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Giles HV, Drayson MT, Kishore B, Pawlyn C, Kaiser M, Cook G, de Tute R, Owen RG, Cairns D, Menzies T, Davies FE, Morgan GJ, Pratt G, Jackson GH. Progression free survival of myeloma patients who become IFE-negative correlates with the detection of residual monoclonal free light chain (FLC) by mass spectrometry. Blood Cancer J 2024; 14:50. [PMID: 38499538 PMCID: PMC10948753 DOI: 10.1038/s41408-024-00995-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 01/17/2024] [Accepted: 01/22/2024] [Indexed: 03/20/2024] Open
Abstract
Deeper responses are associated with improved survival in patients being treated for myeloma. However, the sensitivity of the current blood-based assays is limited. Historical studies suggested that normalisation of the serum free light chain (FLC) ratio in patients who were negative by immunofixation electrophoresis (IFE) was associated with improved outcomes. However, recently this has been called into question. Mass spectrometry (MS)-based FLC assessments may offer a superior methodology for the detection of monoclonal FLC due to greater sensitivity. To test this hypothesis, all available samples from patients who were IFE negative after treatment with carfilzomib and lenalidomide-based induction and autologous stem cell transplantation (ASCT) in the Myeloma XI trial underwent FLC-MS testing. FLC-MS response assessments from post-induction, day+100 post-ASCT and six months post-maintenance randomisation were compared to serum FLC assay results. Almost 40% of patients had discordant results and 28.7% of patients with a normal FLC ratio had residual monoclonal FLC detectable by FLC-MS. FLC-MS positivity was associated with reduced progression-free survival (PFS) but an abnormal FLC ratio was not. This study demonstrates that FLC-MS provides a superior methodology for the detection of residual monoclonal FLC with FLC-MS positivity identifying IFE-negative patients who are at higher risk of early progression.
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Affiliation(s)
- H V Giles
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
- University of Birmingham, Birmingham, UK.
| | | | - B Kishore
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - C Pawlyn
- The Institute of Cancer Research, London and The Royal Marsden Hospital, London, UK
| | - M Kaiser
- The Institute of Cancer Research, London and The Royal Marsden Hospital, London, UK
| | - G Cook
- Leeds Cancer Research UK Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - R de Tute
- Haematological Malignancy Diagnostic Service, Leeds Teaching Hospitals Trust, Leeds, UK
| | - R G Owen
- Haematological Malignancy Diagnostic Service, Leeds Teaching Hospitals Trust, Leeds, UK
| | - D Cairns
- Leeds Cancer Research UK Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - T Menzies
- Leeds Cancer Research UK Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - F E Davies
- Myeloma Research Program, Perlmutter Cancer, NYU Langone Health, New York, USA
| | - G J Morgan
- Myeloma Research Program, Perlmutter Cancer, NYU Langone Health, New York, USA
| | - G Pratt
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- University of Birmingham, Birmingham, UK
| | - G H Jackson
- Department of Haematology, University of Newcastle, Newcastle upon Tyne, UK
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Tay W, Giles H, Wright N, Afzal M, Birtwistle J, Berlanga O, North S, Drayson M, Pratt G, Wallis G, Harding S. T043 Exent mass spectrometry allows early identification of multiclonal MGUS compared to electrophoretic methods. Clin Chim Acta 2022. [DOI: 10.1016/j.cca.2022.04.280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Parry H, McIlroy G, Bruton R, Ali M, Stephens C, Damery S, Otter A, McSkeane T, Rolfe H, Faustini S, Wall N, Hillmen P, Pratt G, Paneesha S, Zuo J, Richter A, Moss P. Antibody responses after first and second Covid-19 vaccination in patients with chronic lymphocytic leukaemia. Blood Cancer J 2021; 11:136. [PMID: 34330895 PMCID: PMC8323747 DOI: 10.1038/s41408-021-00528-x] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/05/2021] [Accepted: 07/09/2021] [Indexed: 12/15/2022] Open
Abstract
B-cell chronic lymphocytic leukaemia (CLL) is associated with immunosuppression and patients are at increased clinical risk following SARS-CoV-2 infection. Covid-19 vaccines offer the potential for protection against severe infection but relatively little is known regarding the profile of the antibody response following first or second vaccination. We studied spike-specific antibody responses following first and/or second Covid-19 vaccination in 299 patients with CLL compared with healthy donors. 286 patients underwent extended interval (10-12 week) vaccination. 154 patients received the BNT162b2 mRNA vaccine and 145 patients received ChAdOx1. Blood samples were taken either by venepuncture or as dried blood spots on filter paper. Spike-specific antibody responses were detectable in 34% of patients with CLL after one vaccine (n = 267) compared to 94% in healthy donors with antibody titres 104-fold lower in the patient group. Antibody responses increased to 75% after second vaccine (n = 55), compared to 100% in healthy donors, although titres remained lower. Multivariate analysis showed that current treatment with BTK inhibitors or IgA deficiency were independently associated with failure to generate an antibody response after the second vaccine. This work supports the need for optimisation of vaccination strategy in patients with CLL including the potential utility of booster vaccines.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Viral/blood
- Antibodies, Viral/immunology
- Antibody Formation/drug effects
- BNT162 Vaccine
- COVID-19/blood
- COVID-19/immunology
- COVID-19/prevention & control
- COVID-19 Vaccines/administration & dosage
- COVID-19 Vaccines/immunology
- Female
- Humans
- Immunization, Secondary
- Leukemia, Lymphocytic, Chronic, B-Cell/blood
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Male
- Middle Aged
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Affiliation(s)
- H Parry
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK
| | - G McIlroy
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - R Bruton
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK
| | - M Ali
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK
| | - C Stephens
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK
| | - S Damery
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - A Otter
- National infection Service, Public Health England, Porton Down, Salisbury, SP4 OJG, UK
| | - T McSkeane
- Cancer Research UK Clinical Trials Unit, University of Birmingham, B15 2TT, Birmingham, UK
| | - H Rolfe
- Cancer Research UK Clinical Trials Unit, University of Birmingham, B15 2TT, Birmingham, UK
| | - S Faustini
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK
| | - N Wall
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK
| | - P Hillmen
- St. James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK
| | - G Pratt
- Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, B15 2TH, UK
| | - S Paneesha
- Birmingham Heartlands Hospital, University Hospitals Birmingham, Bordesley Green East, B9 5SS, Birmingham, UK
| | - J Zuo
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK
| | - A Richter
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK
| | - P Moss
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK.
- Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, B15 2TH, UK.
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Westerland O, Drinkwater KJ, Parikh J, Streetly M, Pratt G, Goh V, Howlett DC. Imaging in myeloma: a Royal College of Radiologists national survey of current imaging practice. Clin Radiol 2021; 76:820-828. [PMID: 34187681 DOI: 10.1016/j.crad.2021.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 05/20/2021] [Indexed: 11/24/2022]
Abstract
AIMS To evaluate current national imaging practice in myeloma with reference to National Institute for Health and Care Excellence (NICE) guidelines (NG35, 2016) and compare results with an initial survey conducted in 2017 (61 participating sites). MATERIALS AND METHODS All UK radiology departments treating myeloma patients and with a Royal College of Radiologists (RCR) Audit Lead were invited to participate. Data were collected using an online questionnaire. Descriptive statistics were performed. RESULTS One hundred and fourteen hospitals supplied data (54% return rate). Skeletal survey (SS) remains the most-commonly performed first-line imaging test for suspected/confirmed myeloma or plasmacytoma (39%, 45/114 hospitals), followed by whole-body magnetic resonance imaging (WBMRI) (27%, 31/114) and whole-body computed tomography (WBCT) (19%, 22/114). Integrated positron-emission tomography/CT (PET/CT) was first-line in 14% (16/114). The NICE recommended initial investigation, WBMRI, is currently offered in 27% of surveyed hospitals (<10% in 2017). Ongoing challenges to implementing WBMRI include scanner availability, financial constraints, reporting time, and radiologist training. CONCLUSION Despite NICE recommendations regarding WBMRI in diagnosis/follow-up of myeloma, SS (poor sensitivity and specificity) remains the most commonly performed first-line test. Radiologists, haematologists, and patients should continue to emphasise the superiority and benefit of modern and more accurate imaging, such that they are prioritised in clinical service planning.
