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Cui Z, Castagna F, Hanif W, Apple S, Zhang L, Tauras J, Braunschweig I, Kaur G, Janakiram M, Wang Y, Fang Y, Pellikka PA, Garcia MJ, Shah N, Slipczuk L. Amyloidosis-related echo features and mortality in patients with multiple myeloma. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background/Introduction
Patients with multiple myeloma (MM) are at increased risk of developing AL amyloidosis. It was determined by screening fat pad and bone marrow biopsy that 38% MM patients had amyloidosis at time of diagnosis and the majority were asymptomatic (1). However, whether amyloidosis-related echo features in MM affect survival remains unknown (1, 2).
Purpose
The goals of our study are to: 1) characterize prevalence of amyloidosis-related echo features in patients with multiple myeloma, 2) investigate whether decrease in longitudinal strain affect survival outcomes.
Methods
Patients diagnosed with MM between Jan 1, 2000 and Dec 31, 2017 at our institution were identified through Clinical Looking Glass. Those with echo within 1 year after myeloma diagnosis and left ventricular ejection fraction (LVEF) greater than 40% were included. Global longitudinal strain (GLS) and LVEF measurements were done using EchoGo (Ultromics, Oxford, UK). The average of GLS obtained from apical 4-chamber and apical 2-chamber views was used for analysis, with decreased GLS defined as absolute value less than 18%. Statistical analysis was conducted with STATA13, using Chi square test and Kruskal-Wallis for univariable analysis and Cox regression model for survival analysis.
Results
From a total cohort of 909 patients, 252 met inclusion criteria, of which 59 (23.4%) patients had decreased average GLS (see Table 1). Patients' mean age was 63±11 years, 44.8% were male and most were Black (42.7%) and the rest Hispanic (33.3%) and White (7.9%). Median follow up time was 4.25 years. The group with decreased GLS had lower percentage of females (22% vs 51.8%, p<0.01), higher percentage of previous MI (11.9% vs 1.6%, p<0.01) and more prior diagnosis of heart failure (20.3% vs 1.6%, p<0.01).
Among patients with decreased GLS, five-year mortality rate was 63.3% compared to 46.0% in those with preserved GLS (p<0.036). Median survival time was 3.9 years among those with reduced GLS and 4.3 years in those without (see Figure 1; p<0.01). Reduced GLS correlated with decreased survival (HR 1.6, p=0.03) even after adjusting for demographic variables (age, gender, race), history of MI, history of CHF, Charlson comorbidity index, myeloma RISS stage, and LVEF (≥50% vs 40–50%).
Forty-seven (18.6%) patients had end diastolic inter-ventricular septum (IVSd) thickness ≥1.2cm. Median GLS in patients with increased IVSd thickness was 19% compared to 21% in those without (p=0.01). Nine patients had the apical sparing strain pattern for amyloidosis.
Total of 158 patients had bone marrow specimen stained with Congo-red with 7 (4.4%) testing positive. Median GLS was 19% in the group staining positive for Congo-red compared 21% in the group with negative stain (p=0.03).
Conclusions
Decrease in GLS on baseline echo correlates with increased mortality in patients with MM and may be due to subclinical cardiac amyloidosis.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- Z Cui
- Montefiore Medical Center Albert Einstein College of Medicine , New York , United States of America
| | - F Castagna
- Montefiore Medical Center Albert Einstein College of Medicine , New York , United States of America
| | - W Hanif
- Montefiore Medical Center Albert Einstein College of Medicine , New York , United States of America
| | - S Apple
- Montefiore Medical Center Albert Einstein College of Medicine , New York , United States of America
| | - L Zhang
- Montefiore Medical Center Albert Einstein College of Medicine , New York , United States of America
| | - J Tauras
- Montefiore Medical Center Albert Einstein College of Medicine , New York , United States of America
| | - I Braunschweig
- Montefiore Medical Center Albert Einstein College of Medicine , New York , United States of America
| | - G Kaur
- Montefiore Medical Center Albert Einstein College of Medicine , New York , United States of America
| | - M Janakiram
- Montefiore Medical Center Albert Einstein College of Medicine , New York , United States of America
| | - Y Wang
- Montefiore Medical Center Albert Einstein College of Medicine , New York , United States of America
| | - Y Fang
- Montefiore Medical Center Albert Einstein College of Medicine , New York , United States of America
| | - P A Pellikka
- Mayo Clinic , Rochester , United States of America
| | - M J Garcia
- Montefiore Medical Center Albert Einstein College of Medicine , New York , United States of America
| | - N Shah
- Montefiore Medical Center Albert Einstein College of Medicine , New York , United States of America
| | - L Slipczuk
