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Abildgaard N, Anttila P, Waage A, Rubin KH, Ørstavik S, Bent-Ennakhil N, Gavini F, Ma Y, Freilich J, Hansson M. Real-world treatment patterns and outcomes for patients with multiple myeloma in Denmark, Finland and Sweden: An analysis using linked Nordic registries. Eur J Cancer 2024; 201:113921. [PMID: 38377776 DOI: 10.1016/j.ejca.2024.113921] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 02/22/2024]
Abstract
AIM The Health outcomes and Understanding of MyelomA multi-National Study (HUMANS) was a large-scale, retrospective study conducted across Denmark, Finland and Sweden using linked data from national registries. We describe the characteristics, treatment patterns and clinical outcomes for patients with newly diagnosed multiple myeloma (NDMM) over 2010-2018. METHODS Patients with NDMM who received MM-specific, first-line treatments, were categorised by treatment (autologous stem cell transplantation [ASCT] or a combination chemotherapy regimen based on bortezomib, lenalidomide or melphalan-prednisolone-thalidomide). RESULTS 11,023 patients received treatment over 2010-2018. Time between diagnosis and treatment was shortest in Denmark (0.9 months), then Sweden (2.9 months) and Finland (4.6 months). Around one third of patients underwent ASCT. Lenalidomide-based regimens were prescribed to 23-28% of patients in Denmark and Finland, versus 12% in Sweden. Patients receiving lenalidomide had the longest wait for treatment, from 3.2 months (Denmark) to 12.1 months (Sweden). Treatment persistence was highest among patients receiving melphalan-prednisolone-thalidomide (7-8 months) in Finland and Sweden and lowest among those receiving bortezomib (3.5 months) in Finland. Overall survival (OS) was longest among patients with ASCT (7-10 years). Among patients receiving chemotherapy, OS (from diagnosis/treatment initiation), varied between cohorts. In a sensitivity analysis excluding patients with smouldering MM, OS decreased for all; for patients receiving bortezomib or lenalidomide, OS from diagnosis was 40-49 and 27-54 months, respectively. CONCLUSIONS This population-based study of patients with NDMM receiving first-line MM-specific treatment, provides real-world data on treatment patterns and outcomes to complement data from randomised clinical trials.
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Affiliation(s)
- Niels Abildgaard
- Hematology Research Unit, Department of Hematology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Pekka Anttila
- Comprehensive Cancer Center, Department of Hematology, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland
| | - Anders Waage
- Department of Hematology, St Olav's University Hospital, Trondheim, Norway
| | - Katrine Hass Rubin
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | | | - François Gavini
- Takeda Pharmaceuticals International AG, Zurich, Switzerland
| | - Yuanjun Ma
- Parexel International, Stockholm, Sweden
| | - Jonatan Freilich
- Parexel International, Stockholm, Sweden; Department of Public Health and Clinical Medicine, Dermatology, Umeå University, Umeå, Sweden
| | - Markus Hansson
- Sahlgrenska Academy and Sahlgrenska University Hospital, Göteborg, Sweden
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Uttervall K, Tätting L, Lemonakis K, Majd M, Crafoord J, Olsson M, Mellqvist U, Hansson M, Nahi H. Effectiveness and infectious complications of BCMA T-cell engagers in treating multiple myeloma: Real-world evidence from Sweden. Cancer Med 2024; 13:e7048. [PMID: 38651177 PMCID: PMC11036077 DOI: 10.1002/cam4.7048] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/03/2024] [Accepted: 02/13/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Multiple myeloma (MM), an incurable disease characterized by frequent relapses and a need for multiple treatments, often progresses to a relapse/refractory status resistant to all available drugs and drug classes. Bispecific antibodies, specifically BCMA T-cell engagers, have emerged as effective treatments for MM, demonstrating impressive efficacy. However, these treatments can adversely affect the immune system, increasing vulnerability to infections. METHODS/RESULTS This study evaluated the efficacy and safety of BCMA T-cell engagers in 58 Swedish patients with poor MM prognosis. The patients exhibited a 69% overall response rate, with 69% survival and 60% progression-free survival at 15 months. CONCLUSIONS Despite the risk of infectious complications, the prognosis of MM patients can be significantly improved with vigilant monitoring and proactive management of infections. This real-world data highlight the potential of BCMA T-cell engagers in treating MM, emphasizing the need for careful patient monitoring to mitigate infection risks.
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Affiliation(s)
- Katarina Uttervall
- Center for Hematology and Regenerative Medicine, Department of Medicine, HuddingeKarolinska InstitutetStockholmSweden
| | - Love Tätting
- Department of Haematology in Linköping, and Department of Biomedical and Clinical SciencesLinköping UniversityLinköpingSweden
| | | | - Mousa Majd
- Center for Hematology and Regenerative Medicine, Department of Medicine, HuddingeKarolinska InstitutetStockholmSweden
| | - Jacob Crafoord
- Department of MedicineOrebro University HospitalOrebroSweden
| | - Mikael Olsson
- Section of Hematology Department of Internal MedicineHallands Sjukhus VarbergVarbergSweden
| | - Ulf‐Henrik Mellqvist
- Section of Hematology and Coagulation, Department of MedicineSahlgrenska University HospitalGothenburgSweden
| | - Markus Hansson
- Section of Hematology and Coagulation, Department of MedicineSahlgrenska University HospitalGothenburgSweden
| | - Hareth Nahi
- Center for Hematology and Regenerative Medicine, Department of Medicine, HuddingeKarolinska InstitutetStockholmSweden
- Department of Haematology in Linköping, and Department of Biomedical and Clinical SciencesLinköping UniversityLinköpingSweden
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Hemminki K, Zitricky F, Försti A, Silvennoinen R, Vangsted A, Hansson M. Large differencies in age-specific survival in multiple myeloma in the nordic countries. Blood Cancer J 2024; 14:43. [PMID: 38467614 PMCID: PMC10928156 DOI: 10.1038/s41408-024-01026-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/26/2024] [Accepted: 02/29/2024] [Indexed: 03/13/2024] Open
Affiliation(s)
- Kari Hemminki
- Biomedical Center, Faculty of Medicine and Biomedical Center in Pilsen, Charles University in Prague, 30605, Pilsen, Czech Republic.
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, D-69120, Heidelberg, Germany.
| | - Frantisek Zitricky
- Biomedical Center, Faculty of Medicine and Biomedical Center in Pilsen, Charles University in Prague, 30605, Pilsen, Czech Republic
| | - Asta Försti
- Hopp Children's Cancer Center (KiTZ), Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Raija Silvennoinen
- Department of Hematology, Helsinki University Hospital Comprehensive Cancer Center, & University of Helsinki, Helsinki, Finland
| | | | - Markus Hansson
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska University Hospital/Sahlgrenska Academy, Bruna stråket 5 plan 5, 41325, Göteborg, Sweden
- Hematology and Transfusion Medicine, Department of Laboratory Medicine, BMC B13, 221 84, Lund, Sweden
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Partanen A, Waage A, Peceliunas V, Schjesvold F, Anttila P, Säily M, Uttervall K, Putkonen M, Carlson K, Haukas E, Sankelo M, Szatkowski D, Hansson M, Marttila A, Svensson R, Axelsson P, Lauri B, Mikkola M, Karlsson C, Abelsson J, Ahlstrand E, Sikiö A, Klimkowska M, Matuzeviciene R, Fenstad MH, Ilveskero S, Pelliniemi TT, Nahi H, Silvennoinen R. Ixazomib, Lenalidomide, and Dexamethasone (IRD) Treatment with Cytogenetic Risk-Based Maintenance in Transplant-Eligible Myeloma: A Phase 2 Multicenter Study by the Nordic Myeloma Study Group. Cancers (Basel) 2024; 16:1024. [PMID: 38473382 DOI: 10.3390/cancers16051024] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 02/17/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024] Open
Abstract
Scarce data exist on double maintenance in transplant-eligible high-risk (HR) newly diagnosed multiple myeloma (NDMM) patients. This prospective phase 2 study enrolled 120 transplant-eligible NDMM patients. The treatment consisted of four cycles of ixazomib-lenalidomide-dexamethasone (IRD) induction plus autologous stem cell transplantation followed by IRD consolidation and cytogenetic risk-based maintenance therapy with lenalidomide + ixazomib (IR) for HR patients and lenalidomide (R) alone for NHR patients. The main endpoint of the study was undetectable minimal residual disease (MRD) with sensitivity of <10-5 by flow cytometry at any time, and other endpoints were progression-free survival (PFS) and overall survival (OS). We present the preplanned analysis after the last patient has been two years on maintenance. At any time during protocol treatment, 28% (34/120) had MRD < 10-5 at least once. At two years on maintenance, 66% of the patients in the HR group and 76% in the NHR group were progression-free (p = 0.395) and 36% (43/120) were CR or better, of which 42% (18/43) had undetectable flow MRD <10-5. Altogether 95% of the patients with sustained MRD <10-5, 82% of the patients who turned MRD-positive, and 61% of those with positive MRD had no disease progression at two years on maintenance (p < 0.001). To conclude, prolonged maintenance with all-oral ixazomib plus lenalidomide might improve PFS in HR patients.
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Affiliation(s)
- Anu Partanen
- Department of Medicine, Kuopio University Hospital, 70210 Kuopio, Finland
| | - Anders Waage
- Department of Hematology, St. Olavs Hospital, 7030 Trondheim, Norway
| | - Valdas Peceliunas
- Hematology, Oncology and Transfusion Medicine Center, Vilnius University Hospital, 08661 Vilnius, Lithuania
| | - Fredrik Schjesvold
- Oslo Myeloma Center, Department of Hematology, Oslo University Hospital, 0450 Oslo, Norway
- KG Jebsen Center for B Cell Malignancies, University of Oslo, 0316 Oslo, Norway
| | - Pekka Anttila
- Helsinki University Hospital Cancer Center Hematology, University of Helsinki, 00029 Helsinki, Finland
| | - Marjaana Säily
- Hematology-Oncology Unit, Oulu University Hospital Hematology, 90220 Oulu, Finland
| | - Katarina Uttervall
- Medical Unit Hematology, Karolinska University Hospital, 171 64 Solna, Sweden
- Department of Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Mervi Putkonen
- Department of Medicine, Turku University Hospital, 20521 Turku, Finland
| | - Kristina Carlson
- Department of Hematology, Uppsala University Hospital, 751 85 Uppsala, Sweden
| | - Einar Haukas
- Stavanger University Hospital, 4011 Stavanger, Norway
| | - Marja Sankelo
- Hematology Unit, Department of Internal Medicine, Tampere University Hospital Hematology, 33520 Tampere, Finland
| | - Damian Szatkowski
- Department of Oncology, Hematology and Palliative Care, Foerde Central Hospital, 6812 Foerde, Norway
| | - Markus Hansson
- Department of Hematology, Skåne University Hospital, 222 42 Lund, Sweden
| | - Anu Marttila
- Department of Medicine, Kymenlaakso Central Hospital, 48210 Kotka, Finland
| | - Ronald Svensson
- Department of Hematology, Linköping University Hospital, 581 85 Linköping, Sweden
| | - Per Axelsson
- Department of Haematology, Helsingborg Hospital, 252 23 Helsingborg, Sweden
| | - Birgitta Lauri
- Department of Hematology, Sunderby Hospital, 971 80 Luleå, Sweden
| | - Maija Mikkola
- Department of Medicine, Päijät-Häme Central Hospital, 15850 Lahti, Finland
| | - Conny Karlsson
- Department of Haematology, Halland Hospital, 302 33 Halmstad, Sweden
| | - Johanna Abelsson
- Department of Hematology, Uddevalla Hospital, 451 53 Uddevalla, Sweden
| | - Erik Ahlstrand
- Department of Medicine, Örebro University Hospital, 701 85 Örebro, Sweden
| | - Anu Sikiö
- Department of Medicine, Central Finland Central Hospital, 40620 Jyväskylä, Finland
| | - Monika Klimkowska
- Department of Clinical Pathology and Cytology, Karolinska University Hospital, 141 86 Stockholm, Sweden
| | - Reda Matuzeviciene
- Department of Physiology, Biochemistry, Microbiology and Laboratory Medicine, Biomedical Sciences Institute, Vilnius University Hospital and Vilnius University Faculty of Medicine, 03101 Vilnius, Lithuania
| | - Mona Hoysaeter Fenstad
- Department of Immunology and Transfusion Medicine, St. Olavs Hospital, 7030 Trondheim, Norway
| | - Sorella Ilveskero
- Clinical Chemistry, Helsinki University Hospital, University of Helsinki, 00014 Helsinki, Finland
| | | | - Hareth Nahi
- Hematology Centre, Karolinska University Hospital Huddinge, 141 57 Stockholm, Sweden
| | - Raija Silvennoinen
- Helsinki University Hospital Cancer Center Hematology, University of Helsinki, 00029 Helsinki, Finland
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Nielsen LK, Schjesvold F, Möller S, Guldbrandsen N, Hansson M, Remes K, Peceliunas V, Abildgaard N, Gregersen H, King MT. Health-related quality of life and quality-adjusted progression free survival for carfilzomib and dexamethasone maintenance following salvage autologous stem-cell transplantation in patients with multiple myeloma: a randomized phase 2 trial by the Nordic Myeloma Study Group. J Patient Rep Outcomes 2024; 8:15. [PMID: 38315268 PMCID: PMC10844184 DOI: 10.1186/s41687-024-00691-2] [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: 08/10/2023] [Accepted: 01/18/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Decisions regarding maintenance therapy in patients with multiple myeloma should be based on both treatment efficacy and health-related quality of life (HRQL) consequences. In the CARFI trial, patients with first relapse of multiple myeloma underwent salvage autologous stem cell transplantation (salvage ASCT) before randomization to carfilzomib-dexamethasone maintenance therapy (Kd) or observation. The primary clinical endpoint was time to progression, which was extended by 8 months by Kd. The aim of this paper is to present the all HRQL endpoints of the CARFI trial including the HRQL effect of Kd maintenance therapy relative to observation. The primary HRQL endpoint was assessed by EORTC QLQ-C30 Summary score (QLQ-C30-sum) at 8 months follow-up. A key secondary HRQL endpoint was quality-adjusted progression-free-survival (QAPFS). METHODS HRQL was assessed with EORTC QLQ-C30, EORTC QLQ-MY20 and FACT/GOG-Ntx at randomization and every second month during follow-up. HRQL data were analyzed with linear mixed effect models until 8 months follow-up. QAPFS per individual was calculated by multiplying progression-free survival (PFS) by two quality-adjustment metrics, the QLQ-C30-sum and EORTC Quality of Life Utility Measure-Core 10 dimensions (QLU-C10D). The QAPFS per treatment group was estimated with the Kaplan-Meier method. P < 0.05 was used for statistical significance, and a between-group minimal important difference of 10 points was interpreted as clinically relevant for the QLQ-C30-sum. RESULTS 168 patients were randomized. HRQL questionnaire compliance was 93%. For the QLQ-C30-sum, the difference of 4.62 points (95% confidence interval (CI) -8.9: -0.4, p = 0.032) was not clinically relevant. PFS was 19.3 months for the Kd maintenance group and 16.8 months for the observation group; difference = 2.5 months (95% CI 0.5; 4.5). QAPFS based on the QLQ-C30-sum for the Kd maintenance group was 18.0 months (95% CI 16.4; 19.6) and for the observation group 15.0 months (95% CI 13.5; 16.5); difference = 3.0 months (95% CI 0.8-5.3). QAPFS based on the QLU-C10D for the Kd maintenance group was 17.5 months (95% CI 15.9; 19.2) and 14.0 months (95% CI 12.4; 15.5) for the observation group; difference = 3.5 months (95% CI 1.1-5.9). CONCLUSIONS Kd maintenance therapy after salvage ASCT did not adversely affect overall HRQL, but adjustment for HRQL reduced the PFS compared to unadjusted PFS. PFS of maintenance therapy should be quality-adjusted to balance the benefits and HRQL impact.
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Affiliation(s)
- Lene Kongsgaard Nielsen
- Quality of life Research Center, Department of Hematology, Odense University Hospital, DK-5000, Odense, Denmark.
- Department of Hematology, Gødstrup Hospital, Herning, Denmark.
- Academy of Geriatric Cancer Research, Odense University Hospital, Odense, Denmark.
| | - Fredrik Schjesvold
- Oslo Myeloma Center, Department of Hematology, Oslo University Hospital, Oslo, Norway
- KG Jebsen Center for B cell malignancies, University of Oslo, Oslo, Norway
| | - Sören Möller
- Open Patient data Explorative Network, OPEN, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Nina Guldbrandsen
- Oslo Myeloma Center, Department of Hematology, Oslo University Hospital, Oslo, Norway
| | - Markus Hansson
- Department of Hematology, Skåne University Hospital, Lund, Sweden
| | - Kari Remes
- Department of Hematology, Turku University Hospital, Turku, Finland
| | - Valdas Peceliunas
- Department of Hematology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Niels Abildgaard
- Quality of life Research Center, Department of Hematology, Odense University Hospital, DK-5000, Odense, Denmark
- Academy of Geriatric Cancer Research, Odense University Hospital, Odense, Denmark
- Open Patient data Explorative Network, OPEN, Odense University Hospital, Odense, Denmark
| | - Henrik Gregersen
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark
| | - Madeleine T King
- Quality of life Research Center, Department of Hematology, Odense University Hospital, DK-5000, Odense, Denmark
- School of Psychology, University of Sydney, Sydney, Australia
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Ajore R, Mattsson J, Pertesi M, Ekdahl L, Ali Z, Hansson M, Nilsson B. Genome-wide CRISPR/Cas9 screen identifies regulators of BCMA expression on multiple myeloma cells. Blood Cancer J 2024; 14:21. [PMID: 38272874 PMCID: PMC10811322 DOI: 10.1038/s41408-024-00986-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/06/2024] [Accepted: 01/09/2024] [Indexed: 01/27/2024] Open
Affiliation(s)
- Ram Ajore
- Division of Hematology and Transfusion Medicine, Department of Laboratory Medicine, Lund University, 221 84, Lund, Sweden
- Lund Stem Cell Center, Lund University, 221 84, Lund, Sweden
| | - Jenny Mattsson
- Division of Hematology and Transfusion Medicine, Department of Laboratory Medicine, Lund University, 221 84, Lund, Sweden
- Lund Stem Cell Center, Lund University, 221 84, Lund, Sweden
- BioInvent International AB, Ideongatan 1, 223 70, Lund, Sweden
| | - Maroulio Pertesi
- Division of Hematology and Transfusion Medicine, Department of Laboratory Medicine, Lund University, 221 84, Lund, Sweden
- Lund Stem Cell Center, Lund University, 221 84, Lund, Sweden
| | - Ludvig Ekdahl
- Division of Hematology and Transfusion Medicine, Department of Laboratory Medicine, Lund University, 221 84, Lund, Sweden
- Lund Stem Cell Center, Lund University, 221 84, Lund, Sweden
| | - Zain Ali
- Division of Hematology and Transfusion Medicine, Department of Laboratory Medicine, Lund University, 221 84, Lund, Sweden
- Lund Stem Cell Center, Lund University, 221 84, Lund, Sweden
| | - Markus Hansson
- Division of Hematology and Transfusion Medicine, Department of Laboratory Medicine, Lund University, 221 84, Lund, Sweden
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, Göteborg University, 41346, Göteborg, Sweden
| | - Björn Nilsson
- Division of Hematology and Transfusion Medicine, Department of Laboratory Medicine, Lund University, 221 84, Lund, Sweden.
- Lund Stem Cell Center, Lund University, 221 84, Lund, Sweden.
- Broad Institute, Cambridge, MA, 02142, USA.
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Lisak M, Nicklasson M, Palmason R, Wichert S, Isaksson C, Andersson PO, Johansson JE, Lenhoff S, Brune M, Hansson M. Higher cyclosporine-A concentration increases the risk of relapse in AML following allogeneic stem cell transplantation from unrelated donors using anti-thymocyte globulin. Sci Rep 2023; 13:22777. [PMID: 38123675 PMCID: PMC10733303 DOI: 10.1038/s41598-023-50105-4] [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: 05/22/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023] Open
Abstract
Cyclosporine-A (CsA) is used to prevent acute graft-versus-host disease (aGvHD). European Society for Blood and Marrow transplantation (EBMT) recommends a CsA target serum concentration of 200-300 µg/L during the first month after allogeneic hematopoietic stem cell transplantation (HSCT). With this study, we investigated whether a median CsA concentration > 200 µg/L (CsAhigh) the first month after HSCT, compared to ≤ 200 µg/L (CsAlow), increased the relapse risk of acute myloid leukemia (AML), using unrelated donors (URD) and antithymocyte globulin (ATG). Data was collected from 157 patients with AML, transplanted 2010-2016. The cumulative incidence of relapse (CIR) at 60 months was 50% in the CsAhigh versus 32% in the CsAlow group (p = 0.016). In univariate analysis, CsAhigh versus CsAlow (p = 0.028), 10-unit increase of CsA as a continuous variable (p = 0.017) and high risk disease (p = 0.003) were associated with higher CIR. The results remained after adjusting for disease risk. Death following relapse occurred more frequently in the CsAhigh group (p = 0.0076). There were no significant differences in rates of aGvHD, chronic GvHD (cGvHD), EBV/CMV-infections or overall survival (OS) between the two groups. In conclusion, we found that a median CsA concentration > 200 µg/L, the first month after HSCT, results in higher CIR of AML when combined with ATG.
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Affiliation(s)
- Mikael Lisak
- Department of Hematology and Coagulation, Sahlgrenska University Hospital, Bruna stråket 5, plan 5, 413 45, Gothenburg, Sweden.
- Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
| | - Malin Nicklasson
- Department of Hematology and Coagulation, Sahlgrenska University Hospital, Bruna stråket 5, plan 5, 413 45, Gothenburg, Sweden
| | - Robert Palmason
- Department of Hematology, Skane University Hospital, Lund, Sweden
| | - Stina Wichert
- Department of Hematology, Skane University Hospital, Lund, Sweden
| | - Cecila Isaksson
- Department of Hematology, Norrland University Hospital, Umeå, Sweden
| | - Per-Ola Andersson
- Department of Hematology and Coagulation, Sahlgrenska University Hospital, Bruna stråket 5, plan 5, 413 45, Gothenburg, Sweden
- Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Jan-Erik Johansson
- Department of Hematology and Coagulation, Sahlgrenska University Hospital, Bruna stråket 5, plan 5, 413 45, Gothenburg, Sweden
- Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Stig Lenhoff
- Department of Hematology, Skane University Hospital, Lund, Sweden
| | - Mats Brune
- Department of Hematology and Coagulation, Sahlgrenska University Hospital, Bruna stråket 5, plan 5, 413 45, Gothenburg, Sweden
- Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Markus Hansson
- Department of Hematology and Coagulation, Sahlgrenska University Hospital, Bruna stråket 5, plan 5, 413 45, Gothenburg, Sweden
- Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Department of Hematology, Skane University Hospital, Lund, Sweden
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Mellqvist UH, Cai Q, Hester LL, Grövdal M, Börsum J, Rahman I, Ammann EM, Hansson M. Epidemiology and clinical outcomes of light-chain amyloidosis in Sweden: A nationwide population-based study. Eur J Haematol 2023; 111:697-705. [PMID: 37533343 DOI: 10.1111/ejh.14063] [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: 03/01/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 08/04/2023]
Abstract
OBJECTIVES This study evaluated data from six Swedish national registries to fill current evidence gaps on the epidemiology, clinical burden, and overall survival (OS) associated with light-chain (AL) amyloidosis. METHODS Patients newly diagnosed with AL amyloidosis were identified using six linked Swedish nationwide population-based registers. For each case, individuals from the general population were selected and matched with a maximum ratio of 1:5 based on age, sex, calendar year, and county. RESULTS 846 patients newly diagnosed with AL amyloidosis and 4227 demographically matched individuals were identified. From 2011 to 2019, annual AL amyloidosis incidence increased from 10.5 to 15.1 cases per million. At baseline, patients with AL amyloidosis had a significantly higher disease burden including higher rates of cardiac and renal failure relative to the comparison group. Among patients with AL amyloidosis, 21.5% had incident heart failure and 17.1% had incident renal failure after initial diagnosis. Median OS for patients with AL amyloidosis was 56 months versus not reached in the matched general population comparison group. CONCLUSION The incidence of newly diagnosed AL amyloidosis in Sweden increased over time with AL amyloidosis being associated with a higher risk of cardiac/renal failure and all-cause mortality compared with the general population.
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Affiliation(s)
- Ulf-Henrik Mellqvist
- Section of Hematology and Coagulation, Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Qian Cai
- Janssen Global Services, Titusville, New Jersey, USA
| | - Laura L Hester
- Janssen Research & Development, Horsham, Pennsylvania, USA
| | | | | | | | | | - Markus Hansson
- Department of Hematology, Sahlgrenska Academy, Göteborg University and Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Hematology, Skåne University Hospital, Lund, Sweden
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Abildgaard N, Freilich J, Anttila P, Bent-Ennakhil N, Ma Y, Lassenius M, Ørstavik S, Toppila I, Waage A, Turesson I, Hansson M. Use of Linked Nordic Registries for Population Studies in Hematologic Cancers: The Case of Multiple Myeloma. Clin Epidemiol 2023; 15:987-999. [PMID: 37745645 PMCID: PMC10516210 DOI: 10.2147/clep.s413587] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/29/2023] [Indexed: 09/26/2023] Open
Abstract
Purpose Linked health-care registries and high coverage in Nordic countries lend themselves well to epidemiologic research. Given its relatively high incidence in Western Europe, complexity in diagnosis, and challenges in registration, multiple myeloma (MM) was selected to compare registries in Denmark, Finland, and Sweden. Patients and Methods Data were obtained from four archetypal registries in each country (spanning January 2005-October 2018): National Patient Registry (NPR), Prescribed Drug Registry (PDR), Cancer Registry (CR), and Cause of Death Registry. Patients newly diagnosed with MM who received MM-specific treatment were included. PDR/NPR treatment records were used to assess incident NPR cases. The registration quality of MM-specific drugs in the PDR of each country was also evaluated. Results In Denmark, only 6% of patients in the NPR were not registered in the CR; in Sweden, it was 16.9%. No systematic differences were identified that could explain this discrepancy. In Denmark, lenalidomide and bortezomib were registered in the NPR with high coverage, but less expensive drugs typically given in combination with bortezomib were not covered in any of the registries. In Finland and Sweden, bortezomib records were not identified in the PDR, but some were in the NPR; other drugs had good coverage in the PDR. Conclusions The registries evaluated in this study can be used to identify the MM population; however, given the gaps in MM registration in the Finnish and Swedish CRs, Danish registries provide the most comprehensive datasets for research on treatment patterns for MM.
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Affiliation(s)
- Niels Abildgaard
- Hematology Research Unit, Department of Hematology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jonatan Freilich
- Department of Access Consulting, PAREXEL International, Stockholm, Sweden
- Department of Public Health and Clinical Medicine, Dermatology, Umeå University, Umeå, Sweden
| | - Pekka Anttila
- Comprehensive Cancer Center, Department of Hematology, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland
| | | | - Yuanjun Ma
- Department of Access Consulting, PAREXEL International, Stockholm, Sweden
| | | | | | | | - Anders Waage
- Department of Hematology, St Olav’s University Hospital, Trondheim, Norway
| | - Ingemar Turesson
- Lund University Cancer Centre, University of Lund, Skåne University Hospital, Lund, Sweden
| | - Markus Hansson
- Sahlgrenska Academy and Sahlgrenska University Hospital, Göteborg, Sweden
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Groen K, Schjesvold FH, van der Holt B, Levin MD, Seefat MR, Hansson M, Leys MB, Regelink JC, Waage A, Szatkowski D, Axelsson P, Hieu Do T, Svirskaite A, van der Spek E, Haukas E, Knut-Bojanowska D, Ypma PF, Blimark CH, Mellqvist UH, van de Donk NW, Sonneveld P, Klostergaard A, Vangsted AJ, Abildgaard N, Zweegman S. Ixazomib-Thalidomide-Dexamethasone Induction Followed by Ixazomib or Placebo Maintenance in Nontransplant Eligible Newly Diagnosed Multiple Myeloma Patients: Long-term Results of HOVON-126/NMSG 21.13. Hemasphere 2023; 7:e940. [PMID: 37663673 PMCID: PMC10470677 DOI: 10.1097/hs9.0000000000000940] [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] [Received: 05/11/2023] [Accepted: 07/07/2023] [Indexed: 09/05/2023] Open
Affiliation(s)
- Kazimierz Groen
- Department of Hematology, Amsterdam UMC, Vrije Universiteit, the Netherlands
- Cancer Center Amsterdam, Treatment and Quality of Life, the Netherlands
| | - Fredrik H. Schjesvold
- Department of Hematology, Oslo Myeloma Center, Oslo University Hospital, Norway
- KG Jebsen Center for B Cell Malignancies, University of Oslo, Norway
| | - Bronno van der Holt
- Department of Hematology, HOVON Data Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Mark-David Levin
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Maarten R. Seefat
- Department of Hematology, Amsterdam UMC, Vrije Universiteit, the Netherlands
- Cancer Center Amsterdam, Treatment and Quality of Life, the Netherlands
| | - Markus Hansson
- Department of Hematology, Skåne University Hospital Lund, Sweden
| | - Maria B.L. Leys
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, the Netherlands
| | - Josien C. Regelink
- Department of Internal Medicine, Meander Medical Centre, Amersfoort, the Netherlands
| | - Anders Waage
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Damian Szatkowski
- Department of Oncology and Hematology, Førde Central Hospital, Norway
| | - Per Axelsson
- Department of Internal Medicine, Helsingborg Hospital, Sweden
| | - Trung Hieu Do
- Haematology Department H 60, Roskilde Sjaelland University, Denmark
| | - Asta Svirskaite
- Department of Hematology, Aalborg University Hospital, Denmark
| | - Ellen van der Spek
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, the Netherlands
| | - Einar Haukas
- Department for Blood and Cancer Diseases, Stavanger University Hospital, Norway
| | | | - Paula F. Ypma
- Department of Hematology, Haga Hospital, The Hague, the Netherlands
| | - Cecilie H. Blimark
- Hematology Department, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Niels W.C.J. van de Donk
- Department of Hematology, Amsterdam UMC, Vrije Universiteit, the Netherlands
- Cancer Center Amsterdam, Treatment and Quality of Life, the Netherlands
| | - Pieter Sonneveld
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | | | | | - Niels Abildgaard
- Department of Hematology, Hematology Research Unit and Academy of Geriatric Research, Odense University Hospital and University of Southern Denmark, Denmark
| | - Sonja Zweegman
- Department of Hematology, Amsterdam UMC, Vrije Universiteit, the Netherlands
- Cancer Center Amsterdam, Treatment and Quality of Life, the Netherlands
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Lemonakis K, Olsson-Arvidsson L, Karlsson C, Johansson B, Hansson M. Impact of 1q gains on treatment outcomes of patients with newly diagnosed multiple myeloma in a real-world Swedish population receiving modern treatment. Eur J Haematol 2023. [PMID: 37271732 DOI: 10.1111/ejh.14018] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/16/2023] [Accepted: 05/23/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Amplification of 1q (amp(1q); ≥4 1q copies) has repeatedly been reported to predict a worse outcome in multiple myeloma (MM), whereas the impact of gain of 1q (gain(1q); three 1q copies) is less clear. METHODS We investigated survival of MM in relation to amp(1q) and gain(1q) by retrospectively analysing 346 consecutively newly diagnosed MM (NDMM) patients. Of these, 62 (18%) had amp(1q), 97 (28%) gain(1q) and 187 (54%) a normal number of 1q copies (no1q). RESULTS The patients with amp(1q) had a shorter median progression-free survival than those with gain(1q) or no(1q) (13.1 months, 95% confidence interval [CI] 8.2-18.1 months vs. 36.1 months, 95% CI 23.1-49.1 months vs. 25.4 months, 95% CI 19.8-31.1 months, p = .005). The 3-year overall survival (OS) was 56% for amp(1q), 76% for gain(1q) and 80% for no1q (p = .003). In the multivariate analysis, the presence of amp(1q) was independently associated with a shorter OS (hazard ratio 1.99, 95% CI 1.03-3.82, p = .039), whereas gain(1q) had no negative effect on survival. CONCLUSION Our results thus suggest that amp(1q) should be considered a high-risk abnormality in NDMM and that new treatment strategies should be explored to mitigate its negative effect on survival.
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Affiliation(s)
| | - Linda Olsson-Arvidsson
- Division of Clinical Genetics, Department of Laboratory Medicine, Lund University, Lund, Sweden
- Department of Clinical Genetics, Pathology, and Molecular Diagnostics, Office for Medical Services, Region Skåne, Lund, Sweden
| | - Conny Karlsson
- Department of Haematology, Halland's hospital, Halmstad, Sweden
| | - Bertil Johansson
- Division of Clinical Genetics, Department of Laboratory Medicine, Lund University, Lund, Sweden
- Department of Clinical Genetics, Pathology, and Molecular Diagnostics, Office for Medical Services, Region Skåne, Lund, Sweden
| | - Markus Hansson
- Department of Haematology, Skåne University Hospital, Lund, Sweden
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, Göteborg University, Gothenburg, Sweden
- Department of Haematology, Sahlgrenska University Hospital, Gothenburg, Sweden
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12
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Weber L, Hansson M, Geijer M. Computed tomography with adjusted dose for body mass index may be superior to whole-body radiography especially in elderly patients with multiple myeloma. Acta Radiol 2023; 64:1896-1903. [PMID: 36760071 DOI: 10.1177/02841851231152325] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
BACKGROUND Whole-body skeletal radiography has traditionally been used in the management of multiple myeloma for defining treatment strategies. For several reasons, radiography has been replaced by computed tomography (CT) covering the same regions. PURPOSE To evaluate the body mass index (BMI) adjusted effective radiation dose from two different methods of whole-body radiologic imaging for multiple myeloma assessment. MATERIAL AND METHODS The current investigation analyses the dose to patients resulting from the two methods, conventional radiography supplemented with tomosynthesis (203 examinations) and CT (264 examinations). All patients subject to myeloma staging for 4.5 years were included in the study. Exposure parameters were collected from the PACS and conversion factors were calculated using the software packages PCXMC and VirtualDose enabling the calculation of the effective dose to each patient based on BMI. The Mann-Whitney U test was used for comparisons between groups. RESULTS Patients were subject to a median effective dose of 2.5 mSv for conventional radiography and 5.1 mSv for CT, a statistically significant difference. CONCLUSION The effective dose for whole-body CT in assessing multiple myeloma is twice as high as for whole-body skeletal survey with modern digital radiography, but at a low level and considerably less than the levels quoted in the earlier studies of ∼30 mSv when the technique was first explored.
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Affiliation(s)
- Lars Weber
- Medical Radiation Physics, Department of Clinical Sciences Lund, Lund University and Radiation Physics, Division of Hematology, Oncology and Radiation Physics, Skane University Hospital, Lund, Sweden
| | - Markus Hansson
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Region Västra Götaland, Sahlgrenska University Hospital, Department of Hematology, Gothenburg, Sweden.,Hematology, Division of Hematology, Oncology and Radiation Physics, Skane University Hospital, Lund, Sweden
| | - Mats Geijer
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Sahlgrenska University Hospital, Department of Radiology, Gothenburg, Sweden.,Department of Clinical Sciences Lund, 5193Lund University, Lund, Sweden
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Westerlund J, Askman S, Pettersson Å, Hellmark T, Johansson ÅCM, Hansson M. Suppression of T-Cell Proliferation by Normal Density Granulocytes Led to CD183 Downregulation and Cytokine Inhibition in T-Cells. J Immunol Res 2022; 2022:8077281. [PMID: 36438199 PMCID: PMC9683987 DOI: 10.1155/2022/8077281] [Citation(s) in RCA: 1] [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] [Received: 08/30/2022] [Revised: 10/11/2022] [Accepted: 10/14/2022] [Indexed: 11/08/2023] Open
Abstract
Normal density granulocytes (NDGs) can suppress T-cell responses in a similar way as myeloid-derived suppressor cells (MDSCs). In this study, we tested the hypothesis that NDGs from healthy donors preferentially inhibit T helper 1 (Th1) cells and investigated the myeloid-derived suppressive effect in different T-cell populations. We found that NDG-induced suppression of T-cell proliferation was contact dependent, mediated by integrin CD11b, and dependent on NDG-production of reactive oxygen species (ROS). The suppression was rapid and occurred within the first few hours of coculture. The suppression did not influence the CD8+/CD4+ ratio indicating an equal sensitivity in these populations. We further analyzed the CD4+ T helper subsets and found that NDGs induced a loss of Th1 surface marker, CD183, that was unrelated to ligand-binding to CD183. In addition, we analyzed the Th1, Th2, and Th17 cytokine production and found that all cytokine groups were suppressed when T-cells were incubated with NDGs. We therefore concluded that NDGs do not preferentially suppress Th1-cells. Instead, NDGs generally suppress Th cells and cytotoxic T-cells but specifically downregulate the Th1 marker CD183.
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Affiliation(s)
- Julia Westerlund
- Lund University, Department of Laboratory Medicine, Division of Hematology and Transfusion Medicine, BMC B13, 22184 Lund, Sweden
| | - Sandra Askman
- Lund University, Department of Laboratory Medicine, Division of Hematology and Transfusion Medicine, BMC B13, 22184 Lund, Sweden
- Skåne University Hospital, Department of Respiratory Medicine and Allergology, 22185 Lund, Sweden
| | - Åsa Pettersson
- Lund University, Department of Laboratory Medicine, Division of Hematology and Transfusion Medicine, BMC B13, 22184 Lund, Sweden
- Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Nephrology, Barngatan 2, 22185 Lund, Sweden
| | - Thomas Hellmark
- Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Nephrology, Barngatan 2, 22185 Lund, Sweden
| | - Åsa C. M. Johansson
- Lund University, Department of Laboratory Medicine, Division of Hematology and Transfusion Medicine, BMC B13, 22184 Lund, Sweden
- Skåne University Hospital, Region Skåne, Clinical Genetics and Pathology, 22185 Lund, Sweden
| | - Markus Hansson
- Skåne University Hospital, Department of Hematology, Oncology and Radiation Physics, 22185 Lund, Sweden
- University of Göteborg, Sahlgrenska Academy, Institute of Medicine, Department of Internal Medicin and clinical nutrition, Bruna stråket 5, Plan 5, 41325 Göteborg, Sweden
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14
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Lemonakis K, Tätting L, Lisak M, Carlson K, Crafoord J, Blimark CH, Santamaria AI, Wichert S, Lenhoff S, Hansson M. Impact of daratumumab-based induction on stem cell collection parameters in Swedish myeloma patients. Haematologica 2022; 108:610-614. [PMID: 36200424 PMCID: PMC9890000 DOI: 10.3324/haematol.2022.281610] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Indexed: 02/03/2023] Open
Affiliation(s)
| | - Love Tätting
- Department of Hematology, University Hospital Linköping, Linköping
| | - Mikael Lisak
- Department of Hematology, Sahlgrenska University Hospital, Gothenburg
| | | | - Jacob Crafoord
- Department of Hematology, Örebro University Hospital, Örebro
| | - Cecilie H Blimark
- Department of Hematology, Sahlgrenska University Hospital, Gothenburg
| | | | - Stina Wichert
- Department of Hematology, Skåne University Hospital, Lund
| | - Stig Lenhoff
- Department of Hematology, Skåne University Hospital, Lund
| | - Markus Hansson
- Department of Hematology, Sahlgrenska University Hospital, Gothenburg
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15
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Hansson M, Voegg ROB, Blixenkrone-Moeller E, Dannesbo S, Dehn AM, Phil C, Sillesen AS, Axelsson Raja A, Damm P, Reinhardt Mathiesen E, Iversen K, Bundgaard H. Maternal pre-existing diabetes and gestational diabetes and the prevalence of septal defects in the offspring. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1823] [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: 11/14/2022] Open
Abstract
Abstract
Background and introduction
Maternal pre-existing and gestational diabetes affect approximately 6% of all pregnancies in Denmark and are well known risk factors for congenital heart disease (CHD). Worldwide, CHD is the most common congenital defect and a leading cause of infant death. The association between maternal diabetes, and CHD in the offspring has previously been studied, however, these studies have been limited by small study cohorts and/or registry studies without systematic transthoracic echocardiography (TTE) of the children.
Purpose
To assess the prevalence of atrial and ventricular septal defects (ASD and VSD) in children born to mothers with pre-existing or gestational diabetes by systematic TTE, in a large, population-based cohort of neonates.
Method
Systematic, standardized TTE was performed in neonates included in a population-based cohort study between 2016 and 2018. For the present study, the prevalence of VSD in cases and controls was assessed in the entire cohort of neonates who underwent TTE within 30 days of birth, and in whom information regarding maternal diabetes was available (n=24,921). The prevalence of ASD was assessed in a sub-cohort of neonates (n=12,682) with the same inclusion criteria and in whom an interatrial communication had been classified as ASD or patent oval foramen according to a validated algorithm. ASD was defined as an interatrial communication with a defect size ≥4mm, a location in the inferior 1/3 of septum, or multiple communications. VSD was defined as flow across the interventricular septum in colour Doppler mode in one or more views. VSDs were classified as either muscular, perimembranous, or subarterial.
Information about maternal pre-existing and gestational diabetes was collected from review of the mother's medical records and from an Obstetrical Database maintained by the participating hospitals.
Cases were compared with controls, which here consists of the full cohort for VSD and sub-cohort for ASD, respectively, after excluding cases.
Results
The median age at examination of the entire cohort was 11 days [interquartile range (IQR) 7; 14] and 48% were female.
The prevalence of VSD in children with maternal diabetes was 3.1% compared with 3.3% among children of mothers without maternal diabetes, RR 1.00 (95% CI 0.99–1.01, p=0.771). There was no difference between cases and controls when comparing the prevalence of subtypes of VSD (table 1).
In the sub-cohort of 12,682 neonates assessed for ASD (median age at examination 12 days [IQR, 8; 15], 48% female), the presence of an ASD was found in 7.3% of cases compared to 5.9% among controls, RR 0.81 (95% CI 0.59–1.13, p=0.214).
Conclusion
In a large population-based cohort of infants, we did not find an increased risk for ASD or VSD, nor any of the subtypes of VSD, among children born to mothers with pre-existing or gestational diabetes as compared to controls.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): The Capital Region of Denmarks Research Fund.The Research Council of Herlev and Gentofte Hospital.