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Affiliation(s)
- O Westerland
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; Clinical Imaging and Medical Physics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - K J Drinkwater
- Directorate of Professional Practice, Royal College of Radiologists, London, UK.
| | - J Parikh
- Clinical Imaging and Medical Physics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - M Streetly
- Clinical Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - G Pratt
- Clinical Haematology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - V Goh
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; Clinical Imaging and Medical Physics, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Affiliation(s)
- S Paneesha
- Birmingham Health Partners, University Hospitals Birmingham NHS Foundation Trust, UK.,University of Birmingham, UK
| | - G Pratt
- Birmingham Health Partners, University Hospitals Birmingham NHS Foundation Trust, UK.,University of Birmingham, UK
| | - H Parry
- Birmingham Health Partners, University Hospitals Birmingham NHS Foundation Trust, UK.,University of Birmingham, UK
| | - P Moss
- Birmingham Health Partners, University Hospitals Birmingham NHS Foundation Trust, UK.,University of Birmingham, UK
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Senko C, Moore J, Hay K, Lwin Z, Pratt G, Fong K, Hughes B. P1.18-14 The Prognostic Significance of Significant Weight Loss in Stage III NSCLC Undergoing Definitive CRT After FDG-PET Staging. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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7
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Blythe R, Pratt G. 26IMPACT OF COMPREHENSIVE GERIATRIC ASSESSMENT AND EARLY COMMUNICATION IN MORE DEBILITATED PATIENTS FOLLOWING STROKE. Age Ageing 2019. [DOI: 10.1093/ageing/afz055.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- R Blythe
- Acute Stroke Unit, Sheffield Teaching Hospitals, Sheffield
| | - G Pratt
- Acute Stroke Unit, Sheffield Teaching Hospitals, Sheffield
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8
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Yap A, Lopez-Olivo MA, Dubowitz J, Pratt G, Hiller J, Gottumukkala V, Sloan E, Riedel B, Schier R. Effect of beta-blockers on cancer recurrence and survival: a meta-analysis of epidemiological and perioperative studies. Br J Anaesth 2018; 121:45-57. [PMID: 29935594 DOI: 10.1016/j.bja.2018.03.024] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 03/05/2018] [Accepted: 03/30/2018] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The biological perturbation associated with psychological and surgical stress is implicated in cancer recurrence. Preclinical evidence suggests that beta-blockers can be protective against cancer progression. We undertook a meta-analysis of epidemiological and perioperative clinical studies to investigate the association between beta-blocker use and cancer recurrence (CR), disease-free survival (DFS), and overall survival (OS). METHODS Databases were searched until September 2017, reported hazard ratios (HRs) pooled, and 95% confidence intervals (CIs) calculated. Comparative studies examining the effect of beta-blockers (selective and non-selective) on cancer outcomes were included. The Newcastle Ottawa Scale was used to assess methodological quality and bias. RESULTS Of the 27 included studies, nine evaluated the incidental use of non-selective beta-blockers, and ten were perioperative studies. Beta-blocker use had no effect on CR. Within subgroups of cancer, melanoma was associated with improved DFS (HR 0.03, 95% CI 0.01-0.17) and OS (HR 0.04, 95% CI 0.00-0.38), while endometrial cancer had an associated reduction in DFS (HR 1.40, 95% CI 1.10-1.80) and OS (HR 1.50, 95% CI 1.12-2.00). There was also reduced OS seen with head and neck and prostate cancer. Non-selective beta-blocker use was associated with improved DFS and OS in ovarian cancer, improved DFS in melanoma, but reduced OS in lung cancer. Perioperative studies showed similar variable effects across cancer types, albeit from a limited data pool. CONCLUSION Beta-blocker use had no evident effect on CR. The beneficial effect of beta-blockers on DFS and OS in the epidemiological or perioperative setting remains variable, tumour-specific, and of low-level evidence at present.
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Affiliation(s)
- A Yap
- Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Department of Anaesthesia and Pain Medicine, Princess Margaret Hospital, Perth, WA, Australia.
| | - M A Lopez-Olivo
- The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - J Dubowitz
- Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Drug Discovery Biology Theme, Monash Institute of Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia
| | - G Pratt
- The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - J Hiller
- Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Department of Anaesthesia, Pain and Perioperative Medicine Unit, The University of Melbourne, Parkville, VIC, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - V Gottumukkala
- The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - E Sloan
- Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Drug Discovery Biology Theme, Monash Institute of Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia; Cousins Center for PNI, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA
| | - B Riedel
- Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Drug Discovery Biology Theme, Monash Institute of Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia; Department of Anaesthesia, Pain and Perioperative Medicine Unit, The University of Melbourne, Parkville, VIC, Australia
| | - R Schier
- Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Germany
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9
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Richer S, Huntjens B, Pratt S, Rutledge G, Perry B, Novil S, Pratt G. Is macular pigment spatial profile a clinical biomarker in children of AMD parents? Acta Ophthalmol 2017. [DOI: 10.1111/j.1755-3768.2017.02164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- S. Richer
- Eye Clinic 112e; Captain James A Lovell Federal Health Care Center; North Chicago IL USA
| | - B. Huntjens
- Applied Vision Research Centre; School of Health Sciences; City University of London; London UK
| | - S. Pratt
- Scripps Clinical Research Service; Scripps Health / Scripps Memorial Hospital; Scripps Mericos Eye Institute; La Jolla CA USA
| | - G. Rutledge
- Ecology and Evolutionary Biology; University of California; Irvine CA USA
| | - B. Perry
- Ophthalmology; University of Iowa; Iowa City IA USA
| | - S. Novil
- Eye Clinic; Captain James A Lovell Federal Health Care Center; North Chicago IL USA
| | - G. Pratt
- Ophthalmology; Steven Pratt- MD Private Practice; La Jolla CA USA
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Abstract
In February 2016, the National Institute for Health and Care Excellence (NICE) published guidelines on multiple myeloma. NICE have published numerous guidelines relating to haematology, but this was the first guideline focusing on a single haematological malignancy. The purpose of this review was to highlight the recommendations made in the guideline and the implications for the management of patients in the UK and also internationally. In addition, we review the NICE process and highlight issues around current guideline development.
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Affiliation(s)
- G Pratt
- Haematology, Centre for Clinical Haematology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - T C Morris
- Haematology, Queen's University Belfast Faculty of Medicine Health and Life Sciences, Belfast, UK
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11
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Jones JR, Cairns DA, Gregory WM, Collett C, Pawlyn C, Sigsworth R, Striha A, Henderson R, Kaiser MF, Jenner M, Cook G, Russell NH, Williams C, Pratt G, Kishore B, Lindsay J, Drayson MT, Davies FE, Boyd KD, Owen RG, Jackson GH, Morgan GJ. Second malignancies in the context of lenalidomide treatment: an analysis of 2732 myeloma patients enrolled to the Myeloma XI trial. Blood Cancer J 2016; 6:e506. [PMID: 27935580 PMCID: PMC5223149 DOI: 10.1038/bcj.2016.114] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 10/24/2016] [Indexed: 12/26/2022] Open
Abstract
We have carried out the largest randomised trial to date of newly diagnosed myeloma patients, in which lenalidomide has been used as an induction and maintenance treatment option and here report its impact on second primary malignancy (SPM) incidence and pathology. After review, 104 SPMs were confirmed in 96 of 2732 trial patients. The cumulative incidence of SPM was 0.7% (95% confidence interval (CI) 0.4–1.0%), 2.3% (95% CI 1.6–2.7%) and 3.8% (95% CI 2.9–4.6%) at 1, 2 and 3 years, respectively. Patients receiving maintenance lenalidomide had a significantly higher SPM incidence overall (P=0.011). Age is a risk factor with the highest SPM incidence observed in transplant non-eligible patients aged >74 years receiving lenalidomide maintenance. The 3-year cumulative incidence in this group was 17.3% (95% CI 8.2–26.4%), compared with 6.5% (95% CI 0.2–12.9%) in observation only patients (P=0.049). There was a low overall incidence of haematological SPM (0.5%). The higher SPM incidence in patients receiving lenalidomide maintenance therapy, especially in advanced age, warrants ongoing monitoring although the benefit on survival is likely to outweigh risk.
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Affiliation(s)
- J R Jones
- The Institute of Cancer Research, London, UK.,The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - D A Cairns
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - W M Gregory
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - C Collett
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - C Pawlyn
- The Institute of Cancer Research, London, UK.,The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - R Sigsworth
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - A Striha
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - R Henderson
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - M F Kaiser
- The Institute of Cancer Research, London, UK.,The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - M Jenner
- Department of Haematology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - G Cook
- University of Leeds, Leeds, UK
| | - N H Russell
- Centre for Clinical Haematology, Nottingham University Hospital, Nottingham, UK
| | - C Williams
- Centre for Clinical Haematology, Nottingham University Hospital, Nottingham, UK
| | - G Pratt
- Heart of England NHS Foundation Trust, Birmingham, UK
| | - B Kishore
- Heart of England NHS Foundation Trust, Birmingham, UK
| | - J Lindsay
- Department of Haematology, East Kent Hospitals University NHS Foundation Trust, Kent, UK
| | - M T Drayson
- Clinical Immunology, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - F E Davies
- The Institute of Cancer Research, London, UK.,The Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - K D Boyd
- The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | | | - G H Jackson
- Department of Haematology, Newcastle University, Newcastle, UK
| | - G J Morgan
- The Institute of Cancer Research, London, UK.,The Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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12
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Ludwig C, Williams DS, Bartlett DB, Essex SJ, McNee G, Allwood JW, Jewell E, Barkhuisen A, Parry H, Anandram S, Nicolson P, Gardener C, Seymour F, Basu S, Dunn WB, Moss PAH, Pratt G, Tennant DA. Alterations in bone marrow metabolism are an early and consistent feature during the development of MGUS and multiple myeloma. Blood Cancer J 2015; 5:e359. [PMID: 26473531 PMCID: PMC4635194 DOI: 10.1038/bcj.2015.85] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- C Ludwig
- School of Cancer Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - D S Williams
- School of Cancer Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - D B Bartlett
- School of Cancer Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - S J Essex
- School of Cancer Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - G McNee
- School of Cancer Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - J W Allwood
- School of Biosciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - E Jewell
- School of Biosciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - A Barkhuisen
- Department of Haematology, The Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - H Parry
- School of Cancer Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - S Anandram
- Department of Haematology, The Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - P Nicolson
- Department of Haematology, Birmingham Heartlands Hospital, Birmingham, UK
| | - C Gardener
- Department of Haematology, Birmingham Heartlands Hospital, Birmingham, UK
| | - F Seymour
- Department of Haematology, Birmingham Heartlands Hospital, Birmingham, UK
| | - S Basu
- Department of Haematology, The Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - W B Dunn
- School of Biosciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - P A H Moss
- School of Cancer Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - G Pratt
- School of Cancer Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Department of Haematology, Birmingham Heartlands Hospital, Birmingham, UK
| | - D A Tennant
- School of Cancer Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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13
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Parry HM, Damery S, Mudondo NP, Hazlewood P, McSkeane T, Aung S, Murray J, Pratt G, Moss P, Milligan DW. Primary care management of early stage chronic lymphocytic leukaemia is safe and effective. QJM 2015; 108:789-94. [PMID: 25638788 PMCID: PMC4586947 DOI: 10.1093/qjmed/hcv017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Chronic lymphocytic leukaemia (CLL) is the commonest leukaemia in western society. Most patients are detected incidentally at an early stage and require 'watch and wait' follow-up. In the UK, management of Stage A0 CLL varies with some centres advising regular outpatient haematology follow-up, whereas others recommend management within primary care. The safety and effectiveness of these two management options are currently unknown. METHODS An observational retrospective cohort study in outpatient Haematology clinics at Queen Elizabeth Hospital Birmingham (QEH) and Birmingham Heartlands Hospital (BHH) and primary care practices in West Midlands, UK. All patients diagnosed with stable stage A0 CLL since 2002 at BHH or QEH were identified. At BHH, patients were discharged to primary care follow-up, whilst QEH patients remained under haematology for follow-up. Evidence of disease progression, need for treatment and overall mortality was documented. RESULTS Two hundred and forty-six Stage A0 CLL patients were identified. One hundred and five (43%) patients were discharged to primary care, whilst 141 (57%) patients were followed up in haematology outpatient clinics. No difference in mortality or need for treatment was found between the two groups. Of those discharged, 93 (66%) remained in primary care. CONCLUSION The management of stable-stage A0 CLL within primary or secondary care leads to equivalent clinical outcomes. The prevalence of early-stage CLL is expected to increase with the ageing population and management within primary care should be considered as a potentially effective approach.
