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Jerbi A, Turki O, Hachicha H, Kallel Sarbeji F, Feki S, Mejdoub S, Kammoun K, Ben Hmida M, Elloumi M, Masmoudi H. The presence of two light chain bands on immunofixation is associated with poor outcomes in newly diagnosed multiple myeloma patients. Ann Hematol 2023; 102:1459-1466. [PMID: 37060464 DOI: 10.1007/s00277-023-05221-6] [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: 12/27/2022] [Accepted: 04/10/2023] [Indexed: 04/16/2023]
Abstract
We aimed to describe the clinical and biological characteristics and the prognosis of patients presenting with an additional light chain (LC) band along with a complete monoclonal protein on immunofixation (IF).An 8-year descriptive study was conducted to assess all cases with confirmed monoclonal gammopathies (MG). We studied those with an entire M-protein with 2 bands of LC of the same isotype based on the results of IF. Data were collected from patients' files.Among 548 cases of MG, we found 32 cases (5.8%) with an additional LC band. We included 28 patients (5%) with a confirmed diagnosis of multiple myeloma (MM). The m/f ratio was 2.5 with a median age of 63 years [32-80 years]. All MM patients had anemia, 16 (57%) had renal failure, 14 (50%) had lytic lesions, 9 (32%) received hemodialysis, and 7 (25%) had hypercalcemia. The free-kappa-lambda ratio was abnormal in all cases: median = 0.07 [0.002-58.57]. The mean overall survival (OS) was 22 months ± 38.76.Fifteen MM patients (48%) received chemotherapy, and 7 (22%) autologous stem cell transplants (SCT). Patients who received SCT had an OS higher than those who received other treatments (p = 0.038). OS was low in patients with high β2microglobulin levels (rho = -0.791; p = 0.001), and abnormally low free-kappa-lambda ratio (rho = -0.852;p = 0.04).The presence of an additional LC band with a complete monoclonal protein seems to identify newly diagnosed MM patients with poor outcomes and frequent renal impairment.
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Affiliation(s)
- Ameni Jerbi
- Immunology Department, Habib Bourguiba University Hospital, University of Sfax, 3000, Sfax, Tunisia.
| | - Omar Turki
- Immunology Department, Habib Bourguiba University Hospital, University of Sfax, 3000, Sfax, Tunisia
| | - Hend Hachicha
- Immunology Department, Habib Bourguiba University Hospital, University of Sfax, 3000, Sfax, Tunisia
| | - Faten Kallel Sarbeji
- Hematology Department, Hedi Chaker University Hospital, University of Sfax, 3000, Sfax, Tunisia
| | - Sawsan Feki
- Immunology Department, Habib Bourguiba University Hospital, University of Sfax, 3000, Sfax, Tunisia
| | - Sabrina Mejdoub
- Immunology Department, Habib Bourguiba University Hospital, University of Sfax, 3000, Sfax, Tunisia
| | - Khaoula Kammoun
- Nephrology Department, Hedi Chaker University Hospital, University of Sfax, 3000, Sfax, Tunisia
| | - Mohamed Ben Hmida
- Nephrology Department, Hedi Chaker University Hospital, University of Sfax, 3000, Sfax, Tunisia
| | - Moez Elloumi
- Hematology Department, Hedi Chaker University Hospital, University of Sfax, 3000, Sfax, Tunisia
| | - Hatem Masmoudi
- Immunology Department, Habib Bourguiba University Hospital, University of Sfax, 3000, Sfax, Tunisia
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Cytogenetic testing by fluorescence in situ hybridization is improved by plasma cell sorting in multiple myeloma. Sci Rep 2022; 12:8287. [PMID: 35585097 PMCID: PMC9117238 DOI: 10.1038/s41598-022-11676-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 04/28/2022] [Indexed: 11/28/2022] Open
Abstract
Accurate detection of cytogenetic abnormalities has become more important for improving risk-adapted treatment strategies in multiple myeloma (MM). However, precise cytogenetic testing by fluorescence in situ hybridization (FISH) is challenged by the dilution effect of bone marrow specimens and poor growth of plasma cells ex vivo. It has been suggested that FISH should be performed in combination with plasma cell enrichment strategies. We examined cytogenetic abnormalities in newly diagnosed MM and compared the efficacy of three different enrichment modalities for FISH: direct FISH (n = 137), fluorescence immunophenotyping and interphase cytogenetics as a tool for the investigation of neoplasms (FICTION) technique (n = 224), and a plasma cell sorting FISH with fluorescence-activated cell sorter (FACS) (n = 132). FISH disclosed cytogenetic abnormalities in 38.0% of samples by direct FISH, 56.3% by FICTION, and 95.5% by FACS-FISH, and the percentage of cells with abnormal signals detected by FISH was significantly higher by FACS-FISH than direct FISH or FICTION. Our results suggest that the efficacy of FISH is dependent on the plasma cell enrichment modalities and reveal that plasma cell sorting FISH with FACS enables better detection of cytogenetic abnormalities in diagnostic MM samples.