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Affiliation(s)
- M Hansson
- Herlev Hospital - Copenhagen University Hospital, Department of Cardiology , Herlev , Denmark
| | - R O B Voegg
- Herlev Hospital - Copenhagen University Hospital, Department of Cardiology , Herlev , Denmark
| | - E Blixenkrone-Moeller
- Herlev Hospital - Copenhagen University Hospital, Department of Cardiology , Herlev , Denmark
| | - S Dannesbo
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - A M Dehn
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiothoracic Surgery , Copenhagen , Denmark
| | - C Phil
- Herlev Hospital - Copenhagen University Hospital, Department of Cardiology , Herlev , Denmark
| | - A S Sillesen
- Herlev Hospital - Copenhagen University Hospital, Department of Cardiology , Herlev , Denmark
| | - A Axelsson Raja
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - P Damm
- Rigshospitalet - Copenhagen University Hospital, Center for Pregnant Women with Diabetes , Copenhagen , Denmark
| | - E Reinhardt Mathiesen
- Rigshospitalet - Copenhagen University Hospital, Center for Pregnant Women with Diabetes , Copenhagen , Denmark
| | - K Iversen
- Herlev Hospital - Copenhagen University Hospital, Department of Cardiology , Herlev , Denmark
| | - H Bundgaard
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
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Molbert N, Ghanavi H, Hansson M. P07-17 Genomic differences between hedgehog populations from southern Sweden in accordance with their pollutant load. Toxicol Lett 2022. [DOI: 10.1016/j.toxlet.2022.07.360] [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: 11/29/2022]
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17
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Westerlind H, Kastbom A, Rönnelid J, Hansson M, Alfredsson L, Mathsson-Alm L, Serre G, Cornillet M, Holmdahl R, Jakobsson PJ, Skriner K, Bang H, Klareskog L, Saevarsdottir S, Lundberg K, Grönwall C, Askling J. POS0515 THE ASSOCIATION BETWEEN AUTOANTIBODIES AND RISK FOR VENOUS THROMBOEMBOLIC EVENTS AMONG PATIENTS WITH RHEUMATOID ARTHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundPatients with rheumatoid arthritis (RA) have an increased risk for cardiovascular disease, including venous thromboembolic events (VTE)1. The reason behind the increased VTE risk is incompletely understood, but inherent features of RA, such as RA specific autoantibodies, could potentially play a role. For example, studies have linked occurrence and levels of rheumatoid factor (RF) in the general population to increased VTE risk2. We and others have demonstrated an association between ACPA and risk of later ischemic cardiovascular events3. There are also potential mechanistic links; citrullinated fibrinogen (cFib) has been associated to clot stability4.ObjectivesWe aimed to examine the association between anti-modified protein antibodies (AMPAs) and risk of VTE in RA.MethodsWe included 2809 individuals newly diagnosed with RA and included in the Swedish EIRA study 1996-2009. Through linkage to nationwide health care registers we identified past and incident events of VTE based on validated ICD code algorithms. We centrally typed baseline sera for anti-CCP2, 20 different ACPA sub-specificities, RF isotypes, carbamylated antibodies and 10 additional post-translational modifications. We followed all individuals from RA diagnosis up until their first ever VTE event, migration, death or end of study (2020-12-31) whichever occurred first. We used a Cox regression to estimate hazard ratios (HR) with 95% confidence intervals (CI). Individuals with a history of a VTE event (n=27) at RA diagnosis were excluded.ResultsWe included 2782 individuals; 72% were women, median age at RA diagnosis was 54 years (inter quartile range (IQR) 18 years) and median follow-up time was 15.5 (IQR 6.8) years. During follow-up 177 incident VTE events were observed corresponding to an incidence of 5.0 per 1,000 person years.1797 (64.6%) patients were positive for IgG anti-CCP2 and the HR for VTE (vs. being negative for anti-CCP2) was 1.33 (95%CI 1.00-1.78). The risk of VTE increased with the level of anti-CCP2, with an HR of 1.49 (95%CI 0.99-2.22) for the group with extreme levels compared to those negative for anti-CCP2 (p-value for trend 0.048). For IgA anti-CCP2 the HR was 1.35 (95% CI 0.99-1.84) when comparing those expressing IgA anti-CCP2 against those who did not.Of 20 ACPA fine-specificities studied, 18 occurred with a frequency > 10% in our sample. The median number of fine-specificities expressed was 6 (IQR 11). The risk of VTE increased with the number of ACPA fine-specificities expressed (p-value for trend 0.033). At the 0.05 significance level, two fine-specificities were each associated with VTE; cPept Z1 [HR=1.40 (95%CI 1.06-84)] and cPept-1 [HR=1.47 (95%CI 1.12-1.93)]. None of the six antibodies against cFib assessed were statistically significantly associated with VTE risk. No associations were observed for other AMPAs. Among the three RF isotypes, only IgM RF was statistically associated with VTE [HR=1.38 (95%CI 1.04-1.83)].ConclusionRA-related antibodies analysed in clinical practice (anti-CCP2 IgG, RF) are associated not only with risk of myocardial infarction, stroke and cardiovascular death as previously demonstrated but also with VTE. There were no clear specific signals with ACPA fine-specificities, other AMPAs, or IgA RA autoantibodies.References[1]Holmqvist ME,et al. Risk of venous thromboembolism in patients with rheumatoid arthritis and association with disease duration and hospitalization. JAMA. 2012;308(13):1350-6.[2]Meyer-Olesen CL, et al. Increased rheumatoid factor and deep venous thrombosis: 2 cohort studies of 54628 individuals from the general population. Clin Chem. 2015;61(2):349-59.[3]Westerlind H, et al. Anti-citrullinated protein antibody specificities, rheumatoid factor isotypes and incident cardiovascular events in patients with rheumatoid arthritis. Arthritis Rheumatol. 2020.[4]Maners J, et al. A Mendelian randomization of gamma’ and total fibrinogen levels in relation to venous thromboembolism and ischemic stroke. Blood. 2020;136(26):3062-9.Disclosure of InterestsHelga Westerlind: None declared, Alf Kastbom: None declared, Johan Rönnelid: None declared, Monika Hansson: None declared, Lars Alfredsson: None declared, Linda Mathsson-Alm Employee of: LMA an employee of Thermo Fisher Scientific producing the ACPA sub-specificity test, Guy Serre: None declared, Martin Cornillet: None declared, Rikard Holmdahl Consultant of: historically several. Currently paid advisor for Lipum AB and Cyxone AB, Per-Johan Jakobsson Consultant of: UCB – Nov 2021 to Feb 2022., Karl Skriner: None declared, Holger Bang Employee of: HB is an employee of Orgentec Diagnostica, an IVRc company, Lars Klareskog: None declared, Saedis Saevarsdottir Employee of: SS is a part-time employee of deCODE genetics Inc., Karin Lundberg: None declared, Caroline Grönwall: None declared, Johan Askling Grant/research support from: AbbVie, AstraZeneca, Bristol Myers Squibb, Eli Lilly, Janssen, Merck, Pfizer, Roche, Samsung Bioepis, Sanofi, and UCB.
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Brink M, Ljung L, Hansson M, Rönnelid J, Holmdahl R, Skriner K, Serre G, Klareskog L, Rantapää Dahlqvist S. OP0307 PULMONARY FIBROSIS IN EARLY RHEUMATOID ARTHRITIS IN RELATION TO GENETIC LOCI AND INDIVIDUAL ACPA SPECIFICITIES. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundPulmonary manifestations in rheumatoid arthritis (RA) are common comorbidities but the underlying mechanisms are largely unknown. We found in a previous study 3 SNPs associated with pulmonary fibrosis (PF); rs35705950 (MUC5B), rs111521887 (TOLLIP), and rs2609255 (FAM13A) besides age, rheumatoid factor positivity and methotrexate treatment.ObjectivesTo evaluate for the added value of a multiplex of anti-citrullinated peptide antibodies (ACPA) for the development of pulmonary fibrosis (PF) in an inception cohort of RA patients.MethodsA total of 1184 patients with early RA were consecutively included and followed prospectively from the date of diagnosis (index date) until death or until 31 December 2016. The diagnosis of PF was based on high resolution tomography. The presence of 21 ACPA fine specificities were analysed in plasma sampled at index date, using a custom-made microarray chip (Thermo Fisher Scientific, Uppsala, Sweden). Data on both ACPA and genetic data was available for 841 RA patients, of whom 50 developed PF. Associations were analysed using logistic regression analysis and presented as the odds ratio (OR) with the 95% confidence interval (CI). Models were adjusted for sex, age, DAS28 and presence of RF at RA diagnosis, smoking ever, and HLA-SE and in a second step for the three SNPs (.rs35705950, rs111521887 and rs2609255), respectively.ResultsIn unadjusted analyses eight ACPA reactivities were found associated with PF development (p< 0.05-0.001). The number of ACPA reactivities was related to PF development, both in crude and adjusted models (p<0.05 for both). In models concomitantly adjusted for the three SNPs (rs35705950, rs111521887 and rs2609255) respectively, in addition to mentioned adjustments the number of ACPA reactivities (p<0.05 for all three nmodels), Vim60-75 (p<0.05, in all three models), Fibβ62–78 (72) (p<0.001-p<0.05) and F4-CIT-R (p<0.01-p<0.05) were all found significantly associated to PF development irrespective of the SNPs.ConclusionThe development of PF in an inception cohort of RA patients was associated both with risk genes and, independently of the risk genes, the presence of certain ACPA, and the number of ACPA reactivities.References[1]Jönsson E, et al. Pulmonary fibrosis in relation to genetic loci in an inception cohort of patients with early rheumatoid arthritis from northern Sweden. Rheumatology (Oxford). 2021 May 16:keab441. doi: 10.1093/rheumatology/keab441.AcknowledgementsI have no acknowledgements to declare. The staff and patients at the departments of rheumatology in northern Sweden.Disclosure of InterestsNone declared
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Frodlund M, Chatzidionysiou K, Södergren A, Klingberg E, Hansson M, Pin E, Olsson S, Bengtsson A, Klareskog L, Kapetanovic MC. POS0255 PREDICTORS OF ANTIBODY RESPONSE TO COVID-19 VACCINE IN RITUXIMAB TREATED PATIENTS WITH INFLAMMATORY RHEUMATIC DISEASES. A SWEDISH NATIONWIDE STUDY (COVID19-REUMA). Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundIn line with other reports, our group showed that patients treated with rituximab had significant impaired antibody response compared to patients treated with other biologic and targeted and synthetic disease modifying anti-rheumatic drugs (csDMARD).ObjectivesTo investigate predictors of response to COVID-19 vaccination (2 doses of mRNA vaccines, 2 doses of virus vector vaccines or combinations of these) in patients with inflammatory rheumatic diseases (IRD) treated with rituximab and controls.MethodsAntibody levels to three antigens: Spike protein full length, Spike S1 and Nucleocapsid C-terminal fragment (to confirm previous COVID-19 infection) were measured in sera collected before vaccination and 2-12 weeks after the second vaccine using a multiplex bead-based serology assay. The antigen-specific cut-off was defined as the median fluorescence intensity signal plus 6x standard deviations across 12 pre-pandemic controls. A good vaccine response was defined as having antibodies over the cut-off level for both spike antigens. Proportion (%) responders was compared between patients and controls (Chi2 test).Patients with IRD receiving last rituximab treatment within a mean (range) 193 (23-501) days before first vaccination participated. Individuals without IRD served as a control group. Predictors of a good vaccine response were explored using multivariate logistic regression analysis adjusted for age, sex, disease duration, diagnosis (systemic vasculitis/RA/JIA/other), concomitant csDMARD, rituximab dose and prednisolone dose. Hazard ratio (chanse) of a good antibody response in relation to time between the last rituximab treatment and vaccination was studied by Kaplan-Meier survival analysis.ResultsIn total, 145 patients receiving rituximab and 61 controls were inclyded. Of these, 82 received rituximab as monotherapy (67% women; mean age 66 years, mean disease duration 13 years; 33% had RA/JIA and 60% vasculitis) and 63 received rituximab+csDMARD (62% women; mean age 66 years; mean disease duration 17 years; 76% had RA/JIA and 10 % vasculitis). Controls (n=61) were 74% women and mean age 49 years. Compared to controls, rituximab patients had lower antibody levels for both spike proteins (p<0.001). Proportion (%) responders among patients receiving rituximab as monotherapy (40.2%) and rituximab+DMARDs (25.4%) was significantly lower than in controls (98.4%) (p<0.001, Chi2). Higher age, concomitant csDMARD at vaccination and shorter time from last rituximab treatment predicted impaired antibody response (multivariate logistic regression model) (Table 1). Longer time between the last rituximab course and vaccination was associated with better antibody response (Figure 1).Table 1.Predictors of good antibody response to two doses of COVID-19 vaccine defined as antibodies over the cut-off level for both spike antigensBp-valueOR95% CIAge at vaccination (years)-0.040.0090.960.93-0.99Sex (male/female)-9.550.2090.580.24-1.36csDMARD at vaccination (yes/no)-1.080.0260.340.13-0.88Prednisolone (mg/dag)-0.100.1030.900.80-1.02Rituximab dos (1000 mg vs 500 mg)-0.010.3700.990.99-1.00Time between the last rituximab and vaccination (months)0.200.0011.311.11-1.55Diagnosis at vaccination (systemic vasculitis vs others)-0.510.3150.600.21-1.64Figure 1.The chance of good antibody response following two doses of COVID-19 vaccine in relation to time between the last rituximab course and vaccination.ConclusionPatients with IRD getting vaccinated with two doses of COVID19 vaccine during the treatment with rituximab have the ability to develop antibody response although the response is impaired. For each month passed after the last rituximab course, the chance of good antibody response increases with 30%. Younger patients receiving rituximab as monotherapy and vaccinated preferably several months after the last rituximab treatment have the highest chance of achieving a good antibody response.AcknowledgementsUnrestricted research grants have been received from Roche and starting grants from The Swedish Rheumatism AssociationDisclosure of InterestsMartina Frodlund: None declared, Katerina Chatzidionysiou Consultant of: consultancy fees from Eli Lilly, AbbVie and Pfizer., Anna Södergren: None declared, Eva Klingberg: None declared, Monika Hansson: None declared, Elisa Pin: None declared, Sophie Olsson: None declared, Anders Bengtsson: None declared, Lars Klareskog Grant/research support from: has eceived research grants from Pfizer, BMS, Affibody, Sonoma Biotherapeutics, Meliha C Kapetanovic Consultant of: have received consultancy fees from Abbvie, Pfizer and GSK, Grant/research support from: have received unrestricted research grants from Roche and Pfizer
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Groen K, Seefat MR, van der Holt B, Schjesvold FH, Stege CA, Levin MD, Hansson M, Leys RB, Regelink J, Waage A, Szatkowski D, Axelsson P, Do TH, Svirskaite A, van der Spek E, Haukas E, Knut-Bojanowska D, Ypma PF, Blimark C, Mellqvist UH, van de Donk NW, Sonneveld P, Klostergaard A, Vangsted AJ, Abdilgaard N, Zweegman S. P905: IXAZOMIB-THALIDOMIDE-DEXAMETHASONE INDUCTION FOLLOWED BY IXAZOMIB OR PLACEBO MAINTENANCE IN NON-TRANSPLANT ELIGIBLE NEWLY DIAGNOSED MULTIPLE MYELOMA PATIENTS; LONG-TERM RESULTS OF HOVON-126/NMSG 21.13. Hemasphere 2022. [PMCID: PMC9429083 DOI: 10.1097/01.hs9.0000846492.51234.76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Wålinder G, Genell A, Juliusson G, Svensson R, Santamaria AI, Crafoord J, Carlson K, Knut‐Bojanowska D, Veskovski L, Lauri B, Lund J, Turesson I, Hansson M, Blimark CH, Nahi H. Regional differences in treatment and outcome for myeloma patients in Sweden: A population based Swedish myeloma register study. Cancer Rep (Hoboken) 2022; 5:e1614. [PMID: 35243814 PMCID: PMC9675390 DOI: 10.1002/cnr2.1614] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 01/11/2022] [Accepted: 02/16/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND We wanted to evaluate if health care for multiple myeloma (MM) patients is equal in different regions of Sweden. AIM To study differences in survival for MM depending on health care region and early use of modern treatment. METHODS AND RESULTS Data from the Swedish Myeloma Register from patients diagnosed between 2008 and 2017 was used. Cohorts were defined by the six healthcare regions (labeled A-F) in Sweden and modern initial treatment was defined as including certain drug combinations. To adjust for time to treatment bias, survival analyses were performed also for patients alive 6 months after diagnosis. In all treated MM patients (n = 5326), we observed a superior overall survival (OS) for region A compared to all other regions (p < .01 for all respectively). After adjusting for time to treatment there was also a superior survival in the region with highest use of modern initial treatment (region A) compared to the regions defined in the study as having intermediate and low use (p < .01 for both). In patients receiving autologous stem cell transplantation (ASCT) a superior survival was observed for region A compared to all regions besides region B. Similar results were seen when adjusting for a time to treatment bias. In patients not receiving ASCT, 75 years or older and adjusted for time to treatment bias, a difference was noted only between region A and E (log rank p = .04, HR 1.2, CI 1.00-1.44, p = .06). In multivariate analyses including age, international staging system stage and time period of diagnosis, differences in survival remained for patients receiving ASCT between region A versus C, D, E and F (p = .01, p < .01, p < .01, p = .03). CONCLUSION We observed a superior survival in region A for patients receiving ASCT. Explanations may be higher usage of modern initial treatment or regional residual confounding. For patients not receiving ASCT, 75 years or older, differences in survival could be adjusted for.
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Affiliation(s)
- Göran Wålinder
- Department of Medicine HuddingeKarolinska InstituteSolnaSweden,Department of HematologyKarolinska University Hospital HuddingeHuddingeSweden
| | | | | | - Ronald Svensson
- Department of HematologyLinköping University HospitalLinköpingSweden
| | | | - Jacob Crafoord
- Department of HematologyÖrebro University HospitalÖrebroSweden
| | - Kristina Carlson
- Department of HematologyUppsala University HospitalUppsalaSweden
| | | | | | | | - Johan Lund
- Department of Medicine HuddingeKarolinska InstituteSolnaSweden,Department of HematologyKarolinska University Hospital HuddingeHuddingeSweden
| | | | - Markus Hansson
- Department of HematologySahlgrenska University HospitalGothenburgSweden
| | | | - Hareth Nahi
- Department of Medicine HuddingeKarolinska InstituteSolnaSweden,Department of HematologyKarolinska University Hospital HuddingeHuddingeSweden
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22
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Schmitz A, Brøndum RF, Johnsen HE, Mellqvist UH, Waage A, Gimsing P, op Bruinink DH, van der Velden V, van der Holt B, Hansson M, Andersen NF, Frølund UC, Helleberg C, Schjesvold FH, Ahlberg L, Gulbrandsen N, Andreasson B, Lauri B, Haukas E, Bødker JS, Roug AS, Bøgsted M, Severinsen MT, Gregersen H, Abildgaard N, Sonneveld P, Dybkær K. Longitudinal minimal residual disease assessment in multiple myeloma patients in complete remission – results from the NMSG flow-MRD substudy within the EMN02/HO95 MM trial. BMC Cancer 2022; 22:147. [PMID: 35123422 PMCID: PMC8818194 DOI: 10.1186/s12885-022-09184-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/07/2022] [Indexed: 11/20/2022] Open
Abstract
Background Multiple myeloma remains an incurable disease with multiple relapses due to residual myeloma cells in the bone marrow of patients after therapy. Presence of small number of cancer cells in the body after cancer treatment, called minimal residual disease, has been shown to be prognostic for progression-free and overall survival. However, for multiple myeloma, it is unclear whether patients attaining minimal residual disease negativity may be candidates for treatment discontinuation. We investigated, if longitudinal flow cytometry-based monitoring of minimal residual disease (flow-MRD) may predict disease progression earlier and with higher sensitivity compared to biochemical assessments. Methods Patients from the Nordic countries with newly diagnosed multiple myeloma enrolled in the European-Myeloma-Network-02/Hovon-95 (EMN02/HO95) trial and undergoing bone marrow aspiration confirmation of complete response, were eligible for this Nordic Myeloma Study Group (NMSG) substudy. Longitdudinal flow-MRD assessment of bone marrow samples was performed to identify and enumerate residual malignant plasma cells until observed clinical progression. Results Minimal residual disease dynamics were compared to biochemically assessed changes in serum free light chain and M-component. Among 20 patients, reaching complete response or stringent complete response during the observation period, and with ≥3 sequential flow-MRD assessments analysed over time, increasing levels of minimal residual disease in the bone marrow were observed in six cases, preceding biochemically assessed disease and clinical progression by 5.5 months and 12.6 months (mean values), respectively. Mean malignant plasma cells doubling time for the six patients was 1.8 months (95% CI, 1.4–2.3 months). Minimal malignant plasma cells detection limit was 4 × 10–5. Conclusions Flow-MRD is a sensitive method for longitudinal monitoring of minimal residual disease dynamics in multiple myeloma patients in complete response. Increasing minimal residual disease levels precedes biochemically assessed changes and is an early indicator of subsequent clinical progression. Trial registration NCT01208766 Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09184-1.
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Gregersen H, Peceliunas V, Remes K, Schjesvold F, Abildgaard N, Nahi H, Andersen NF, Vangsted AJ, Klausen TW, Helleberg C, Carlson K, Frølund UC, Axelsson P, Stromberg O, Blimark CH, Crafoord J, Tsykunova G, Eshoj HR, Waage A, Hansson M, Gulbrandsen N. Carfilzomib and dexamethasone maintenance following salvage ASCT in multiple myeloma: A randomised phase 2 trial by the Nordic Myeloma Study Group. Eur J Haematol 2021; 108:34-44. [PMID: 34536308 PMCID: PMC9292771 DOI: 10.1111/ejh.13709] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 12/19/2022]
Abstract
Objective We investigated the efficacy and safety of carfilzomib‐containing induction before salvage high‐dose melphalan with autologous stem‐cell transplantation (salvage ASCT) and maintenance with carfilzomib and dexamethasone after salvage ASCT in multiple myeloma. Methods This randomised, open‐label, phase 2 trial included patients with first relapse of multiple myeloma after upfront ASCT who were re‐induced with four cycles of carfilzomib, cyclophosphamide and dexamethasone. Two months after salvage, ASCT patients were randomised to either observation or maintenance therapy with iv carfilzomib 27 → 56 mg/sqm and p.o. dexamethasone 20 mg every second week. The study enrolled 200 patients of which 168 were randomised to either maintenance with carfilzomib and dexamethasone (n = 82) or observation (n = 86). Results Median time to progression (TTP) after randomisation was 25.1 months (22.5‐NR) in the carfilzomib‐dexamethasone maintenance group and 16.7 months (14.4–21.8) in the control group (HR 0.46, 95% CI 0.30–0.71; P = .0004). The most common adverse events during maintenance were thrombocytopenia, anaemia, hypertension, dyspnoea and bacterial infections. Conclusion In summary, maintenance therapy with carfilzomib and dexamethasone after salvage ASCT prolonged TTP with 8 months. The maintenance treatment was in general well‐tolerated with manageable toxicity.
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Affiliation(s)
- Henrik Gregersen
- Department of Haematology, Aalborg University Hospital, Aalborg, Denmark
| | - Valdas Peceliunas
- Department of Haematology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Kari Remes
- Department of Haematology, Turku University Hospital, Turku, Finland
| | - Fredrik Schjesvold
- Oslo Myeloma Center, Oslo University Hospital, Oslo, Norway.,KG Jebsen Center for B cell malignancies, University of Oslo, Oslo, Norway
| | - Niels Abildgaard
- Department of Haematology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Hareth Nahi
- Department of Haematology, Karolinska University Hospital, Stockholm, Sweden
| | | | | | | | | | - Kristina Carlson
- Department of Haematology, Uppsala University Hospital, Uppsala, Sweden
| | | | - Per Axelsson
- Department of Haematology, Helsingborg Hospital, Helsingborg, Sweden
| | - Olga Stromberg
- Department of Haematology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Jacob Crafoord
- Department of Haematology, Örebro University Hospital, Örebro, Sweden
| | - Galina Tsykunova
- Department of Haematology, Haukeland University Hospital, Bergen, Norway
| | - Henrik Rode Eshoj
- Quality of Life Research Center, Department of Haematology, Odense University Hospital, Odense, Denmark.,OPEN, Open Patient data Explorative Network, Odense University Hospital, Region of Southern Denmark, Denmark
| | - Anders Waage
- Department of Haematology, St Olavs hospital and Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Markus Hansson
- Department of Haematology, Skåne University Hospital, Lund, Sweden
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Hemminki K, Försti A, Hansson M. Incidence, mortality and survival in multiple myeloma compared to other hematopoietic neoplasms in Sweden up to year 2016. Sci Rep 2021; 11:17272. [PMID: 34446811 PMCID: PMC8390646 DOI: 10.1038/s41598-021-96804-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 02/23/2021] [Accepted: 07/31/2021] [Indexed: 12/13/2022] Open
Abstract
Survival in multiple myeloma (MM) has developed favorably over the past decades for reasons that have been ascribed to new medications and treatment. However, development of survival over a long period and comparison to other hematopoietic neoplasms (HN) is less well known. Here we used Swedish cancer data from the Nordcan database, spanning a 50-year period from 1967 to 2016, and analyzed 1- and 5-year survival data. As a novel type of analysis we calculate the difference in survival between year 1 and 5 which indicates how well survival was maintained in the 4-year period following year 1 after diagnosis. The relative 1- and 5- year survival increased constantly; the 5-year survival graph for women was almost linear. The difference between 1- and 5-year survival revealed that the 5-year survival gain was entirely due to the improvement in 1-year survival, except for the last period. Survival improvement in all HNs exceeded that in MM. The linear 5-year survival increase for female MM patients suggests a contribution by many small improvements in the first year care rather than single major events. The future challenges are to push the gains past year 1 and to extend them to old patients.