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Affiliation(s)
| | - S Damery
- School of Primary Care Clinical Sciences
| | - N P Mudondo
- School of Medicine and Dentistry, University of Birmingham, Edgbaston, West Midlands B15 2TT, UK
| | | | | | - S Aung
- Centre for Haematology and Stem Cell Transplantation, Heart of England NHS Foundation Trust, Birmingham, West Midlands B9 5SS, UK and
| | - J Murray
- Centre for Clinical Haematology, Morris House, Queen Elizabeth Hospital, Birmingham, West Midlands B15 2TH, UK
| | - G Pratt
- Centre for Haematology and Stem Cell Transplantation, Heart of England NHS Foundation Trust, Birmingham, West Midlands B9 5SS, UK and
| | | | - D W Milligan
- Centre for Haematology and Stem Cell Transplantation, Heart of England NHS Foundation Trust, Birmingham, West Midlands B9 5SS, UK and
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14
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Sava GP, Speedy HE, Di Bernardo MC, Dyer MJS, Holroyd A, Sunter NJ, Marr H, Mansouri L, Deaglio S, Karabon L, Frydecka I, Jamroziak K, Woszczyk D, Juliusson G, Smedby KE, Jayne S, Majid A, Wang Y, Dearden C, Hall AG, Mainou-Fowler T, Jackson GH, Summerfield G, Harris RJ, Pettitt AR, Allsup DJ, Bailey JR, Pratt G, Pepper C, Fegan C, Rosenquist R, Catovsky D, Allan JM, Houlston RS. Common variation at 12q24.13 (OAS3) influences chronic lymphocytic leukemia risk. Leukemia 2015; 29:748-51. [PMID: 25363670 PMCID: PMC4360210 DOI: 10.1038/leu.2014.311] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
MESH Headings
- 2',5'-Oligoadenylate Synthetase/genetics
- Alleles
- Case-Control Studies
- Chromosome Mapping
- Chromosomes, Human, Pair 12/chemistry
- Gene Frequency
- Genetic Loci
- Genetic Predisposition to Disease
- Genome-Wide Association Study
- Humans
- Introns
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Odds Ratio
- Polymorphism, Single Nucleotide
- Risk
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Affiliation(s)
- G P Sava
- Division of Genetics and Epidemiology, The Institute of Cancer Research, Sutton, UK
| | - H E Speedy
- Division of Genetics and Epidemiology, The Institute of Cancer Research, Sutton, UK
| | - M C Di Bernardo
- Division of Genetics and Epidemiology, The Institute of Cancer Research, Sutton, UK
| | - M J S Dyer
- The Ernest and Helen Scott Haematological Research Institute, Department of Biochemistry and Department of Cancer Studies and Molecular Medicine, University of Leicester, Leicester, UK
| | - A Holroyd
- Division of Genetics and Epidemiology, The Institute of Cancer Research, Sutton, UK
| | - N J Sunter
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - H Marr
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - L Mansouri
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - S Deaglio
- Department of Medical Sciences and Human Genetics Foundation, University of Turin, Turin, Italy
| | - L Karabon
- Department of Experimental Therapy, Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroclaw, Poland
- Department and Clinic of Urology, Wroclaw Medical University, Wroclaw, Poland
| | - I Frydecka
- Department of Experimental Therapy, Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroclaw, Poland
| | - K Jamroziak
- Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - D Woszczyk
- Department of Haematology, State Hospital, Opole, Poland
| | - G Juliusson
- Lund Strategic Research Center for Stem Cell Biology and Cell Therapy, Hematology and Transplantation, Lund University, Lund, Sweden
| | - K E Smedby
- Unit of Clinical Epidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - S Jayne
- The Ernest and Helen Scott Haematological Research Institute, Department of Biochemistry and Department of Cancer Studies and Molecular Medicine, University of Leicester, Leicester, UK
| | - A Majid
- Medical Research Council Toxicology Unit, Leicester University, Leicester, UK
| | - Y Wang
- Division of Genetics and Epidemiology, The Institute of Cancer Research, Sutton, UK
| | - C Dearden
- Haemato-Oncology, Division of Pathology, The Institute of Cancer Research, Sutton, UK
| | - A G Hall
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - T Mainou-Fowler
- Haematological Sciences, Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - G H Jackson
- Department of Haematology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - G Summerfield
- Department of Haematology, Queen Elizabeth Hospital, Gateshead, Newcastle upon Tyne, UK
| | - R J Harris
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - A R Pettitt
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - D J Allsup
- Department of Haematology, Hull Royal Infirmary, Hull, UK
| | - J R Bailey
- Hull York Medical School and University of Hull, Hull, UK
| | - G Pratt
- Department of Haematology, Birmingham Heartlands Hospital, Birmingham, UK
| | - C Pepper
- Department of Haematology, School of Medicine, Cardiff University, Cardiff, UK
| | - C Fegan
- Cardiff and Vale National Health Service Trust, Heath Park, Cardiff, UK
| | - R Rosenquist
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - D Catovsky
- Haemato-Oncology, Division of Pathology, The Institute of Cancer Research, Sutton, UK
| | - J M Allan
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - R S Houlston
- Division of Genetics and Epidemiology, The Institute of Cancer Research, Sutton, UK
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15
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Pepper C, Buggins AGS, Jones CH, Walsby EJ, Forconi F, Pratt G, Devereux S, Stevenson FK, Fegan C. Phenotypic heterogeneity in IGHV-mutated CLL patients has prognostic impact and identifies a subset with increased sensitivity to BTK and PI3Kδ inhibition. Leukemia 2014; 29:744-7. [PMID: 25349153 PMCID: PMC4360209 DOI: 10.1038/leu.2014.308] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- C Pepper
- Cardiff CLL Research Group, Institute of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - A G S Buggins
- Department of Haematology, King's College London, London, UK
| | - C H Jones
- Cardiff CLL Research Group, Institute of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - E J Walsby
- Cardiff CLL Research Group, Institute of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - F Forconi
- Cancer Sciences Unit, CRUK Clinical Centre, University of Southampton, Southampton, UK
| | - G Pratt
- CRUK Institute for Cancer Studies, University of Birmingham, Birmingham, UK
| | - S Devereux
- Department of Haematology, King's College London, London, UK
| | - F K Stevenson
- Cancer Sciences Unit, CRUK Clinical Centre, University of Southampton, Southampton, UK
| | - C Fegan
- Cardiff CLL Research Group, Institute of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, UK
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16
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Rabin N, Lai M, Pratt G, Morgan G, Snowden J, Bird J, Cook G, Bowcock S, Owen R, Yong K, Wechalaker A, Low E, Davies F. United Kingdom Myeloma Forum position statement on the use of consolidation and maintenance treatment in myeloma. Int J Lab Hematol 2014; 36:665-75. [DOI: 10.1111/ijlh.12205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Accepted: 02/06/2014] [Indexed: 11/28/2022]
Affiliation(s)
- N. Rabin
- Department of Haematology; University College London Hospitals; London UK
| | | | - G. Pratt
- Department of Haematology; Birmingham Hertlands Hospital; Birmingham UK
| | - G. Morgan
- Haemato-oncology; Royal Marsden Hospital; London UK
| | - J. Snowden
- Department of Haematology; Sheffield Teaching Hospitals; Sheffield UK
| | - J. Bird
- Department of Haematology; University Hospitals Bristol; Bristol UK
| | - G. Cook
- St James's Institute of Oncology; Leeds Teaching Hospitals Trust; Leeds UK
| | - S. Bowcock
- Department of Haematology; Princess Royal Hospital; Orpington Kent UK
| | - R. Owen
- St James's Institute of Oncology; Leeds Teaching Hospitals Trust; Leeds UK
| | - K. Yong
- Department of Haematology; University College London Hospitals; London UK
| | - A. Wechalaker
- Centre for Amyloidosis and Acute Phase Proteins; Royal Free Hospital; London UK
| | | | - F. Davies
- Haemato-oncology; Royal Marsden Hospital; London UK
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17
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Burmeister A, Assi LK, Ferro CJ, Hughes RG, Barnett AH, Bellary S, Cockwell P, Pratt G, Hutchison CA. The relationship between high-sensitivity CRP and polyclonal Free Light Chains as markers of inflammation in chronic disease. Int J Lab Hematol 2013; 36:415-24. [DOI: 10.1111/ijlh.12159] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 09/16/2013] [Indexed: 11/27/2022]
Affiliation(s)
- A. Burmeister
- Renal Institute of Birmingham; University Hospital Birmingham; Birmingham UK
- The Binding Site Group Ltd; Birmingham UK
| | - L. K. Assi
- The Binding Site Group Ltd; Birmingham UK
| | - C. J. Ferro
- Renal Institute of Birmingham; University Hospital Birmingham; Birmingham UK
- University of Birmingham; Birmingham UK
| | | | - A. H. Barnett
- University of Birmingham; Birmingham UK
- Diabetes Centre; Heart of England NHS Trust; Birmingham UK
| | - S. Bellary
- Diabetes Centre; Heart of England NHS Trust; Birmingham UK
- Aston University; Birmingham UK
| | - P. Cockwell
- Renal Institute of Birmingham; University Hospital Birmingham; Birmingham UK
- University of Birmingham; Birmingham UK
| | - G. Pratt
- Department of Haematology; Heart of England NHS Trust; Birmingham UK
| | - C. A. Hutchison
- Renal Institute of Birmingham; University Hospital Birmingham; Birmingham UK
- University of Birmingham; Birmingham UK
- Hawke's Bay District Health Board; Hawke's Bay New Zealand
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18
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Pratt G, Bowcock S, Lai M, Bell S, Bird J, D'Sa S, Cavenagh J, Cook G, Morgan G, Owen R, Snowden JA, Yong K, Davies F. United Kingdom Myeloma Forum (UKMF) position statement on the use of bendamustine in myeloma. Int J Lab Hematol 2013; 36:20-8. [PMID: 23615178 DOI: 10.1111/ijlh.12097] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 02/25/2013] [Indexed: 11/29/2022]
Abstract
Bendamustine is a unique bifunctional alkylating agent with promising activity in myeloma. Despite the increasing number of studies demonstrating its efficacy in both the upfront and relapse settings, including patients with renal insufficiency, the optimal use of bendamustine, in terms of dosage, schedule and combination with other agents, has yet to be defined. It is currently licensed for use as frontline treatment with prednisolone for patients with myeloma who are unsuitable for transplantation and who are contraindicated for thalidomide and bortezomib. Studies in relapsed/refractory patients are currently ongoing with other combinations. Given the increasing data to date, the UK Myeloma Forum believes that bendamustine with steroids alone or in combination with a novel agent could be considered for patients with multiply relapsed myeloma. This document provides guidance for the use of bendamustine for patients with myeloma until the results of definitive studies are available.
