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Van Den Berghe T, Verberckmoes B, Kint N, Wallaert S, De Vos N, Algoet C, Behaeghe M, Dutoit J, Van Roy N, Vlummens P, Dendooven A, Van Dorpe J, Offner F, Verstraete K. Predicting cytogenetic risk in multiple myeloma using conventional whole-body MRI, spinal dynamic contrast-enhanced MRI, and spinal diffusion-weighted imaging. Insights Imaging 2024; 15:106. [PMID: 38597979 PMCID: PMC11006637 DOI: 10.1186/s13244-024-01672-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 03/08/2024] [Indexed: 04/11/2024] Open
Abstract
OBJECTIVES Cytogenetic abnormalities are predictors of poor prognosis in multiple myeloma (MM). This paper aims to build and validate a multiparametric conventional and functional whole-body MRI-based prediction model for cytogenetic risk classification in newly diagnosed MM. METHODS Patients with newly diagnosed MM who underwent multiparametric conventional whole-body MRI, spinal dynamic contrast-enhanced (DCE-)MRI, spinal diffusion-weighted MRI (DWI) and had genetic analysis were retrospectively included (2011-2020/Ghent University Hospital/Belgium). Patients were stratified into standard versus intermediate/high cytogenetic risk groups. After segmentation, 303 MRI features were extracted. Univariate and model-based methods were evaluated for feature and model selection. Testing was performed using receiver operating characteristic (ROC) and precision-recall curves. Models comparing the performance for genetic risk classification of the entire MRI protocol and of all MRI sequences separately were evaluated, including all features. Four final models, including only the top three most predictive features, were evaluated. RESULTS Thirty-one patients were enrolled (mean age 66 ± 7 years, 15 men, 13 intermediate-/high-risk genetics). None of the univariate models and none of the models with all features included achieved good performance. The best performing model with only the three most predictive features and including all MRI sequences reached a ROC-area-under-the-curve of 0.80 and precision-recall-area-under-the-curve of 0.79. The highest statistical performance was reached when all three MRI sequences were combined (conventional whole-body MRI + DCE-MRI + DWI). Conventional MRI always outperformed the other sequences. DCE-MRI always outperformed DWI, except for specificity. CONCLUSIONS A multiparametric MRI-based model has a better performance in the noninvasive prediction of high-risk cytogenetics in newly diagnosed MM than conventional MRI alone. CRITICAL RELEVANCE STATEMENT An elaborate multiparametric MRI-based model performs better than conventional MRI alone for the noninvasive prediction of high-risk cytogenetics in newly diagnosed multiple myeloma; this opens opportunities to assess genetic heterogeneity thus overcoming sampling bias. KEY POINTS • Standard genetic techniques in multiple myeloma patients suffer from sampling bias due to tumoral heterogeneity. • Multiparametric MRI noninvasively predicts genetic risk in multiple myeloma. • Combined conventional anatomical MRI, DCE-MRI, and DWI had the highest statistical performance to predict genetic risk. • Conventional MRI alone always outperformed DCE-MRI and DWI separately to predict genetic risk. DCE-MRI alone always outperformed DWI separately, except for the parameter specificity to predict genetic risk. • This multiparametric MRI-based genetic risk prediction model opens opportunities to noninvasively assess genetic heterogeneity thereby overcoming sampling bias in predicting genetic risk in multiple myeloma.
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Affiliation(s)
- Thomas Van Den Berghe
- Department of Radiology and Medical Imaging, Ghent University Hospital, Building -1K12, Corneel Heymanslaan 10, Ghent, B-9000, Belgium.
| | - Bert Verberckmoes
- Department of Radiology and Medical Imaging, Ghent University Hospital, Building -1K12, Corneel Heymanslaan 10, Ghent, B-9000, Belgium
| | - Nicolas Kint
- Department of Clinical Hematology, Ghent University Hospital, Corneel Heymanslaan 10, Ghent, B-9000, Belgium
| | - Steven Wallaert
- Department of Biostatistics, Ghent University Hospital, Corneel Heymanslaan 10, Ghent, B-9000, Belgium
| | - Nicolas De Vos
- Department of Radiology and Medical Imaging, Ghent University Hospital, Building -1K12, Corneel Heymanslaan 10, Ghent, B-9000, Belgium
| | - Chloé Algoet
- Department of Radiology and Medical Imaging, Ghent University Hospital, Building -1K12, Corneel Heymanslaan 10, Ghent, B-9000, Belgium
| | - Maxim Behaeghe
- Department of Radiology and Medical Imaging, Ghent University Hospital, Building -1K12, Corneel Heymanslaan 10, Ghent, B-9000, Belgium
| | - Julie Dutoit
- Department of Radiology and Medical Imaging, Ghent University Hospital, Building -1K12, Corneel Heymanslaan 10, Ghent, B-9000, Belgium
| | - Nadine Van Roy
- Center for Medical Genetics, Ghent University Hospital, Corneel Heymanslaan 10, Ghent, B-9000, Belgium
| | - Philip Vlummens
- Department of Clinical Hematology, Ghent University Hospital, Corneel Heymanslaan 10, Ghent, B-9000, Belgium
| | - Amélie Dendooven
- Department of Pathology, Ghent University Hospital, Corneel Heymanslaan 10, Ghent, B-9000, Belgium
| | - Jo Van Dorpe
- Department of Pathology, Ghent University Hospital, Corneel Heymanslaan 10, Ghent, B-9000, Belgium
| | - Fritz Offner
- Department of Clinical Hematology, Ghent University Hospital, Corneel Heymanslaan 10, Ghent, B-9000, Belgium
| | - Koenraad Verstraete
- Department of Radiology and Medical Imaging, Ghent University Hospital, Building -1K12, Corneel Heymanslaan 10, Ghent, B-9000, Belgium
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Yavorkovsky LL. The role of staging in multiple myeloma. Expert Rev Hematol 2023; 16:933-942. [PMID: 37902242 DOI: 10.1080/17474086.2023.2277876] [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: 09/22/2023] [Accepted: 10/27/2023] [Indexed: 10/31/2023]
Abstract
INTRODUCTION The importance of cancer staging is determined by how accurately it can predict prognosis, and how useful it is for treatment decisions. Compared to other malignancies, multiple myeloma (MM) staging proved more challenging because of unreliable prognostic factors and wide-ranging life expectancy. As traditional MM staging continues to evolve, it requires reassessment of its prognostic and predictive value. AREAS COVERED The studies that included prognostic and predictive value of MM stages from 1975 through 2023 were selected for this review using PubMed, MEDLINE platforms. The history and evolution of MM staging are revisited, including its role in predicting survival, treatment planning and potential practical implications for the future. The role of MM staging for oncological practice and patient counseling is discussed. EXPERT OPINION The utility of the traditional MM staging remains unsatisfactory because it lacks a strong connection with the disease biology, prognosis or treatment planning. Additionally, it demonstrates a modest value for patient counseling because individual prognosis is subject to under- or overestimation, and the median survival or survival rates are difficult concepts to grasp. Although the role of MM stages may change in the future, the current research upholds the notion that MM staging benefits more medical research and clinical trials than oncological practice.