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Kumar V, Batool S, Misra S, Ahuja A, Marwah S, Baweja G, Kumar S. Reactive bone marrow plasmacytosis: A common denominator with diverse etiology. HAMDAN MEDICAL JOURNAL 2022. [DOI: 10.4103/hmj.hmj_52_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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He J, He D, Han X, Zheng G, Wei G, Zhao Y, Yang Y, Wu W, Fu J, Shou L, Kong H, Huang H, Cai Z. Bortezomib-Based Regimens for Newly Diagnosed Multiple Myeloma in China: A Report of 12-Year Real-World Data. Front Pharmacol 2020; 11:561601. [PMID: 33362538 PMCID: PMC7759685 DOI: 10.3389/fphar.2020.561601] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 10/13/2020] [Indexed: 11/23/2022] Open
Abstract
Background: Improve the treatment quality might affect patients’ efficacy and survival. Methods: Five hundred thirty multiple myeloma patients treated in four hematological centers in China from February 2006 to August 2018 were enrolled. General characteristics, treatment regimens and cycles, efficacy, survival and adverse events of the patients treated before and after August 2013 (later refer to as the before-2013 and after-2013 group) were analyzed and compared. Results: The results suggested that patients who received optimized treatment regimen and route of administration completed more cycles of treatment in the after-2013 group. Although the overall response rate was similar between the two groups (88.6 vs. 90.5%), patients in the after-2013 group had higher complete remission rate (39.1 vs. 28.6%) and better progression-free survival. Subgroup analysis suggested that patients aged 65 years and older, with non-high-risk D-S, ISS, and R-ISS stages, had a significant benefit in progression-free survival. Conclusion: Therefore, in clinical practice in China, by reducing the economic burden brought by the treatment on patients and optimizing the treatment regimen, more patients can be treated with better regimens in a prolonged duration to achieve better efficacy and survival, especially in elderly and non-high-risk patients.
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Affiliation(s)
- Jingsong He
- Bone Marrow Transplantation Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Donghua He
- Bone Marrow Transplantation Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaoyan Han
- Bone Marrow Transplantation Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Gaofeng Zheng
- Bone Marrow Transplantation Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Guoqing Wei
- Bone Marrow Transplantation Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yi Zhao
- Bone Marrow Transplantation Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yang Yang
- Bone Marrow Transplantation Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Wenjun Wu
- Bone Marrow Transplantation Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jiaping Fu
- Department of Hematology, Shaoxing People's Hospital, Shaoxing, China
| | - Lihong Shou
- Department of Hematology, Huzhou Central Hospital, Huzhou, China
| | - Hongwei Kong
- Department of Hematology, People's Hospital of Quzhou City, Quzhou, China
| | - He Huang
- Bone Marrow Transplantation Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhen Cai
- Bone Marrow Transplantation Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Gao W, Jian Y, Du J, Li X, Zhou H, Zhang Z, Yang G, Wang G, Tian Y, Li Y, Wu Y, Fu W, Li J, Chen W. Gain of 1q21 is an adverse prognostic factor for multiple myeloma patients treated by autologous stem cell transplantation: A multicenter study in China. Cancer Med 2020; 9:7819-7829. [PMID: 32881351 PMCID: PMC7643680 DOI: 10.1002/cam4.3254] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 05/07/2020] [Accepted: 05/30/2020] [Indexed: 11/08/2022] Open
Abstract
Background Autologous stem cell transplantation (ASCT) has been recommended as a standard approach for young multiple myeloma (MM) patients for decades, even in the era of novel agents. Gain of chromosome 1q21 is a common cytogenetic abnormality in MM, while its clinical prognostic value is still controversial. Methods In this multicenter study, we retrospectively analyzed 1q21 gain in 446 newly diagnosed MM patients who received at least one ASCT from three large myeloma centers in China. Results Of the all 446 patients, 1q21 gain was an adverse predictor of progression‐free survival (PFS) (34 vs 56 months, P = .005) and overall survival (OS) (69 vs 100 months, P = .002). Gain of 1q21 was more likely to coexist with t(4;14), t(14;16), and del(13q). Nevertheless, isolated 1q21 gain still exhibited unfavorable effects on PFS (35 vs 66 months, P = .045) and OS (61 vs 100 months, P = .026). The coexistence of 1q21 gain and high‐risk cytogenetics (HRCs) [del(17p), t(4;14),and/or t(14;16)] showed poor prognosis on both PFS and OS, while no additional adverse effect could be identified when compared with HRCs alone. Moreover, when coexisting with t(11;14), patients with 1q21 gain showed a comparable survival to those without 1q21 gain. For patients treated with novel induction regimens followed by ASCT, 1q21 gain also conferred an inferior prognosis. Multivariate analysis further confirmed 1q21 gain could independently predict shorter PFS and OS. Conclusion In conclusion, 1q21 gain is an adverse prognostic factor for MM patients received ASCT.