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Affiliation(s)
- G Pratt
- Haematology, Heart of England NHS Trust, Institute for Cancer Studies, University of Birmingham, Birmingham, UK
| | - S Bowcock
- Haematology, South London Healthcare NHS Trust, Haematology Kent, Kent, UK
| | - M Lai
- Myeloma UK, Edinburgh, UK
| | - S Bell
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - J Bird
- Avon Haematology Unit, Bristol Haematology and Oncology Centre, Bristol, UK
| | - S D'Sa
- Department of Haematology, University College Hospital, London, UK
| | - J Cavenagh
- Department of Haematology, St. Bartholomew's Hospital, London, UK
| | - G Cook
- Department of Haematology, St. James's Institute of Oncology, Leeds, UK
| | - G Morgan
- Haemato-Oncology Unit, Royal Marsden Hospital, Sutton, UK
| | - R Owen
- Haematological Malignancy Diagnostic Service Laboratory, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - J A Snowden
- Department of Haematology, Royal Hallamshire Hospital, Sheffield, UK
| | - K Yong
- Department of Haematology, University College Hospital, London, UK
| | - F Davies
- Haemato-Oncology Unit, Royal Marsden Hospital, Sutton, UK
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19
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Abstract
Screening for a monoclonal protein is a common part of the assessment of patients presenting with a renal injury. While in the settings of acute kidney injury, chronic kidney disease and proteinuria monoclonal proteins can be associated with significant pathologies such as cast nephropathy, amyloidosis, and light chain deposition disease, they can also be an unrelated finding. The purpose of this review is to provide the nephrologist with an update to the diagnostic assessment and risk stratification of monoclonal proteins to avoid unnecessary investigation and monitoring of those patients with low-risk monoclonal gammopathies.
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20
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Piper KP, Karanth M, McLarnon A, Kalk E, Khan N, Murray J, Pratt G, Moss PAH. Chronic lymphocytic leukaemia cells drive the global CD4+ T cell repertoire towards a regulatory phenotype and leads to the accumulation of CD4+ forkhead box P3+ T cells. Clin Exp Immunol 2011; 166:154-63. [PMID: 21985361 DOI: 10.1111/j.1365-2249.2011.04466.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Advanced chronic lymphocytic leukaemia (CLL) is associated with profound immunodeficiency, including changes in T regulatory cells (T(regs)). We determined the pattern of expression of forkhead box P3 (FoxP3), CD25, CD27 and CD127 and showed that the frequency of CD4+ FoxP3+ T cells was increased in CLL patients (12% versus 8% in controls). This increase was seen only in advanced disease, with selective expansion of FoxP3-expressing cells in the CD4+ CD25(low) population, whereas the number of CD4+ CD25(high) FoxP3+ cells was unchanged. CD4+ CD25(low) cells showed reduced expression of CD127 and increased CD27, and this regulatory phenotype was also seen on all CD4 T cells subsets in CLL patients, irrespective of CD25 or FoxP3 expression. Incubation of CD4+ T cells with primary CLL tumours led to a sixfold increase in the expression of FoxP3 in CD4+ CD25- T cells. Patients undergoing treatment with fludarabine demonstrated a transient increase in the percentage of CD4+ FoxP3+ T cells, but this reduced to normal levels post-treatment. This work demonstrates that patients with CLL exhibit a systemic T cell dysregulation leading to the accumulation of CD4+ FoxP3+ T cells. This appears to be driven by interaction with malignant cells, and increased understanding of the mechanisms that are involved could provide novel avenues for treatment.
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Affiliation(s)
- K P Piper
- School of Cancer Sciences, University of Birmingham, Birmingham, UK
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21
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Gursu M, Aydin Z, Karadag S, Uzun S, Ogul S, Kiris A, Doventas Y, Koldas M, Ozturk S, Kazancioglu R, Mandreoli M, Bellasi A, Baldrati L, Corradini M, Rigotti A, Russo G, David S, Malmusi G, DiNicolo' P, Orsi C, Zambianchi L, Caruso F, Poisetti P, Fabbri A, Santoro A, Barton Pai A, Grabe D, Eisele G, Hutchison CA, Bevins A, Lukacik P, Hughes RG, Pratt G, Viana JL, Bishop NC, Kosmadakis G, Bevington A, Clapp EL, Feehally J, Smith AC, Joki N, Hase H, Tanaka Y, Iwasaki M, Yamaka T, Shigematsu T, Dou L, Gondouin B, Cerini C, Duval-Sabatier A, Poitevin S, Dignat-George F, Burtey S, Brunet P, Carrasco F, Salvador F, Origaca C, Nogueira E, Silva N, Silva A, Sikole A, Trajceska L, Selim G, Gelev S, Dzekova P, Amitov V, Arsov S, Dalboni M, Cruz E, Manfredi S, Mouro M, Quinto M, Grabulosa C, Batista M, Cendoroglo M, Hirayama A, Matsui H, Nagano Y, Ueda A, Aoyagi K, Owada S, Schepers E, Barreto D, Liabeuf S, Glorieux G, Eloot S, Barreto F, Massy Z, Vanholder R, Secara IF, Oleniuc M, Nistor I, Onofriescu M, Covic A, Aguerrevere S, Granada M, Bayes B, Pastor M, Sancho A, Bonal J, Canas L, Lauzurica R, Teixido J, Troya M, Romero R, Capitanini A, D'Alessandro C, Ferretti V, Petrone I, Pasquariello G, Cupisti A, Parastayeva MM, Berseneva ON, Kucher AG, Ivanova GT, Smirnov AV, Kayukov IG, Kayabasi H, Esmer S, Yilmaz Z, Kadiroglu AK, Yilmaz ME, Radic J, Kovacic V, Radic M, Ljutic D, Sain M, Karakan S, Sezer S, Tutal E, Ozdemir Acar FN, Bi G, Xing C, Chen R, Romero-Garcia A, Jacobo-Arias F, Martin del Campo F, Gonzalez-Espinoza L, Pazarin L, Cueto-Manzano AM, Panagoutsos S, Kriki P, Mourvati E, Tziakas D, Chalikias G, Stakos D, Apostolakis S, Tsigalou C, Gioka T, Konstantinides S, Vargemezis V, Nascimento M, Hayashi S, Seeberger A, Yamamoto T, Qureshi AR, Lind B, Riella M, Brodin LA, Lindholm B, Meier P, Menne J, Kruger K, Mooren FC, Weissmann N, Seimetz M, Haller H, Gusev E, Solomatina L, Zhuravleva J, Striker G, Uribarri J, Cai W, Goodman S, Pyzik R, Grosjean F, Vlassara H, So A, Gimona A, Kiechle T, Shpilsky A, Schlesinger N. Malnutrition & inflammation in CKD 1-5. Clin Kidney J 2011. [DOI: 10.1093/ndtplus/4.s2.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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22
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Fishpool S, Owens D, Pratt G, Roblin D. Ensuring correct posture whilst using the microscope. Clin Otolaryngol 2010; 35:244-5. [DOI: 10.1111/j.1749-4486.2010.02115.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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23
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Delgado J, Pillai S, Phillips N, Brunet S, Pratt G, Briones J, Lovell R, Martino R, Ewing J, Sureda A, Milligan D, Sierra J. Does reduced-intensity allogeneic transplantation confer a survival advantage to patients with poor prognosis chronic lymphocytic leukaemia? A case–control retrospective analysis. Ann Oncol 2009; 20:2007-12. [DOI: 10.1093/annonc/mdp259] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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24
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Pemberton NC, Paneesha S, Hiller L, Starczynski J, Hooper L, Pepper C, Pratt G, Fegan C. The SDF-1 G > A polymorphism at position 801 plays no role in multiple myeloma but may contribute to an inferior cause-specific survival in chronic lymphocytic leukemia. Leuk Lymphoma 2009; 47:1239-44. [PMID: 16923552 DOI: 10.1080/10428190600562112] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The growth and circulation of B lymphocytes is largely under the control of bone marrow stromal cells, cytokines and chemokines. The gene responsible for the pivotal B cell growth factor, stromal derived factor-1 (SDF-1), has recently been shown to contain a single nucleotide polymorphism G > A at position 801 which leads to higher SDF-1 secretion. This polymorphism is common in the normal population and has been shown to play a potential role in the development of both HIV and non-HIV related non-Hodgkin's lymphoma. We therefore undertook a large single-centre study to ascertain its role in the pathogenesis of two other common B-cell malignancies, notably chronic lymphocytic leukemia (CLL- 197 patients) and multiple myeloma (126 patients). We show that the 801 G > A polymorphism plays no role in the incidence of multiple myeloma or CLL nor the outcome in multiple myeloma. By contrast, it trends towards an inferior cause-specific survival in CLL.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Cell Line, Tumor