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Affiliation(s)
- Kari Hemminki
- Faculty of Medicine and Biomedical Center in Pilsen, Biomedical Center, Charles University in Prague, 30605, Pilsen, Czech Republic. .,Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, 69120, Heidelberg, Germany.
| | - Asta Försti
- Hopp Children's Cancer Center (KiTZ), Heidelberg, Germany.,Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Markus Hansson
- Sahlgrenska Academy, 413 25, Göteborg, Sweden.,Sahlgrenska University Hospital, 413 25, Göteborg, Sweden
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Richardson PG, Kumar SK, Masszi T, Grzasko N, Bahlis NJ, Hansson M, Pour L, Sandhu I, Ganly P, Baker BW, Jackson SR, Stoppa AM, Gimsing P, Garderet L, Touzeau C, Buadi FK, Laubach JP, Cavo M, Darif M, Labotka R, Berg D, Moreau P. Final Overall Survival Analysis of the TOURMALINE-MM1 Phase III Trial of Ixazomib, Lenalidomide, and Dexamethasone in Patients With Relapsed or Refractory Multiple Myeloma. J Clin Oncol 2021; 39:2430-2442. [PMID: 34111952 DOI: 10.1200/jco.21.00972] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE The double-blind, placebo-controlled, phase III TOURMALINE-MM1 study demonstrated a statistically significant improvement in progression-free survival with ixazomib-lenalidomide-dexamethasone (ixazomib-Rd) versus placebo-Rd in patients with relapsed or refractory multiple myeloma. We report the final analyses for overall survival (OS). PATIENTS AND METHODS Patients were randomly assigned to ixazomib-Rd (n = 360) or placebo-Rd (n = 362), stratified by number of prior therapies (1 v 2 or 3), previous proteasome inhibitor (PI) exposure (yes v no), and International Staging System disease stage (I or II v III). OS (intent-to-treat population) was a key secondary end point. RESULTS With a median follow-up of 85 months, median OS with ixazomib-Rd versus placebo-Rd was 53.6 versus 51.6 months (hazard ratio, 0.939; P = .495). Lower hazard ratios, indicating larger magnitude of OS benefit with ixazomib-Rd versus placebo-Rd, were seen in predefined subgroups: refractory to any (0.794) or last (0.742) treatment line; age > 65-75 years (0.757); International Staging System stage III (0.779); 2/3 prior therapies (0.845); high-risk cytogenetics (0.870); and high-risk cytogenetics and/or 1q21 amplification (0.862). Following ixazomib-Rd versus placebo-Rd, 71.7% versus 69.9% of patients received ≥ 1 anticancer therapy, of whom 24.7% versus 33.9% received daratumumab and 71.8% versus 76.9% received PIs (next-line therapy: 47.5% v 55.8%). Rates of new primary malignancies were similar with ixazomib-Rd (10.3%) and placebo-Rd (11.9%). There were no new or additional safety concerns. CONCLUSION Median OS values in both arms were the longest reported in phase III studies of Rd-based triplets in relapsed or refractory multiple myeloma at the time of this analysis; progression-free survival benefit with ixazomib-Rd versus placebo-Rd did not translate into a statistically significant OS benefit on intent-to-treat analysis. OS benefit was greater in subgroups with adverse prognostic factors. OS interpretation was confounded by imbalances in subsequent therapies received, especially PIs and daratumumab.
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Affiliation(s)
| | | | - Tamás Masszi
- 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Norbert Grzasko
- Department of Experimental Haematooncology, Medical University of Lublin, Lublin, Poland.,Center of Oncology of the Lublin Region St Jana z Dukli, Lublin, Poland
| | - Nizar J Bahlis
- Arnie Charbonneau Cancer Research Institute, University of Calgary, Calgary, Canada
| | - Markus Hansson
- Department of Hematology, Skåne University Hospital, Lund, Sweden.,Sahlgrenska Academy, Göteborg, Sweden
| | - Luděk Pour
- Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | | | - Peter Ganly
- Department of Haematology, Christchurch Hospital, Christchurch, New Zealand
| | - Bartrum W Baker
- Department of Haematology, Palmerston North Hospital, Palmerston North, New Zealand
| | - Sharon R Jackson
- Department of Haematology, Middlemore Hospital, Auckland, New Zealand
| | - Anne-Marie Stoppa
- Department of Hematology, Institut Paoli-Calmettes, Marseille, France
| | - Peter Gimsing
- Department of Hematology, University Hospital Rigshospitalet, Copenhagen, Denmark
| | | | | | | | | | - Michele Cavo
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
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Grönwall C, Liljefors L, Bang H, Hensvold A, Hansson M, Mathsson-Alm L, Israelsson L, Svärd A, Clavel C, Svenungsson E, Gunnarsson I, Serre G, Saevarsdottir S, Kastbom A, Alfredsson L, Malmström V, Rönnelid J, Catrina A, Lundberg K, Klareskog L. POS0009 THE RELATIONSHIP BETWEEN DIFFERENT IGG AND IGA ANTI-MODIFIED PROTEIN AUTOANTIBODIES IN RHEUMATOID ARTHRITIS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Seropositive rheumatoid arthritis (RA) is characterized by the presence of rheumatoid factor (RF) and anti-citrullinated protein autoantibodies (ACPA) with different fine-specificities. Yet, other serum anti-modified protein autoantibodies (AMPA), e.g. anti-carbamylated (Carb), anti-acetylated (KAc), and anti-malondialdehyde acetaldehyde (MAA) modified protein antibodies, have been described. By using RA patient single-cell derived monoclonal antibodies we have previously shown that individual ACPA clones recognize small distinct citrulline-containing epitopes giving them extensive multireactivity when these epitopes are found in many peptides and proteins. Moreover, certain CCP2+ multireactive ACPA clones bind also to cabamylated and acetylated autoantigens [1].Objectives:To provide a comprehensive evaluation of serum IgG and IgA autoreactivity to different post-translational modifications in RA.Methods:We analyzed 30 different IgG and IgA AMPA reactivities to modified antigens by ELISA and autoantigen arrays, in N=1985 newly diagnosed RA patients and population controls. The study utilized both previously established (i.e IgG and IgA CCP2; IgG ACPA fine-specificities; IgG anti-Carb fibrinogen and Carb FCS; IgG and IgA Cit/Carb/KAc/Orn(Ac)-vimentin), and novel assays (e.g. IgG anti-MAA and IgG anti-acetylated histones). Association with patient characteristics such as smoking and disease activity were explored. The newly developed assays were also evaluated in SLE disease controls and CCP2+ RA-risk individuals without arthritis.Results:Carb and KAc reactivities by different assays were primarily seen in patients also positive for citrulline-reactivity. Modified vimentin (mod-Vim) peptides were used for direct comparison of different AMPA reactivities, revealing that IgA AMPA recognizing mod-Vim was mainly detected in subsets of patients with high IgG anti-Cit-Vim levels and a history of smoking. IgG acetylation reactivity was mainly detected in a subset of patients with Cit and Carb reactivity. Anti-acetylated histone 2B reactivity was RA-specific and associated with high anti-CCP2 IgG levels, multiple ACPA fine-specificities, and smoking. This reactivity was also found to be present in CCP2+ RA-risk individuals without arthritis. Our data further demonstrate that IgG autoreactivity to MAA was increased in RA compared to controls with highest levels in CCP2+ RA, but was not RA-specific, and showed low correlation with other AMPA. Anti-MAA was instead associated with disease activity and was not significantly increased in CCP2+ individuals at risk of RA. Notably, RA patients could be subdivided into four different subsets based on their AMPA IgG and IgA reactivity profiles.Conclusion:We conclude that autoantibodies exhibiting different patterns of ACPA fine-specificities as well as Carb and KAc reactivity are present in RA and may be derived from multireactive B-cell clones. Anti-Carb and anti-KAc could be considered reactivities within the “Cit-umbrella” similar to ACPA fine-specificities, while MAA is distinctly different.References:[1]Sahlström P, Hansson M, Steen J, Amara K, Titcombe PJ, Forsström B, Stålesen R, Israelsson L, Piccoli L, Lundberg K, Klareskog L, Mueller DL, Catrina AI, Skriner K, Malmström V, Grönwall C. Different Hierarchies of Anti-Modified Protein Autoantibody Reactivities in Rheumatoid Arthritis. Arthritis Rheumatol. 2020 Oct;72(10):1643-1657. PMID: 32501655Caroline Grönwall: None declared, Lisa Liljefors: None declared, Holger Bang Employee of: Employee at ORGENTEC Diagnostika GmbH, Aase Hensvold: None declared, Monika Hansson: None declared, Linda Mathsson-Alm Employee of: Employee at Thermo Fisher Scientific, Lena Israelsson: None declared, Anna Svärd: None declared, Cyril CLAVEL: None declared, Elisabet Svenungsson: None declared, Iva Gunnarsson: None declared, Guy Serre: None declared, Saedis Saevarsdottir: None declared, Alf Kastbom: None declared, Lars Alfredsson: None declared, Vivianne Malmström: None declared, Johan Rönnelid: None declared, Anca Catrina: None declared, Karin Lundberg: None declared, Lars Klareskog: None declared
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Lourido L, Ruiz-Romero C, Collado L, Hansson M, Klareskog L, Sjöberg R, Pin E, Nilsson P, Blanco FJ. POS0392 PRESENCE OF FOUR SERUM AUTOANTIBODIES ASSOCIATES WITH THE ACPA STATUS IN EARLY RHEUMATOID ARTHRITIS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:The presence of anti-citrullinated protein antibodies (ACPAs) is a hallmark of rheumatoid arthritis (RA) that precede the development of the disease by years and is used for its clinical diagnosis. However, there are RA subjects that test negative for ACPA and thus the early diagnosis on these patients may be delayed. Furthermore, the presence or absence of ACPA in RA supports the hypothesis that on these two subsets of patients underlie different pathogenesis and clinical outcomes.Objectives:In this work, we searched for serum autoantibodies useful to assist the early diagnosis of ACPA-seronegative RA and its management.Methods:We profiled the serum autoantibody repertoire of 80 ACPA-seronegative and 80 ACPA-seropositive RA subjects from the Swedish population-based Epidemiological Investigation of RA (EIRA) cohort. A suspension bead array platform built on protein fragments within Human Protein Atlas and selected from an initial untargeted screening using arrays containing 2660 total antigens was employed to identify IgG and IgA serum autoantibodies. A validation phase on antigen suspension bead arrays was carried out on another set of samples from EIRA containing 386 ACPA-seropositive, 358 ACPA-seronegative and 372 randomly selected control subjects of the same age and sex. A sample-specific threshold based on 20 times the median absolute deviation plus the median of all signals was selected to determine the reactivity of samples. The Wilcoxon rank sum test and Fisher’s test were applied for the comparison of autoantibody levels and reactivity frequencies between the groups.Results:Our data revealed four antigens associated with the ACPA status (Table 1). Testis-specific Y-encoded-like protein 4 (TSPYL4) showed significantly higher IgG reactivity frequency in ACPA-seronegative subjects compared to ACPA-seropositive (8% vs. 3%; P<0.05). Significant differences at IgG autoantibody levels (P<0.05) were also observed between ACPA-seronegative subjects and controls for this specific antigen. Significantly higher IgG autoantibody levels (P<0.05) towards another antigen, dual specificity mitogen-activated protein kinase kinase 6 (MAP2K6), were also observed in ACPA-seronegative subjects compared to ACPA-seropositive and controls. In contrast, we found significantly higher IgG autoantibody levels (P<0.05) in ACPA-seropositive individuals compared to ACPA-seronegative and controls towards two antigens, anosmin-1 (ANOS-1) and muscle related coiled-coil protein (MURC). ANOS-1 shows also significantly higher IgG reactivity frequency in ACPA-seropositive individuals compared to ACPA-seronegative and controls (22%, 9% and 6% respectively; P<0.05). Interestingly, three out of the four antigens discovered to be associated with the ACPA status in early RA are highly expressed in lungs and heart, two of the main extraarticular sites affected in RA. No significant differences were observed at IgA levels for any of the antigens analyzed.Table 1.Scheme of the different phases of the study, the features within each phase and the results. The reactivity to four antigens allows to distinguish ACPA-seronegative (ACPA-), ACPA seropositive (ACPA+) and controls.PhasesUntargeteddiscoveryTargeteddiscoveryTargetedvalidationNumber of samples80 ACPA-80 ACPA-358 ACPA-372 Controls80 ACPA+80 ACPA+386 ACPA+Antigen arrayplatformPlanararraysSuspensionbead array 1Suspensionbead array 2Number of antigens26606227Number of candidatebiomarkers6227 4 (TSPYL4,MAP2K6,ANOS1,MURC)Conclusion:Upon further validation in other early RA sample cohorts, our data suggest the measurement of these four autoantibodies may be useful for the early diagnosis of ACPA-seronegative RA and give insight into the pathogenesis of the different RA subsets.Characters from table content including title and footnotes:Disclosure of Interests:None declared
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Linnér E, Pilebro B, Eldhagen P, Hansson M, Andersson B, Wikström G, Gustav Smith J. [Not Available]. Lakartidningen 2021; 118:20138. [PMID: 33884589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Erik Linnér
- doktorand, ST-läkare, VO akutsjukvård och internmedicin, Skånes universitetssjukhus Malmö
| | - Björn Pilebro
- med dr, överläkare, Hjärtcentrum, Norrlands universitetssjukhus, Umeå
| | - Per Eldhagen
- doktorand, bitr överläkare, ME kardiologi, Karolinska universitetssjukhuset, Stockholm
| | - Markus Hansson
- professor, överläkare, sektionen för hematologi och koagulation, Sahlgrenska universitetssjukhuset, Göteborg
| | - Bert Andersson
- professor, överläkare, , Kardiologi, Sahlgrenska universitetssjukhuset, Göteborg
| | - Gerhard Wikström
- professor, överläkare, institutionen för medi-cinska vetenskaper, Uppsala universitet
| | - J Gustav Smith
- professor, överläkare, Kardiologi, Sahlgrenska universitetssjukhuset, Göteborg
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Duran-Lozano L, Thorleifsson G, Lopez de Lapuente Portilla A, Niroula A, Went M, Thodberg M, Pertesi M, Ajore R, Cafaro C, Olason PI, Stefansdottir L, Bragi Walters G, Halldorsson GH, Turesson I, Kaiser MF, Weinhold N, Abildgaard N, Andersen NF, Mellqvist UH, Waage A, Juul-Vangsted A, Thorsteinsdottir U, Hansson M, Houlston R, Rafnar T, Stefansson K, Nilsson B. Germline variants at SOHLH2 influence multiple myeloma risk. Blood Cancer J 2021; 11:76. [PMID: 33875642 PMCID: PMC8055668 DOI: 10.1038/s41408-021-00468-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/17/2021] [Accepted: 03/31/2021] [Indexed: 12/17/2022] Open
Abstract
Multiple myeloma (MM) is caused by the uncontrolled, clonal expansion of plasma cells. While there is epidemiological evidence for inherited susceptibility, the molecular basis remains incompletely understood. We report a genome-wide association study totalling 5,320 cases and 422,289 controls from four Nordic populations, and find a novel MM risk variant at SOHLH2 at 13q13.3 (risk allele frequency = 3.5%; odds ratio = 1.38; P = 2.2 × 10-14). This gene encodes a transcription factor involved in gametogenesis that is normally only weakly expressed in plasma cells. The association is represented by 14 variants in linkage disequilibrium. Among these, rs75712673 maps to a genomic region with open chromatin in plasma cells, and upregulates SOHLH2 in this cell type. Moreover, rs75712673 influences transcriptional activity in luciferase assays, and shows a chromatin looping interaction with the SOHLH2 promoter. Our work provides novel insight into MM susceptibility.
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Affiliation(s)
- Laura Duran-Lozano
- Hematology and Transfusion Medicine, Department of Laboratory Medicine, 221 84, Lund, Sweden
| | | | | | - Abhishek Niroula
- Hematology and Transfusion Medicine, Department of Laboratory Medicine, 221 84, Lund, Sweden
- Broad Institute, 415 Main Street, Cambridge, MA, 02124, USA
| | - Molly Went
- Division of Genetics and Epidemiology, The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
| | - Malte Thodberg
- Hematology and Transfusion Medicine, Department of Laboratory Medicine, 221 84, Lund, Sweden
| | - Maroulio Pertesi
- Hematology and Transfusion Medicine, Department of Laboratory Medicine, 221 84, Lund, Sweden
| | - Ram Ajore
- Hematology and Transfusion Medicine, Department of Laboratory Medicine, 221 84, Lund, Sweden
| | - Caterina Cafaro
- Hematology and Transfusion Medicine, Department of Laboratory Medicine, 221 84, Lund, Sweden
| | - Pall I Olason
- deCODE genetics, Sturlugata 8, IS-101, Reykjavik, Iceland
| | | | | | | | - Ingemar Turesson
- Hematology Clinic, Lund University Hospital, 221 85, Lund, Sweden
| | - Martin F Kaiser
- Division of Genetics and Epidemiology, The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
| | - Niels Weinhold
- Department of Internal Medicine V, University Hospital of Heidelberg, 69120, Heidelberg, Germany
| | - Niels Abildgaard
- Hematology Research Unit, Department of Clinical Research, University of Southern Denmark and Department of Hematology, Odense University Hospital, Odense, Denmark
| | | | | | - Anders Waage
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Department of Hematology, and Biobank1, St Olavs hospital, Trondheim, Norway
| | - Annette Juul-Vangsted
- Department of Haematology, University Hospital of Copenhagen at Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Unnur Thorsteinsdottir
- deCODE genetics, Sturlugata 8, IS-101, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Markus Hansson
- Hematology and Transfusion Medicine, Department of Laboratory Medicine, 221 84, Lund, Sweden
- Hematology Clinic, Lund University Hospital, 221 85, Lund, Sweden
| | - Richard Houlston
- Division of Genetics and Epidemiology, The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
| | - Thorunn Rafnar
- deCODE genetics, Sturlugata 8, IS-101, Reykjavik, Iceland
| | - Kari Stefansson
- deCODE genetics, Sturlugata 8, IS-101, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Björn Nilsson
- Hematology and Transfusion Medicine, Department of Laboratory Medicine, 221 84, Lund, Sweden.
- Broad Institute, 415 Main Street, Cambridge, MA, 02124, USA.
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Nahi H, Walinder G, Patel V, Qu Y, Levine A, Majer I, Kutikova L, Hellqvist Franck E, Svensson MK, Hansson M. Burden of Treatment-Induced Peripheral Neuropathy in Patients with Multiple Myeloma in Sweden. Acta Haematol 2021; 144:519-527. [PMID: 33631745 DOI: 10.1159/000512165] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 10/08/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Treatment-induced peripheral neuropathy (TIPN) is a complication of multiple myeloma (MM) treatment. OBJECTIVE This real-world, retrospective study used electronic medical record (EMR) data from 3 Swedish clinics to assess the occurrence and economic burden of TIPN in patients with MM. METHODS Eligible patients had an MM diagnosis in the Swedish Cancer Registry between 2006 and 2015 and initiated treatment during that period. Follow-up was until last EMR visit, death, or study end (April 2017). The current analyses included patients receiving bortezomib, lenalidomide, carfilzomib, or thalidomide at any treatment line. To discern healthcare resource utilization (HCRU) and costs associated with TIPN from other causes, patients with TIPN were matched with those without on baseline characteristics, treatment, and line of therapy. All analyses were descriptive. RESULTS Overall, 457 patients were included; 102 (22%) experienced TIPN. Patients experiencing TIPN during first-line treatment mostly received bortezomib-based regimens (n = 48/57 [84%]); those with TIPN during second- and third/fourth-line treatment mostly received lenalidomide/thalidomide-based regimens (19/31 [61%], 8/14 [57%], respectively). Patients with TIPN had higher HCRU/costs than those without TIPN (mean differences in hospital outpatient visits: 5.2, p = 0.0031; total costs per patient-year: EUR 17,183, p = 0.0007). CONCLUSIONS Effective MM treatments associated with a reduced incidence of TIPN could result in decreased healthcare expenditure.