- Montefiore Medical Center Albert Einstein College of Medicine , New York , United States of America
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Depaus J, Wagner‐Johnston N, Zinzani PL, Phillips TJ, Maly J, Ferrari S, Bachy E, Bryan LJ, Delwail V, Janakiram M, de Guibert S, Tani M, Dai V, Havenith K, Boni J, He X, Ervin‐Haynes A, Carlo‐Stella C. CLINICAL ACTIVITY OF LONCASTUXIMAB TESIRINE PLUS IBRUTINIB IN NON‐HODGKIN LYMPHOMA: UPDATED LOTIS 3 PHASE 1 RESULTS. Hematol Oncol 2021. [DOI: 10.1002/hon.150_2880] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- J Depaus
- CHU UCL Namur site Godinne Department of Hematology Yvoir Belgium
| | - N Wagner‐Johnston
- The Sidney Kimmel Comprehensive Cancer Center Johns Hopkins University School of Medicine Division of Oncology, Baltimore Maryland USA
| | - P. L Zinzani
- Università di Bologna IRCCS Azienda Ospedaliero‐Universitaria di Bologna Istituto di Ematologia "Seràgnoli", and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Bologna Italy
| | - T. J Phillips
- University of Michigan Comprehensive Cancer Center Ann Arbor USA
| | - J Maly
- Norton Cancer Institute, Medical Oncology Louisville Kentucky USA
| | - S Ferrari
- Azienda Ospedaliera Papa Giovanni XXIII Hematology and Bone Marrow Transplant Unit Bergamo Italy
| | - E Bachy
- Hôpital Lyon Sud Department of Hematology Pierre‐Bénite France
| | - L. J Bryan
- Georgia Cancer Center at Augusta University Department of Medicine Division of Hematology/Oncology Augusta Georgia USA
| | - V Delwail
- Centre Hospitalier Universitaire de Poitiers Department of Hematology and Cell Therapy Poitiers France
| | - M Janakiram
- University of Minnesota, Division of Hematology, Oncology and Transplantation Minneapolis Minnesota USA
| | - S de Guibert
- Centre Hospitalier Universitaire de Rennes Hôpital Pontchaillou Department of Clinical Hematology Rennes France
| | - M Tani
- Santa Maria delle Crioci Hospital Unit of Hematology Ravenna Italy
| | - V Dai
- ADC Therapeutics America, Inc Clinical Development Murray Hill New Jersey USA
| | - K Havenith
- ADC Therapeutics (UK) Ltd Research and Development London UK
| | - J Boni
- ADC Therapeutics America, Inc Clinical Development Murray Hill New Jersey USA
| | - X He
- ADC Therapeutics America, Inc Clinical Development Murray Hill New Jersey USA
| | - A Ervin‐Haynes
- ADC Therapeutics America, Inc Clinical Development Murray Hill New Jersey USA
| | - C Carlo‐Stella
- Humanitas Clinical and Research Center – IRCCS, and Humanitas University Department of Oncology and Hematology Rozzano Milan Italy
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Goyal A, O'Leary D, Goyal K, Rubin N, Janakiram M. Screening for second malignancies in mycosis fungoides: non-Hodgkin lymphoma, Hodgkin lymphoma, lung cancer, bladder cancer and melanoma. J Eur Acad Dermatol Venereol 2021; 35:1821-1829. [PMID: 34013554 DOI: 10.1111/jdv.17384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 04/12/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patients with mycosis fungoides (MF) are at increased risk of developing non-Hodgkin lymphoma (NHL), Hodgkin lymphoma (HL), lung cancer, bladder cancer and melanoma. The characteristics of patients developing these malignancies have not been specifically delineated. In addition, there are no established guidelines for screening MF patients for second malignancies. MATERIALS/METHODS We identified 742 patients with MF who developed second malignancies in the Surveillance Epidemiology and End Result-18 database. RESULTS The majority of second malignancy patients were white and male, mean age 55-67 years at diagnosis of MF, and mean age 61-72 years at diagnosis of second malignancy. The majority of patients diagnosed with second malignancies had early stage MF. MF patients with NHL, lung cancer, and bladder cancer tended to be diagnosed at earlier stages of the second malignancy than patients without MF and demonstrated better 5-year overall survival. There was no improvement in stage at diagnosis or survival for MF patients who were diagnosed with melanoma compared to patients without MF. CONCLUSIONS Improvements in survival in MF/NHL, MF/lung cancer and MF/bladder cancer patients may reflect differences in disease biology secondary to having MF or the importance of increased contact with the healthcare system. MF/melanoma data suggest that patients require regular pigmented-lesion-focused skin examinations. Tools for screening include regular lymph node examinations, pigmented-lesion-focused examinations and detailed review of systems questions. Smoking cessation counseling is key intervention in this population, as is ensuring that all age- and sex-specific cancer screenings are up-to-date (e.g. lung cancer screening, mammography, and colonoscopy). The utility of regular imaging for second malignancy screening and lab testing such as routine urinalysis requires additional study and expert consensus.