- Chemokine CXCL12
- Chemokines, CXC/genetics
- Cohort Studies
- Female
- Gene Expression Regulation, Neoplastic
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Male
- Middle Aged
- Multiple Myeloma/genetics
- Multiple Myeloma/mortality
- Polymorphism, Genetic
- Prognosis
- Receptors, CXCR4/genetics
- Treatment Outcome
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Affiliation(s)
- N C Pemberton
- Department of Haematology, Heartlands and Solihull NHS Trust, Bordesley Green East, Birmingham, UK
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25
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Abstract
e17540 Background: Cancer cachexia affects about 250,000 patients in the US worsening treatment outcome and quality of life. To evaluate the scholar contribution to cancer cachexia, we analyzed the cachexia literature and funding support. Methods: In May 2008, we conducted a search of the major databases Medline, Web of Sciences, and Scopus of all publications with MeSH heading “cachexia” or keywords “cachexia, cachectic, cachexic” since 1982, distinguishing “original research” from “review” articles. To examine the trend over time, we compared the publication rate in the field of cachexia to that of published manuscripts in reference fields (cancer, AIDS, Alzheimer's disease, and CHF). To study the federal funding for cachexia research, we examined the Computer Retrieval of Information on Scientific Projects database. Only descriptive statistical analysis was adopted because of the heterogeneity of methods. Results: We identified 1990 published manuscripts, 677 (34%) of which are “reviews”. Out of the 2,890 country of origin affiliations, the US is the lead contributor (N = 1,105; 38%). In the last 5 years, the ratio of “review” articles in cachexia increased significantly (49%), compared to cancer (17%), and science publications (8%). Unlike the of publications in reference fields, the increase in cachexia has been mostly due to the dominance of “review” articles (ratio of original/review of 0.928 in cachexia, versus 0.417 in CHF, 0.337 in Alzheimer and 0.206 in AIDS). Nevertheless, published cachexia articles in journals with high impact factors (IF ≥ 4.0) remains similar (8.49%) to that of science research (8.63%) with a predominance of “review’ articles. Only one in four published manuscripts (24%) acknowledged federal support. Cachexia research support by US federal agencies declined significantly in the last decade (with a peak of 161 awards in 1999 down to 40 in 2006), the NCI remains the leading funding agency (17%). Only 275 out of the total of 121,997 NCI- awards over 25 years (0.22%) were awarded to cachexia research, with a clear decline in the latest decade by 50% (0.14% vs. 0.29%). Conclusions: Advances in the field of original cancer cachexia research have been very limited, perhaps related to the lack of federal research funding support, which is on the decline. No significant financial relationships to disclose.
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Affiliation(s)
- F. S. Braiteh
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - G. Pratt
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - R. Kurzrock
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - E. Bruera
- University of Texas M. D. Anderson Cancer Center, Houston, TX
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26
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Ryan G, Martinelli G, Kuper-Hommel M, Tsang R, Pruneri G, Yuen K, Roos D, Lennard A, Devizzi L, Crabb S, Hossfeld D, Pratt G, Dell'Olio M, Choo SP, Bociek RG, Radford J, Lade S, Gianni AM, Zucca E, Cavalli F, Seymour JF. Primary diffuse large B-cell lymphoma of the breast: prognostic factors and outcomes of a study by the International Extranodal Lymphoma Study Group. Ann Oncol 2007; 19:233-41. [PMID: 17932394 DOI: 10.1093/annonc/mdm471] [Citation(s) in RCA: 143] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Primary diffuse large B-cell lymphoma (DLBCL) of breast is rare. We aimed to define clinical features, prognostic factors, patterns of failure, and treatment outcomes. PATIENTS AND METHODS A retrospective international study of 204 eligible patients presenting to the International Extranodal Lymphoma Study Group-affiliated institutions from 1980 to 2003. RESULTS Median age was 64 years, with 95% of patients presenting with unilateral disease. Median overall survival (OS) was 8.0 years, and median progression-free survival 5.5 years. In multifactor analysis, favourable International Prognostic Index score, anthracycline-containing chemotherapy, and radiotherapy (RT) were significantly associated with longer OS (each P < or = 0.03). There was no benefit from mastectomy, as opposed to biopsy or lumpectomy only. At a median follow-up time of 5.5 years, 37% of patients had progressed--16% in the same or contralateral breast, 5% in the central nervous system, and 14% in other extranodal sites. CONCLUSIONS The combination of limited surgery, anthracycline-containing chemotherapy, and involved-field RT produced the best outcome in the pre-rituximab era. A prospective trial on the basis of these results should be pursued to confirm these observations and to determine whether the impact of rituximab on the patterns of relapse and outcome parallels that of DLBCL presenting at other sites.
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Affiliation(s)
- G Ryan
- Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Australia.
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27
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Pepper C, Ward R, Lin TT, Brennan P, Starczynski J, Musson M, Rowntree C, Bentley P, Mills K, Pratt G, Fegan C. Highly purified CD38+ and CD38- sub-clones derived from the same chronic lymphocytic leukemia patient have distinct gene expression signatures despite their monoclonal origin. Leukemia 2007; 21:687-96. [PMID: 17287849 DOI: 10.1038/sj.leu.2404587] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
CD38 expression is an important prognostic marker in chronic lymphocytic leukemia (CLL) with high levels of CD38 associated with shorter overall survival. In this study, we used gene expression profiling and protein analysis of highly purified cell-sorted CD38(+) and CD38(-) chronic lymphocytic leukemia cells to elucidate a molecular basis for the association between CD38 expression and inferior clinical outcome. Paired CD38(+) and CD38(-) CLL cells derived from the same patient were shown to be monoclonal by V(H) gene sequencing but despite this, CD38(+) CLL cells possessed a distinct gene expression profile when compared with their CD38(-) sub-clones. Importantly, CD38(+) CLL cells relatively over expressed vascular endothelial growth factor (VEGF) and appeared to preferentially utilize an internal autocrine VEGF survival loop. Elevated VEGF expression was associated with increased expression of the anti-apoptotic protein Mcl-1. Inhibition of VEGF receptor signaling also resulted in a reduction in cell viability. In contrast, exogenous VEGF caused a significant increase in CD38(-) CLL cell viability and a marked induction of Mcl-1; both effects were less obvious in CD38(+) CLL cells. Taken together, our data provide a biological rationale for the poor prognosis of CD38(+) CLL and indicate that both VEGF and Mcl-1 may prove to be useful therapeutic targets.
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MESH Headings
- ADP-ribosyl Cyclase 1/blood
- ADP-ribosyl Cyclase 1/deficiency
- ADP-ribosyl Cyclase 1/genetics
- Antigens, CD/blood
- Antigens, CD/genetics
- Gene Expression Regulation, Neoplastic
- Humans
- Immunoglobulin Heavy Chains/genetics
- Immunoglobulin Variable Region/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Oligonucleotide Array Sequence Analysis
- Restriction Mapping
- Survival Analysis
- Vascular Endothelial Growth Factor A/genetics
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Affiliation(s)
- C Pepper
- Department of Haematology, School of Medicine, Cardiff University, Heath Park, Cardiff, UK.