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Affiliation(s)
- Leonid L Yavorkovsky
- Kaiser Permanente San Jose Medical Center, Oncology Division, 271 International Circle, San Jose, CA, USA
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Baker D, Bimali M, Carrillo L, Sachedina A, Alapat D, Hoque MS, Kottarathara M, Parikh R, Erra A, Mitma AA, Mathur P, Ogunsesan Y, Yarlagadda L, Gundarlapalli S, Thanendrarajan S, Zangari M, Van Rhee F, Tricot G, Schinke C. Predicting risk of progression in relapsed multiple myeloma using traditional risk models, focal lesion assessment with PET-CT and minimal residual disease status. Haematologica 2021; 106:3215-3218. [PMID: 34847659 PMCID: PMC8634177 DOI: 10.3324/haematol.2021.278779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Indexed: 12/05/2022] Open
Affiliation(s)
- David Baker
- Myeloma Center, Division of Hematology/Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock
| | - Milan Bimali
- Arkansas Children's Nutrition Center, Arkansas Children's Hospital, Little Rock, AR; Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock
| | - Luis Carrillo
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock
| | - Archana Sachedina
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock
| | - Daisy Alapat
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock
| | - Md Shadiqul Hoque
- Myeloma Center, Division of Hematology/Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock
| | - Mathew Kottarathara
- Myeloma Center, Division of Hematology/Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock
| | - Richa Parikh
- Myeloma Center, Division of Hematology/Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock
| | - Amani Erra
- Myeloma Center, Division of Hematology/Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock
| | - Angel A Mitma
- Myeloma Center, Division of Hematology/Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock
| | - Pankaj Mathur
- Myeloma Center, Division of Hematology/Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock
| | - Yetunde Ogunsesan
- Myeloma Center, Division of Hematology/Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock
| | - Lakshmi Yarlagadda
- Myeloma Center, Division of Hematology/Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock
| | - Sravani Gundarlapalli
- Myeloma Center, Division of Hematology/Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock
| | - Sharmilan Thanendrarajan
- Myeloma Center, Division of Hematology/Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock
| | - Maurizio Zangari
- Myeloma Center, Division of Hematology/Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock
| | - Frits Van Rhee
- Myeloma Center, Division of Hematology/Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock
| | - Guido Tricot
- Myeloma Center, Division of Hematology/Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock
| | - Carolina Schinke
- Myeloma Center, Division of Hematology/Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock.
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Initial Therapeutic Approaches to Patients with Multiple Myeloma. Adv Ther 2021; 38:3694-3711. [PMID: 34145483 DOI: 10.1007/s12325-021-01824-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/08/2021] [Indexed: 12/11/2022]
Abstract
Multiple Myeloma (MM) is part of a spectrum of plasma cell disorders that may result in end organ damage. MM is subclassified into high and standard risk based on cytogenetic and laboratory markers. The treatment of newly diagnosed multiple myeloma is constantly changing with the advent of novel therapies. Recent advances in therapies have resulted in longer time to remission and overall survival. the introduction of targeted therapy with monoclonal antibodies such as Daratumumab has improved stringent complete response to 39%. In this review, we outline the current approach to diagnosis, prognosis, and management of newly diagnosed multiple myeloma in both transplant eligible and ineligible patients.
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Attia HRM, Abdelrahman AH, Ibrahim MH, Eid MM, Eid OM, Sallam MT, El Gammal MM, Kamel MM. Altered Expression of MicroRNAs in the Bone Marrow of Multiple Myeloma Patients and their Relationship to Cytogenetic Aberrations. Curr Pharm Biotechnol 2020; 21:1394-1401. [PMID: 32196445 DOI: 10.2174/1389201021666200320135139] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/24/2020] [Accepted: 03/11/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND Multiple Myeloma (MM) is a complex hematologic malignancy, driven by several genetic and epigenetic alterations. MiRNAs as biomarkers have become a rapidly growing research area in the last decade. AIM The aim was to study the expression pattern of selected miRNAs and to explore the impact of cytogenetic aberrations in MM patients for therapeutic tools. PATIENTS AND METHODS Forty Egyptian adult patients were selected for the study with symptomatic newly diagnosed MM disease. Bone marrow samples were collected to investigate twelve miRNAs selected according to their relation to the most common cytogenetic aberrations with relevant prognostic value. The relative expression of the selected miRNAs was determined using a real-time PCR technique. Fluorescence In Situ Hybridization (FISH) technique was performed for cytogenetic analysis. RESULTS Eight miRNAs were down-regulated [miR-15a (p<0.001), miR214-3p (p<0.001), miR135b (p<0.001), miR19a-3p (p<0.001), miR19b-3p ((p=0.026), miR30e-5p (NS), miR133a (NS), miR146a- 5p (p<0.001)]. Four miRNAs were up-regulated [miR99b-5p (p=0.028), miR125a-3p (p=0.004), let7b- 5p (p<0.001), let7c-5p (p<0.001)]. Significant relation was observed between positive 14q32 rearrangement using the break apart re-arrangement probe for 14q32.33 locus and lower expression levels of miR15a (p= 0.014), 214-3p (p=0.046), 99b-5p (p=0.014), 146a-5p (p=0.041). A higher expression level of miR30e-5p was significantly related to positive 14q32 rearrangement. CONCLUSION Deregulated miRNAs were identified and the association with 14q32 rearrangement and MM pathogenesis has been determined.
