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Oner AO, Özdemir Ç, Yavaşoğlu F, Şenol Y, Adsız SN. The relationship between immunohistochemical parameters, bone marrow fibrosis and bone marrow 18F-FDG uptake in multiple myeloma patients undergoing PET/CT examination. Rev Esp Med Nucl Imagen Mol 2023; 42:289-295. [PMID: 36963759 DOI: 10.1016/j.remnie.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2023]
Abstract
PURPOSE The aim of this study was to determine the power of the SUVmax value obtained from 18F-FDG PET/CT in multiple myeloma (MM) patients to be able to predict immunophenotype characteristics (CD20, CD44, CD56, CD117, CD138 antigen expressions), bone marrow fibrosis, cyclin D1 oncogene, and M-protein subtypes which play a role in diagnosis-treatment and prognosis of the disease. MATERIAL AND METHOD The study included 54 patients with multiple myeloma who underwent PET/CT for initial staging and bone marrow biopsy. The relationship was examined in these patients between the SUVmax value measured from the iliac bone region and the immunohistochemical and bone marrow fibrosis data of the biopsy taken from the iliac bone. The Mann Whitney U test was used in the comparisons of dependent paired groups, and the Kruskal Wallis H test in the comparisons of three or more groups. RESULTS The median SUVmax value was 4.5 (1.9-15.6) in patients with CD117 antigen positivity, which was statistically significantly higher than the value in the patients with CD117 negativity (p = 0.031). When patient grouping was made according to the reticulin level; we found that the median SUVmax value was 4.9 (3.0-14.8) in the group with increased fibrosis and 3.6 (1.6-15.6) in the group with low fibrosis. The median SUVmax was statistically significantly higher in the group with increased fibrosis compared to the group with low fibrosis (p = 0.004). No statistically significant difference was determined in the comparisons of the SUVmax values when the patients were grouped according to the immunoglobulin heavy chain and light chain, CD20, CD44, CD56, and cyclin D1 characteristics (p > 0.05). CONCLUSION In MM patients who underwent PET/CT for initial staging, significant relationships were determined between FDG uptake in the bone marrow (SUVmax) and CD117 antigen and bone marrow fibrosis, which is an important prognostic factor. Higher SUVmax values were determined in the bone marrow of patients with increased fibrosis and CD117 positivity.
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Affiliation(s)
- Ali Ozan Oner
- Department of Nuclear Medicine, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey.
| | - Çiğdem Özdemir
- Department of Pathology, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Filiz Yavaşoğlu
- Department of Hematology, Faculty of Medicine, Eskisehir Osmangazi University, Eskişehir, Turkey
| | - Yiğit Şenol
- Public Health Services, Afyonkarahisar Provincial Health Directorate, Afyonkarahisar, Turkey
| | - Sena Naz Adsız
- Department of Pathology, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
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Mengich I, Rajput S, Malkit R, Moloo Z, Kagotho E, Lalani EN, Mwirigi A. Immunophenotypic expression profile of multiple myeloma cases at a tertiary hospital in Nairobi Kenya. Front Med (Lausanne) 2023; 10:1177775. [PMID: 37250623 PMCID: PMC10213391 DOI: 10.3389/fmed.2023.1177775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 04/17/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction Multiple myeloma (MM) is a plasma cell neoplasm that constitutes 10-15% of all hematopoietic neoplasms. Kenya is placed among the top five African countries for MM incidence and MM-related mortality. Prior studies have suggested that the aberrant expression of Cyclin D1, CD56, CD117 and Ki-67 on neoplastic plasma cells is useful in disease prognostication. The prevalence and significance of expression of these markers in a cohort of MM cases in Kenya has not been studied previously. Methods A retrospective cross-sectional study was carried out at the Aga Khan University Hospital, Nairobi. The study population included 83 MM cases with available trephine blocks archived between 1st of January 2009 and 31st of March 2020. Immunohistochemical expression of Cyclin D1, CD56, CD117, and Ki-67 was analyzed and scored. The biomarkers were described using frequencies based on the positive and negative results. Fisher's exact test was used to determine the association between the immunophenotypic markers and categorical variables. Results Of the 83 selected cases, expression of Cyclin D1, CD56, CD117 and Ki-67 was identified in 28.9, 34.9, 7.2, and 50.6%, respectively. Cyclin D1 positivity was significantly associated with hypercalcemia. Absence of CD117 expression was noted to be associated with adverse risk parameters including an IgA isotype or light chain disease, International Staging System (ISS) stage III disease, abnormal baseline serum free light chains (sFLC) and a high plasma cell burden. Conclusion Cyclin D1 expression was congruent with previously reported studies. The frequency of CD56 and CD117 expression was lower than previously reported. This may be due to differences in disease biology between the study populations. Approximately half of cases were Ki-67 positive. Our data showed limited associations between the expression of studied markers and clinicopathologic variables. However, this could be attributed to the small study sample size. We would recommend further characterization of the disease in a larger prospective study with the inclusion of survival outcomes and cytogenetic studies.