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Affiliation(s)
- Hareth Nahi
- Haematology Centre Karolinska, Karolinska University Hospital, Stockholm, Sweden,
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden,
| | - Göran Walinder
- Haematology Centre Karolinska, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | | | | | | | | | | | - Maria K Svensson
- Amgen AB, Stockholm, Sweden
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Markus Hansson
- Department of Hematology, Lund University, Lund, Sweden
- Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, Göteborg, Sweden
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Zweegman S, Stege CA, Haukas E, Schjesvold FH, Levin MD, Waage A, Leys RB, Klein SK, Szatkowski D, Axelsson P, Do TH, Knut-Bojanowska D, van der Spek E, Svirskaite A, Klostergaard A, Salomo M, Blimark C, Ypma PF, Mellqvist UH, Poddighe PJ, Stevens-Kroef M, van de Donk NW, Sonneveld P, Hansson M, van der Holt B, Abildgaard N. Ixazomib-Thalidomide-low dose dexamethasone induction followed by maintenance therapy with ixazomib or placebo in newly diagnosed multiple myeloma patients not eligible for autologous stem cell transplantation; results from the randomized phase II HOVON-126/NMSG 21.13 trial. Haematologica 2020; 105:2879-2882. [PMID: 33256392 PMCID: PMC7716358 DOI: 10.3324/haematol.2019.240374] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Sonja Zweegman
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Claudia A.M. Stege
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Einar Haukas
- Stavanger University Hospital-Rogaland Hospital, Stavanger, Norway
| | | | | | - Anders Waage
- St Olavs Hospital and Norwegian University of Science, Trondheim, Norway
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Pino J. Poddighe
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | | | - Niels W.C.J. van de Donk
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Pieter Sonneveld
- Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands and
| | | | | | - Niels Abildgaard
- Hematology Research Unit and Academy of Geriatric Cancer Research, Odense University Hospital and University of Southern Denmark, Denmark
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Circiumaru A, Kisten Y, Hansson M, Joshua V, Sun M, Rezaei H, Af Klint E, Antovic A, Catrina A, Hensvold A. SAT0584 SPECIFIC ACPA REACTIVITIES AND INFLAMMATORY BIOMARKERS ALONG WITH ULTRASOUND TENOSYNOVITIS ARE ASSOCIATED WITH ARTHRITIS ONSET IN A POPULATION AT RISK FOR RHEUMATOID ARTHRITIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Anti-citrullinated protein antibodies (ACPA) are characteristic markers for rheumatoid arthritis (RA), developing years before disease onset. Early clinical and biological biomarkers could provide useful information on the onset of RA in predisposed individuals.Objectives:The aim of the study was to investigate whether ACPA along with inflammatory markers and musculoskeletal ultrasound changes could predict arthritis development in individuals at risk for RA.Methods:ACPA-positive individuals with musculoskeletal complaints were referred from primary care to a rheumatology clinic, recruited in the Risk-RA research program and followed-up for up to 3 years, between April 2014 and October 2019. All individuals lacked arthritis both at clinical examination by a trained rheumatologist and ultrasound assessment of hands and feet and any other symptomatic joints (according to EULAR-OMERACT definition). Blood samples were collected at inclusion and were analyzed for 15 ACPA fine specificities (by custom made peptide array), 92 inflammation-associated protein biomarkers (by multiplex immunoassay with Olink extension technology) and HLA-SE (DR low resolution kit). Statistical analysis used univariate and multivariate models with backwards selection and cox regression.Results:268 individuals with a median age of 48 (36-58) were recruited, out of which 212 (79%) were females. 75 (28%) developed arthritis within 11 months of follow-up while the median follow-up for those not developing arthritis was 21 months (14-28). Increased ACPA levels, shorter symptom duration and RF positivity were the main differences between individuals developing arthritis and those who did not. In univariate models, the presence of HLA-SE, specific ACPA reactivities, certain inflammatory markers and ultrasound-detected tenosynovitis were associated with arthritis development. In multivariate analysis the presence of anti-cit-fillagrin (HR 2.1 (95% CI 1.2-3.7, p 0.01), IL6 levels (HR 1.4 (95% CI 1.2-1.7, p 0.0001) and tenosynovitis (HR 2.9 (95% CI 1.7-5.0, p 0.0001) remained significant predictors for arthritis onset.Conclusion:Certain ACPA reactivities together with inflammatory markers and ultrasound-detected tenosynovitis predict arthritis development in predisposed individuals for developing RA.Disclosure of Interests:None declared
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Cavo M, Gay F, Beksac M, Pantani L, Petrucci MT, Dimopoulos MA, Dozza L, van der Holt B, Zweegman S, Oliva S, van der Velden VHJ, Zamagni E, Palumbo GA, Patriarca F, Montefusco V, Galli M, Maisnar V, Gamberi B, Hansson M, Belotti A, Pour L, Ypma P, Grasso M, Croockewit A, Ballanti S, Offidani M, Vincelli ID, Zambello R, Liberati AM, Andersen NF, Broijl A, Troia R, Pascarella A, Benevolo G, Levin MD, Bos G, Ludwig H, Aquino S, Morelli AM, Wu KL, Boersma R, Hajek R, Durian M, von dem Borne PA, Caravita di Toritto T, Zander T, Driessen C, Specchia G, Waage A, Gimsing P, Mellqvist UH, van Marwijk Kooy M, Minnema M, Mandigers C, Cafro AM, Palmas A, Carvalho S, Spencer A, Boccadoro M, Sonneveld P. Autologous haematopoietic stem-cell transplantation versus bortezomib-melphalan-prednisone, with or without bortezomib-lenalidomide-dexamethasone consolidation therapy, and lenalidomide maintenance for newly diagnosed multiple myeloma (EMN02/HO95): a multicentre, randomised, open-label, phase 3 study. Lancet Haematol 2020; 7:e456-e468. [PMID: 32359506 DOI: 10.1016/s2352-3026(20)30099-5] [Citation(s) in RCA: 212] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/12/2020] [Accepted: 03/12/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The emergence of highly active novel agents has led some to question the role of autologous haematopoietic stem-cell transplantation (HSCT) and subsequent consolidation therapy in newly diagnosed multiple myeloma. We therefore compared autologous HSCT with bortezomib-melphalan-prednisone (VMP) as intensification therapy, and bortezomib-lenalidomide-dexamethasone (VRD) consolidation therapy with no consolidation. METHODS In this randomised, open-label, phase 3 study we recruited previously untreated patients with multiple myeloma at 172 academic and community practice centres of the European Myeloma Network. Eligible patients were aged 18-65 years, had symptomatic multiple myeloma stage 1-3 according to the International Staging System (ISS), measurable disease (serum M protein >10 g/L or urine M protein >200 mg in 24 h or abnormal free light chain [FLC] ratio with involved FLC >100 mg/L, or proven plasmacytoma by biopsy), and WHO performance status grade 0-2 (grade 3 was allowed if secondary to myeloma). Patients were first randomly assigned (1:1) to receive either four 42-day cycles of bortezomib (1·3 mg/m2 administered intravenously or subcutaneously on days 1, 4, 8, 11, 22, 25, 29, and 32) combined with melphalan (9 mg/m2 administered orally on days 1-4) and prednisone (60 mg/m2 administered orally on days 1-4) or autologous HSCT after high-dose melphalan (200 mg/m2), stratified by site and ISS disease stage. In centres with a double HSCT policy, the first randomisation (1:1:1) was to VMP or single or double HSCT. Afterwards, a second randomisation assigned patients to receive two 28-day cycles of consolidation therapy with bortezomib (1·3 mg/m2 either intravenously or subcutaneously on days 1, 4, 8, and 11), lenalidomide (25 mg orally on days 1-21), and dexamethasone (20 mg orally on days 1, 2, 4, 5, 8, 9, 11, and 12) or no consolidation; both groups received lenalidomide maintenance therapy (10 mg orally on days 1-21 of a 28-day cycle). The primary outcomes were progression-free survival from the first and second randomisations, analysed in the intention-to-treat population, which included all patients who underwent each randomisation. All patients who received at least one dose of study drugs were included in the safety analyses. This study is registered with the EU Clinical Trials Register (EudraCT 2009-017903-28) and ClinicalTrials.gov (NCT01208766), and has completed recruitment. FINDINGS Between Feb 25, 2011, and April 3, 2014, 1503 patients were enrolled. 1197 patients were eligible for the first randomisation, of whom 702 were assigned to autologous HSCT and 495 to VMP; 877 patients who were eligible for the first randomisation underwent the second randomisation to VRD consolidation (n=449) or no consolidation (n=428). The data cutoff date for the current analysis was Nov 26, 2018. At a median follow-up of 60·3 months (IQR 52·2-67·6), median progression-free survival was significantly improved with autologous HSCT compared with VMP (56·7 months [95% CI 49·3-64·5] vs 41·9 months [37·5-46·9]; hazard ratio [HR] 0·73, 0·62-0·85; p=0·0001). For the second randomisation, the number of events of progression or death at data cutoff was lower than that preplanned for the final analysis; therefore, the results from the second protocol-specified interim analysis, when 66% of events were reached, are reported (data cutoff Jan 18, 2018). At a median follow-up of 42·1 months (IQR 32·3-49·2), consolidation therapy with VRD significantly improved median progression-free survival compared with no consolidation (58·9 months [54·0-not estimable] vs 45·5 months [39·5-58·4]; HR 0·77, 0·63-0·95; p=0·014). The most common grade ≥3 adverse events in the autologous HSCT group compared to the VMP group included neutropenia (513 [79%] of 652 patients vs 137 [29%] of 472 patients), thrombocytopenia (541 [83%] vs 74 [16%]), gastrointestinal disorders (80 [12%] vs 25 [5%]), and infections (192 [30%] vs 18 [4%]). 239 (34%) of 702 patients in the autologous HSCT group and 135 (27%) of 495 in the VMP group had at least one serious adverse event. Infection was the most common serious adverse event in each of the treatment groups (206 [56%] of 368 and 70 [37%] of 189). 38 (12%) of 311 deaths from first randomisation were likely to be treatment related: 26 (68%) in the autologous HSCT group and 12 (32%) in the VMP group, most frequently due to infections (eight [21%]), cardiac events (six [16%]), and second primary malignancies (20 [53%]). INTERPRETATION This study supports the use of autologous HSCT as intensification therapy and the use of consolidation therapy in patients with newly diagnosed multiple myeloma, even in the era of novel agents. The role of high-dose chemotherapy needs to be reassessed in future studies, in particular in patients with undetectable minimal residual disease after four-drug induction regimens including a monoclonal antiboby combined with an immunomodulatory agent and a proteasome inhibitor plus dexamethasone. FUNDING Janssen and Celgene.
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Affiliation(s)
- Michele Cavo
- Seràgnoli Institute of Hematology, Department of Experimental, Diagnostic and Specialty Medicine, Bologna University School of Medicine, S Orsola Malpighi Hospital, Bologna, Italy.
| | - Francesca Gay
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Meral Beksac
- Department of Hematology, Ankara University School of Medicine, Ankara, Turkey
| | - Lucia Pantani
- Seràgnoli Institute of Hematology, Department of Experimental, Diagnostic and Specialty Medicine, Bologna University School of Medicine, S Orsola Malpighi Hospital, Bologna, Italy
| | - Maria Teresa Petrucci
- Hematology, Department of Translational and Precision Medicine, Azienda Ospedaliera Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Luca Dozza
- Seràgnoli Institute of Hematology, Department of Experimental, Diagnostic and Specialty Medicine, Bologna University School of Medicine, S Orsola Malpighi Hospital, Bologna, Italy
| | - Bronno van der Holt
- Department of Trials and Statistics-HOVON Data Centre, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Sonja Zweegman
- Department of Hematology, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Stefania Oliva
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | | | - Elena Zamagni
- Seràgnoli Institute of Hematology, Department of Experimental, Diagnostic and Specialty Medicine, Bologna University School of Medicine, S Orsola Malpighi Hospital, Bologna, Italy
| | - Giuseppe A Palumbo
- Dipartimento di Science Mediche Chirurgiche e Tecnologie Avanzate "GF Ingrassia", Università degli Studi di Catania, Catania, Italy
| | - Francesca Patriarca
- Clinical Hematology and Bone Marrow Transplant Centre, S Maria della Misericordia University Hospital, DAME, University of Udine, Udine, Italy
| | - Vittorio Montefusco
- Hematology Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Monica Galli
- Hematology and Bone Marrow Transplant Unit, ASST-Papa Giovanni XXIII, Bergamo, Italy
| | - Vladimir Maisnar
- 4th Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Kralove, Czech Republic
| | | | | | - Angelo Belotti
- SC Ematologia e Dipartimento di Oncologia Clinica, AO Spedali Civili, Brescia, Italy
| | - Ludek Pour
- University Hospital Brno, Brno, Czech Republic
| | - Paula Ypma
- Department of Hematology, Haga Hospital, The Hague, Netherlands
| | - Mariella Grasso
- SC Ematologia, Azienda Ospedaliera S Croce-Carle, Cuneo, Italy
| | | | - Stelvio Ballanti
- Reparto di Ematologia con TMO, Ospedale Santa Maria della Misericordia, Perugia, Italy
| | - Massimo Offidani
- Clinica di Ematologia, AOU Ospedali Riuniti di Ancona, Ancona, Italy
| | - Iolanda D Vincelli
- Division of Haematology, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | | | | | | | - Annemiek Broijl
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Rossella Troia
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Anna Pascarella
- Hematology Unit, Ospedale dell'Angelo, Mestre, Venice, Italy
| | - Giulia Benevolo
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Mark-David Levin
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, Netherlands
| | - Gerard Bos
- Department of Haematology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Heinz Ludwig
- Wilhelminen Cancer Research Institute, Wilhelminenspital, Vienna, Austria
| | - Sara Aquino
- Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Anna Maria Morelli
- Clinical Hematology, Department of Hematology, Transfusion Medicine and Biotechnology, "Spirito Santo" Civic Hospital, Pescara, Italy
| | - Ka Lung Wu
- Department of Hematology, ZNA Stuivenberg, Antwerp, Belgium
| | - Rinske Boersma
- Department of Internal Medicine, Amphia Hospital Breda, Breda, Netherlands
| | - Roman Hajek
- Department of Hematooncology, University Hospital Ostrava and University of Ostrava, Ostrava, Czech Republic
| | - Marc Durian
- University Hospital and Faculty of Medicine, Hradec Kralove, Czech Republic
| | | | | | - Thilo Zander
- Department Oncology/Hematology, Kantonsspital, Lucerne, Switzerland
| | | | | | - Anders Waage
- Department of Hematology, St Olavs Hospital and Norwegian University of Science and Technology, Trondheim, Norway
| | - Peter Gimsing
- Department of Haematology, University of Copenhagen, Copenhagen, Denmark
| | - Ulf-Henrik Mellqvist
- Department of Medicine, Section of Hematology and Coagulation, South Elvsborg Hospital, Gothenburg, Sweden
| | | | - Monique Minnema
- Department of Hematology, UMC Utrecht, University Utrecht, Utrecht, Netherlands
| | - Caroline Mandigers
- Department of Hematology, Canisius-Wilhelmina Hospital, Nijmegen, Netherlands
| | - Anna Maria Cafro
- Department of Hematology, ASST Grande Ospedale Metropolitano, Niguarda, Milan, Italy
| | | | - Susanna Carvalho
- Instituto Português de Oncologia de Lisboa Francisco Gentil, IPOLFG, Lisbon, Portugal
| | - Andrew Spencer
- Department of Haematology, Alfred Hospital-Monash University, Melbourne, VIC, Australia
| | - Mario Boccadoro
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Pieter Sonneveld
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
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Wålinder G, Samuelsson J, Näsman P, Hansson M, Juliusson G, Forsberg K, Svensson R, Linder O, Carlson K, Kristinsson SY, Mellqvist UH, Hveding Blimark C, Turesson I, Nahi H. Outcome and characteristics of non‐measurable myeloma: A cohort study with population‐based data from the Swedish Myeloma Registry. Eur J Haematol 2020; 104:376-382. [DOI: 10.1111/ejh.13351] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/05/2019] [Accepted: 11/06/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Göran Wålinder
- Department of Medicine Karolinska Institutet Stockholm Sweden
- Department of Hematology Karolinska University Hospital Huddinge Huddinge Sweden
| | - Jan Samuelsson
- Department of Hematology Linkoping University Hospital Linköping Sweden
| | - Per Näsman
- Center for Safety Research KTH Royal Institute of Technology Stockholm Sweden
| | - Markus Hansson
- Hematology Lund University Lund Sweden
- Department of Hematology Skåne University Hospital Lund‐Malmö Sweden
| | | | - Karin Forsberg
- Department of Hematology Norrlands University Hospital Umeå Sweden
| | - Ronald Svensson
- Department of Hematology Linkoping University Hospital Linköping Sweden
| | - Olle Linder
- Department of Hematology Örebro University Hospital Örebro Sweden
| | - Kristina Carlson
- Department of Hematology Uppsala University Hospital Uppsala Sweden
| | | | | | | | - Ingemar Turesson
- Hematology Lund University Lund Sweden
- Department of Hematology Skåne University Hospital Lund‐Malmö Sweden
| | - Hareth Nahi
- Department of Medicine Karolinska Institutet Stockholm Sweden
- Department of Hematology Karolinska University Hospital Huddinge Huddinge Sweden
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35
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Pertesi M, Went M, Hansson M, Hemminki K, Houlston RS, Nilsson B. Genetic predisposition for multiple myeloma. Leukemia 2020; 34:697-708. [PMID: 31913320 DOI: 10.1038/s41375-019-0703-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 12/24/2019] [Indexed: 12/14/2022]
Abstract
Multiple myeloma (MM) is the second most common blood malignancy. Epidemiological family studies going back to the 1920s have provided evidence for familial aggregation, suggesting a subset of cases have an inherited genetic background. Recently, studies aimed at explaining this phenomenon have begun to provide direct evidence for genetic predisposition to MM. Genome-wide association studies have identified common risk alleles at 24 independent loci. Sequencing studies of familial cases and kindreds have begun to identify promising candidate genes where variants with strong effects on MM risk might reside. Finally, functional studies are starting to give insight into how identified risk alleles promote the development of MM. Here, we review recent findings in MM predisposition field, and highlight open questions and future directions.
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Affiliation(s)
- Maroulio Pertesi
- Hematology and Transfusion Medicine, Department of Laboratory Medicine, BMC B13, 221 84, Lund, Sweden
| | - Molly Went
- Division of Genetics and Epidemiology, The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey, SM2 5NG, UK
| | - Markus Hansson
- Hematology and Transfusion Medicine, Department of Laboratory Medicine, BMC B13, 221 84, Lund, Sweden
| | - Kari Hemminki
- Department of Cancer Epidemiology, German Cancer Research Center, Im Neuenheimer Feld, Heidelberg, Germany.,Faculty of Medicine and Biomedical Center, Charles University in Prague, 30605, Pilsen, Czech Republic
| | - Richard S Houlston
- Division of Genetics and Epidemiology, The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey, SM2 5NG, UK
| | - Björn Nilsson
- Hematology and Transfusion Medicine, Department of Laboratory Medicine, BMC B13, 221 84, Lund, Sweden. .,Broad Institute, 415 Main Street, Cambridge, MA, 02142, USA.
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36
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Schmidt AF, Holmes MV, Preiss D, Swerdlow DI, Denaxas S, Fatemifar G, Faraway R, Finan C, Valentine D, Fairhurst-Hunter Z, Hartwig FP, Horta BL, Hypponen E, Power C, Moldovan M, van Iperen E, Hovingh K, Demuth I, Norman K, Steinhagen-Thiessen E, Demuth J, Bertram L, Lill CM, Coassin S, Willeit J, Kiechl S, Willeit K, Mason D, Wright J, Morris R, Wanamethee G, Whincup P, Ben-Shlomo Y, McLachlan S, Price JF, Kivimaki M, Welch C, Sanchez-Galvez A, Marques-Vidal P, Nicolaides A, Panayiotou AG, Onland-Moret NC, van der Schouw YT, Matullo G, Fiorito G, Guarrera S, Sacerdote C, Wareham NJ, Langenberg C, Scott RA, Luan J, Bobak M, Malyutina S, Pająk A, Kubinova R, Tamosiunas A, Pikhart H, Grarup N, Pedersen O, Hansen T, Linneberg A, Jess T, Cooper J, Humphries SE, Brilliant M, Kitchner T, Hakonarson H, Carrell DS, McCarty CA, Lester KH, Larson EB, Crosslin DR, de Andrade M, Roden DM, Denny JC, Carty C, Hancock S, Attia J, Holliday E, Scott R, Schofield P, O'Donnell M, Yusuf S, Chong M, Pare G, van der Harst P, Said MA, Eppinga RN, Verweij N, Snieder H, Christen T, Mook-Kanamori DO, Gustafsson S, Lind L, Ingelsson E, Pazoki R, Franco O, Hofman A, Uitterlinden A, Dehghan A, Teumer A, Baumeister S, Dörr M, Lerch MM, Völker U, Völzke H, Ward J, Pell JP, Meade T, Christophersen IE, Maitland-van der Zee AH, Baranova EV, Young R, Ford I, Campbell A, Padmanabhan S, Bots ML, Grobbee DE, Froguel P, Thuillier D, Roussel R, Bonnefond A, Cariou B, Smart M, Bao Y, Kumari M, Mahajan A, Hopewell JC, Seshadri S, Dale C, Costa RPE, Ridker PM, Chasman DI, Reiner AP, Ritchie MD, Lange LA, Cornish AJ, Dobbins SE, Hemminki K, Kinnersley B, Sanson M, Labreche K, Simon M, Bondy M, Law P, Speedy H, Allan J, Li N, Went M, Weinhold N, Morgan G, Sonneveld P, Nilsson B, Goldschmidt H, Sud A, Engert A, Hansson M, Hemingway H, Asselbergs FW, Patel RS, Keating BJ, Sattar N, Houlston R, Casas JP, Hingorani AD. Phenome-wide association analysis of LDL-cholesterol lowering genetic variants in PCSK9. BMC Cardiovasc Disord 2019; 19:240. [PMID: 31664920 PMCID: PMC6820948 DOI: 10.1186/s12872-019-1187-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 08/19/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND We characterised the phenotypic consequence of genetic variation at the PCSK9 locus and compared findings with recent trials of pharmacological inhibitors of PCSK9. METHODS Published and individual participant level data (300,000+ participants) were combined to construct a weighted PCSK9 gene-centric score (GS). Seventeen randomized placebo controlled PCSK9 inhibitor trials were included, providing data on 79,578 participants. Results were scaled to a one mmol/L lower LDL-C concentration. RESULTS The PCSK9 GS (comprising 4 SNPs) associations with plasma lipid and apolipoprotein levels were consistent in direction with treatment effects. The GS odds ratio (OR) for myocardial infarction (MI) was 0.53 (95% CI 0.42; 0.68), compared to a PCSK9 inhibitor effect of 0.90 (95% CI 0.86; 0.93). For ischemic stroke ORs were 0.84 (95% CI 0.57; 1.22) for the GS, compared to 0.85 (95% CI 0.78; 0.93) in the drug trials. ORs with type 2 diabetes mellitus (T2DM) were 1.29 (95% CI 1.11; 1.50) for the GS, as compared to 1.00 (95% CI 0.96; 1.04) for incident T2DM in PCSK9 inhibitor trials. No genetic associations were observed for cancer, heart failure, atrial fibrillation, chronic obstructive pulmonary disease, or Alzheimer's disease - outcomes for which large-scale trial data were unavailable. CONCLUSIONS Genetic variation at the PCSK9 locus recapitulates the effects of therapeutic inhibition of PCSK9 on major blood lipid fractions and MI. While indicating an increased risk of T2DM, no other possible safety concerns were shown; although precision was moderate.
