVD was associated with unfavorable outcome. CONCLUSION The study demonstrated an evidence of increased angiogenesis in acute leukemia detected by high bone marrow MVD which may play a significant role in leukemic process. Understanding its role may help in designing new therapeutic strategies for acute leukemia.
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MESH Headings
- Adolescent
- Adult
- Aged
- Antineoplastic Agents/therapeutic use
- Bone Marrow/blood supply
- Bone Marrow/drug effects
- Bone Marrow/pathology
- Breast Neoplasms/blood supply
- Breast Neoplasms/pathology
- Child
- Child, Preschool
- Female
- Humans
- Immunohistochemistry
- Induction Chemotherapy/methods
- Leukemia, Myeloid, Acute/diagnosis
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/mortality
- Leukemia, Myeloid, Acute/pathology
- Male
- Microvessels/drug effects
- Microvessels/pathology
- Middle Aged
- Neovascularization, Pathologic/diagnosis
- Neovascularization, Pathologic/drug therapy
- Neovascularization, Pathologic/mortality
- Neovascularization, Pathologic/pathology
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/diagnosis
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/mortality
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/pathology
- Prognosis
- Survival Analysis
- Treatment Outcome
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15
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Kaur M, Singh Rana AP, Kapoor S, Puri A. Diagnostic value of bone marrow aspiration and biopsy in routine hematology practice. J Clin Diagn Res 2014; 8:FC13-6. [PMID: 25302200 DOI: 10.7860/jcdr/2014/9823.4760] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 06/17/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND The bone marrow is frequently involved in variety of cases presenting with hematological and non-hematological disorders, which are diagnosed by two separate but interrelated techniques such as bone marrow aspiration (BMA) and bone marrow biopsy (BMB). AIM This study was aimed to assess the diagnostic value of the BMA and BMB and role of both the procedures to reach final diagnosis when done simultaneously. SETTINGS AND DESIGN It was a prospective study. The findings of BMA smears were correlated with BMB sections and data obtained was analysed. MATERIALS AND METHODS BMA and BMB were performed on 50 patients. Criteria of inclusion included the main indications for performing this procedure, the availability of full medical records and patient consent. The patients had a male to female sex ratio of 1.6:1 and a wide age range from 4 years to 74 years. RESULTS In the present study, the main indications for bone marrow examination were categorized. Out of 50 cases studied, in 23 cases, a strong positive correlation between BMA and BMB was noted. However, it was found that in the cases of aplastic anaemia, different phases of myeloproliferative neoplasm (MPN), multiple myeloma, tubercular granulomas and hemato-lymphoid neoplasm, involvement of the marrow was detected better in bone marrow biopsies. CONCLUSION The study concludes that preparations of aspirate and trephine biopsy are easy, rapid and complementary to each other in majority of the lesions. The advantage of both the procedures done together enabled us to study the cytomorphology of the cells along with the pattern of distribution of the cells depending on the cases, hence help in making the diagnosis accurately.
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Affiliation(s)
- Manjit Kaur
- Assistant Professor, Department of Pathology, Guru Gobind Singh Medical College , Faridkot, India
| | - Amrit Pal Singh Rana
- Assistant Professor, Department of Surgery, Guru Gobind Singh Medical College , Faridkot, India
| | | | - Arun Puri
- Professor, Department of Pathology, Guru Gobind Singh Medical College , Faridkot, India
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Gulic T, Laskarin G, Redzovic A, Eminović S, Haller H, Rukavina D. The significance of heat-shock protein gp96 and its receptors' CD91 and Toll-like receptor 4 expression at the maternal foetal interface. Am J Reprod Immunol 2013; 70:10-23. [PMID: 23755898 DOI: 10.1111/aji.12096] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 01/19/2013] [Indexed: 11/27/2022] Open
Abstract
PROBLEM Differences in the expression of gp96 and its receptors were analysed in normal and pathological human pregnancy. MATERIAL AND METHODS Immunohistology and immunofluorescence of sections from decidual part of term placenta, first trimester normal decidua, missed abortion and blighted ovum decidua were performed together with reverse transcriptase-quantitative polymerase chain reaction and flow cytometry. RESULTS In missed abortion, gp96 was intensively stained, when compared to normal early pregnancy. The intensity of CD91 and TLR4 was higher in the first trimester pregnancy and blighted ovum, when compared to missed abortion. Decidual part of the term placenta is invaded with gp96⁺ , CD91⁺ and TLR4+ trophoblast. Progesterone-induced blocking factor (PIBF) decreased the frequency of TLR4⁺ T lymphocytes, CD91⁺ T, natural killer (NK) and mature dendritic cells after an 18-h culture. Decidual mononuclear cells (DMCs) treated with PIBF down-regulated CD91, TLR4 and gp96 gene expression. CONCLUSION The presence of gp96, CD91 and TLR4 at the maternal-foetal interface provides a molecular basis for their interaction, particularly in the absence of PIBF.
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Affiliation(s)
- Tamara Gulic
- Department of Physiology and Immunology, Medical Faculty, University of Rijeka, Rijeka, Croatia
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