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Affiliation(s)
- Hanaa R M Attia
- Department of Clinical and Chemical Pathology, National Research Centre, Cairo, Egypt
| | - Amany H Abdelrahman
- Department of Clinical and Chemical Pathology, National Research Centre, Cairo, Egypt
| | - Mona H Ibrahim
- Department of Clinical and Chemical Pathology, National Research Centre, Cairo, Egypt
| | - Maha M Eid
- Department of Human Cytogenetics, National Research Centre, Cairo, Egypt
| | - Ola M Eid
- Department of Human Cytogenetics, National Research Centre, Cairo, Egypt
| | - Mohamed T Sallam
- Department of Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mosaad M El Gammal
- Department of Medical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Mahmoud M Kamel
- Immunology & Bone Marrow Transplantation (BMT) Unit, National Cancer Institute, Cairo University, Cairo, Egypt
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CNV Radar: an improved method for somatic copy number alteration characterization in oncology. BMC Bioinformatics 2020; 21:98. [PMID: 32143562 PMCID: PMC7060549 DOI: 10.1186/s12859-020-3397-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 02/07/2020] [Indexed: 12/15/2022] Open
Abstract
Background Cancer associated copy number variation (CNV) events provide important information for identifying patient subgroups and suggesting treatment strategies. Technical and logistical issues, however, make it challenging to accurately detect abnormal copy number events in a cost-effective manner in clinical studies. Results Here we present CNV Radar, a software tool that utilizes next-generation sequencing read depth information and variant allele frequency patterns, to infer the true copy number status of genes and genomic regions from whole exome sequencing data. Evaluation of CNV Radar in a public multiple myeloma dataset demonstrated that CNV Radar was able to detect a variety of CNVs associated with risk of progression, and we observed > 70% concordance with fluorescence in situ hybridization (FISH) results. Compared to other CNV callers, CNV Radar showed high sensitivity and specificity. Similar results were observed when comparing CNV Radar calls to single nucleotide polymorphism array results from acute myeloid leukemia and prostate cancer datasets available on TCGA. More importantly, CNV Radar demonstrated its utility in the clinical trial setting: in POLLUX and CASTOR, two phase 3 studies in patients with relapsed or refractory multiple myeloma, we observed a high concordance rate with FISH for del17p, a risk defining CNV event (88% in POLLUX and 90% in CASTOR), therefore allowing for efficacy assessments in clinically relevant disease subgroups. Our case studies also showed that CNV Radar is capable of detecting abnormalities such as copy-neutral loss of heterozygosity that elude other approaches. Conclusions We demonstrated that CNV Radar is more sensitive than other CNV detection methods, accurately detects clinically important cytogenetic events, and allows for further interrogation of novel disease biology. Overall, CNV Radar exhibited high concordance with standard methods such as FISH, and its success in the POLLUX and CASTOR clinical trials demonstrated its potential utility for informing clinical and therapeutic decisions.
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Consensus Guidelines on the Diagnosis of Multiple Myeloma and Related Disorders: Recommendations of the Myeloma Canada Research Network Consensus Guideline Consortium. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 20:e352-e367. [PMID: 32249195 DOI: 10.1016/j.clml.2020.01.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/17/2020] [Accepted: 01/24/2020] [Indexed: 02/07/2023]
Abstract
Multiple myeloma (MM) is a plasma cell (PC) malignancy of terminally differentiated B lymphocytes that is typically associated with the secretion of partial and/or complete monoclonal immunoglobulins and a constellation of particular symptoms and signs. MM is a treatable condition, and timely diagnosis is essential to limit or avoid irreversible target-organ damage and to prolong survival. The Myeloma Canada Research Network Consensus Guideline Consortium (MCRN-CGC) proposes national consensus recommendations for the diagnosis of MM and associated PC neoplasms. The focus is on widely available tests but also highlights recent advancements that are important to include in the diagnostic paradigm. By clarifying and updating the required laboratory, radiographic, and bone marrow investigations, the MCRN-CGC hopes to address the needs of Canadian physicians and people living with MM across the country through accurate and timely diagnosis of MM, as well as appropriate initial stratification to improve treatment selection and outcomes. The MCRN-CGC will periodically review the recommendations herein and update as necessary. Recommendations on the therapeutic approaches and associated monitoring of MM will follow.
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Dolgova EV, Petrova DD, Proskurina AS, Ritter GS, Kisaretova PE, Potter EA, Efremov YR, Bayborodin SI, Karamysheva TV, Romanenko MV, Netesov SV, Taranov OS, Ostanin AA, Chernykh ER, Bogachev SS. Identification of the xenograft and its ascendant sphere-forming cell line as belonging to EBV-induced lymphoma, and characterization of the status of sphere-forming cells. Cancer Cell Int 2019; 19:120. [PMID: 31080361 PMCID: PMC6503443 DOI: 10.1186/s12935-019-0842-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 04/27/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND We have characterized the human cell line arised from the Epstein-Barr virus (EBV) positive multiple myeloma aspirate subjected to the long-term cultivation. This cell line has acquired the ability to form free-floating spheres and to produce a xenograft upon transplantation into NOD/SCID mice. METHODS Cells from both in vitro culture and developed xenografts were investigated with a number of analytical approaches, including pathomorphological analysis, FISH analysis, and analysis of the surface antigens and of the VDJ locus rearrangement. RESULTS The obtained results, as well as the confirmed presence of EBV, testify that both biological systems are derived from B-cells, which, in turn, is a progeny of the EBV-transformed B-cellular clone that supplanted the primordial multiple myeloma cells. Next we assessed whether cells that (i) were constantly present in vitro in the investigated cell line, (ii) were among the sphere-forming cells, and (iii) were capable of internalizing a fluorescent TAMRA-labeled DNA probe (TAMRA+ cells) belonged to one of the three types of undifferentiated bone marrow cells of a multiple myeloma patient: CD34+ hematopoietic stem cells, CD90+ mesenchymal stem cells, and clonotypic multiple myeloma cell. CONCLUSION TAMRA+ cells were shown to constitute the fourth independent subpopulation of undifferentiated bone marrow cells of the multiple myeloma patient. We have demonstrated the formation of ectopic contacts between TAMRA+ cells and cells of other types in culture, in particular with CD90+ mesenchymal stem cells, followed by the transfer of some TAMRA+ cell material into the contacted cell.