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Affiliation(s)
- Amand F Schmidt
- Institute of Cardiovascular Science, University College London, 222 Euston Road, London, NW1 2DA, UK.
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
- UCL's BHF Research Accelerator Centre, London, UK.
| | - Michael V Holmes
- Medical Research Council Population Health Research Unit, Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - David Preiss
- Medical Research Council Population Health Research Unit, Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Daniel I Swerdlow
- Institute of Cardiovascular Science, University College London, 222 Euston Road, London, NW1 2DA, UK
- Department of Medicine, Imperial College London, London, UK
| | - Spiros Denaxas
- UCL's BHF Research Accelerator Centre, London, UK
- Health Data Research UK, University College London, 222 Euston Road, London, NW1 2DA, UK
- Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA, UK
- The Alan Turing Institute, British Library, 96 Euston Rd, London, NW1 2DB, UK
| | - Ghazaleh Fatemifar
- UCL's BHF Research Accelerator Centre, London, UK
- Health Data Research UK, University College London, 222 Euston Road, London, NW1 2DA, UK
- Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA, UK
| | - Rupert Faraway
- Institute of Cardiovascular Science, University College London, 222 Euston Road, London, NW1 2DA, UK
| | - Chris Finan
- Institute of Cardiovascular Science, University College London, 222 Euston Road, London, NW1 2DA, UK
- UCL's BHF Research Accelerator Centre, London, UK
| | - Dennis Valentine
- UCL's BHF Research Accelerator Centre, London, UK
- University College London, Farr Institute of Health Informatics, London, UK
| | - Zammy Fairhurst-Hunter
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LF, UK
| | | | - Bernardo Lessa Horta
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Elina Hypponen
- Centre for Population Health Research, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
- Population, Policy and Practice, UCL GOS Institute of Child Health, London, UK
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Christine Power
- Population, Policy and Practice, UCL GOS Institute of Child Health, London, UK
| | - Max Moldovan
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Erik van Iperen
- Durrer Center for Cardiovascular Research, Netherlands Heart Institute, Utrecht, The Netherlands
- Department of Clinical Epidemiology, Biostatistics And Bioinformatics, Academic Medical Center Amsterdam, Amsterdam, the Netherlands
| | - Kees Hovingh
- Department of vascular medicine, Academic Medical Center Amsterdam, Amsterdam, the Netherlands
| | - Ilja Demuth
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Lipid Clinic at the Interdisciplinary Metabolism Center, Berlin, Germany
- Charité - Universitätsmedizin Berlin, BCRT - Berlin Institute of Health Center for Regenerative Therapies, Berlin, Germany
| | - Kristina Norman
- Institute of Nutritional Science, University of Potsdam, 14558, Nuthetal, Germany
- Geriatrics Research Group, Charité - Universitätsmedizin Berlin, 13347, Berlin, Germany
- Department of Nutrition and Gerontology, German Institute of Human Nutrition Potsdam-Rehbruecke, 14558, Nuthetal, Germany
| | - Elisabeth Steinhagen-Thiessen
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Lipid Clinic at the Interdisciplinary Metabolism Center, Berlin, Germany
| | | | - Lars Bertram
- Lübeck Interdisciplinary Platform for Genome Analytics (LIGA), Institutes of Neurogenetics & Cardiogenetics, University of Lübeck, Lübeck, Germany
- Center for Lifespan Changes in Brain and Cognition (LCBC), Dept. Psychology, University of Oslo, Oslo, Norway
| | - Christina M Lill
- Genetic and Molecular Epidemiology Group, Lübeck Interdisciplinary Platform for Genome Analytics (LIGA), Institutes of Neurogenetics & Cardiogenetics, University of Lübeck, Lübeck, Germany
- Institute of Human Genetics, Lübeck, Germany
- Ageing Epidemiology Research Unit, School of Public Health, Imperial College, London, UK
| | - Stefan Coassin
- Institute of Genetic Epidemiology, Department of Genetics and Pharmacology, Medical University of Innsbruck, 6020, Innsbruck, Austria
| | - Johann Willeit
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Stefan Kiechl
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Karin Willeit
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Dan Mason
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | - John Wright
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | - Richard Morris
- Department Primary Care & Population Health, University College London, London, UK
| | - Goya Wanamethee
- Department Primary Care & Population Health, University College London, London, UK
| | - Peter Whincup
- Population Health Research Institute, St George's, University of London, London, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Stela McLachlan
- Centre for Population Health Sciences, The Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Jackie F Price
- Centre for Population Health Sciences, The Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Mika Kivimaki
- Department of Epidemiology and Public Health, UCL Institute of Epidemiology and Health Care, University College London, London, UK
| | - Catherine Welch
- Department of Epidemiology and Public Health, UCL Institute of Epidemiology and Health Care, University College London, London, UK
| | - Adelaida Sanchez-Galvez
- Department of Epidemiology and Public Health, UCL Institute of Epidemiology and Health Care, University College London, London, UK
| | - Pedro Marques-Vidal
- Department of Medicine, Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Andrew Nicolaides
- Department of Vascular Surgery, Imperial College, London, United Kingdom
- Department of Surgery, Nicosia Medical School, University of Nicosia, Nicosia, Cyprus
| | - Andrie G Panayiotou
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - N Charlotte Onland-Moret
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Yvonne T van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Giuseppe Matullo
- Italian Institute for Genomic Medicine (IIGM), Turin, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Giovanni Fiorito
- Italian Institute for Genomic Medicine (IIGM), Turin, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Simonetta Guarrera
- Italian Institute for Genomic Medicine (IIGM), Turin, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Carlotta Sacerdote
- Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital and Center for Cancer Prevention (CPO), Turin, Italy
| | - Nicholas J Wareham
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, UK
| | - Claudia Langenberg
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, UK
| | - Robert A Scott
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, UK
| | - Jian'an Luan
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, UK
| | - Martin Bobak
- Department of Epidemiology and Public Health, UCL Institute of Epidemiology and Health Care, University College London, London, UK
| | - Sofia Malyutina
- Novosibirsk State Medical University, Novosibirsk, Russian Federation
- Institute of Internal and Preventive Medicine, Siberian Branch of the Russian Academy of Medical Sciences, Novosibirsk, Russian Federation
| | - Andrzej Pająk
- Department of Epidemiology and Population Studies, Faculty of Health Sciences, Jagiellonian University Medical College, Kraków, Poland
| | | | | | - Hynek Pikhart
- Department of Epidemiology and Public Health, UCL Institute of Epidemiology and Health Care, University College London, London, UK
| | - Niels Grarup
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Oluf Pedersen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Torben Hansen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Allan Linneberg
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, The Capital Region of Denmark, Denmark
| | - Tine Jess
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, The Capital Region of Denmark, Denmark
| | - Jackie Cooper
- Centre for Cardiovascular Genetics, Department of Medicine, University College London, London, UK
| | - Steve E Humphries
- Centre for Cardiovascular Genetics, Department of Medicine, University College London, London, UK
| | - Murray Brilliant
- Center for Human Genetics, Marshfield Clinic Research Institute, Marshfield, USA
| | - Terrie Kitchner
- Center for Human Genetics, Marshfield Clinic Research Institute, Marshfield, USA
| | | | - David S Carrell
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | | | | | - Eric B Larson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - David R Crosslin
- Department of Biomedical Informatics and Medical Education University of Washington Seattle, Seattle, WA, USA
| | | | - Dan M Roden
- Department of Medicine, Department of Pharmacology, Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | | | | | | | - John Attia
- University of Newcastle, Newcastle, NSW, Australia
- Public Health Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Elizabeth Holliday
- University of Newcastle, Newcastle, NSW, Australia
- Public Health Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Rodney Scott
- University of Newcastle, Newcastle, NSW, Australia
| | - Peter Schofield
- Hunter New England Local Health District, Newcastle, NSW, Australia
| | | | - Salim Yusuf
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Michael Chong
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Guillaume Pare
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Pim van der Harst
- Durrer Center for Cardiovascular Research, Netherlands Heart Institute, Utrecht, The Netherlands
- Department of Clinical Epidemiology, Biostatistics And Bioinformatics, Academic Medical Center Amsterdam, Amsterdam, the Netherlands
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M Abdullah Said
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ruben N Eppinga
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Niek Verweij
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Harold Snieder
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Tim Christen
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - D O Mook-Kanamori
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Stefan Gustafsson
- Department of Medical Sciences, Molecular Epidemiology, Uppsala University, Uppsala, Sweden
| | - Lars Lind
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Erik Ingelsson
- Department of Medical Sciences, Molecular Epidemiology, Uppsala University, Uppsala, Sweden
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Raha Pazoki
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Oscar Franco
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Andre Uitterlinden
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Abbas Dehghan
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Alexander Teumer
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
| | - Sebastian Baumeister
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
- Chair of Epidemiology, Ludwig-Maximilians-Universität München, UNIKA-T Augsburg, Augsburg, Germany
| | - Marcus Dörr
- DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Markus M Lerch
- Department of Internal Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Uwe Völker
- DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
- Interfaculty Institute of Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
| | - Joey Ward
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, G12 8RZ, Scotland, UK
| | - Jill P Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, G12 8RZ, Scotland, UK
| | - Tom Meade
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Ingrid E Christophersen
- The Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway
| | - Anke H Maitland-van der Zee
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
- Department of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Robin Young
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Archie Campbell
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Sandosh Padmanabhan
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, G12 8TA, UK
| | - Michiel L Bots
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - Diederick E Grobbee
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - Philippe Froguel
- CNRS UMR 8199, European Genomic Institute for Diabetes (EGID), Institut Pasteur de Lille, University of Lille, 59000, Lille, France
- Department of Genomics of Common Disease, Imperial College London, W12 0NN, London, United Kingdom
| | - Dorothée Thuillier
- CNRS UMR 8199, European Genomic Institute for Diabetes (EGID), Institut Pasteur de Lille, University of Lille, 59000, Lille, France
| | - Ronan Roussel
- INSERM, U-1138, Centre de Recherche des Cordeliers, Paris, France
- UFR de Médecine, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
- Départment de Diabétologie, Endocrinologie et Nutrition, Assistance Publique Hôpitaux de Paris, Hôpital Bicha, Paris, France
| | - Amélie Bonnefond
- CNRS UMR 8199, European Genomic Institute for Diabetes (EGID), Institut Pasteur de Lille, University of Lille, 59000, Lille, France
| | - Bertrand Cariou
- l'institut du Thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes, Nantes, France
| | - Melissa Smart
- Institute for Social and Economic Research, University of Essex, Essex, UK
| | - Yanchun Bao
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, England
| | - Meena Kumari
- Boston University School of Medicine, Boston, MA, USA
| | - Anubha Mahajan
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, England
| | - Jemma C Hopewell
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LF, UK
| | | | - Caroline Dale
- University College London, Farr Institute of Health Informatics, London, UK
| | | | - Paul M Ridker
- Harvard Medical School Center for Cardiovascular Disease Prevention Brigham and Women's Hospital, Boston, USA
| | - Daniel I Chasman
- Harvard Medical School Center for Cardiovascular Disease Prevention Brigham and Women's Hospital, Boston, USA
| | | | | | | | - Alex J Cornish
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - Sara E Dobbins
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - Kari Hemminki
- Div. Molecular Genetic Epidemiology German Cancer Research Center, Im Neuenheimer Feld 580, 69120, Heidelberg, Germany
- Deutsches Krebsforschungszentrum, Heidelberg, Germany
| | - Ben Kinnersley
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - Marc Sanson
- The Institut du Cerveau et de la Moelle épinière - ICM, Paris, France
- Sorbonne Universités, UPMC Université Paris 06, UMR S 1127, F-75013, Paris, France
| | - Karim Labreche
- The Institut du Cerveau et de la Moelle épinière - ICM, Paris, France
- Sorbonne Universités, UPMC Université Paris 06, UMR S 1127, F-75013, Paris, France
| | - Matthias Simon
- Department of Neurosurgery, Bethel Clinic, Kantensiek 11, 33617, Bielefeld, Germany
| | - Melissa Bondy
- Division of Hematology-Oncology, Department of Pediatrics, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas, 77030, USA
| | - Philip Law
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - Helen Speedy
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - James Allan
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Ni Li
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - Molly Went
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - Niels Weinhold
- Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Gareth Morgan
- Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Pieter Sonneveld
- Department of Hematology, Erasmus MC Cancer Institute, 3075 EA, Rotterdam, the Netherlands
| | - Björn Nilsson
- Hematology and Transfusion Medicine, Department of Laboratory Medicine, BMC B13, SE-221 84, Lund, Sweden
| | - Hartmut Goldschmidt
- University Clinic Heidelberg, Internal Medicine V and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Amit Sud
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - Andreas Engert
- Department of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Markus Hansson
- Hematology Clinic, Skåne University Hospital, Skåne, Sweden
- Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
| | - Harry Hemingway
- UCL's BHF Research Accelerator Centre, London, UK
- Health Data Research UK, University College London, 222 Euston Road, London, NW1 2DA, UK
- Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA, UK
- The National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London, 222 Euston Road, London, NW1 2DA, UK
| | - Folkert W Asselbergs
- Institute of Cardiovascular Science, University College London, 222 Euston Road, London, NW1 2DA, UK
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- UCL's BHF Research Accelerator Centre, London, UK
- Health Data Research UK and Institute of Health Informatics, University College London, London, United Kingdom
| | - Riyaz S Patel
- Institute of Cardiovascular Science, University College London, 222 Euston Road, London, NW1 2DA, UK
- UCL's BHF Research Accelerator Centre, London, UK
- The Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | | | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, G12 8TA, UK
| | - Richard Houlston
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - Juan P Casas
- Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC) Veterans Affairs Boston Healthcare System, Boston, USA
| | - Aroon D Hingorani
- Institute of Cardiovascular Science, University College London, 222 Euston Road, London, NW1 2DA, UK
- UCL's BHF Research Accelerator Centre, London, UK
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Nielsen LK, Stege C, Lissenberg-Witte B, van der Holt B, Mellqvist UH, Salomo M, Bos G, Levin MD, Visser-Wisselaar H, Hansson M, van der Velden A, Deenik W, Coenen J, Hinge M, Klein S, Tanis B, Szatkowski D, Brouwer R, Westerman M, Leys R, Sinnige H, Haukås E, van der Hem K, Durian M, Gimsing P, van de Donk N, Sonneveld P, Waage A, Abildgaard N, Zweegman S. Health-related quality of life in transplant ineligible newly diagnosed multiple myeloma patients treated with either thalidomide or lenalidomide-based regimen until progression: a prospective, open-label, multicenter, randomized, phase 3 study. Haematologica 2019; 105:1650-1659. [PMID: 31515355 PMCID: PMC7271593 DOI: 10.3324/haematol.2019.222299] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 04/19/2019] [Accepted: 09/11/2019] [Indexed: 11/12/2022] Open
Abstract
Data on the impact of long term treatment with immunomodulatory drugs (IMiD) on health-related quality of life (HRQoL) is limited. The HOVON-87/NMSG18 study was a randomized, phase 3 study in newly diagnosed transplant ineligible patients with multiple myeloma, comparing melphalan-prednisolone in combination with thalidomide or lenalidomide, followed by maintenance therapy until progression (MPT-T or MPR-R). The EORTC QLQ-C30 and MY20 questionnaires were completed at baseline, after three and nine induction cycles and six and 12 months of maintenance therapy. Linear mixed models and minimal important differences were used for evaluation. 596 patients participated in HRQoL reporting. Patients reported clinically relevant improvement in global quality of life (QoL), future perspective and role and emotional functioning, and less fatigue and pain in both arms. The latter being of large effect size. In general, improvement occurred after 6–12 months of maintenance only and was independent of the World Health Organisation performance at baseline. Patients treated with MPR-R reported clinically relevant worsening of diarrhea, and patients treated with MPT-T reported a higher incidence of neuropathy. Patients who remained on lenalidomide maintenance therapy for at least three months reported clinically meaningful improvement in global QoL and role functioning at six months, remaining stable thereafter. There were no clinically meaningful deteriorations, but patients on thalidomide reported clinically relevant worsening in neuropathy. In general, HRQoL improves both during induction and maintenance therapy with immunomodulatory drugs. The side effect profile of treatment did not negatively affect global QoL, but it was, however, clinically relevant for the patients. (Clinicaltrials.gov identifier: NTR1630).
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Affiliation(s)
- Lene Kongsgaard Nielsen
- Quality of Life Research Center, Department of Haematology, Odense University Hospital, Odense, Denmark
| | - Claudia Stege
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Hematology, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Birgit Lissenberg-Witte
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam, the Netherlands
| | - Bronno van der Holt
- HOVON Data Center, Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Ulf-Henrik Mellqvist
- Section of Hematology and Coagulation, Department of Medicine, Sahlgrenska University Hospital, Gotheborg, Sweden
| | - Morten Salomo
- Department of Haematology, Rigshospitalet, Copenhagen, Denmark
| | - Gerard Bos
- Department of Haematology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Mark-David Levin
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Heleen Visser-Wisselaar
- HOVON Data Center, Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Markus Hansson
- Department of Haematology and Wallenberg Center for Molecular Medicine, Skåne University Hospital, Lund University, Lund, Sweden
| | | | - Wendy Deenik
- Department of Internal Medicine, Tergooi Ziekenhuis, Hilversum, the Netherlands
| | - Juleon Coenen
- Department of Internal Medicine, Isala, Zwolle, the Netherlands
| | - Maja Hinge
- Department of Internal Medicine, Division of Hematology, Vejle Hospital, Vejle, Denmark
| | - Saskia Klein
- Department of Internal Medicine, Meander Medisch Centrum, Amersfoort, the Netherlands
| | - Bea Tanis
- Department of Internal Medicine, Groene Hart Ziekenhuis, Gouda, the Netherlands
| | - Damian Szatkowski
- Department of Oncology, Haematology and Palliative Care, Førde Central Hospital, Førde, Norway
| | - Rolf Brouwer
- Department of Internal Medicine, Reinier de Graaf Ziekenhuis, Delft, the Netherlands
| | - Matthijs Westerman
- Department of Internal Medicine, Northwest Clinics, Alkmaar, the Netherlands
| | - Rineke Leys
- Department of Internal Medicine, Maasstad Ziekenhuis, Rotterdam, the Netherlands
| | - Harm Sinnige
- Department of Internal Medicine, Jeroen Bosch Ziekenhuis, Den Bosch, the Netherlands
| | - Einar Haukås
- Department of Haematology, Stavanger University Hospital, Stavanger, Norway
| | - Klaas van der Hem
- Department of Internal Medicine, Zaans Medisch Centrum, Zaandam, the Netherlands
| | - Marc Durian
- Department of Internal Medicine, Tweesteden Ziekenhuis, Tilburg, the Netherlands
| | - Peter Gimsing
- Department of Haematology, Rigshospitalet, Copenhagen, Denmark
| | - Niels van de Donk
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Hematology, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Pieter Sonneveld
- Department of Haematology, Erasmus Medical Center Cancer Center, Rotterdam, the Netherlands
| | - Anders Waage
- Department of Haematology, St Olavs Hospital and Norwegian University of Science and Technology, Trondheim, Norway
| | - Niels Abildgaard
- Quality of Life Research Center, Department of Haematology, Odense University Hospital, Odense, Denmark
| | - Sonja Zweegman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Hematology, Cancer Center Amsterdam, Amsterdam, the Netherlands
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38
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Went M, Kinnersley B, Sud A, Johnson DC, Weinhold N, Försti A, van Duin M, Orlando G, Mitchell JS, Kuiper R, Walker BA, Gregory WM, Hoffmann P, Jackson GH, Nöthen MM, da Silva Filho MI, Thomsen H, Broyl A, Davies FE, Thorsteinsdottir U, Hansson M, Kaiser M, Sonneveld P, Goldschmidt H, Stefansson K, Hemminki K, Nilsson B, Morgan GJ, Houlston RS. Transcriptome-wide association study of multiple myeloma identifies candidate susceptibility genes. Hum Genomics 2019; 13:37. [PMID: 31429796 PMCID: PMC6700979 DOI: 10.1186/s40246-019-0231-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 08/12/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND While genome-wide association studies (GWAS) of multiple myeloma (MM) have identified variants at 23 regions influencing risk, the genes underlying these associations are largely unknown. To identify candidate causal genes at these regions and search for novel risk regions, we performed a multi-tissue transcriptome-wide association study (TWAS). RESULTS GWAS data on 7319 MM cases and 234,385 controls was integrated with Genotype-Tissue Expression Project (GTEx) data assayed in 48 tissues (sample sizes, N = 80-491), including lymphocyte cell lines and whole blood, to predict gene expression. We identified 108 genes at 13 independent regions associated with MM risk, all of which were in 1 Mb of known MM GWAS risk variants. Of these, 94 genes, located in eight regions, had not previously been considered as a candidate gene for that locus. CONCLUSIONS Our findings highlight the value of leveraging expression data from multiple tissues to identify candidate genes responsible for GWAS associations which provide insight into MM tumorigenesis. Among the genes identified, a number have plausible roles in MM biology, notably APOBEC3C, APOBEC3H, APOBEC3D, APOBEC3F, APOBEC3G, or have been previously implicated in other malignancies. The genes identified in this TWAS can be explored for follow-up and validation to further understand their role in MM biology.
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Affiliation(s)
- Molly Went
- Division of Genetics and Epidemiology, The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey, SM2 5NG, UK.