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Affiliation(s)
- Wen Gao
- Department of Hematology, Myeloma Research Center of Beijing, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yuan Jian
- Department of Hematology, Myeloma Research Center of Beijing, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Juan Du
- Department of Hematology, The Myeloma & Lymphoma Center, Changzheng Hospital, The Second Military Medical University, Shanghai, China
| | - Xiaozhe Li
- Department of Hematology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Huixing Zhou
- Department of Hematology, Myeloma Research Center of Beijing, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Zhiyao Zhang
- Department of Hematology, Myeloma Research Center of Beijing, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Guangzhong Yang
- Department of Hematology, Myeloma Research Center of Beijing, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Guorong Wang
- Department of Hematology, Myeloma Research Center of Beijing, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Ying Tian
- Department of Hematology, Myeloma Research Center of Beijing, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yanchen Li
- Department of Hematology, Myeloma Research Center of Beijing, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yin Wu
- Department of Hematology, Myeloma Research Center of Beijing, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Weijun Fu
- Department of Hematology, The Myeloma & Lymphoma Center, Changzheng Hospital, The Second Military Medical University, Shanghai, China
| | - Juan Li
- Department of Hematology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Wenming Chen
- Department of Hematology, Myeloma Research Center of Beijing, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Goldman‐Mazur S, Jurczyszyn A, Castillo JJ, Waszczuk‐Gajda A, Grząśko N, Radocha J, Bittrich M, Kortüm KM, Gozzetti A, Usnarska‐Zubkiewicz L, Davila Valls J, Jayabalan DS, Niesvizky R, Kelman J, Coriu D, Rosiñol L, Szukalski Ł, González‐Calle V, Mateos MV, Jamroziak K, Hus I, Avivi I, Cohen Y, Suska A, Chappell A, Madduri D, Chhabra S, Kleman A, Hari P, Delforge M, Robak P, Gentile M, Kozłowska I, Goldberg SL, Czepiel J, Silbermann R, Olszewski AJ, Barth P, Mikala G, Chim CS, Długosz‐Danecka M, Grosicki S, Vesole DH. A multicenter retrospective study of 223 patients with t(14;16) in multiple myeloma. Am J Hematol 2020; 95:503-509. [PMID: 32072687 DOI: 10.1002/ajh.25758] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 02/01/2020] [Accepted: 02/05/2020] [Indexed: 12/20/2022]
Abstract
The t(14;16) translocation, found in 3%-5% of newly diagnosed (ND) multiple myeloma (MM), has been associated with adverse outcomes. However, the studies establishing the characteristics of t(14;16) included solely small cohorts. The goal of the current international, multicenter (n = 25 centers), retrospective study was to describe the characteristics and outcomes of t(14;16) patients in a large, real-world cohort (n = 223). A substantial fraction of patients had renal impairment (24%) and hemoglobin <10 g/dL (56%) on initial presentation. Combined therapy of both immunomodulatory drug and proteasome inhibitor (PI) in the first line was used in 35% of patients. Autologous stem cell transplantation was performed in 42% of patients. With a median follow up of 4.1 years (95% CI 3.7-18.7), the median progression-free survival (PFS) and overall survival (OS) from first line therapy were 2.1 years (95% CI 1.5-2.4) and 4.1 years (95% CI 3.3-5.5), respectively. Worse OS was predicted by age > 60 years (HR = 1.65, 95% CI [1.05-2.58]), as well as revised International Scoring System (R-ISS) 3 (vs R-ISS 2; HR = 2.59, 95% CI [1.59-4.24]). In conclusion, based on the largest reported cohort of t(14;16) patients, quarter of this subset of MM patients initially presents with renal failure, while older age and the R-ISS 3 predict poor survival.