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28
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Pepper C, Brennan P, Alghazal S, Ward R, Pratt G, Starczynski J, Lin T, Rowntree C, Fegan C. CD38+ chronic lymphocytic leukaemia cells co-express high levels of ZAP-70 and are functionally distinct from their CD38- counter-parts. Leukemia 2006; 20:743-4. [PMID: 16452999 DOI: 10.1038/sj.leu.2404133] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
MESH Headings
- ADP-ribosyl Cyclase 1/biosynthesis
- ADP-ribosyl Cyclase 1/genetics
- B-Lymphocytes/pathology
- Flow Cytometry
- Gene Expression Regulation, Leukemic
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/metabolism
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Lymphocyte Count
- Signal Transduction
- ZAP-70 Protein-Tyrosine Kinase/biosynthesis
- ZAP-70 Protein-Tyrosine Kinase/genetics
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29
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Abstract
Indigenous hepatitis E is increasingly recognized in developed countries, where it may be a zoonosis. We describe the first case of transfusion-transmitted hepatitis E in the UK from a blood donor who had no history of recent travel abroad. Follow-up of the donor and recipients of the blood products was carried out using serological and molecular techniques. Acute hepatitis E was transmitted to one of two recipients. The infected patient would have received a larger volume of the donor's plasma. HEV subgenomic sequences carried by the donor and recipient were identical. This is the first case of post-transfusion hepatitis E in the UK. Secondary transmission of hepatitis E indigenous to a nonhyperendemic country may occur by blood transfusion. It is important that blood donors inform the transfusion service of all post-donation illnesses so that appropriate interventions can take place.
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Affiliation(s)
- E Boxall
- National Blood Service, Vincent Drive, Birmingham, UK.
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30
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Boxall E, Herborn A, Pratt G, Kochethu G, Adams D, Ijaz S, Teo C. P.318 Transfusion transmitted hepatitis E in a ‘non hyperendemic’ country. J Clin Virol 2006. [DOI: 10.1016/s1386-6532(06)80493-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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32
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Fong K, Bowman R, Abraham R, Windsor M, Pratt G, Fielding D, Armstrong J, Zimmerman P. P-326 Queensland Integrated Lung Cancer Outcomes Project (QILCOP): 2000 – 2003. Lung Cancer 2005. [DOI: 10.1016/s0169-5002(05)80820-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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33
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O'Brien P, Roos D, Pratt G, Liew K, Barton M, Poulsen M, Olver I, Trotter G. 712 Improved survival at the cost of neurotoxicity in primary CNS lymphoma (PCNSL). Long-term follow-up of a Phase 2 multicentre combined modality study (Trans-Tasman Radiation Oncology Group-TROG). EJC Suppl 2003. [DOI: 10.1016/s1359-6349(03)90743-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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34
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Abstract
Multiple myeloma is a malignant tumour of plasma cells with a median survival of two to three years. Karyotypic instability is seen at the earliest stage of the disease and increases with disease progression, leading to extreme genetic abnormalities similar to solid tumours. Translocations involving the immunoglobulin heavy chain region on chromosome 14q32 are clearly important in the pathogenesis of most myelomas. This review focuses on the different genetic abnormalities found in myeloma and discusses possible pathogenetic mechanisms and the implications for biologically based treatments.
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Affiliation(s)
- G Pratt
- Department of Haematology, Birmingham Heartlands Hospital, Bordesley Green East, UK.
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35
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Abstract
Translocations at the immunoglobulin heavy chain locus (14q32) are now considered the commonest karyotypic change in multiple myeloma. These translocations are thought to be intimately involved in the pathogenesis of this disease. The heavy chain locus is strongly transcriptionally active in B and plasma cells and transfer of a potential oncogene to 14q32 would result in its dysregulation. Molecular characterization suggests that the majority of these breakpoints cluster in switch regions within the heavy chain locus. Switch regions are normally involved in the regulated process of isotype switching so that in myeloma the rearrangements are believed to be a result of so-called illegitimate (aberrant) switch recombination and are likely to be an early event in myeloma development. A legitimate switch recombination event occurs between two switch regions producing a hybrid switch; this is necessary for class switching to proceed on a productive allele. In this review we describe the process of isotype switching and how illegitimate class switching may be related to the pathogenesis of multiple myeloma.
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Affiliation(s)
- J A L Fenton
- Department of Molecular Oncology, Algernon Firth Building, University of Leeds, Leeds, UK
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36
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Pratt G, Kinsey SE. Remission of severe, intractable autoimmune haemolytic anaemia following matched unrelated donor transplantation. Bone Marrow Transplant 2001; 28:791-3. [PMID: 11781633 DOI: 10.1038/sj.bmt.1703232] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2001] [Accepted: 07/30/2001] [Indexed: 11/09/2022]
Abstract
Immune-mediated haemolytic anaemia presenting post allogeneic bone marrow transplantation is often alloimmune in origin due to ABO or minor red cell incompatibilities. Autoimmune haemolytic anaemia is also recognised, is frequently difficult to treat and overall prognosis is often poor, usually from associated problems. Here, we present a case report of autoimmune haemolysis presenting in an 8-year-old boy 6 months post allogeneic bone marrow transplant requiring 4 years of immunosuppressive therapy before remission of haemolysis. This case report highlights the fact that it is possible for haemolysis to resolve post transplant even after years of immunosuppressive therapy.
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MESH Headings
- Adrenal Cortex Hormones/therapeutic use
- Alemtuzumab
- Anemia, Hemolytic, Autoimmune/drug therapy
- Anemia, Hemolytic, Autoimmune/etiology
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal, Humanized
- Antibodies, Neoplasm
- Blood Transfusion
- Bone Marrow Transplantation/adverse effects
- Child
- Combined Modality Therapy
- Cranial Irradiation
- Cyclophosphamide
- Cyclosporine/administration & dosage
- Graft vs Host Disease/prevention & control
- Humans
- Immunoglobulins, Intravenous/therapeutic use
- Immunosuppressive Agents/therapeutic use
- Leukemia-Lymphoma, Adult T-Cell/complications
- Leukemia-Lymphoma, Adult T-Cell/drug therapy
- Leukemia-Lymphoma, Adult T-Cell/radiotherapy
- Leukemia-Lymphoma, Adult T-Cell/therapy
- Lymphocyte Depletion
- Male
- Prednisolone/administration & dosage
- Remission Induction
- Thalidomide/therapeutic use
- Transplantation Conditioning/adverse effects
- Transplantation, Homologous/adverse effects
- Whole-Body Irradiation
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Affiliation(s)
- G Pratt
- Yorkshire Regional Centre for Paediatric Oncology and Haematology, St James's University Hospital, Leeds, UK
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37
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Pratt G, Rawstron AC, English AE, Johnson RJ, Jack AS, Morgan GJ, Smith GM. Analysis of CD34+ cell subsets in stem cell harvests can more reliably predict rapidity and durability of engraftment than total CD34+ cell dose, but steady state levels do not correlate with bone marrow reserve. Br J Haematol 2001; 114:937-43. [PMID: 11564089 DOI: 10.1046/j.1365-2141.2001.03027.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In peripheral blood stem cell transplantation (PBSCT), the number of CD34+ cells transplanted has been shown to correlate well with both rapidity and durability of engraftment. However, it is clear that engraftment does not necessarily correlate with total CD34+ cell numbers in some patients. Consequently, there is increasing interest in evaluating the role of CD34+ subsets in haemopoietic recovery as a more accurate marker of harvest quality. We analysed the numbers of CD34+ cell subsets, namely Thy-1+, L-Selectin+ and CD38-, and correlated this with engraftment in 86 patients undergoing PBSCT. Adequate engraftment was defined as being a platelet count greater than 50 x 10(9)/l and a neutrophil count greater than 1.0 x 10(9)/l. CD34+L-Selectin+ provided the best prediction of engraftment rapidity, although the improvement over total CD34+ cell dose was minor. Only the dose of CD34+Thy-1+ cells transplanted correlated with durable engraftment. The probability of adequate 3-month engraftment increased with the dose of CD34+ cells transplanted, but 10% of patients receiving > 5 x 10(6)/kg still showed poor engraftment at 3 months. However, all patients receiving > 2.5 x 10(5)/kg CD34+Thy-1+ showed adequate engraftment at this time point. We also demonstrated that CD34+Thy-1+ progenitors were restricted to the bone marrow under normal conditions and, during stem cell mobilization, their kinetics generally paralleled total CD34+ numbers.
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MESH Headings
- ADP-ribosyl Cyclase
- ADP-ribosyl Cyclase 1
- Adult
- Aged
- Antigens, CD
- Antigens, CD34/immunology
- Antigens, Differentiation/immunology
- Bone Marrow Cells/immunology
- Breast Neoplasms/immunology
- Breast Neoplasms/surgery
- Hematopoietic Stem Cell Transplantation
- Hodgkin Disease/immunology
- Hodgkin Disease/surgery
- Humans
- L-Selectin/immunology
- Leukemia, Lymphocytic, Chronic, B-Cell/surgery
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/immunology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/surgery
- Lymphocyte Count
- Lymphocyte Subsets
- Lymphoma, Non-Hodgkin/immunology
- Lymphoma, Non-Hodgkin/surgery
- Membrane Glycoproteins
- Middle Aged
- Multiple Myeloma/immunology
- Multiple Myeloma/surgery
- NAD+ Nucleosidase/immunology
- Neutrophils/immunology
- Prognosis
- Stem Cells/immunology
- Thy-1 Antigens/immunology
- Transplantation Immunology
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Affiliation(s)
- G Pratt
- Institution HMDS, Department of Haematology, General Infirmary at Leeds, Calverley Street, Leeds, West Yorkshire LS1 3EX, UK
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Davies FE, Forsyth PD, Rawstron AC, Owen RG, Pratt G, Evans PA, Richards SJ, Drayson M, Smith GM, Selby PJ, Child JA, Morgan GJ. The impact of attaining a minimal disease state after high-dose melphalan and autologous transplantation for multiple myeloma. Br J Haematol 2001; 112:814-9. [PMID: 11260088 DOI: 10.1046/j.1365-2141.2001.02530.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Initial studies with high-dose therapy (HDT) in myeloma suggest some beneficial effects of attaining a complete response (CR); however, the effect on survival is difficult to assess owing to inconsistencies in the definition of response between studies. We have analysed 96 newly diagnosed patients aged less than 65 years who received HDT and assessed the effect of response on survival using electrophoresis, immunofixation and fluorescent IgH polymerase chain reaction (PCR) to define CR. Patients received induction chemotherapy with C-VAMP (adriamycin, vincristine, methylprednisolone, cyclophosphamide) followed by melphalan 200 mg/m2 and reinfusion of peripheral blood stem cells. There was a high response to C-VAMP [CR = 24%, partial response (PR) = 64%], with all but one patient improving the depth of response after HDT (CR = 69%, PR = 31%). The progression-free survival (PFS) and overall survival (OS) were excellent at a median of 46.4 months and 72+ months. There was a trend towards an improved PFS in patients with an immunofixation-negative CR compared with patients with a PR (49.4 months, 41.14 months; P = 0.26). This was not evident when electrophoresis was used to define CR. The method used to define CR did not impact on the overall survival and fluorescent IgH PCR failed to add any additional prognostic information. This study supports the widespread use of the European Bone Marrow Transplantation group (EBMT) response criteria and suggests that immunofixation should be performed on all patients who become electrophoresis negative.