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Affiliation(s)
- Evgeniya V. Dolgova
- Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Sciences, 10 Lavrentiev Ave., Novosibirsk, 630090 Russia
| | | | - Anastasia S. Proskurina
- Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Sciences, 10 Lavrentiev Ave., Novosibirsk, 630090 Russia
| | - Genrikh S. Ritter
- Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Sciences, 10 Lavrentiev Ave., Novosibirsk, 630090 Russia
- Novosibirsk State University, Novosibirsk, Russia
| | - Polina E. Kisaretova
- Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Sciences, 10 Lavrentiev Ave., Novosibirsk, 630090 Russia
- Novosibirsk State University, Novosibirsk, Russia
| | - Ekaterina A. Potter
- Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Sciences, 10 Lavrentiev Ave., Novosibirsk, 630090 Russia
| | - Yaroslav R. Efremov
- Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Sciences, 10 Lavrentiev Ave., Novosibirsk, 630090 Russia
- Novosibirsk State University, Novosibirsk, Russia
| | - Sergey I. Bayborodin
- Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Sciences, 10 Lavrentiev Ave., Novosibirsk, 630090 Russia
| | - Tatiana V. Karamysheva
- Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Sciences, 10 Lavrentiev Ave., Novosibirsk, 630090 Russia
| | | | | | - Oleg S. Taranov
- State Research Center of Virology and Biotechnology “Vector”, Koltsovo, Novosibirsk, Russia
| | | | - Elena R. Chernykh
- Research Institute of Fundamental and Clinical Immunology, Novosibirsk, Russia
| | - Sergey S. Bogachev
- Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Sciences, 10 Lavrentiev Ave., Novosibirsk, 630090 Russia
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Hyperhaploid plasma cell myeloma characterized by poor outcome and monosomy 17 with frequently co-occurring TP53 mutations. Blood Cancer J 2019; 9:20. [PMID: 30783078 PMCID: PMC6381150 DOI: 10.1038/s41408-019-0182-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 01/18/2019] [Accepted: 01/30/2019] [Indexed: 01/20/2023] Open
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Saltarella I, Morabito F, Giuliani N, Terragna C, Omedè P, Palumbo A, Bringhen S, De Paoli L, Martino E, Larocca A, Offidani M, Patriarca F, Nozzoli C, Guglielmelli T, Benevolo G, Callea V, Baldini L, Grasso M, Leonardi G, Rizzo M, Falcone AP, Gottardi D, Montefusco V, Musto P, Petrucci MT, Dammacco F, Boccadoro M, Vacca A, Ria R. Prognostic or predictive value of circulating cytokines and angiogenic factors for initial treatment of multiple myeloma in the GIMEMA MM0305 randomized controlled trial. J Hematol Oncol 2019; 12:4. [PMID: 30626425 PMCID: PMC6327520 DOI: 10.1186/s13045-018-0691-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 12/25/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Several new drugs are approved for treatment of patients with multiple myeloma (MM), but no validated biomarkers are available for the prediction of a clinical outcome. We aimed to establish whether pretreatment blood and bone marrow plasma concentrations of major cytokines and angiogenic factors (CAFs) of patients from a phase 3 trial of a MM treatment could have a prognostic and predictive value in terms of response to therapy and progression-free and overall survival and whether these patients could be stratified for their prognosis. METHODS Blood and bone marrow plasma levels of Ang-2, FGF-2, HGF, VEGF, PDGF-β, IL-8, TNF-α, TIMP-1, and TIMP-2 were determined at diagnosis in MM patients enrolled in the GIMEMA MM0305 randomized controlled trial by an enzyme-linked immunosorbent assay (ELISA). These levels were correlated both reciprocally and with the type of therapy and patients' characteristics and with a group of non-MM patients as controls. RESULTS No significant differences were detected between the blood and bone marrow plasma levels of angiogenic cytokines. A cutoff for each CAF was established. The therapeutic response of patients with blood plasma levels of CAFs lower than the cutoff was better than the response of those with higher levels in terms of percentage of responding patients and quality of response. CONCLUSION FGF-2, HGF, VEGF, and PDGF-β plasma levels at diagnosis have predictive significance for response to treatment. The stratification of patients based on the levels of CAFs at diagnosis and their variations after therapy is useful to characterize different risk groups concerning outcome and response to therapy. TRIAL REGISTRATION Clinical trial information can be found at the following link: NCT01063179.
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Affiliation(s)
- Ilaria Saltarella
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Fortunato Morabito
- Biothecnology Research Unit, Aprigliano, Cosenza, Italy.,Hemato-oncology Department Augusta Victoria Hospital, Jerusalem, Israel
| | - Nicola Giuliani
- Department of Clinical and Experimental Medicine, Myeloma Unit, University of Parma, Parma, Italy
| | - Carolina Terragna
- "Seràgnoli" Institute of Hematology, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Bologna University School of Medicine, Bologna, Italy
| | - Paola Omedè
- Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Antonio Palumbo
- Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Sara Bringhen
- Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | | | - Enrica Martino
- Division of Hematology, AOU "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Alessandra Larocca
- Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | | | | | - Chiara Nozzoli
- Cellular Therapies and Transfusion Medicine Unit, AOU Careggi, Florence, Italy
| | | | - Giulia Benevolo
- SC Hematology AO Città della Salute e della Scienza, Turin, Italy
| | - Vincenzo Callea
- Divisione di Ematologia, Ospedali Riuniti, Reggio di Calabria, Italy
| | - Luca Baldini
- Hematology Unit, Fondazione IRCCS, Cà Granda, OM Policlinico, DIPO, University of Milan, Milan, Italy
| | | | - Giovanna Leonardi
- Department of Oncology and Hematology AOU, Hematology Unit, Modena, Italy
| | | | | | - Daniela Gottardi
- A.O.U. S. Giovanni Battista A.O. Mauriziano-Umberto I, Turin, Italy
| | | | - Pellegrino Musto
- IRCCS Centro di Riferimento Oncologico della Basilicata, Rionero in Vulture, Italy
| | - Maria Teresa Petrucci
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Rome, Italy
| | - Franco Dammacco
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Mario Boccadoro
- Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Angelo Vacca
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Roberto Ria
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro" Medical School, Bari, Italy. .,Internal Medicine "G. Baccelli", Myeloma Unit, University of Bari "Aldo Moro" Medical School, Azienda Ospedaliero-Universitaria Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy.