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Affiliation(s)
- Sarah Goldman‐Mazur
- Department of HematologyJagiellonian University Medical College Cracow Poland
| | - Artur Jurczyszyn
- Department of HematologyJagiellonian University Medical College Cracow Poland
| | - Jorge J. Castillo
- Division of Hematological MalignanciesDana‐Farber Cancer Institute, Harvard Medical School Boston Massachusetts
| | - Anna Waszczuk‐Gajda
- Department of Hematology, Oncology and Internal DiseasesWarsaw Medical University Warsaw Poland
| | - Norbert Grząśko
- Department of Experimental HematologyMedical University of Lublin Lublin Poland
- Department of HematologySt. Johnʼs Cancer Center Lublin Poland
| | - Jakub Radocha
- 4th Department of Internal Medicine– HematologyUniversity Hospital and Faculty of Medicine in Hradec Kralove, Charles University Hradec Kralove Czech Republic
| | - Max Bittrich
- Department of Internal Medicine IIUniversity Hospital Würzburg Würzburg Germany
| | - K. Martin Kortüm
- Department of Internal Medicine IIUniversity Hospital Würzburg Würzburg Germany
| | - Alessandro Gozzetti
- Hematology, Department of Medical Science, Surgery and NeuroscienceUniversity of Siena Siena Italy
| | - Lidia Usnarska‐Zubkiewicz
- Department of HematologyBlood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University Wroclaw Poland
| | | | | | | | | | - Daniel Coriu
- Department of HematologyFundeni Clinical Institute, University of Medicine and Pharmacy “Carol Davila” Bucharest Romania
| | - Laura Rosiñol
- Department of HematologyAmyloidosis and Myeloma Unit, Hospital Clínic, IDIBAPS, University of Barcelona Barcelona Spain
| | - Łukasz Szukalski
- Department of HematologyCollegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń Bydgoszcz Poland
| | - Veronica González‐Calle
- Hospital Universitario de Salamanca/ Instituto Biosanitario de Salamanca (IBSAL) Salamanca Spain
| | - Maria V. Mateos
- Hospital Universitario de Salamanca/ Instituto Biosanitario de Salamanca (IBSAL) Salamanca Spain
| | | | - Iwona Hus
- Department of Experimental HematologyMedical University of Lublin Lublin Poland
- Institute of Hematology and Transfusion Medicine Warsaw Poland
| | - Irit Avivi
- Tel Aviv Sourasky Medical Center Tel Aviv Israel
- The Sackler Faculty of MedicineTel Aviv University Tel Aviv Israel
| | - Yael Cohen
- Tel Aviv Sourasky Medical Center Tel Aviv Israel
- The Sackler Faculty of MedicineTel Aviv University Tel Aviv Israel
| | - Anna Suska
- Department of HematologyJagiellonian University Medical College Cracow Poland
| | - Aimee Chappell
- Department of Hematology/OncologyMedstar Georgetown University Hospital Washington DC
| | - Deepu Madduri
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai New York New York
| | - Saurabh Chhabra
- Division of Hematology/Oncology Department of Medicine Medical College of Wisconsin Milwaukee Wisconsin
| | - Ariel Kleman
- Division of Hematology/Oncology Department of Medicine Medical College of Wisconsin Milwaukee Wisconsin
| | - Parameswaran Hari
- Division of Hematology/Oncology Department of Medicine Medical College of Wisconsin Milwaukee Wisconsin
| | | | | | | | | | - Stuart L. Goldberg
- John Theurer Cancer CenterHackensack University Medical Center Hackensack New Jersey
- Cota Inc. New York New York
| | - Jacek Czepiel
- Department of Infectious and Tropical DiseasesJagiellonian University Medical College Cracow Poland
| | - Rebecca Silbermann
- Division of Hematology and Medical OncologyKnight Cancer Institute, Oregon Health and Science University Portland Oregon
| | - Adam J. Olszewski
- Department of MedicineWarren Alpert Medical School, Brown University Providence Rhode Island
| | - Peter Barth
- Department of MedicineWarren Alpert Medical School, Brown University Providence Rhode Island
| | - Gabor Mikala
- Department of Hematology and Stem Cell TransplantationSouth‐Pest Central Hospital, National Institute of Hematology and Infectology Budapest Hungary
| | - Chor S. Chim
- Department of MedicineQueen Mary Hospital, University of Hong Kong Pokfulam, Hong Kong
| | - Monika Długosz‐Danecka
- Department of Clinical OncologyMaria Sklodowska‐Curie National Institute of Oncology Cracow Poland
| | - Sebastian Grosicki
- Department of Cancer PreventionMedical University of Silesia Katowice Poland
| | - David H. Vesole
- John Theurer Cancer CenterHackensack University Medical Center Hackensack New Jersey
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Prognostic Nomogram for the Overall Survival of Patients with Newly Diagnosed Multiple Myeloma. BIOMED RESEARCH INTERNATIONAL 2019; 2019:5652935. [PMID: 31080823 PMCID: PMC6476154 DOI: 10.1155/2019/5652935] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 03/28/2019] [Indexed: 12/25/2022]
Abstract