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Affiliation(s)
- F E Davies
- Academic Department of Haematology and Oncology, University of Leeds, Leeds LS1, UK
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39
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Pratt G, Fenton JA, Davies FE, Rawstron AC, Richards SJ, Collins JE, Owen RG, Jack AS, Smith GM, Morgan GJ. Insertional events as well as translocations may arise during aberrant immunoglobulin switch recombination in a patient with multiple myeloma. Br J Haematol 2001; 112:388-91. [PMID: 11167836 DOI: 10.1046/j.1365-2141.2001.02588.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The majority of patients with multiple myeloma have translocations involving the immunoglobulin heavy chain switch regions on chromosome 14q32 and a promiscuous range of partner chromosomes. We describe a patient with an insertion of 132 bp of chromosome 22q12 sequence into the 5' region flanking S(mu) on chromosome 14q32. The 132 bp region from chromosome 22q12 contains the whole of exon 3 from a novel gene of unknown function in man. The significance of such insertional events remains unclear. The description of insertional events occurring as a result of abnormal switch recombination suggests that, in myeloma, dysregulation of oncogenes may occur by a mechanism other than chromosomal translocation.
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Affiliation(s)
- G Pratt
- Academic Unit of Haematology and Oncology, Department of Haematology, The General Infirmary at Leeds, UK
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40
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Rawstron AC, Fenton JA, Ashcroft J, English A, Jones RA, Richards SJ, Pratt G, Owen R, Davies FE, Child JA, Jack AS, Morgan G. The interleukin-6 receptor alpha-chain (CD126) is expressed by neoplastic but not normal plasma cells. Blood 2000; 96:3880-6. [PMID: 11090073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Interleukin-6 (IL-6) is reported to be central to the pathogenesis of myeloma, inducing proliferation and inhibiting apoptosis in neoplastic plasma cells. Therefore, abrogating IL-6 signaling is of therapeutic interest, particularly with the development of humanized anti-IL-6 receptor (IL-6R) antibodies. The use of such antibodies clinically requires an understanding of IL-6R expression on neoplastic cells, particularly in the cycling fraction. IL-6R expression levels were determined on plasma cells from patients with myeloma (n = 93) and with monoclonal gammopathy of undetermined significance (MGUS) or plasmacytoma (n = 66) and compared with the levels found on normal plasma cells (n = 11). In addition, 4-color flow cytometry was used to assess the differential expression by stage of differentiation and cell cycle status of the neoplastic plasma cells. IL-6R alpha chain (CD126) was not detectable in normal plasma cells, but was expressed in approximately 90% of patients with myeloma. In all groups, the expression levels showed a normal distribution. In patients with MGUS or plasmacytoma, neoplastic plasma cells expressed significantly higher levels of CD126 compared with phenotypically normal plasma cells from the same marrow. VLA-5(-) "immature" plasma cells showed the highest levels of CD126 expression, but "mature" VLA-5(+) myeloma plasma cells also overexpressed CD126 when compared with normal subjects. This study demonstrates that CD126 expression is restricted to neoplastic plasma cells, with little or no detectable expression by normal cells. Stromal cells in the bone marrow microenvironment do not induce the overexpression because neoplastic cells express higher levels of CD126 than normal plasma cells from the same bone marrow in individuals with MGUS. (Blood. 2000;96:3880-3886)
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Affiliation(s)
- A C Rawstron
- Haematological Malignancy Diagnostic Service, Department of Haematology, Leeds General Infirmary, Leeds, United Kingdom
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41
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Davies FE, Rawstron AC, Pratt G, Coupe R, Clarke D, Lubenko A, Short K, Perren TJ, Selby PJ, Maclennan S, Major K, Woodhead V, Robinson F, Child JA, Smith GM, Johnson PW, Morgan GJ. Positive and negative selection to reduce tumour contamination in peripheral blood stem cell harvests. Hematol Oncol 2000; 18:111-20. [PMID: 11027980 DOI: 10.1002/1099-1069(200009)18:3<111::aid-hon657>3.0.co;2-#] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Peripheral blood progenitor cells used during high dose treatments for malignancy may be contaminated with tumour cells that could later contribute to recurrence. CD34+ selected harvests still contain tumour cells and an additional negative selection may be capable of reducing this contamination. We have assessed a two-stage technique in which a CD34+ selection is followed by a tumour specific depletion stage using a B cell or breast cancer specific antibody panel. Initial small-scale selections on 11 patients with NHL and breast cancer showed that cell loss was greatest following the CD34+ selection with a median yield of 38.8 per cent (range 17. 2-56.4 per cent). The addition of the depletion stage resulted in a minimal loss of CD34+ cells with a yield for this step of 94.2 per cent (range 77.5-99.3 per cent). Clinical scale selections were performed on seven patients with CLL and a median of 2.8x10(6)/kg CD34+ cells (range 1.5-6.1x10(6)/kg) were collected. Cell recovery was 53.3 per cent following CD34+ selection and 76.9 per cent following the tumour specific depletion stage, resulting in a final product containing a median of 1.0x10(6)/kg CD34+ cells (range 0. 55-2.0x10(6)/kg). All unmanipulated harvests were heavily contaminated with tumour cells (median contamination 10.2 per cent, range 2.0-83.1 per cent) as measured by flow cytometry and a median 4.7 log (range 3-5 log) tumour cell purge was produced following two-stage selection. Six of the patients have received cells manipulated in this way with median engraftment times of neutrophils>0.5x10(9)/l=16 days (range 13-20 days) and platelets>20x10(9)/l=16.5 days (range 11-42 days). At a median follow-up of 25 months, these transplanted patients remain well and in molecular complete remission.
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Affiliation(s)
- F E Davies
- Academic Department of Haematology and Oncology, University of Leeds, U.K
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42
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O'Brien P, Roos D, Pratt G, Liew K, Barton M, Poulsen M, Olver I, Trotter G. Phase II multicenter study of brief single-agent methotrexate followed by irradiation in primary CNS lymphoma. J Clin Oncol 2000; 18:519-26. [PMID: 10653867 DOI: 10.1200/jco.2000.18.3.519] [Citation(s) in RCA: 182] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To assess, in a multi-institutional setting, the impact on relapse, survival, and toxicity of adding two cycles of intravenous methotrexate to cranial irradiation for immunocompetent patients with primary CNS lymphoma. PATIENTS AND METHODS Forty-six patients with a median age of 58 years and Eastern Cooperative Oncology Group performance status 0 to 3 were entered onto this phase II study. The protocol consisted of methotrexate 1 g/m(2) on days 1 and 8 followed by cranial irradiation on day 15. A whole-brain dose of 45 Gy was followed by a boost of 5.4 Gy. Intrathecal chemotherapy and spinal irradiation were given only to patients for whom cytologic examination of CSF was positive for CNS lymphoma. The median follow-up time was 36 months, with a minimum potential follow-up of 12 months. RESULTS Median survival was 33 months, with 2-year probability of survival 62% +/- 15% (95% confidence interval). Twenty patients have relapsed. The predominant site of relapse was the brain. Neither performance status nor age was found to influence survival. Six patients developed a dementing illness at a median of 16 months after treatment, and three of these died as a consequence. CONCLUSION A brief course of intravenous methotrexate before cranial irradiation is associated with 2-year and median survival rates superior to those reported for radiotherapy alone and similar to more intensive combined-modality regimens. Neurotoxicity remains an important competing risk for these patients.
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Affiliation(s)
- P O'Brien
- Trans-Tasman Radiation Oncology Group: Department of Radiation Oncology, Newcastle Mater Hospital, Newcastle, New South Wales, Australia.