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11
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Zhang Y, Shen XJ, Wu XH, Cong H, Ni HB, Ju SQ, Su JY. [miR-202 contributes to sensitizing MM cells to drug significantly via activing JNK/SAPK signaling pathway]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2018; 37:987-992. [PMID: 27995886 PMCID: PMC7348509 DOI: 10.3760/cma.j.issn.0253-2727.2016.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
目的 研究microRNA-202(miR-202)对多发性骨髓瘤(MM)细胞生长的影响,并初步探讨miR-202在MM细胞药物敏感性中的作用机制。 方法 荧光定量PCR检测miR-202及其靶基因B淋巴细胞刺激因子(BAFF)在MM细胞中的表达水平。将miR-202模拟物、miR-202抑制物、BAFF干扰质粒(siBAFF)及其阴性对照转染U266细胞,Western blot检测Bcl-2家族和MAPK信号通路蛋白的表达。WST-1法、流式细胞术(Annexin V-FLUOS)分别检测转染后U266细胞的增殖和凋亡情况。 结果 U266细胞、MM患者CD138+细胞中miR-202 mRNA表达(分别为0.052±0.009、0.304±0.354)均低于健康对照组(3.550±1.126)(P<0.001,P=0.009),BAFF表达水平(5.700±0.734、9.576±2.887)均高于健康对照组(1.819±0.853)(P<0.001,P=0.006)。miR-202模拟物转染组细胞增殖抑制率高于对照组[(56.04±0.02)%对(18.89±0.32)%,P=0.002]。Western blot结果显示,转染miR-202模拟物后,U266细胞Bcl-2表达下调约24%,而Bax蛋白的表达上调约1.24倍,miR-202模拟物组细胞凋亡率高于对照组[(49.60 ± 4.89)%对(26.20 ± 1.28)%,P=0.029]。硼替佐米和miR-202模拟物联合组细胞凋亡率为(51.23 ± 5.41)%,高于硼替佐米单独处理组(31.70 ± 4.40)%和硼替佐米与模拟物对照联合处理组[(51.23±5.41)%对(31.70±4.40)%,P=0.047;(51.23±5.41)%对(27.94±4.04)%,P=0.028)],而miR-202模拟物联合沙利度胺和地塞米松与miR-202模拟物对照组相比差异无统计学意义[(11.66±1.91)%对(10.63±1.74)%,P=0.700;(16.35±1.32)%对(17.43±1.95)%,P=0.400]。miR-202模拟物联合硼替佐米对U266细胞的增殖抑制率高于硼替佐米单独处理组[(36.93±5.98)%对(18.18±4.10)%,P=0.029]。miR-202模拟物及硼替佐米处理U266细胞后,p-JNK蛋白表达水平下调。 结论 miR-202模拟物和硼替佐米可协同抑制MM细胞增殖、诱导其凋亡,可能通过miR-202负向调控靶基因BAFF的表达、抑制JNK/SAPK信号通路的活化来实现的。
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Affiliation(s)
- Y Zhang
- Laboratory Medicine Center, Affiliated Hospital of Nantong University, Nantong Jiangsu 226001, China
| | | | | | | | | | | | - J Y Su
- Laboratory Medicine Center, Affiliated Hospital of Nantong University, Nantong Jiangsu 226001, China
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12
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Abstract
Multiple myeloma treatment has changed tremendously over recent years leading to overall improvement in patient outcomes. With therapeutic advancements, patient care has become increasingly complex and variability is seen in healthcare delivery as well as outcomes when various patient subgroups are analyzed based on sociodemographic factors. It is imperative to understand this variability so that while overall the outcomes get better, specific focus is placed on subgroups that may remain disadvantaged and may not be able to fully access the advancements in therapeutics. Research in multiple myeloma has specifically looked at several such patient subgroups based on socioeconomic status, age, race/ethnicity, insurance carrier, and geographic location that may affect healthcare utilization and patient outcomes. Exploring and understanding these would certainly help address disparities and lead to further equity in healthcare access and, hopefully, patient outcomes.
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13
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Lohr JG, Kim S, Gould J, Knoechel B, Drier Y, Cotton MJ, Gray D, Birrer N, Wong B, Ha G, Zhang CZ, Guo G, Meyerson M, Yee AJ, Boehm JS, Raje N, Golub TR. Genetic interrogation of circulating multiple myeloma cells at single-cell resolution. Sci Transl Med 2017; 8:363ra147. [PMID: 27807282 DOI: 10.1126/scitranslmed.aac7037] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 09/13/2016] [Indexed: 12/17/2022]
Abstract
Multiple myeloma (MM) remains an incurable disease, with a treatment-refractory state eventually developing in all patients. Constant clonal evolution and genetic heterogeneity of MM are a likely explanation for the emergence of drug-resistant disease. Monitoring of MM genomic evolution on therapy by serial bone marrow biopsy is unfortunately impractical because it involves an invasive and painful procedure. We describe how noninvasive and highly sensitive isolation and characterization of circulating tumor cells (CTCs) from peripheral blood at single-cell resolution recapitulate MM in the bone marrow. We demonstrate that CTCs provide the same genetic information as bone marrow MM cells and even reveal mutations with greater sensitivity than bone marrow biopsies in some cases. Single CTC RNA sequencing enables classification of MM and quantitative assessment of genes that are relevant for prognosis. We propose that the genomic characterization of CTCs should be included in clinical trials to follow the emergence of resistant subclones after MM therapy.