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Affiliation(s)
- A Goyal
- Department of Dermatology, University of Minnesota, Minneapolis, MN, USA
| | - D O'Leary
- Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, MN, USA
| | - K Goyal
- Department of Dermatology, University of Minnesota, Minneapolis, MN, USA
| | - N Rubin
- Biostatistics Core, Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - M Janakiram
- Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, MN, USA
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Janakiram M, Villaorduna A, Sica R, Kornblum N, Braunschweig I, Chung E, Shah U, Wang Y, Verma A, Ye H. UPDATED ANALYSIS OF GENETIC SEQUENCING OF NORTH AMERICAN ATLL. Hematol Oncol 2019. [DOI: 10.1002/hon.159_2631] [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: 11/08/2022]
Affiliation(s)
- M. Janakiram
- HOT; University of Minnesota; Minneapolis United States
| | - A. Villaorduna
- Oncology; Albert Einstein College of Medicine; Bronx United States
| | - R. Sica
- Oncology; Albert Einstein College of Medicine; Bronx United States
| | - N. Kornblum
- Oncology; Albert Einstein College of Medicine; Bronx United States
| | - I. Braunschweig
- Oncology; Albert Einstein College of Medicine; Bronx United States
| | - E. Chung
- Oncology; Albert Einstein College of Medicine; Bronx United States
| | - U.A. Shah
- Oncology; Memorial Sloan Kettering Cancer Center; Bronx United States
| | - Y. Wang
- Oncology; Albert Einstein College of Medicine; Bronx United States
| | - A.K. Verma
- Oncology; Albert Einstein College of Medicine; Bronx United States
| | - H.B. Ye
- Oncology; Albert Einstein College of Medicine; Bronx United States
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Janakiram M, Ye H, Carjaval L, Villaorduna A, Ramesh K, Shah U, Kornblum N, Fehn K, Braunschweig I, Ueda K, Thiruthuvanathan V, Will B, Pinchasik D, Aivado M, Goel S, Steidl U, Verma A. EXCEPTIONAL RESPONSE OF REFRACTORY ATLL WITH MDM4 AMPLIFICATION TO NOVEL STAPLED PEPTIDE DUAL MDM4/2 INHIBITOR. Hematol Oncol 2019. [DOI: 10.1002/hon.210_2631] [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: 11/11/2022]
Affiliation(s)
- M. Janakiram
- HOT; University of Minnesota; Minneapolis United States
| | - H.B. Ye
- Oncology; Albert Einstein College of Medicine; Bronx United States
| | | | - A. Villaorduna
- Oncology; Albert Einstein College of Medicine; Bronx United States
| | - K. Ramesh
- Oncology; Albert Einstein College of Medicine; Bronx United States
| | - U. Shah
- Oncology; Memorial Sloan Kettering Cancer Center; New York United States
| | - N. Kornblum
- Oncology; Albert Einstein College of Medicine; Bronx United States
| | - K. Fehn
- Oncology; Albert Einstein College of Medicine; Bronx United States
| | - I. Braunschweig
- Oncology; Albert Einstein College of Medicine; Bronx United States
| | - K. Ueda
- Oncology; Albert Einstein College of Medicine; Bronx United States
| | | | - B. Will
- Oncology; Albert Einstein College of Medicine; Bronx United States
| | | | - M. Aivado
- ALRN Therapeutics; MA; United States
| | - S. Goel
- Oncology; Albert Einstein College of Medicine; Bronx United States
| | - U. Steidl
- Oncology; Albert Einstein College of Medicine; Bronx United States
| | - A.K. Verma
- Oncology; Albert Einstein College of Medicine; Bronx United States
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Janakiram M, Zhang L, White R, Ayyappan S, Sparano J. Abstract P1-08-08: Tumor infiltrating lymphocytes (TILs) in breast cancer: A meta-analysis of response to neoadjuvant chemotherapy based on TIL status. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p1-08-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:
TILs involving tumor and/or its associated stroma may be indicative of an immune response that may either facilitate anti-tumor immunity and clearance or immune tolerance and evasion. In this study we performed a meta-analysis evaluating the relationship between TILs and pathologic response to neoadjuvant chemotherapy (NAC) since this is considered as a surrogate endpoint of disease outcomes in ER negative or Her2 positive tumors.