- Division of Molecular Pathology, The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey, SM2 5NG, UK.
| | - Ben Kinnersley
- Division of Genetics and Epidemiology, The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey, SM2 5NG, UK
| | - Amit Sud
- Division of Genetics and Epidemiology, The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey, SM2 5NG, UK
| | - David C Johnson
- Division of Molecular Pathology, The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey, SM2 5NG, UK
| | - Niels Weinhold
- Department of Internal Medicine V, University of Heidelberg, 69117, Heidelberg, Germany
| | - Asta Försti
- German Cancer Research Center, 69120, Heidelberg, Germany
| | - Mark van Duin
- Department of Hematology, Erasmus MC Cancer Institute, 3075, EA, Rotterdam, The Netherlands
| | - Giulia Orlando
- Division of Genetics and Epidemiology, The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey, SM2 5NG, UK
| | - Jonathan S Mitchell
- Division of Genetics and Epidemiology, The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey, SM2 5NG, UK
| | - Rowan Kuiper
- Department of Hematology, Erasmus MC Cancer Institute, 3075, EA, Rotterdam, The Netherlands
| | - Brian A Walker
- Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Walter M Gregory
- Clinical Trials Research Unit, University of Leeds, Leeds, LS2 9PH, UK
| | - Per Hoffmann
- Institute of Human Genetics, University of Bonn, D-53127, Bonn, Germany
- Division of Medical Genetics, Department of Biomedicine, University of Basel, 4003, Basel, Switzerland
| | | | - Markus M Nöthen
- Institute of Human Genetics, University of Bonn, D-53127, Bonn, Germany
- Department of Genomics, Life & Brain Center, University of Bonn, D-53127, Bonn, Germany
| | | | - Hauke Thomsen
- German Cancer Research Center, 69120, Heidelberg, Germany
| | - Annemiek Broyl
- Department of Hematology, Erasmus MC Cancer Institute, 3075, EA, Rotterdam, The Netherlands
| | - Faith E Davies
- Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | | | - Markus Hansson
- Hematology Clinic, Skåne University Hospital, SE-221 85, Lund, Sweden
- Hematology and Transfusion Medicine, Department of Laboratory Medicine, BMC B13, SE-221 84, Lund, Sweden
| | - Martin Kaiser
- Division of Molecular Pathology, The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey, SM2 5NG, UK
| | - Pieter Sonneveld
- Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Hartmut Goldschmidt
- Department of Internal Medicine V, University of Heidelberg, 69117, Heidelberg, Germany
- Institute of Human Genetics, University of Bonn, D-53127, Bonn, Germany
| | | | - Kari Hemminki
- German Cancer Research Center, 69120, Heidelberg, Germany
| | - Björn Nilsson
- Hematology and Transfusion Medicine, Department of Laboratory Medicine, BMC B13, SE-221 84, Lund, Sweden
- Broad Institute, 7 Cambridge Center, Cambridge, MA, 02142, USA
| | - Gareth J Morgan
- Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Richard S Houlston
- Division of Genetics and Epidemiology, The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey, SM2 5NG, UK
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39
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Grauman Å, Hansson M, James S, Veldwijk J, Höglund A. Exploring research participants' perceptions of cardiovascular risk information-Room for improvement and empowerment. Patient Educ Couns 2019; 102:1528-1534. [PMID: 30928343 DOI: 10.1016/j.pec.2019.03.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 02/22/2019] [Accepted: 03/16/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The objective of this study was to explore research participants' (adults, age 50-65) perceptions of receiving cardiovascular risk information. METHODS Five focus group interviews (N = 31) were performed with research participants aged 50-65 who participated in the Swedish CArdioPulmonary BioImage Study (SCAPIS). The interviews were analyzed using qualitative content analysis. RESULTS The categories; the complexity of cardiovascular risk; insufficient presentation of test result; emotional responses; and health examinations provides confirmation, emerged. The test results were written in medical terms and lacked recommendations for further action which made it difficult for lay people to understand and use, and for some, also caused unnecessary worry. CONCLUSION There was inadequate guidance concerning the implications of the test results, especially for participants without clinical findings. In order to allow research participants to obtain better cognitive and behavioral control, improvements are needed with regard to how personal risk information is communicated in research projects connected to health services. PRACTICAL IMPLICATIONS The participants largely relied on physical signs when assessing their own cardiovascular risk. Health examinations are crucial for helping to add nuance to individuals' risk perceptions. For personal health information to have any real value for individuals, it must be designed from a user perspective.
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Affiliation(s)
- Å Grauman
- Centre for Research Ethics & Bioethics, Uppsala University, Uppsala, Sweden.
| | - M Hansson
- Centre for Research Ethics & Bioethics, Uppsala University, Uppsala, Sweden
| | - S James
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - J Veldwijk
- Erasmus Choice Modelling Centre, Erasmus University, Rotterdam, the Netherlands
| | - A Höglund
- Centre for Research Ethics & Bioethics, Uppsala University, Uppsala, Sweden
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40
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Ali M, Lemonakis K, Wihlborg AK, Veskovski L, Turesson I, Mellqvist UH, Gullberg U, Hansson M, Nilsson B. Sequence variation at the MTHFD1L-AKAP12 and FOPNL loci does not influence multiple myeloma survival in Sweden. Blood Cancer J 2019; 9:57. [PMID: 31363079 PMCID: PMC6667490 DOI: 10.1038/s41408-019-0222-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/22/2019] [Accepted: 04/30/2019] [Indexed: 11/09/2022] Open
Affiliation(s)
- Mina Ali
- Hematology and Transfusion Medicine, Department of Laboratory Medicine, BMC B13, 221 84, Lund, Sweden
| | - Konstantinos Lemonakis
- Hematology and Transfusion Medicine, Department of Laboratory Medicine, BMC B13, 221 84, Lund, Sweden.,Hematology Clinic, Skåne University Hospital, 221 85, Lund, Sweden
| | - Anna-Karin Wihlborg
- Hematology and Transfusion Medicine, Department of Laboratory Medicine, BMC B13, 221 84, Lund, Sweden
| | - Ljupco Veskovski
- Section of Hematology, South Elvsborg Hospital, SE 501 83, Borås, Sweden
| | - Ingemar Turesson
- Hematology and Transfusion Medicine, Department of Laboratory Medicine, BMC B13, 221 84, Lund, Sweden
| | | | - Urban Gullberg
- Hematology and Transfusion Medicine, Department of Laboratory Medicine, BMC B13, 221 84, Lund, Sweden
| | - Markus Hansson
- Hematology and Transfusion Medicine, Department of Laboratory Medicine, BMC B13, 221 84, Lund, Sweden.,Hematology Clinic, Skåne University Hospital, 221 85, Lund, Sweden.,Wallenberg Center for Molecular Medicine, 221 84, Lund, Sweden
| | - Björn Nilsson
- Hematology and Transfusion Medicine, Department of Laboratory Medicine, BMC B13, 221 84, Lund, Sweden. .,Broad Institute, 7 Cambridge Center, Cambridge, MA, 02142, USA.
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41
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Hellmark T, Ohlsson S, Pettersson Å, Hansson M, Johansson ÅCM. Eosinophils in anti-neutrophil cytoplasmic antibody associated vasculitis. BMC Rheumatol 2019; 3:9. [PMID: 30886997 PMCID: PMC6408823 DOI: 10.1186/s41927-019-0059-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 02/26/2019] [Indexed: 01/03/2023] Open
Abstract
Background Anti-neutrophil cytoplasmic antibodies associated vasculitides (AAV) are characterized by autoimmune small vessel inflammation. Eosinophils are multifunctional cells with both pro-inflammatory and immunoregulatory properties. Tissue activated eosinophils secrete cyto- and chemokines and form extracellular traps (EETs), they release free granules and produce reactive oxygen species. The role of eosinophils is well established in eosinophilic granulomatosis with polyangiitis (EGPA) but very little is known about their role in granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA). Methods The expression of surface markers CD11c, CD11b, CD16, CD35, CD62L, CD64, CD88, Siglec-8 and CD193 and reactive oxygen species production by peripheral blood eosinophils were studied using flow cytometry. Fluorescence microscopy was used to visualize the release of eosinophil extracellular DNA traps (EETs). 98 GPA and MPA patients and 121 healthy controls were included in the study. Results Both GPA and MPA patients had decreased frequency of eosinophils in peripheral blood compared with healthy controls (p < 0.0001), which could not solely be explained by corticosteroid treatment. The patient’s eosinophils showed increased surface expression of the Fc receptors CD16 (p < 0.0001) and CD64 (p = 0.0035) as well as CCR3 (CD193) (p = 0.0022). Decreased expression was found of the complement receptors CD35 (p = 0.0022), CD88 (p < 0,0001) as well as CD11c (p < 0,0001), CD11b (p = 0.0061) and Siglec-8 (p = 0,0015). Moreover, GPA and MPA eosinophils, showed decreased capacity to produce ROS (p < 0.0001). ANCA stimulation of eosinophils from GPA and MPA patients after C5a priming enhanced EETosis (p = 0,0088). Conclusions The percentage of eosinophils were decreased in peripheral blood in GPA and MPA patients and showed altered surface marker expression and function. The enhanced EETosis after ANCA stimulation, suggests that eosinophil can contribute to the autoantibody driven inflammatory process. Electronic supplementary material The online version of this article (10.1186/s41927-019-0059-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Thomas Hellmark
- Department of Clinical Sciences, Nephrology, Lund University, Skåne University Hospital, BMC-B13, SE-221 84 Lund, Sweden
| | - Sophie Ohlsson
- Department of Clinical Sciences, Nephrology, Lund University, Skåne University Hospital, BMC-B13, SE-221 84 Lund, Sweden
| | - Åsa Pettersson
- Department of Clinical Sciences, Nephrology, Lund University, Skåne University Hospital, BMC-B13, SE-221 84 Lund, Sweden
| | - Markus Hansson
- 2Department of Hematology, Skane University Hospital and Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
| | - Åsa C M Johansson
- 2Department of Hematology, Skane University Hospital and Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden.,3Department of Clinical Immunology and Transfusion Medicine, Lund University and Regional Laboratories Region Skane, Lund, Sweden
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Mateos MV, Ludwig H, Bazarbachi A, Beksac M, Bladé J, Boccadoro M, Cavo M, Delforge M, Dimopoulos MA, Facon T, Geraldes C, Goldschmidt H, Hájek R, Hansson M, Jamroziak K, Leiba M, Masszi T, Mendeleeva L, O’Dwyer M, Plesner T, San-Miguel JF, Straka C, van de Donk NW, Yong K, Zver S, Moreau P, Sonneveld P. Insights on Multiple Myeloma Treatment Strategies. Hemasphere 2019; 3:e163. [PMID: 31723802 PMCID: PMC6745941 DOI: 10.1097/hs9.0000000000000163] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [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: 08/16/2018] [Accepted: 10/27/2018] [Indexed: 12/14/2022] Open
Abstract
The introduction of new agents and management strategies over the past decade has resulted in a major step change in treatment outcomes with deepening responses and increased survival for patients with multiple myeloma. In daily clinical practice, healthcare professionals are now faced with challenges including, optimal treatment sequencing and changing treatment goals. In light of this, a group of experts met to discuss diagnostic and treatment guidelines, examine current clinical practice, and consider how new clinical trial data may be integrated into the management of multiple myeloma in the future.
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Affiliation(s)
- María-Victoria Mateos
- Complejo Asistencial Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (CAUSA/IBSAL), Salamanca, Spain
| | - Heinz Ludwig
- Wilhelminen Cancer Research Institute, Wilhelminenspital, Vienna, Austria
| | - Ali Bazarbachi
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Meral Beksac
- Ankara University School of Medicine, Ankara, Turkey
| | - Joan Bladé
- Institut d’Investigac’ons Biomedques August Pi Sunyer (IDiBAPS), Barcelona, Spain
| | - Mario Boccadoro
- University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Michele Cavo
- Seràgnoli Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
| | | | | | - Thierry Facon
- Service des Maladies du Sang, Hôpital Claude Huriez, Lille, France
| | | | - Hartmut Goldschmidt
- Department of Internal Medicine V, University Clinic Heidelberg and National Center of Tumor Diseases, Heidelberg, Germany
| | - Roman Hájek
- Department of Hematooncology, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Markus Hansson
- Department of Hematology, Skåne University Hospital und Lund University, Lund, Sweden
| | | | - Merav Leiba
- Assuta Ashdod University Hospital, Faculty of Health Science, Ben-Gurion University of the Negev, Negev, Israel
| | - Tamás Masszi
- 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Larisa Mendeleeva
- National Research Center for Hematology of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | | | - Torben Plesner
- Vejle Hospital and University of Southern Denmark, Vejle, Denmark
| | | | | | | | - Kwee Yong
- Cancer Institute, University College London, London, United Kingdom
| | - Samo Zver
- University Clinical Center Ljubljana and Medical Faculty, Ljubljana, Slovenia
| | | | - Pieter Sonneveld
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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43
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Went M, Sud A, Försti A, Halvarsson BM, Weinhold N, Kimber S, van Duin M, Thorleifsson G, Holroyd A, Johnson DC, Li N, Orlando G, Law PJ, Ali M, Chen B, Mitchell JS, Gudbjartsson DF, Kuiper R, Stephens OW, Bertsch U, Broderick P, Campo C, Bandapalli OR, Einsele H, Gregory WA, Gullberg U, Hillengass J, Hoffmann P, Jackson GH, Jöckel KH, Johnsson E, Kristinsson SY, Mellqvist UH, Nahi H, Easton D, Pharoah P, Dunning A, Peto J, Canzian F, Swerdlow A, Eeles RA, Kote-Jarai Z, Muir K, Pashayan N, Nickel J, Nöthen MM, Rafnar T, Ross FM, da Silva Filho MI, Thomsen H, Turesson I, Vangsted A, Andersen NF, Waage A, Walker BA, Wihlborg AK, Broyl A, Davies FE, Thorsteinsdottir U, Langer C, Hansson M, Goldschmidt H, Kaiser M, Sonneveld P, Stefansson K, Morgan GJ, Hemminki K, Nilsson B, Houlston RS. Author Correction: Identification of multiple risk loci and regulatory mechanisms influencing susceptibility to multiple myeloma. Nat Commun 2019; 10:213. [PMID: 30631080 PMCID: PMC6328616 DOI: 10.1038/s41467-018-08107-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
The original version of this Article contained an error in the spelling of a member of the PRACTICAL Consortium, Manuela Gago-Dominguez, which was incorrectly given as Manuela Gago Dominguez. This has now been corrected in both the PDF and HTML versions of the Article. Furthermore, in the original HTML version of this Article, the order of authors within the author list was incorrect. The PRACTICAL consortium was incorrectly listed after Richard S. Houlston and should have been listed after Nora Pashayan. This error has been corrected in the HTML version of the Article; the PDF version was correct at the time of publication.
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Affiliation(s)
- Molly Went
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, SW7 3RP, UK
| | - Amit Sud
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, SW7 3RP, UK
| | - Asta Försti
- German Cancer Research Center, 69120, Heidelberg, Germany
- Center for Primary Health Care Research, Lund University, SE-205 02, Malmo, Sweden
| | - Britt-Marie Halvarsson
- Hematology and Transfusion Medicine, Department of Laboratory Medicine, BMC B13, Lund University, SE-221 84, Lund, Sweden
| | - Niels Weinhold
- Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
- Department of Internal Medicine V, University of Heidelberg, 69117, Heidelberg, Germany
| | - Scott Kimber
- Division of Molecular Pathology, The Institute of Cancer Research, London, SW7 3RP, UK
| | - Mark van Duin
- Department of Hematology, Erasmus MC Cancer Institute, 3075 EA, Rotterdam, The Netherlands
| | | | - Amy Holroyd
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, SW7 3RP, UK
| | - David C Johnson
- Division of Molecular Pathology, The Institute of Cancer Research, London, SW7 3RP, UK
| | - Ni Li
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, SW7 3RP, UK
| | - Giulia Orlando
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, SW7 3RP, UK
| | - Philip J Law
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, SW7 3RP, UK
| | - Mina Ali
- Hematology and Transfusion Medicine, Department of Laboratory Medicine, BMC B13, Lund University, SE-221 84, Lund, Sweden
| | - Bowang Chen
- German Cancer Research Center, 69120, Heidelberg, Germany
| | - Jonathan S Mitchell
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, SW7 3RP, UK
| | - Daniel F Gudbjartsson
- deCODE Genetics, Sturlugata 8, IS-101, Reykjavik, Iceland
- School of Engineering and Natural Sciences, University of Iceland, IS-101, Reykjavik, Iceland
| | - Rowan Kuiper
- Department of Hematology, Erasmus MC Cancer Institute, 3075 EA, Rotterdam, The Netherlands
| | - Owen W Stephens
- Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Uta Bertsch
- German Cancer Research Center, 69120, Heidelberg, Germany
- National Centre of Tumor Diseases, 69120, Heidelberg, Germany
| | - Peter Broderick
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, SW7 3RP, UK
| | - Chiara Campo
- German Cancer Research Center, 69120, Heidelberg, Germany
| | | | | | - Walter A Gregory
- Clinical Trials Research Unit, University of Leeds, Leeds, LS2 9PH, UK
| | - Urban Gullberg
- Hematology and Transfusion Medicine, Department of Laboratory Medicine, BMC B13, Lund University, SE-221 84, Lund, Sweden
| | - Jens Hillengass
- Department of Internal Medicine V, University of Heidelberg, 69117, Heidelberg, Germany
| | - Per Hoffmann
- Institute of Human Genetics, University of Bonn, D-53127, Bonn, Germany
- Division of Medical Genetics, Department of Biomedicine, University of Basel, 4003, Basel, Switzerland
| | | | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University of Duisburg-Essen, Essen, D-45147, Germany
| | - Ellinor Johnsson
- Hematology and Transfusion Medicine, Department of Laboratory Medicine, BMC B13, Lund University, SE-221 84, Lund, Sweden
| | - Sigurður Y Kristinsson
- Department of Hematology, Landspitali, National University Hospital of Iceland, IS-101, Reykjavik, Iceland
| | - Ulf-Henrik Mellqvist
- Section of Hematology, Sahlgrenska University Hospital, Gothenburg, 413 45, Sweden
| | - Hareth Nahi
- Center for Hematology and Regenerative Medicine, SE-171 77, Stockholm, Sweden
| | - Douglas Easton
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, CB1 8RN, UK
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB1 8RN, UK
| | - Paul Pharoah
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, CB1 8RN, UK
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB1 8RN, UK
| | - Alison Dunning
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, CB1 8RN, UK
| | - Julian Peto
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Federico Canzian
- Genomic Epidemiology Group, German Cancer Research Center (DKFZ), Heidelberg, 69120, Germany
| | - Anthony Swerdlow
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, SW7 3RP, UK
- Division of Breast Cancer Research, The Institute of Cancer Research, London, SW7 3RP, UK
| | - Rosalind A Eeles
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, SW7 3RP, UK
- Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Zsofia Kote-Jarai
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, SW7 3RP, UK
| | - Kenneth Muir
- Institute of Population Health, University of Manchester, Manchester, M13 9PL, UK
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Nora Pashayan
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, CB1 8RN, UK
- Department of Applied Health Research, University College London, London, WC1E 7HB, UK
| | - Jolanta Nickel
- Department of Internal Medicine V, University of Heidelberg, 69117, Heidelberg, Germany
| | - Markus M Nöthen
- Institute of Human Genetics, University of Bonn, D-53127, Bonn, Germany
- Department of Genomics, Life & Brain Center, University of Bonn, D-53127, Bonn, Germany
| | - Thorunn Rafnar
- deCODE Genetics, Sturlugata 8, IS-101, Reykjavik, Iceland
| | - Fiona M Ross
- Wessex Regional Genetics Laboratory, University of Southampton, Salisbury, SP2 8BJ, UK
| | | | - Hauke Thomsen
- German Cancer Research Center, 69120, Heidelberg, Germany
| | - Ingemar Turesson
- Hematology Clinic, Skåne University Hospital, SE-221 85, Lund, Sweden
| | - Annette Vangsted
- Department of Haematology, University Hospital of Copenhagen at Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Niels Frost Andersen
- Department of Haematology, Aarhus University Hospital, Tage-Hansens Gade 2, DK-8000, Aarhus C, Denmark
| | - Anders Waage
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Box 8905, N-7491, Trondheim, Norway
| | - Brian A Walker
- Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Anna-Karin Wihlborg
- Hematology and Transfusion Medicine, Department of Laboratory Medicine, BMC B13, Lund University, SE-221 84, Lund, Sweden
| | - Annemiek Broyl
- Department of Hematology, Erasmus MC Cancer Institute, 3075 EA, Rotterdam, The Netherlands
| | - Faith E Davies
- Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Unnur Thorsteinsdottir
- deCODE Genetics, Sturlugata 8, IS-101, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, IS-101, Reykjavik, Iceland
| | - Christian Langer
- Department of Internal Medicine III, University of Ulm, D-89081, Ulm, Germany
| | - Markus Hansson
- Hematology and Transfusion Medicine, Department of Laboratory Medicine, BMC B13, Lund University, SE-221 84, Lund, Sweden
- Hematology Clinic, Skåne University Hospital, SE-221 85, Lund, Sweden
| | - Hartmut Goldschmidt
- Department of Internal Medicine V, University of Heidelberg, 69117, Heidelberg, Germany
- National Centre of Tumor Diseases, 69120, Heidelberg, Germany
| | - Martin Kaiser
- Division of Molecular Pathology, The Institute of Cancer Research, London, SW7 3RP, UK
| | - Pieter Sonneveld
- Department of Hematology, Erasmus MC Cancer Institute, 3075 EA, Rotterdam, The Netherlands
| | | | - Gareth J Morgan
- Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Kari Hemminki
- German Cancer Research Center, 69120, Heidelberg, Germany.
- Center for Primary Health Care Research, Lund University, SE-205 02, Malmo, Sweden.
| | - Björn Nilsson
- Hematology and Transfusion Medicine, Department of Laboratory Medicine, BMC B13, Lund University, SE-221 84, Lund, Sweden.
- Broad Institute, 7 Cambridge Center, Cambridge, MA, 02142, USA.
| | - Richard S Houlston
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, SW7 3RP, UK.
- Division of Molecular Pathology, The Institute of Cancer Research, London, SW7 3RP, UK.
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Svendsen K, González IG, Hansson M, Svensson JB, Ekerfelt H, Persson A, Lundh O. Optimization of soft X-ray phase-contrast tomography using a laser wakefield accelerator. Opt Express 2018; 26:33930-33941. [PMID: 30650824 DOI: 10.1364/oe.26.033930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 11/02/2018] [Indexed: 06/09/2023]
Abstract
X-ray phase-contrast imaging allows for non-invasive analysis in low-absorbing materials, such as soft tissue. Its application in medical or materials science has yet to be realized on a wider scale due to the requirements on the X-ray source, demanding high flux and small source size. Laser wakefield accelerators generate betatron X-rays fulfilling these criteria and can be suitable sources for phase-contrast imaging. In this work, we present the first phase-contrast images obtained by using ionization injection-based laser wakefield acceleration, which results in a higher photon yield and smoother X-ray beam profile compared to self-injection. A peak photon yield of 1.9 × 1011 ph/sr and a source size of 3 μm were estimated. Furthermore, the current laser parameters produce an X-ray spectrum mainly in the soft X-ray range, in which laser-plasma based phase-contrast imaging had yet to be studied. The phase-contrast images of a Chrysopa lacewing resolve features on the order of 4 μm. These images are further used for a tomographic reconstruction and a volume rendering, showing details on the order of tens of μm.