To establish a nomogram for predicting the overall survival (OS) of patients with newly diagnosed multiple myeloma (MM), 304 patients with newly diagnosed MM were recruited between June 1, 2010, and June 30, 2015, from the Beijing Chaoyang Hospital, Capital Medical University, and randomly divided into training (n=214) and validation (n=90) cohorts. The Kaplan-Meier method and the Cox proportional hazards regression model were used to evaluate the prognostic effects of multiple clinical and laboratory parameters on survival. Significant prognostic factors were combined to build a nomogram. The discriminative ability and predictive accuracy of the nomogram were evaluated using the index of concordance (C-index) and calibration curves and compared with the five staging systems currently used for MM. Multivariate analysis of the training cohort revealed that the age at diagnosis, clonal bone marrow plasma cells, serum lactate dehydrogenase, serum β2-microglobulin, and del (17p) were independent risk factors for OS and were used to establish the nomogram. The C-index value of the nomogram for predicting OS was 0.749, which was significantly higher than the C-indices of the five most common staging systems currently used for MM. In the validation cohort, the C-index for nomogram-based predictions was 0.711 for OS, and the nomogram discrimination was better than the above mentioned five staging systems (P<0.001). All calibration curves revealed good consistency between predicted and actual survivals. The proposed nomogram is more accurate in predicting the prognoses of patients with newly diagnosed MM.
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Prognostic Value of 1q21 Gain in Multiple Myeloma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 19:e159-e164. [DOI: 10.1016/j.clml.2018.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 06/29/2018] [Accepted: 12/11/2018] [Indexed: 11/19/2022]
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Epperly R, Ozolek J, Soltys K, Cohen D, Goyal R, Friehling E. Treatment of pediatric plasma cell myeloma type post-transplant lymphoproliferative disorder with modern risk-directed therapy. Pediatr Blood Cancer 2018; 65:e27283. [PMID: 29893485 DOI: 10.1002/pbc.27283] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 05/21/2018] [Accepted: 05/22/2018] [Indexed: 01/08/2023]
Abstract
Post-transplant lymphoproliferative disorder (PTLD) related plasma cell neoplasms are rare in pediatric patients. We report a pediatric liver transplant recipient with plasma cell myeloma type PTLD. Cytogenetics included 1q duplication, associated with poor prognosis in adult multiple myeloma, and t(8;14). High-risk cytogenetics has not been reported in pediatric plasma cell myeloma type PTLD. The patient was treated with bortezomib, dexamethasone, and lenalidomide with subsequent autologous stem cell transplant. He achieved a 6-year remission, demonstrating tolerance to and efficacy of this modern myeloma regimen in a pediatric patient. Unfortunately, he subsequently died from complications of repeat liver transplant.
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Affiliation(s)
- Rebecca Epperly
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - John Ozolek
- Department of Pathology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Kyle Soltys
- Thomas E. Starzl Transplantation Institute, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Debra Cohen
- Pediatric Hematology-Oncology, University of Florida, Pensacola, Florida
| | - Rakesh Goyal
- Department of Hematology/Oncology/BMT, Children's Mercy, Kansas City, Missouri
| | - Erika Friehling
- Division of Pediatric Hematology/Oncology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
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Solmaz Medeni S, Acar C, Olgun A, Acar A, Seyhanlı A, Taskıran E, Sevindik OG, Alacacıoglu I, Piskin O, Ozcan MA, Demirkan F, Undar B, Ozsan GH. Can Neutrophil-to-Lymphocyte Ratio, Monocyte-to-Lymphocyte Ratio, and Platelet-to-Lymphocyte Ratio at Day +100 be used as a prognostic marker in Multiple Myeloma patients with autologous transplantation? Clin Transplant 2018; 32:e13359. [PMID: 30053318 DOI: 10.1111/ctr.13359] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 07/11/2018] [Accepted: 07/22/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Recent reports have showed that neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) are predictors of progression-free survival (PFS) and overall survival (OS) in many types of cancer. This study evaluates the predictive value of NLR, MLR, and PLR for survival in MM patients treated with to ASCT. METHODS A set of data consisting of 150 patients who underwent autologous stem cell transplantation (ASCT) for MM was collected retrospectively. The prognostic value of NLR, MLR, and PLR was investigated with Kaplan-Meier method. RESULTS The prognostic value of NLR, MLR, and PLR was analyzed by a receiver operating characteristic (ROC) curve established to determine the cutoff. These cutoff values of NLR, PLR, and MLR were found 1.46, 86, and 0.27, respectively, on the 100th day of post-transplantation period. The overall survival (OS) and the post-transplantation OS of the patients with high NLR, MLR, and PLR levels on the 100th day of post-transplantation were shorter than the other group (P = 0.05, P = 0.018 [NLR], P = 0.05, P = 0.002 [MLR], P = 0.000, P = 0.001 [PLR]). The post-transplantation progression-free survival (PFS) of the patients with high NLR, MLR, and PLR levels on the 100th day of post-transplantation was shorter as well (P = 0.036, P = 0.001, P = 0.001, respectively). CONCLUSION As increased NLR, MLR, and PLR predicted poor clinical outcome in MM patients with autologous transplantation in this study, they may serve as cost-effective and rapidly available prognostic biomarkers for these patients.