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Affiliation(s)
- Isabella Mengich
- Department of Pathology, Aga Khan University Hospital, Nairobi, Kenya
| | - Sheerien Rajput
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
- Centre for Regenerative Medicine and Stem Cell Research, Aga Khan University, Karachi, Pakistan
| | - Riyat Malkit
- Department of Pathology, Aga Khan University Hospital, Nairobi, Kenya
| | - Zahir Moloo
- Department of Pathology, Aga Khan University Hospital, Nairobi, Kenya
| | - Elizabeth Kagotho
- Department of Pathology, Aga Khan University Hospital, Nairobi, Kenya
| | - El-Nasir Lalani
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
- Centre for Regenerative Medicine and Stem Cell Research, Aga Khan University, Karachi, Pakistan
| | - Anne Mwirigi
- Department of Pathology, Aga Khan University Hospital, Nairobi, Kenya
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Geng C, Zhou H, Wang H, Li Y, Leng Y, Zhang Z, Jian Y, Yang G, Chen W. Newly diagnosed multiple myeloma patients with CD56 expression benefit more from autologous stem cell transplantation. BMC Cancer 2022; 22:1349. [PMID: 36564753 PMCID: PMC9783713 DOI: 10.1186/s12885-022-10382-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 11/29/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Several studies showed that lack of CD56 expression was a poor prognostic factor for patients with newly diagnosed multiple myeloma (NDMM). However, other studies were not able to confirm the prognostic value of CD56 in NDMM. This study aimed to evaluate the prognostic value of CD56 expression for patients with NDMM who received autologous stem cell transplantation (ASCT). METHODS We retrospectively analyzed 370 patients with NDMM under 66 years old and the propensity score matching technique was used to reduce the bias between two groups. RESULTS CD56 expression was observed in 250 (67.6%) patients, and only half of transplant-eligible patients received ASCT for financial and adverse effects concerns after induction therapy. 54.8% (137/250) CD56 positive patients received ASCT; and 47.5% (57/120) CD56 negative patients received ASCT. Univariate and multivariate analyses showed that ASCT was correlated with longer overall survival (OS) (p < 0.001) and progression-free survival (PFS) (p < 0.001) for CD56 positive patients. However, ASCT had no impact on OS and PFS in univariate and multivariate analysis (p > 0.05). In the propensity score matching analysis, 186 CD56 positive patients were identified, 93 patients had received ASCT and 93 patients had no ASCT. Among 120 CD56 negative patients, 80 patients, 40 in each group, were identified. Among 186 matched CD56 positive patients, patients with ASCT had longer OS (87.6 vs.56.1 months, p = 0.049) and PFS (36.7 vs.30.9 months, p = 0.040). However, ASCT had no impact on OS and PFS for matched CD56 negative patients (p > 0.05). CONCLUSIONS These results demonstrated that ASCT may improve OS and PFS of CD56 positive patients and had no impact on survival of CD56 negative patients.
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Affiliation(s)
- Chuanying Geng
- grid.24696.3f0000 0004 0369 153XDepartment of Hematology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020 China
| | - Huixing Zhou
- grid.24696.3f0000 0004 0369 153XDepartment of Hematology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020 China
| | - Huijuan Wang
- grid.24696.3f0000 0004 0369 153XDepartment of Hematology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020 China
| | - Yanchen Li
- grid.24696.3f0000 0004 0369 153XDepartment of Hematology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020 China
| | - Yun Leng
- grid.24696.3f0000 0004 0369 153XDepartment of Hematology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020 China
| | - Zhiyao Zhang
- grid.24696.3f0000 0004 0369 153XDepartment of Hematology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020 China
| | - Yuan Jian
- grid.24696.3f0000 0004 0369 153XDepartment of Hematology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020 China
| | - Guangzhong Yang
- grid.24696.3f0000 0004 0369 153XDepartment of Hematology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020 China
| | - Wenming Chen
- grid.24696.3f0000 0004 0369 153XDepartment of Hematology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020 China
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Dual Negativity of CD56 and CD117 Links to Unfavorable Cytogenetic Abnormalities and Predicts Poor Prognosis in Multiple Myeloma. J Clin Med 2022; 11:jcm11216524. [DOI: 10.3390/jcm11216524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/22/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022] Open
Abstract
The prognostic value of CD56 and CD117 expression on myeloma cells is controversial. This study aims to analyze the correlation of CD56 and CD117 expression with cytogenetic abnormalities and survival. A total of 128 patients with newly diagnosed multiple myeloma (NDMM) were recruited in this single-center retrospective study. Flow cytometry and FISH tests of marrow cells were performed for all of the subjects. The statistical methods included a chi-squared test, univariate and multivariate COX regressions, and a Kaplan-Meier survival curve analysis. Regarding the cytogenetics, the incidence of IgH/FGFR3 translocation was more frequent in patients with a negative CD56 (p = 0.003). CD56 negativity was an independent adverse factor associated with a poor prognosis (p = 0.019) and indicated a shorter overall survival (OS) (p = 0.021). Patients with dual negative CD56 and CD117 trended toward a poorer OS (CD56−CD117− vs. CD56+CD117−, p = 0.011; CD56−CD117− vs. CD56+CD117+, p = 0.013). In conclusion, CD56 is a prognostic marker that independently affects OS and is associated with adverse cytogenetic abnormalities. Patients with a dual negativity of CD56 and CD117 have a worse clinical outcome.