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Affiliation(s)
- Jens G Lohr
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA. .,Departments of Medical Oncology, Pathology, and Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA 02214, USA.,Harvard Medical School, Boston, MA 02115, USA
| | - Sora Kim
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Joshua Gould
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Birgit Knoechel
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA.,Departments of Medical Oncology, Pathology, and Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA 02214, USA.,Harvard Medical School, Boston, MA 02115, USA
| | - Yotam Drier
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA.,Harvard Medical School, Boston, MA 02115, USA.,Division of Hematology and Oncology/Pathology, Massachusetts General Hospital Cancer Center, MA 02114, USA
| | - Matthew J Cotton
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA.,Division of Hematology and Oncology/Pathology, Massachusetts General Hospital Cancer Center, MA 02114, USA.,Howard Hughes Medical Institute, Chevy Chase, MD 20815, USA
| | - Daniel Gray
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Nicole Birrer
- Division of Hematology and Oncology/Pathology, Massachusetts General Hospital Cancer Center, MA 02114, USA
| | - Bang Wong
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Gavin Ha
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA.,Departments of Medical Oncology, Pathology, and Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA 02214, USA
| | - Cheng-Zhong Zhang
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA.,Departments of Medical Oncology, Pathology, and Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA 02214, USA
| | - Guangwu Guo
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA.,Departments of Medical Oncology, Pathology, and Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA 02214, USA.,Harvard Medical School, Boston, MA 02115, USA
| | - Matthew Meyerson
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA.,Departments of Medical Oncology, Pathology, and Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA 02214, USA.,Harvard Medical School, Boston, MA 02115, USA
| | - Andrew J Yee
- Harvard Medical School, Boston, MA 02115, USA.,Division of Hematology and Oncology/Pathology, Massachusetts General Hospital Cancer Center, MA 02114, USA
| | - Jesse S Boehm
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Noopur Raje
- Harvard Medical School, Boston, MA 02115, USA.,Division of Hematology and Oncology/Pathology, Massachusetts General Hospital Cancer Center, MA 02114, USA
| | - Todd R Golub
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA. .,Departments of Medical Oncology, Pathology, and Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA 02214, USA.,Harvard Medical School, Boston, MA 02115, USA.,Howard Hughes Medical Institute, Chevy Chase, MD 20815, USA
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14
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[Prognostic value of the revised international staging system for newly diagnosed multiple myeloma patients]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2017; 38:475-479. [PMID: 28655089 PMCID: PMC7342976 DOI: 10.3760/cma.j.issn.0253-2727.2017.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To assess the prognostic value of revised international staging system (R-ISS) for multiple myeloma (MM) in real world. Methods: A total of 202 newly diagnosis symptomatic MM patients were enrolled from May 2010 to April 2015 and the clinical data were retrospectively analyzed. All the patients received at least four courses of bortezomib-based or thalidomide-based induction therapy. Results: With a median follow-up of 31 months, the cohort included 56 cases in R-ISSⅠ, 108 in R-ISS Ⅱ, and 38 in R-ISS Ⅲ, and the median OS was not reached/61/38 months, respectively (P=0.001). According to the ISS system, 62 patients were classified in ISS-Ⅰ, 70 in ISS-Ⅱ and 70 in ISS-Ⅲ, with the median OS was 58, 52 and 40 months, respectively (P=0.001). The relative risk (HR) of R-ISS stage Ⅲ vs Ⅰ, Ⅱ vs Ⅰ were 9.606 (P=0.008) and 4.038 (P=0.029). The HR of Ⅲ vs Ⅰ, Ⅱ vs Ⅰ of ISS system were 4.127 (P=0.070) and 2.877 (P=0.005). In the subgroup analysis, R-ISS predicted survival for patients who were not transplanted (P=0.003) , receiving bortezomib-based therapy (P=0.010) , and patients younger than 65 years (P=0.001). Conclusion: R-ISS system could better predict prognosis for OS in unselected nonclinical trial myeloma patients than ISS system, especially for the younger patients, patients with bortezomib-based therapy, and patients without transplantation.
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Shen X, Zhang Y, Wu X, Guo Y, Shi W, Qi J, Cong H, Wang X, Wu X, Ju S. Upregulated lncRNA-PCAT1 is closely related to clinical diagnosis of multiple myeloma as a predictive biomarker in serum. Cancer Biomark 2017; 18:257-263. [PMID: 28085010 DOI: 10.3233/cbm-160158] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The purpose of this study was to explore serum PCAT-1 expression in multiple myeloma (MM) and examine the potential usefulness of this molecule as a biomarker for diagnosis in MM. METHODS Serum samples were collected from 60 newly diagnosed untreated MM patients, and 48 healthy controls. Serum PCAT-1 expression levels were detected by RT-qPCR. In addition, correlations between the relative expression of serum PCAT-1 and the concentrations of lactic acid dehydrogenase (LDH), β2M, λ light chain and κ light chain were assessed. RESULTS It was found that the relative expression of serum PCAT-1 in MM patients (81.02 ± 136.9) was higher than that in healthy controls (3.17 ± 5.75) (U= 307.0, P< 0.0001) and was significantly correlated with β2M concentration (r= 0.461, P= 0.0002), but not with LDH, κ light and λ light chain concentration (r= 0.061, P= 0.641; r= 0.007, P= 0.956; r=-0.090, P= 0.499 respectively). Additionally, it was significantly correlated with different isotype of MM (H= 7.464, P= 0.024). The AUC of the ROC curve of serum PCAT-1 was 0.892 (95% CI 0.833-0.950), which was higher than other markers. Combining PCAT-1 and β2M together, the sensitivity was highest compared with other markers alone, or combined. CONCLUSION The expression levels of serum PCAT-1 in MM patients were significantly higher than that in healthy controls, suggesting that it may be useful in the auxiliary diagnosis of MM.