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Affiliation(s)
| | - Celal Acar
- Hematology, Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Aybuke Olgun
- Faculty of Medicine Hematology, Dokuz Eylul University, Izmir, Turkey
| | - Alev Acar
- Faculty of Medicine Hematology, Dokuz Eylul University, Izmir, Turkey
| | - Ahmet Seyhanlı
- Faculty of Medicine Hematology, Dokuz Eylul University, Izmir, Turkey
| | - Emin Taskıran
- Faculty of Medicine Hematology, Dokuz Eylul University, Izmir, Turkey
| | | | - Inci Alacacıoglu
- Faculty of Medicine Hematology, Dokuz Eylul University, Izmir, Turkey
| | - Ozden Piskin
- Faculty of Medicine Hematology, Dokuz Eylul University, Izmir, Turkey
| | - Mehmet Ali Ozcan
- Faculty of Medicine Hematology, Dokuz Eylul University, Izmir, Turkey
| | - Fatih Demirkan
- Faculty of Medicine Hematology, Dokuz Eylul University, Izmir, Turkey
| | - Bulent Undar
- Faculty of Medicine Hematology, Dokuz Eylul University, Izmir, Turkey
| | - Guner Hayri Ozsan
- Faculty of Medicine Hematology, Dokuz Eylul University, Izmir, Turkey
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Brandelik SC, Krzykalla J, Hielscher T, Hillengass J, Kloth JK, Kauczor HU, Weber MA. [Focal lesions in whole-body MRI in multiple myeloma : Quantification of tumor mass and correlation with disease-related parameters and prognosis]. Radiologe 2017; 58:72-78. [PMID: 28905085 DOI: 10.1007/s00117-017-0299-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND OBJECTIVES In this study, we evaluated methods of quantification of tumor mass in whole-body MRI (wb-MRI) in multiple myeloma and correlated these with disease-related parameters in serum and bone marrow. MATERIALS AND METHODS We retrospectively evaluated wb-MRIs of 52 patients with focal infiltration pattern and a total of 700 focal lesions (subsequently called lesions). We determined the longest diameter (LD), the segmented volume (SV), and the morphology (spherical or non-spherical). We correlated total number/volume of the lesions with clinical parameters and prognosis and furthermore LD with SV. After that we analyzed the agreement of SV and estimated volume (EV) using the volume formula of a sphere based on LD. RESULTS Results showed no significant correlations of total number/volume with prognosis or clinical parameters. The latter were situated predominantly in the normal range. Furthermore, 10% of lesions were spherical. SV and LD correlated significantly in single lesions and on patient level. SV was in lesions <6 cm3 systematically larger and in lesions ≥6 cm3 smaller than EV. In 95%, we found in small lesions a deviation of EV versus SV from +0.9 cm3 to -4.6 cm3 and in large lesions from +160 cm3 to -111 cm3 (EV-SV). CONCLUSIONS Quantification of tumor mass in the focal infiltration pattern is performed more accurately by volumetry than LD due to the predominant existence of non-spherical lesions. The patient cohort with clinical parameters predominantly in the normal range is distributed to ISS stage I and partly pretreated, a fact that makes interpretation of absent correlations more difficult. Consider also a variation in activitiy of lesions and a diffuse infiltration not detectable by MRI.