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44
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Pratt G, Kennedy B, Smith G. Cyclosporin neurotoxicity after chemotherapy. Case had features of thrombotic thrombocytopenic purpura and haemolytic uraemic syndrome. BMJ 1999; 319:54; author reply 54-5. [PMID: 10390471 PMCID: PMC1116154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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45
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Davies FE, Rawstron AC, Pratt G, O'Connor S, Su'ut L, Blythe D, Fenton J, Claydon D, Child JA, Jack AS, Morgan GJ. FICTION-TSA analysis of the B-cell compartment in myeloma shows no significant expansion of myeloma precursor cells. Br J Haematol 1999; 106:40-6. [PMID: 10444161 DOI: 10.1046/j.1365-2141.1999.01506.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Studies utilizing flow cytometry and PCR have shown that the B-cell compartment in myeloma contains cells which are clonally related to the myelomatous plasma cells. Current data, however, remains inconclusive regarding the extent of this involvement. By combining fluorescent immunophenotyping, tyramine signal amplification and fluorescence in-situ hybridization (FICTION-TSA), we have used the presence of numerical chromosomal abnormalities within plasma cells as a clonal marker to examine the CD20+ B-cell compartment for the presence of aneuploidy. A series of 54 cases of myeloma were screened for the presence of numerical abnormalities of chromosomes 3 and 11. FICTION-TSA was performed on 13 cases with either trisomy 3 or 11 and on a control group of six cases known to be disomic for the two chromosomes. B-cell numbers were reduced in the myeloma cases compared to the normal controls (median 1.8% v 3.0%, P = 0.05). In the cases with a chromosomal marker, three signals were seen in a median of 1.88% of CD20+ B cells compared to 2.58% within the control group. Comparison of the two groups using a Wilcoxon-Mann-Whitney U test showed no statistical significant difference. Using this data set, it was possible to exclude a 3.03% expansion of clonally related B cells (95% confidence level). We conclude that the B-cell compartment in myeloma does not represent the major site of clonal expansion, and if clonally related cells are present then the numbers are few.
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Affiliation(s)
- F E Davies
- Department of Haematology, The General Infirmary at Leeds, Leeds
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46
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Proffitt J, Fenton J, Pratt G, Yates Z, Morgan G. Isolation and characterisation of recombination events involving immunoglobulin heavy chain switch regions in multiple myeloma using long distance vectorette PCR (LDV-PCR). Leukemia 1999; 13:1100-7. [PMID: 10400427 DOI: 10.1038/sj.leu.2401465] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Immunoglobulin class switching occurs as a result of recombination between pairs of switch region sequences located 5' to each constant heavy chain gene except Cdelta. In the B cell neoplasm multiple myeloma, tumour cells have generally undergone class switching and often contain oncogenic sequences translocated into switch regions, presumably as a result of aberrant switch recombination. We have developed a method (LDV-PCR) which combines long distance PCR with one-sided vectorette PCR that is capable of detecting and isolating both normal and aberrant switch recombination breakpoints from multiple myeloma cell lines and primary multiple myeloma tumour material. Using LDV-PCR we have directly cloned the translocation breakpoints present in two multiple myeloma cell lines and isolated a normal productive switch recombination event from a primary tumour. Furthermore, we have isolated a novel translocation t(14;22)(q32;q12) from a primary tumour sample and have demonstrated that internal deletions within switch regions can occur in multiple myeloma cells. Compared to a Southern blotting approach, LDV-PCR is simpler and more rapid to perform, allows the simultaneous detection and isolation of recombination events, and can also be applied to amounts of DNA which are too low to permit the conventional cloning of recombination breakpoints.
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MESH Headings
- Base Sequence
- Chromosomes, Human, Pair 11
- Chromosomes, Human, Pair 14
- Chromosomes, Human, Pair 16
- Chromosomes, Human, Pair 22
- Genetic Vectors
- Humans
- Immunoglobulin Switch Region/genetics
- Molecular Sequence Data
- Multiple Myeloma/genetics
- Polymerase Chain Reaction/methods
- Recombination, Genetic
- Translocation, Genetic
- Tumor Cells, Cultured
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Affiliation(s)
- J Proffitt
- Institute of Pathology, University of Leeds, UK
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47
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MacKenzie IZ, Bowell P, Gregory H, Pratt G, Guest C, Entwistle CC. Routine antenatal Rhesus D immunoglobulin prophylaxis: the results of a prospective 10 year study. Br J Obstet Gynaecol 1999; 106:492-7. [PMID: 10430201 DOI: 10.1111/j.1471-0528.1999.tb08304.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To assess the clinical and financial impact, and identify the problems, of providing routine antenatal RhD immunoglobulin prophylaxis for Rhesus D negative nulliparae. DESIGN A retrospective (1980-1986) and prospective (1987-1996) comparison between two similar populations, one population with nulliparae offered routine RhD immunoglobulin 500 IU prophylaxis at 28 and 34 weeks of gestation part way through the study period, and the other population not offered prophylaxis at any time. SETTING Obstetric units in two counties (three health districts) with similar annual numbers of maternities and the Regional Blood Transfusion Service antenatal serology laboratory. PARTICIPANTS Non-sensitised Rhesus D negative pregnant nulliparae. INTERVENTIONS Intramuscular RhD immunoglobulin 500 IU at 28 and 34 weeks of gestation to eligible women booked for confinement in one county; the intervention not offered in the other county. MAIN OUTCOME MEASURES 1. Rhesus D sensitised second pregnancy rate; 2. success in providing prophylaxis to eligible women; 3. serology laboratory activity changes; 4. potential savings from the prophylaxis programme. RESULTS Prophylaxis significantly reduced iso-immunisation in the next pregnancy when compared with historical (OR 0.28, CI 0.14-0.53; P < 0.0001) and contemporary controls (OR 0.43, CI 0.22-0.86; P = 0.02). However, success at achieving comprehensive prophylaxis was disappointing, with only 89% of eligible women receiving the first injection, 74% both injections, and for only 29% were both at the correct gestation. Fifty-two percent of women delivered after 40 weeks of gestation, beyond the period of adequate prophylaxis protection. The savings in antenatal interventions, neonatal care and possible long term ill-health that result from very preterm birth should be considerable. CONCLUSION Routine prophylaxis for nulliparae significantly reduces the incidence of sensitised next pregnancies with consequent savings, and its adoption nationwide should be encouraged. A programme offering antenatal prophylaxis for all Rhesus D negative women is unlikely to be economic. Improvement in uptake of prophylaxis is needed; alternative administration strategies should be explored.
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Affiliation(s)
- I Z MacKenzie
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford, John Radcliffe Hospital, UK
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48
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Christie DR, Barton MB, Bryant G, Cheuk R, Gebski V, Hornsey J, Lonergan D, MacLeod C, Pratt G, Roos D, Shannon J, Thornton D, Wirth A. Osteolymphoma (primary bone lymphoma): an Australian review of 70 cases. Australasian Radiation Oncology Lymphoma Group (AROLG). Aust N Z J Med 1999; 29:214-9. [PMID: 10342020 DOI: 10.1111/j.1445-5994.1999.tb00686.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND To examine prognostic factors, treatment outcomes and design future studies for Osteolymphoma (OL)--also known as primary bone lymphoma. METHODS Between 1979 and 1993, 70 patients with OL were treated in nine Australian centres. The effect of patient-, tumour-, and treatment-related factors on local control, distant disease-free survival and overall survival were assessed by multivariate analysis. RESULTS Most patients (94%) received radiotherapy (RT) (median dose 40 Gy) and 56% received chemotherapy. Multifocal disease was present in 20% of patients. The five year rates of overall survival and local control were 59% and 82%. Although there was a trend towards better results with the addition of chemotherapy, on multivariate analysis, there were no factors identified which appeared to impact upon overall and disease-free survival. Among the distant recurrences, there was a high proportion in bone (33%). Six patients suffered pathological fractures after treatment. CONCLUSION High rates of local control were achieved by RT, but the overall survival remains relatively poor, worse than nodal lymphoma. The natural history of the disease suggests that OL may be a distinct entity, different to nodal lymphomas, so the results of clinical trials in nodal lymphoma may not be relevant to OL. Prospective studies could define the outcome of combined modality therapy and set a benchmark for testing further proposals, as well as improving our knowledge of the clinical features of OL.
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Affiliation(s)
- D R Christie
- East Coast Cancer Centre, John Flynn Hospital, Tugun, Qld
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49
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O'Brien P, Roos D, Liew K, Pratt G, Barton M, Poulsen M, Olver I, Trotter G. 2099 A trans-tasman radiation oncology group (TROG) phase 2 study of a simple combined modality regimen using methotrexate and irradiation in primary CNS lymphoma. Int J Radiat Oncol Biol Phys 1999. [DOI: 10.1016/s0360-3016(99)90369-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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50
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Rawstron A, Barrans S, Blythe D, Davies F, English A, Pratt G, Child A, Morgan G, Jack A. Distribution of myeloma plasma cells in peripheral blood and bone marrow correlates with CD56 expression. Br J Haematol 1999; 104:138-43. [PMID: 10027726 DOI: 10.1046/j.1365-2141.1999.01134.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
There is a wide variation in the degree of marrow and blood involvement between patients with multiple myeloma. Both of these parameters are known to be highly significant prognostic factors, and the differences between patients may be due to variable expression of adhesion molecules. To test this we used three-colour flow cytometry to study three adhesion molecules associated with myeloma, namely CD38, CD56 and CD138. The level of expression of these molecules was compared with the distribution of myeloma plasma cells in bone marrow (n=59) and peripheral blood (n=26) in patients at presentation or relapse. The extent of marrow infiltration on the trephine biopsy correlated inversely with CD56 expression (Mann-Whitney U Test, P=0.022); there was no difference in CD38 or in CD138 expression. CD56 expression also correlated inversely with the number of circulating plasma cells (linear regression, R2=0.4268, slope=-0.58, P=0.0003). Peripheral blood plasma cell numbers correlated weakly with bone marrow plasmacytosis, and inversely with CD38 expression. The level of CD56 expression by neoplastic plasma cells was assessed in 37 patients over a median of 11 months (range 6-25). There was no significant change in expression (Wilcoxon Signed Rank, P=0.6271). We conclude that plasma cell CD56 expression is constant over the course of the disease; unlike CD138 expression, it is significantly linked to the degree of both bone marrow and peripheral blood involvement.
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Affiliation(s)
- A Rawstron
- Department of Haematology, The General Infirmary at Leeds
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