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Affiliation(s)
- Xianjuan Shen
- Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu, China
| | - Yan Zhang
- Laboratory Medicine Center, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu, China
| | - Xian Wu
- Yancheng Central Blood Station, Yancheng 224000, Jiangsu, China
| | - Yuehua Guo
- Nantong University, Nantong 226001, Jiangsu, China
| | - Wei Shi
- Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu, China
| | - Jing Qi
- Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu, China
| | - Hui Cong
- Laboratory Medicine Center, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu, China
| | - Xudong Wang
- Laboratory Medicine Center, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu, China
| | - Xinhua Wu
- Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu, China
| | - Shaoqing Ju
- Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu, China.,Laboratory Medicine Center, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu, China
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16
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Shen X, Ye Y, Qi J, Shi W, Wu X, Ni H, Cong H, Ju S. Identification of a novel microRNA, miR-4449, as a potential blood based marker in multiple myeloma. Clin Chem Lab Med 2017; 55:748-754. [PMID: 27155004 DOI: 10.1515/cclm-2015-1108] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 04/04/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND miRNAs act in diverse biological processes including development, cell growth, apoptosis, and hematopoiesis, suggesting their role in cancer. METHODS We examined the miRNAs perturbed in CD138+ primary multiple myeloma (MM) cells, using microarray analysis and real-time quantitative PCR (RT-qPCR). Serum miR-4449 expression levels were detected from 71 primary MM patients and 46 healthy controls by RT-qPCR. RESULTS Our analysis revealed up-regulation of 54 and down-regulation of 28 miRNAs in MM subjects compared to healthy controls. miR-4449 has not been reported in MM. It was found that the relative expression of bone marrow miR-4449 in MM patients (2.14±1.42) was higher than that in healthy controls (0.815±0.165) (U=8, p=0.0093). The relative expression of serum miR-4449 in MM patients (2.11±2.10) was significantly higher than that in healthy controls (0.357±0.235) (U=374, p<0.0001) and was significantly correlated with β2M, λ light and κ light chain concentration (r=0.480, p=0.0003; r=0.560, p<0.0001; r=0.560, p<0.0001), but not correlated with the lactate dehydrogenase (LDH) concentration (r=0.247, p=0.0611). The area under the curve (AUC) of the receiver-operating characteristics (ROC) curve of serum miR-4449 was 0.885 (95% CI, 0.826-0.945), which is higher than for other markers. Combining miR-4449, λ light chain, and β2M together, the sensitivity was highest compared with λ light chain or β2M alone, or combined. CONCLUSIONS The expression levels of serum miR-4449 in MM patients were significantly higher than in healthy controls, suggesting that it may prove to be useful in the auxiliary diagnosis of MM.
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Affiliation(s)
- Xianjuan Shen
- Surgical Comprehensive Laboratory, Affiliated Hospital of Nantong University, Nantong, P.R
| | - Yan Ye
- Laboratory Medicine Center, Affiliated Hospital of Nantong University, Nantong, P.R
| | - Jing Qi
- Surgical Comprehensive Laboratory, Affiliated Hospital of Nantong University, Nantong, P.R
| | - Wei Shi
- Surgical Comprehensive Laboratory, Affiliated Hospital of Nantong University, Nantong, P.R
| | - Xinhua Wu
- Surgical Comprehensive Laboratory, Affiliated Hospital of Nantong University, Nantong, P.R
| | - Hongbing Ni
- Laboratory Medicine Center, Affiliated Hospital of Nantong University, Nantong, P.R
| | - Hui Cong
- Laboratory Medicine Center, Affiliated Hospital of Nantong University, Nantong, P.R
| | - Shaoqing Ju
- Laboratory Medicine Center, Affiliated Hospital of Nantong University, #20 Xisi Road, Nantong 226001, JS, P.R
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17
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Towards Stratified Medicine in Plasma Cell Myeloma. Int J Mol Sci 2016; 17:ijms17101760. [PMID: 27775669 PMCID: PMC5085784 DOI: 10.3390/ijms17101760] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 09/26/2016] [Accepted: 10/05/2016] [Indexed: 02/06/2023] Open
Abstract
Plasma cell myeloma is a clinically heterogeneous malignancy accounting for approximately one to 2% of newly diagnosed cases of cancer worldwide. Treatment options, in addition to long-established cytotoxic drugs, include autologous stem cell transplant, immune modulators, proteasome inhibitors and monoclonal antibodies, plus further targeted therapies currently in clinical trials. Whilst treatment decisions are mostly based on a patient’s age, fitness, including the presence of co-morbidities, and tumour burden, significant scope exists for better risk stratification, sub-classification of disease, and predictors of response to specific therapies. Clinical staging, recurring acquired cytogenetic aberrations, and serum biomarkers such as β-2 microglobulin, and free light chains are in widespread use but often fail to predict the disease progression or inform treatment decision making. Recent scientific advances have provided considerable insight into the biology of myeloma. For example, gene expression profiling is already making a contribution to enhanced understanding of the biology of the disease whilst Next Generation Sequencing has revealed great genomic complexity and heterogeneity. Pathways involved in the oncogenesis, proliferation of the tumour and its resistance to apoptosis are being unravelled. Furthermore, knowledge of the tumour cell surface and its interactions with bystander cells and the bone marrow stroma enhance this understanding and provide novel targets for cell and antibody-based therapies. This review will discuss the development in understanding of the biology of the tumour cell and its environment in the bone marrow, the implementation of new therapeutic options contributing to significantly improved outcomes, and the progression towards more personalised medicine in this disorder.