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Affiliation(s)
- S C Brandelik
- Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.
| | - J Krzykalla
- Biostatistik, Deutsches Krebsforschungszentrum (dkfz), Heidelberg, Deutschland
| | - T Hielscher
- Biostatistik, Deutsches Krebsforschungszentrum (dkfz), Heidelberg, Deutschland
| | - J Hillengass
- Hämatologie und Onkologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - J K Kloth
- Radiologie Löbau, Löbau, Deutschland
| | - H U Kauczor
- Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - M A Weber
- Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
- Diagnostische und Interventionelle Radiologie, Universitätsmedizin Rostock, Rostock, Deutschland
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12
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Clinical implications of c-maf expression in plasma cells from patients with multiple myeloma. Exp Hematol Oncol 2017; 6:16. [PMID: 28560070 PMCID: PMC5446722 DOI: 10.1186/s40164-017-0076-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Accepted: 05/12/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Multiple myeloma (MM) is a type of hematological malignancy with significant heterogeneity in clinical features and prognosis. Cytogenetic abnormalities are the major factors affecting patient outcomes. Studies have shown that immunohistochemistry (IHC)-based detection of cancer-related genes expression could be alternative indicators for the prognosis of MM. METHODS Nuclear expression of c-maf protein in the bone marrow plasma cells of 128 multiple myeloma patients were examined by IHC, and its association with the clinicopathological features of MM patients was analyzed as well. RESULTS Among the 128 patients, the positive rate of c-maf protein expression was up to 30.5%, which had no correlation with patient age, M protein type, Durie-Salmon staging system, the International Staging System, abnormal plasma cell ratio in the bone marrow, or the level of peripheral blood hemoglobin, serum calcium or lactate dehydrogenase. However, the c-maf-positive patients had a significantly higher rate of hypoproteinemia (p = 0.026) and higher serum β2-microglobulin levels (>2500 μg/L) (p = 0.007). Patients with negative c-maf expression had higher remission rates upon the treatment of non-bortezomib-based regimens although no effect of c-maf expression on progression-free survival or overall survival was observed. CONCLUSION Patients with negative c-maf expression had higher remission rates upon the treatment of non-bortezomib-based regimens although no effect of c-maf expression on survival was observed. A further large-scale prospective study is required to verify these findings.
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Wu H, Dai X, Wang E. Plumbagin inhibits cell proliferation and promotes apoptosis in multiple myeloma cells through inhibition of the PI3K/Akt-mTOR pathway. Oncol Lett 2016; 12:3614-3618. [PMID: 27900044 DOI: 10.3892/ol.2016.5048] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 04/22/2016] [Indexed: 12/31/2022] Open
Abstract
Plumbagin is the primary component of the traditional Chinese medicine Baihua Dan, and possesses anti-infection and anticancer effects with the ability to enhance the sensitivity of tumor cells to radiation therapy. The present study aimed to investigate the potential anticancer effect and mechanism of plumbagin on multiple myeloma (MM) cells. Human MM OPM1 cells were treated with plumbagin, and its impact on cell viability, cytotoxicity, apoptosis and caspase-3 activity was examined by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide, lactate dehydrogenase leakage, flow cytometry and colorimetric assays. In addition, the protein expression levels of phosphoinositide 3-kinase, phosphorylated (p)-Akt and p-mammalian target of rapamycin (mTOR) in OPM1 cells were analyzed by western blotting. The results demonstrated that plumbagin treatment inhibited cell viability, increased cell cytotoxicity, activated cell apoptosis and promoted caspase-3 activity in the OPM1 cells. Furthermore, pretreatment of plumbagin significantly suppressed PI3K, p-Akt and p-mTOR protein expression levels in the OPM1 cells. In conclusion, the present study indicates that plumbagin inhibits cell proliferation and promotes apoptosis in MM cells through inhibition of PI3K/Akt-mTOR expression.