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Li L, Li X, Shang A, Zhao Y, Jin L, Zhao M, Shen W. Prognostic significance of CD56 antigen in newly diagnosed multiple myeloma: A real-world retrospective study. Medicine (Baltimore) 2022; 101:e30988. [PMID: 36221376 PMCID: PMC9542762 DOI: 10.1097/md.0000000000030988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The prognostic value of plasma cell CD56 expression of patients with multiple myeloma (MM) has been reported in many studies, but the results are controversial. This study aimed to examine the prognostic significance of CD56 in MM patients. Eighty seven patients with newly diagnosed MM were enrolled in this study, and their clinical characteristics, immunophenotypes, and cytogenetics were retrospectively analyzed to explore the prognostic significance of CD56 expression. Multiparameter flow cytometry was used to detect MM in bone marrow samples from all patients. Patients were divided into 2 groups based on whether they expressed CD56: CD56 + group and CD56 - group. After 4 cycles of chemotherapy, the overall response rate of the CD56 - patients was lower than that of the CD56 + patients (60.0% vs 81.1%, P = .036). Survival analysis showed that the median progression-free survival (PFS) was 10 months for the CD56 - group and 27 months for the CD56 + group (P = .007). The median overall survival (OS) of patients for the CD56 - group was 25 months versus not reached in the CD56 + group (P = .010). In addition, among the high-risk patients detected by fluorescence in situ hybridization (FISH), the median PFS was 4 months for the CD56 - group and 16 months for the CD56 + group (P = .012). The median OS of the CD56 + group and CD56 - group was 36 months and 15 months, respectively, with statistically significant differences (P = .017). Our study confirmed that CD56 - patients with MM had a worse prognosis than that of CD56 + patients with MM. Among the patients with ≥ 2 high-risk cytogenetics, the existence of the CD56 negativity can further identify MM patients with poor PFS and OS.
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Affiliation(s)
- Liping Li
- Department of Oncology and Hematology, The Second Hospital of Jilin University, Nanguan District, Changchun City, Jilin, China
| | - Xiaofeng Li
- Department of Oncology and Hematology, The Second Hospital of Jilin University, Nanguan District, Changchun City, Jilin, China
| | - An Shang
- Department of Oncology and Hematology, The Second Hospital of Jilin University, Nanguan District, Changchun City, Jilin, China
| | - Yan Zhao
- Department of Oncology and Hematology, The Second Hospital of Jilin University, Nanguan District, Changchun City, Jilin, China
| | - Lifang Jin
- Department of Oncology and Hematology, The Second Hospital of Jilin University, Nanguan District, Changchun City, Jilin, China
| | - Meng Zhao
- Department of Oncology and Hematology, The Second Hospital of Jilin University, Nanguan District, Changchun City, Jilin, China
| | - Weizhang Shen
- Department of Oncology and Hematology, The Second Hospital of Jilin University, Nanguan District, Changchun City, Jilin, China
- *Correspondence: Weizhang Shen, Department of Oncology and Hematology, The Second Hospital of Jilin University, No 218, Lane Ziqiang, Nanguan District, Changchun City, Jilin Province, 130041, China (e-mail: )
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Gupta S, Master S, Graham C. Extramedullary Multiple Myeloma: A Patient-Focused Review of the Pathogenesis of Bone Marrow Escape. World J Oncol 2022; 13:311-319. [PMID: 36406195 PMCID: PMC9635794 DOI: 10.14740/wjon1521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 09/22/2022] [Indexed: 08/11/2023] Open
Abstract
Multiple myeloma (MM) is a neoplastic clonal proliferation of plasma cells, predominantly in the bone marrow. The presentation of MM in extramedullary tissue, particularly the liver, is uncommon with only a few reported cases in literature. We report a rare and unusual presentation of kappa light chain restricted MM with progression of disease to involve the liver. MM was initially diagnosed on bone marrow biopsy, initially treated with carfilzomib, lenalidomide and dexamethasone, later changed to bortezomib, daratumumab and dexamethasone. There was subsequent progression with a new biopsy-proven myelomatous liver lesion. The patient could not receive high-dose chemotherapy due to multiple co-morbidities and extent of disease and eventually succumbed to her disease rapidly. This article emphasizes the poor prognosis of extramedullary involvement in MM and the pathogenic mechanisms by which it develops. Based on a review of the literature of other cases and case series of solitary or diffuse myeloma involvement in the liver, high-dose chemotherapy in combination with proteasome inhibitors and immunomodulators has the best success rate with less relapse and progressive disease in extramedullary myeloma. Our analysis concluded that the gain of CD44, loss of CD56, loss of very late antigen-4 (VLA-4), imbalance of the chemokine receptor-4-chemokine ligand-12 (CXCR4-CXCL12) axis, metastasis-associated lung adenocarcinoma 1 (MALAT1) upregulation, RAS pathway activation as well as 13q and 17p deletions show an increased propensity of malignant plasma cells to leave the bone marrow and hone in extramedullary sites giving rise to more aggressive extramedullary diseases. Targeted therapeutics such as CD44v-directed therapy and reactivation of p53 to wild-type conformation could potentially be evaluated as treatment options in the future to improve outcomes in this aggressive form of MM, especially in patients with advanced disease and limited treatment options.