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Jimenez-Zepeda VH, Duggan P, Neri P, Rashid-Kolvear F, Tay J, Bahlis NJ. Revised International Staging System Applied to Real World Multiple Myeloma Patients. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2016; 16:511-518. [DOI: 10.1016/j.clml.2016.06.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 05/10/2016] [Accepted: 06/01/2016] [Indexed: 10/21/2022]
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19
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Borgman CJ. Concomitant multiple myeloma spectrum diagnosis in a central retinal vein occlusion: a case report and review. Clin Exp Optom 2016; 99:309-12. [PMID: 27079282 DOI: 10.1111/cxo.12319] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Revised: 04/14/2015] [Accepted: 05/08/2015] [Indexed: 12/19/2022] Open
Abstract
Multiple myeloma is a neoplastic plasma-cell disorder resulting from malignant plasma cells in the bone marrow. It can cause a hyperviscosity syndrome secondary to the paraproteinaemia associated with the disease. The increased hyperviscosity can lead to retinal vein occlusions and other ocular problems that may challenge clinicians. In patients with multiple myeloma and hypertension and/or diabetes mellitus, retinal changes appear similar and changes due to one disease or the other may be difficult to determine. A 48-year-old white female presented to the clinic with a complaint of blurry vision in her left eye. A full comprehensive ocular examination revealed a central retinal vein occlusion presumably from the patient's history of hypertension, diabetes mellitus and hypercholesterolaemia. Further bloodwork revealed monoclonal protein in the patient's serum and an increased percentage of plasma cells in the bone marrow. She was diagnosed with monoclonal gammopathy of undetermined significance, part of the multiple myeloma disease spectrum. She was referred to a retinal specialist for initiation of intravitreal injections of anti-vascular endothelial growth factor. Multiple myeloma has been implicated in younger patients as an underlying cause of retinal vein occlusions. Multiple myeloma should be considered as a differential diagnosis in young patients with retinal vein occlusions, even if other risk factors for venous occlusion like hypertension, diabetes mellitus and hypercholesterolaemia are present. Timely referral to the patient's primary care physician and haematologist is important for appropriate treatment and control of underlying systemic conditions.
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Shen X, Guo Y, Qi J, Shi W, Wu X, Ni H, Ju S. Study on the Association Between miRNA-202 Expression and Drug Sensitivity in Multiple Myeloma Cells. Pathol Oncol Res 2015; 22:531-9. [DOI: 10.1007/s12253-015-0035-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 12/15/2015] [Indexed: 11/24/2022]
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21
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Yang G, Geng C, Chen W. Clinical characteristics of a group of patients with multiple myeloma who had two different λ light chains by immunofixation electrophoresis: A retrospective study from a single center. Exp Ther Med 2015; 9:1895-1900. [PMID: 26136911 DOI: 10.3892/etm.2015.2352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 02/13/2015] [Indexed: 11/05/2022] Open
Abstract
The objective of the present study was to conduct a retrospective analysis of the clinical characteristics of a group of patients with multiple myeloma (MM) who had two different immunoglobulin λ light chains as determined by immunofixation electrophoresis (IFE). A total of 26 patients with MM had two different λ light chains by IFE at diagnosis in hospital from January 2006 to June 2012. Data were collected from the medical records of these patients. The clinical characteristics, laboratory parameters, responses, risk factors and outcomes of this special group of patients were retrospectively analyzed. The patients with MM and two different λ light chains by IFE accounted for 5.4% (26/483) of all the patients with MM during the same period. There were 17 patients (65.4%) with renal dysfunction and 10 patients (38.5%) with extramedullary plasmacytoma (EMP) at diagnosis. Ten patients (38.5%) had abnormalities by fluorescence in situ hybridization (FISH) including t(4;14), t(14;16) and/or del17p. Of these patients, three (11.5%) achieved complete remission (CR), six (23.1%) very good partial remission (VGPR), six (23.1%) partial remission (PR) and the overall remission (OR) rate was 57.7% (15/26). The OR rate of the patients who received chemotherapy with bortezomib was superior to that of the patients who received chemotherapy without bortezomib (78.6% vs. 33.3%; P<0.05). The OR rate of the patients who received autologous stem cell transplantation (SCT) was superior to that of the patients who did not receive autologous SCT (77.8% vs. 47.1%; P<0.05). The median overall survival (OS) was 12.6 months (range, 2-38 months) in this study. The patients who received chemotherapy with bortezomib had a significantly longer median OS as compared with the patients who received chemotherapy without bortezomib (19 vs. 6 months; P=0.049). The patients who received autologous SCT also had significantly longer median OS as compared with the patients who did not receive autologous SCT (18 vs. 7 months; P=0.041). The median duration of remission (DOR) was 5 months (range, 0-28 months). The patients who received bortezomib or autologous SCT had significantly longer median DOR than those who did not (P=0.046 and P=0.012, respectively). The patients with abnormalities by FISH had similar OR rates, median OS and median DOR as compared with the patients without abnormalities by FISH and there was no statistically significant difference in OR rate, median OS and median DOR between the patients with EMP and those without. The MM patients with two different λ light chains by IFE may have specific characteristics, and are accompanied by a high incidence of renal dysfunction and EMP. They have a poor prognosis and require novel therapy including bortezomib and autologous SCT.
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Affiliation(s)
- Guangzhong Yang
- Department of Hematology and Multiple Myeloma Research Center of Beijing, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, P.R. China
| | - Chuanying Geng
- Department of Hematology and Multiple Myeloma Research Center of Beijing, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, P.R. China
| | - Wenming Chen
- Department of Hematology and Multiple Myeloma Research Center of Beijing, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, P.R. China
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Richardson PG, Bladé J. The comprehensive clinical management of multiple myeloma and related-plasma cell disorders. Expert Rev Hematol 2014; 7:1-3. [PMID: 24483345 DOI: 10.1586/17474086.2014.882763] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Whilst we think of multiple myeloma and related plasma cell disorders as incurable to date, never before has there been such hope and enthusiasm about advances in the research and treatment of these various diseases. Translational research is very much at the forefront of progress for further refining targeted therapies and continuing to improve clinical efficacy. Whilst some of these advances in the last decade have been truly dramatic in their scope and timing, it is also worth noting that relatively incremental changes have favorably impacted on patient outcome, and this comprehensive clinical management review captures these accordingly. We hope therefore that this concise overview will give readers, be they specialist hemato-oncologists, or other providers and researchers in the field, an enlightening insight into the exciting future of therapeutic opportunities, as well as a practical 'hands on' approach.
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Affiliation(s)
- Paul G Richardson
- RJ Corman Professor of Medicine, Harvard Medical School Department of Medical Oncology, Dana-Farber Cancer Institute, Jerome Lipper Multiple Myeloma Center, Boston, MA, USA
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Change in ploidy status from hyperdiploid to near-tetraploid in multiple myeloma associated with bortezomib/lenalidomide resistance. Cancer Genet 2014; 207:326-31. [DOI: 10.1016/j.cancergen.2014.06.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 05/21/2014] [Accepted: 06/21/2014] [Indexed: 10/25/2022]
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