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Affiliation(s)
- Hongwei Wu
- Department of Hematology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan 610500, P.R. China
| | - Xiaozhen Dai
- Department of Biological and Medical Sciences, Chengdu Medical College, Chengdu, Sichuan 610500, P.R. China
| | - Enren Wang
- Department of Neuromedicine, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan 610500, P.R. China
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Jian Y, Chen X, Zhou H, Zhu W, Liu N, Geng C, Chen W. Prognostic Impact of Cytogenetic Abnormalities in Multiple Myeloma: A Retrospective Analysis of 229 Patients. Medicine (Baltimore) 2016; 95:e3521. [PMID: 27175647 PMCID: PMC4902489 DOI: 10.1097/md.0000000000003521] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The identification of specific cytogenetic abnormalities by interphase fluorescence in situ hybridization (i-FISH) has become a routine procedure for prognostic stratification of multiple myeloma (MM) patients. In this study, the prognostic significance of cytogenetic abnormalities detected by interphase fluorescence in situ hybridization (iFISH) in 229 newly diagnosed multiple myeloma patients was retrospectively analyzed. Results showed that del (17p), t(4;14), and 1q21 gain were adverse predictors of progression-free survival (PFS). Patients who carried these cytogenetic abnormalities were more likely to have more adverse biological parameters and lower response rate. Multivariate analysis showed that del (17p), t(4;14), and 1q21 gain were statistically independent predictors of PFS, whereas del (17p) was also adverse predictor of overall survival. Multiple coexisting cytogenetic abnormalities also had a negative correlation with PFS. Bortezomib-based therapy could improve the rate and depth of response in patients with t(4;14) translocation and 1q21 gain. Autologous stem cell transplantation could improve, but not overcome the adverse prognostic effect of high-risk cytogenetic abnormalities. These results demonstrate that MM patients with iFISH abnormalities, especially del (17p), are more likely to have a poor prognosis.
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Affiliation(s)
- Yuan Jian
- From the Department of Hematology (YJ, XC, HZ, WZ, NL, CG, WC); and Multiple Myeloma Research Center of Beijing (YJ, XC, HZ, WZ, NL, CG, WC), Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People's Republic of China
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15
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Meng S, Lu C, Zhang W, Shen W, Wei Y, Su D, Zhou F. MMSA-1 expression pattern in multiple myeloma and its clinical significance. Clin Exp Med 2015; 16:599-609. [PMID: 26493349 DOI: 10.1007/s10238-015-0393-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 09/12/2015] [Indexed: 12/17/2022]
Abstract
Multiple myeloma-associated antigen-1 (MMSA-1) is a novel multiple myeloma (MM)-associated antigen which has been recently identified. Herein, we have tried to examine its clinical significance by studying the relationship between its expression and selected clinicopathological features. We extracted mononuclear cells from the bone marrow of MM patients and healthy donors and compared the MMSA-1 expression by RT-PCR and Western blot analysis. In addition, we also analyzed MMSA-1 expression in patients that were grouped based on selected clinical parameters. Moreover, the impact of MMSA-1 on patients' survival was also explored. MMSA-1 mRNA and protein were significantly upregulated in MM patients in comparison with healthy donors. Moreover, among the newly diagnosed and relapsed/refractory patients, the MMSA-1 expression was higher in relapsed/refractory patients. In addition, MMSA-1 mRNA expression not only showed significantly higher correlation with clinical parameters such as age, Durie and Salmon stage, bone lesion condition, albumin, creatinine and lactate dehydrogenase but also has a close relationship with myeloma bone disease-related cytokines, genetic abnormalities and treatment response. Multivariate COX analysis predicted MMSA-1 and LDH levels to be independently associated with a poor progression-free survival and overall survival in myeloma patients. Our findings provide initial proof of concept that MMSA-1 is a potent gene that is specifically expressed in MM patients and could be a feasible biomarker and independent prognostic factor.
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Affiliation(s)
- Shan Meng
- Department of Clinical Hematology, Second Affiliated Hospital, Medical School of Xi'an Jiaotong University, West Five Road, No. 157, Xi'an, 710004, Shaanxi Province, People's Republic of China
| | - Chenyang Lu
- Department of Clinical Hematology, Second Affiliated Hospital, Medical School of Xi'an Jiaotong University, West Five Road, No. 157, Xi'an, 710004, Shaanxi Province, People's Republic of China
| | - Wanggang Zhang
- Department of Clinical Hematology, Second Affiliated Hospital, Medical School of Xi'an Jiaotong University, West Five Road, No. 157, Xi'an, 710004, Shaanxi Province, People's Republic of China.
| | - Wenjun Shen
- Division of Endocrinology, Gerontology and Metabolism, School of Medicine, Stanford University, Stanford, CA, USA
| | - Yongchang Wei
- Department of Clinical Oncology, The First Affiliated Hospital, College of Medicine of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi Province, People's Republic of China
| | - Dan Su
- Department of Clinical Hematology, Second Affiliated Hospital, Medical School of Xi'an Jiaotong University, West Five Road, No. 157, Xi'an, 710004, Shaanxi Province, People's Republic of China
| | - Fuling Zhou
- Department of Clinical Hematology, Second Affiliated Hospital, Medical School of Xi'an Jiaotong University, West Five Road, No. 157, Xi'an, 710004, Shaanxi Province, People's Republic of China.
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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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