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Affiliation(s)
- Supriya Gupta
- Division of Hematology-Oncology, Feist Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Samip Master
- Division of Hematology-Oncology, Feist Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Christopher Graham
- Division of Hematology-Oncology, Feist Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport, LA, USA
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Wang H, Zhou X, Zhu JW, Ye JN, Guo HF, Sun C. Association of CD117 and HLA-DR expression with shorter overall survival and/or progression-free survival in patients with multiple myeloma treated with bortezomib and thalidomide combination treatment without transplantation. Oncol Lett 2018; 16:5655-5666. [PMID: 30344721 PMCID: PMC6176261 DOI: 10.3892/ol.2018.9365] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 06/27/2018] [Indexed: 12/14/2022] Open
Abstract
Certain immunophenotypes in multiple myeloma (MM), including CD56 and CD117, have been reported to be associated with overall survival (OS). However, previous reports have ignored the impact of different treatment regimens and the long-term prognostic value of immunophenotyping in MM when treated with novel agents, including thalidomide and bortezomib, in the absence of transplantation for autologous stem cell transplantation and allo-hematopoietic stem cell transplantation. To further understand the long-term prognostic value of immunophenotyping in MM, when treated with bortezomib combined with thalidomide-based regimens without transplantation, 80 patients who were newly diagnosed between January 2007 and December 2015, were analyzed retrospectively. In contrast to previous studies, no significant survival time difference was observed between CD56+/CD117+ and CD56-/CD117- groups. Multivariate analysis suggested that human leukocyte antigen-antigen D-related (HLA-DR)+ was independently associated with shorter OS and progression-free survival (PFS), while CD117+ was an independent prognostic factor for decreased PFS. In addition, the myeloma prognostic index (MPI), defined by HLA-DR+, age ≥65 years and international staging system stage III, was suitable for risk stratification of patients treated with novel agents for OS and PFS. The results of the current study suggested that HLA-DR+ patients had a shorter OS and PFS and CD117+ patients had shorter PFS. HLA-DR+ or CD117+ was sufficient to affect survival. Evaluating these markers may reveal valuable prognostic factors for MM in patients receiving bortezomib combined with thalidomide-based regimens without autologous stem cell transplantation and allo-hematopoietic stem cell transplantation). MPI may describe an accessible tool to predict the prognosis of patients with MM.
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Affiliation(s)
- Huan Wang
- Department of Hematology, Affiliated Wuxi People's Hospital, Nanjing Medical University, Wuxi, Jiangsu 214023, P.R. China
| | - Xin Zhou
- Department of Hematology, Affiliated Wuxi People's Hospital, Nanjing Medical University, Wuxi, Jiangsu 214023, P.R. China
| | - Jian-Wei Zhu
- Department of Hematology, Affiliated Wuxi People's Hospital, Nanjing Medical University, Wuxi, Jiangsu 214023, P.R. China
| | - Jian-Nan Ye
- Department of Hematology, Affiliated Wuxi People's Hospital, Nanjing Medical University, Wuxi, Jiangsu 214023, P.R. China
| | - Hong-Feng Guo
- Department of Hematology, Affiliated Wuxi People's Hospital, Nanjing Medical University, Wuxi, Jiangsu 214023, P.R. China
| | - Chao Sun
- Department of Hematology, Affiliated Wuxi People's Hospital, Nanjing Medical University, Wuxi, Jiangsu 214023, P.R. China
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