Methods:
We searched PubMed and Embase (1991-May 2013), and ASCO abstracts (2009-2012), using a combination of free text search and controlled vocabulary search. We identified 1147 reports which met our initial search criteria, and they were reviewed to identify those which met the following criteria: (1) evaluated the presence of TILs, defined as tumor and/or stromal lymphocytes (CD4, CD8 or FOXP3) identified by H&E, IHC or gene expression before NAC, (2) classified TIL's “high/low” or “positive/negative”, and (3) correlated TILs with pathological complete response (pCR) or near pCR after NAC. Standard anthracycline-containing regimens were used as NAC in most studies, and anti-HER2 therapy was not used in most studies with HER2-positive disease. Results are presented as pooled odds ratios (OR) with 95% confidence intervals (CI), based on random-effects (to account for between study variance and heterogeneity due to different cutoffs and subtypes of T lymphocytes). Sensitivity analysis was done and publication bias was investigated using a funnel plot. We employed the Chi(2) test and calculated the I(2) statistic to investigate study heterogeneity. Meta-analysis statistics were calculated using StatsDirect Version 2.7.9.
Results:
Seven studies including 1641 patients met our criteria for inclusion in this analysis. A TIL ratio classified as either high or positive was associated with a significantly higher likelihood of achieving a pCR/near pCR after NAC (OR 3.68; 95% CI 1.93–7.01. p<0.0001) [Table 1]. This effect was driven mainly by a difference in ER negative tumors (OR 4.04, 95% CI 2.16-7.57. p<0.0001) and Her2 positive tumors (OR 5.61, 95% CI 1.8–17.47, p = 0.0007); the association was present, but nonsignificant, in ER positive tumors (OR 2.17, 95% CI 0.95-4.98). Sensitivity analyses did not change the inference. Funnel plots suggested low likelihood of publication bias (Harbord Egger test, p = 0.604) for all studies, and the I(2) statistic was 67.5%.
Table 1. Characteristics and Odds ratio for individual subtypesSubtypeNNo of studiesTIL low pCR%TIL high pCR%OR95% CIAll1641712.5%28.6%3.681.93 -7.01ER-/PR- and HER2- [except one study defined by ER-/PR-]403423.6%41.3%4.042.16 - 7.57Her2+326316.9%23.4%5.611.80 - 17.47ER/PR+55825.6%11.5%2.170.95 - 4.98
Conclusions:
In this systematic review and meta-analysis, high or positive TIL status before NAC was associated with a significantly better pathologic response to NAC (surrogate for DFS and OS), particularly in patients with ER/PR-negative or HER2-overexpressing disease. Patients with tumors characterized by low or absent TILs require novel therapeutic approaches, and may be candidates for immunotherapeutic approaches to enhance innate immunity or reverse immune tolerance.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-08-08.
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Affiliation(s)
- M Janakiram
- Albert Einstein College of Medicine, Bronx, NY; Montefiore Medical Center, Bronx, NY; Case Western Reserve University, Cleveland, OH
| | - L Zhang
- Albert Einstein College of Medicine, Bronx, NY; Montefiore Medical Center, Bronx, NY; Case Western Reserve University, Cleveland, OH
| | - R White
- Albert Einstein College of Medicine, Bronx, NY; Montefiore Medical Center, Bronx, NY; Case Western Reserve University, Cleveland, OH
| | - S Ayyappan
- Albert Einstein College of Medicine, Bronx, NY; Montefiore Medical Center, Bronx, NY; Case Western Reserve University, Cleveland, OH
| | - J Sparano
- Albert Einstein College of Medicine, Bronx, NY; Montefiore Medical Center, Bronx, NY; Case Western Reserve University, Cleveland, OH
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