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45
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Went M, Sud A, Speedy H, Sunter NJ, Försti A, Law PJ, Johnson DC, Mirabella F, Holroyd A, Li N, Orlando G, Weinhold N, van Duin M, Chen B, Mitchell JS, Mansouri L, Juliusson G, Smedby KE, Jayne S, Majid A, Dearden C, Allsup DJ, Bailey JR, Pratt G, Pepper C, Fegan C, Rosenquist R, Kuiper R, Stephens OW, Bertsch U, Broderick P, Einsele H, Gregory WM, Hillengass J, Hoffmann P, Jackson GH, Jöckel KH, Nickel J, Nöthen MM, da Silva Filho MI, Thomsen H, Walker BA, Broyl A, Davies FE, Hansson M, Goldschmidt H, Dyer MJS, Kaiser M, Sonneveld P, Morgan GJ, Hemminki K, Nilsson B, Catovsky D, Allan JM, Houlston RS. Genetic correlation between multiple myeloma and chronic lymphocytic leukaemia provides evidence for shared aetiology. Blood Cancer J 2018; 9:1. [PMID: 30602759 PMCID: PMC6315026 DOI: 10.1038/s41408-018-0162-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 11/19/2018] [Indexed: 02/08/2023] Open
Abstract
The clustering of different types of B-cell malignancies in families raises the possibility of shared aetiology. To examine this, we performed cross-trait linkage disequilibrium (LD)-score regression of multiple myeloma (MM) and chronic lymphocytic leukaemia (CLL) genome-wide association study (GWAS) data sets, totalling 11,734 cases and 29,468 controls. A significant genetic correlation between these two B-cell malignancies was shown (Rg = 0.4, P = 0.0046). Furthermore, four of the 45 known CLL risk loci were shown to associate with MM risk and five of the 23 known MM risk loci associate with CLL risk. By integrating eQTL, Hi-C and ChIP-seq data, we show that these pleiotropic risk loci are enriched for B-cell regulatory elements and implicate B-cell developmental genes. These data identify shared biological pathways influencing the development of CLL and, MM and further our understanding of the aetiological basis of these B-cell malignancies.
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Affiliation(s)
- Molly Went
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, SW7 3RP, UK.
| | - Amit Sud
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, SW7 3RP, UK
| | - Helen Speedy
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, SW7 3RP, UK
| | - Nicola J Sunter
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Asta Försti
- German Cancer Research Center, 69120, Heidelberg, Germany
- Center for Primary Health Care Research, Lund University, SE-205 02, Malmo, Sweden
| | - Philip J Law
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, SW7 3RP, UK
| | - David C Johnson
- Division of Molecular Pathology, The Institute of Cancer Research, London, SW7 3RP, UK
| | - Fabio Mirabella
- Division of Molecular Pathology, The Institute of Cancer Research, London, SW7 3RP, UK
| | - Amy Holroyd
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, SW7 3RP, UK
| | - Ni Li
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, SW7 3RP, UK
| | - Giulia Orlando
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, SW7 3RP, UK
| | - Niels Weinhold
- Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
- Department of Internal Medicine V, University of Heidelberg, 69117, Heidelberg, Germany
| | - Mark van Duin
- Department of Hematology, Erasmus MC Cancer Institute, 3075 EA, Rotterdam, The Netherlands
| | - Bowang Chen
- German Cancer Research Center, 69120, Heidelberg, Germany
| | - Jonathan S Mitchell
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, SW7 3RP, UK
| | - Larry Mansouri
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, 75105, Uppsala, Sweden
| | - Gunnar Juliusson
- Lund Strategic Research Center for Stem Cell Biology and Cell Therapy, Hematology and Transplantation, Lund University, Lund, Sweden
| | - Karin E Smedby
- Unit of Clinical Epidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Sandrine Jayne
- Ernest and Helen Scott Haematological Research Institute, Leicester University, Leicester, UK
| | - Aneela Majid
- Ernest and Helen Scott Haematological Research Institute, Leicester University, Leicester, UK
| | - Claire Dearden
- Division of Molecular Pathology, The Institute of Cancer Research, London, SW7 3RP, UK
| | - David J Allsup
- Department of Haematology, Hull Royal Infirmary, Hull, UK
| | - James R Bailey
- Hull York Medical School and University of Hull, Hull, UK
| | - Guy Pratt
- Department of Haematology, Birmingham Heartlands Hospital, Birmingham, UK
| | - Chris Pepper
- Department of Haematology, School of Medicine, Cardiff University, Cardiff, UK
| | - Chris Fegan
- Cardiff and Vale National Health Service Trust, Heath Park, Cardiff, UK
| | - Richard Rosenquist
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, 75105, Uppsala, Sweden
| | - Rowan Kuiper
- Department of Hematology, Erasmus MC Cancer Institute, 3075 EA, Rotterdam, The Netherlands
| | - Owen W Stephens
- Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Uta Bertsch
- German Cancer Research Center, 69120, Heidelberg, Germany
- National Centre of Tumor Diseases, 69120, Heidelberg, Germany
| | - Peter Broderick
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, SW7 3RP, UK
| | | | - Walter M Gregory
- Clinical Trials Research Unit, University of Leeds, Leeds, LS2 9PH, UK
| | - Jens Hillengass
- Department of Internal Medicine V, University of Heidelberg, 69117, Heidelberg, Germany
| | - Per Hoffmann
- Institute of Human Genetics, University of Bonn, D-53127, Bonn, Germany
- Division of Medical Genetics, Department of Biomedicine, University of Basel, 4003, Basel, Switzerland
| | | | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Jolanta Nickel
- Department of Internal Medicine V, University of Heidelberg, 69117, Heidelberg, Germany
| | - Markus M Nöthen
- Institute of Human Genetics, University of Bonn, D-53127, Bonn, Germany
- Department of Genomics, Life and Brain Center, University of Bonn, D-53127, Bonn, Germany
| | | | - Hauke Thomsen
- German Cancer Research Center, 69120, Heidelberg, Germany
| | - Brian A Walker
- Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Annemiek Broyl
- Department of Hematology, Erasmus MC Cancer Institute, 3075 EA, Rotterdam, The Netherlands
| | - Faith E Davies
- Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Markus Hansson
- Center for Primary Health Care Research, Lund University, SE-205 02, Malmo, Sweden
- Hematology and Transfusion Medicine, Department of Laboratory Medicine, BMC B13, SE-221 84 Lund University, Lund, Sweden
| | - Hartmut Goldschmidt
- Department of Internal Medicine V, University of Heidelberg, 69117, Heidelberg, Germany
- National Centre of Tumor Diseases, 69120, Heidelberg, Germany
| | - Martin J S Dyer
- Ernest and Helen Scott Haematological Research Institute, Leicester University, Leicester, UK
| | - Martin Kaiser
- Division of Molecular Pathology, The Institute of Cancer Research, London, SW7 3RP, UK
| | - Pieter Sonneveld
- Department of Hematology, Erasmus MC Cancer Institute, 3075 EA, Rotterdam, The Netherlands
| | - Gareth J Morgan
- Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Kari Hemminki
- German Cancer Research Center, 69120, Heidelberg, Germany
- Center for Primary Health Care Research, Lund University, SE-205 02, Malmo, Sweden
| | - Björn Nilsson
- Hematology and Transfusion Medicine, Department of Laboratory Medicine, BMC B13, SE-221 84 Lund University, Lund, Sweden
- Broad Institute, 7 Cambridge Center, Cambridge, MA, 02142, USA
| | - Daniel Catovsky
- Division of Molecular Pathology, The Institute of Cancer Research, London, SW7 3RP, UK
| | - James M Allan
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Richard S Houlston
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, SW7 3RP, UK
- Division of Molecular Pathology, The Institute of Cancer Research, London, SW7 3RP, UK
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Dimopoulos MA, Grosicki S, Jędrzejczak WW, Nahi H, Gruber A, Hansson M, Gupta N, Byrne C, Labotka R, Teng Z, Yang H, Grzasko N, Kumar S. All-oral ixazomib, cyclophosphamide, and dexamethasone for transplant-ineligible patients with newly diagnosed multiple myeloma. Eur J Cancer 2018; 106:89-98. [PMID: 30471652 DOI: 10.1016/j.ejca.2018.09.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 06/27/2018] [Revised: 09/07/2018] [Accepted: 09/15/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND Novel efficacious treatments with long-term tolerability are needed for transplant-ineligible, newly diagnosed multiple myeloma (NDMM) patients. This phase 2 study evaluated the safety and efficacy of all-oral ixazomib-cyclophosphamide-dexamethasone (ICd) followed by single-agent ixazomib maintenance. PATIENTS AND METHODS Patients were randomised (1:1) to receive 4.0 mg of ixazomib, 300 (Arm A) or 400 (Arm B) mg/m2 of cyclophosphamide (days 1, 8, and 15), and 40 mg of dexamethasone (days 1, 8, 15, and 22) as induction (up to 13 × 28-day cycles), followed by single-agent ixazomib maintenance (28-day cycles) until progressive disease, death, or unacceptable toxicity. Primary end-point was complete response (CR) + very good partial response (VGPR) rate for ICd induction. RESULTS Seventy patients were enrolled (n = 36 Arm A; n = 34 Arm B); median age was 73 years (range, 61-87). At data cut-off, 66% of patients had completed 13 induction cycles followed by ixazomib maintenance. Median overall treatment duration was 19 cycles (range, 1-29); 21% of patients discontinued treatment during induction and 3% during maintenance due to adverse events (AEs). During induction, among 67 response-evaluable patients, CR+VGPR rate was 25%, and overall response rate (ORR) was 73%. Including the maintenance phase, CR+VGPR rate was 33%, and ORR was 76%. Median progression-free survival was 23.5 months (median follow-up: 26.1 months). The most common all-grade AE was neutropenia (31%). Grade ≥3 AEs were reported by 73% of patients. Five on-study deaths occurred (not treatment-related). CONCLUSIONS ICd treatment followed by ixazomib maintenance is tolerable and active in elderly, transplant-ineligible NDMM patients. TRIAL REGISTRATION NUMBER NCT02046070.
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Affiliation(s)
- Meletios A Dimopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
| | - Sebastian Grosicki
- Department of Cancer Prevention, Silesian Medical University, Katowice, Poland.
| | - Wiesław W Jędrzejczak
- Department of Haematology and Oncology, Medical University of Warsaw, Warsaw, Poland.
| | - Hareth Nahi
- Center for Hematology and Regenerative Medicine, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden.
| | - Astrid Gruber
- Center for Hematology and Regenerative Medicine, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden.
| | - Markus Hansson
- Hematology Clinic, Skåne University Hospital, Lund, Sweden; Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden.
| | - Neeraj Gupta
- Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA.
| | - Catriona Byrne
- Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA.
| | - Richard Labotka
- Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA.
| | - Zhaoyang Teng
- Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA.
| | - Huyuan Yang
- Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA.
| | - Norbert Grzasko
- Department of Haematology, St. John's Cancer Centre, Lublin, Poland; Department of Experimental Haemato-oncology, Medical University of Lublin, Lublin, Poland(1).
| | - Shaji Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.
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Wichert S, Pettersson Å, Hellmark T, Johansson Å, Hansson M. Bone marrow eosinophils in plasma cell disorders. Exp Hematol 2018; 66:27-31.e5. [DOI: 10.1016/j.exphem.2018.06.288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 06/26/2018] [Accepted: 06/28/2018] [Indexed: 12/15/2022]
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48
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Went M, Sud A, Försti A, Halvarsson BM, Weinhold N, Kimber S, van Duin M, Thorleifsson G, Holroyd A, Johnson DC, Li N, Orlando G, Law PJ, Ali M, Chen B, Mitchell JS, Gudbjartsson DF, Kuiper R, Stephens OW, Bertsch U, Broderick P, Campo C, Bandapalli OR, Einsele H, Gregory WA, Gullberg U, Hillengass J, Hoffmann P, Jackson GH, Jöckel KH, Johnsson E, Kristinsson SY, Mellqvist UH, Nahi H, Easton D, Pharoah P, Dunning A, Peto J, Canzian F, Swerdlow A, Eeles RA, Kote-Jarai ZS, Muir K, Pashayan N, Nickel J, Nöthen MM, Rafnar T, Ross FM, da Silva Filho MI, Thomsen H, Turesson I, Vangsted A, Andersen NF, Waage A, Walker BA, Wihlborg AK, Broyl A, Davies FE, Thorsteinsdottir U, Langer C, Hansson M, Goldschmidt H, Kaiser M, Sonneveld P, Stefansson K, Morgan GJ, Hemminki K, Nilsson B, Houlston RS. Identification of multiple risk loci and regulatory mechanisms influencing susceptibility to multiple myeloma. Nat Commun 2018; 9:3707. [PMID: 30213928 PMCID: PMC6137048 DOI: 10.1038/s41467-018-04989-w] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 06/06/2018] [Indexed: 02/08/2023] Open
Abstract
Genome-wide association studies (GWAS) have transformed our understanding of susceptibility to multiple myeloma (MM), but much of the heritability remains unexplained. We report a new GWAS, a meta-analysis with previous GWAS and a replication series, totalling 9974 MM cases and 247,556 controls of European ancestry. Collectively, these data provide evidence for six new MM risk loci, bringing the total number to 23. Integration of information from gene expression, epigenetic profiling and in situ Hi-C data for the 23 risk loci implicate disruption of developmental transcriptional regulators as a basis of MM susceptibility, compatible with altered B-cell differentiation as a key mechanism. Dysregulation of autophagy/apoptosis and cell cycle signalling feature as recurrently perturbed pathways. Our findings provide further insight into the biological basis of MM.
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Affiliation(s)
- Molly Went
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, SW7 3RP, UK
| | - Amit Sud
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, SW7 3RP, UK
| | - Asta Försti
- German Cancer Research Center, 69120, Heidelberg, Germany
- Center for Primary Health Care Research, Lund University, SE-205 02, Malmo, Sweden
| | - Britt-Marie Halvarsson
- Hematology and Transfusion Medicine, Department of Laboratory Medicine, BMC B13, Lund University, SE-221 84, Lund, Sweden
| | - Niels Weinhold
- Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
- Department of Internal Medicine V, University of Heidelberg, 69117, Heidelberg, Germany
| | - Scott Kimber
- Division of Molecular Pathology, The Institute of Cancer Research, London, SW7 3RP, UK
| | - Mark van Duin
- Department of Hematology, Erasmus MC Cancer Institute, 3075 EA, Rotterdam, The Netherlands
| | | | - Amy Holroyd
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, SW7 3RP, UK
| | - David C Johnson
- Division of Molecular Pathology, The Institute of Cancer Research, London, SW7 3RP, UK
| | - Ni Li
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, SW7 3RP, UK
| | - Giulia Orlando
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, SW7 3RP, UK
| | - Philip J Law
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, SW7 3RP, UK
| | - Mina Ali
- Hematology and Transfusion Medicine, Department of Laboratory Medicine, BMC B13, Lund University, SE-221 84, Lund, Sweden
| | - Bowang Chen
- German Cancer Research Center, 69120, Heidelberg, Germany
| | - Jonathan S Mitchell
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, SW7 3RP, UK
| | - Daniel F Gudbjartsson
- deCODE Genetics, Sturlugata 8, IS-101, Reykjavik, Iceland
- School of Engineering and Natural Sciences, University of Iceland, IS-101, Reykjavik, Iceland
| | - Rowan Kuiper
- Department of Hematology, Erasmus MC Cancer Institute, 3075 EA, Rotterdam, The Netherlands
| | - Owen W Stephens
- Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Uta Bertsch
- German Cancer Research Center, 69120, Heidelberg, Germany
- National Centre of Tumor Diseases, 69120, Heidelberg, Germany
| | - Peter Broderick
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, SW7 3RP, UK
| | - Chiara Campo
- German Cancer Research Center, 69120, Heidelberg, Germany
| | | | | | - Walter A Gregory
- Clinical Trials Research Unit, University of Leeds, Leeds, LS2 9PH, UK
| | - Urban Gullberg
- Hematology and Transfusion Medicine, Department of Laboratory Medicine, BMC B13, Lund University, SE-221 84, Lund, Sweden
| | - Jens Hillengass
- Department of Internal Medicine V, University of Heidelberg, 69117, Heidelberg, Germany
| | - Per Hoffmann
- Institute of Human Genetics, University of Bonn, D-53127, Bonn, Germany
- Division of Medical Genetics, Department of Biomedicine, University of Basel, 4003, Basel, Switzerland
| | | | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University of Duisburg-Essen, Essen, D-45147, Germany
| | - Ellinor Johnsson
- Hematology and Transfusion Medicine, Department of Laboratory Medicine, BMC B13, Lund University, SE-221 84, Lund, Sweden
| | - Sigurður Y Kristinsson
- Department of Hematology, Landspitali, National University Hospital of Iceland, IS-101, Reykjavik, Iceland
| | - Ulf-Henrik Mellqvist
- Section of Hematology, Sahlgrenska University Hospital, Gothenburg, 413 45, Sweden
| | - Hareth Nahi
- Center for Hematology and Regenerative Medicine, SE-171 77, Stockholm, Sweden
| | - Douglas Easton
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, CB1 8RN, UK
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB1 8RN, UK
| | - Paul Pharoah
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, CB1 8RN, UK
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB1 8RN, UK
| | - Alison Dunning
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, CB1 8RN, UK
| | - Julian Peto
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Federico Canzian
- Genomic Epidemiology Group, German Cancer Research Center (DKFZ), Heidelberg, 69120, Germany
| | - Anthony Swerdlow
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, SW7 3RP, UK
- Division of Breast Cancer Research, The Institute of Cancer Research, London, SW7 3RP, UK
| | - Rosalind A Eeles
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, SW7 3RP, UK
- Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - ZSofia Kote-Jarai
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, SW7 3RP, UK
| | - Kenneth Muir
- Institute of Population Health, University of Manchester, Manchester, M13 9PL, UK
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Nora Pashayan
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, CB1 8RN, UK
- Department of Applied Health Research, University College London, London, WC1E 7HB, UK
| | - Jolanta Nickel
- Department of Internal Medicine V, University of Heidelberg, 69117, Heidelberg, Germany
| | - Markus M Nöthen
- Institute of Human Genetics, University of Bonn, D-53127, Bonn, Germany
- Department of Genomics, Life & Brain Center, University of Bonn, D-53127, Bonn, Germany
| | - Thorunn Rafnar
- deCODE Genetics, Sturlugata 8, IS-101, Reykjavik, Iceland
| | - Fiona M Ross
- Wessex Regional Genetics Laboratory, University of Southampton, Salisbury, SP2 8BJ, UK
| | | | - Hauke Thomsen
- German Cancer Research Center, 69120, Heidelberg, Germany
| | - Ingemar Turesson
- Hematology Clinic, Skåne University Hospital, SE-221 85, Lund, Sweden
| | - Annette Vangsted
- Department of Haematology, University Hospital of Copenhagen at Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Niels Frost Andersen
- Department of Haematology, Aarhus University Hospital, Tage-Hansens Gade 2, DK-8000, Aarhus C, Denmark
| | - Anders Waage
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Box 8905, N-7491, Trondheim, Norway
| | - Brian A Walker
- Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Anna-Karin Wihlborg
- Hematology and Transfusion Medicine, Department of Laboratory Medicine, BMC B13, Lund University, SE-221 84, Lund, Sweden
| | - Annemiek Broyl
- Department of Hematology, Erasmus MC Cancer Institute, 3075 EA, Rotterdam, The Netherlands
| | - Faith E Davies
- Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Unnur Thorsteinsdottir
- deCODE Genetics, Sturlugata 8, IS-101, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, IS-101, Reykjavik, Iceland
| | - Christian Langer
- Department of Internal Medicine III, University of Ulm, D-89081, Ulm, Germany
| | - Markus Hansson
- Hematology and Transfusion Medicine, Department of Laboratory Medicine, BMC B13, Lund University, SE-221 84, Lund, Sweden
- Hematology Clinic, Skåne University Hospital, SE-221 85, Lund, Sweden
| | - Hartmut Goldschmidt
- Department of Internal Medicine V, University of Heidelberg, 69117, Heidelberg, Germany
- National Centre of Tumor Diseases, 69120, Heidelberg, Germany
| | - Martin Kaiser
- Division of Molecular Pathology, The Institute of Cancer Research, London, SW7 3RP, UK
| | - Pieter Sonneveld
- Department of Hematology, Erasmus MC Cancer Institute, 3075 EA, Rotterdam, The Netherlands
| | | | - Gareth J Morgan
- Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Kari Hemminki
- German Cancer Research Center, 69120, Heidelberg, Germany.
- Center for Primary Health Care Research, Lund University, SE-205 02, Malmo, Sweden.
| | - Björn Nilsson
- Hematology and Transfusion Medicine, Department of Laboratory Medicine, BMC B13, Lund University, SE-221 84, Lund, Sweden.
- Broad Institute, 7 Cambridge Center, Cambridge, MA, 02142, USA.
| | - Richard S Houlston
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, SW7 3RP, UK.
- Division of Molecular Pathology, The Institute of Cancer Research, London, SW7 3RP, UK.
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49
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Lund J, Gruber A, Lauri B, Duru AD, Blimark C, Swedin A, Hansson M, Forsberg K, Ahlberg L, Carlsson C, Waage A, Gimsing P, Vangsted AJ, Frølund U, Holmberg E, Gahrton G, Alici E, Hardling M, Mellqvist U, Nahi H. Lenalidomide versus lenalidomide + dexamethasone prolonged treatment after second-line lenalidomide + dexamethasone induction in multiple myeloma. Cancer Med 2018; 7:2256-2268. [PMID: 29673108 PMCID: PMC6010717 DOI: 10.1002/cam4.1422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/27/2017] [Revised: 01/24/2018] [Accepted: 01/26/2018] [Indexed: 11/25/2022] Open
Abstract
Lenalidomide (Len) plus dexamethasone (Dex) is approved for the treatment of relapsed or refractory multiple myeloma (RRMM). It is possible that single-agent Len may be effective as prolonged treatment regimen in RRMM once patients demonstrate an initial response to Len+Dex induction. Patients with RRMM who responded to first-line Len+Dex in an observational study (NCT01430546) received up to 24 cycles of either Len (25 mg/day) or Len+Dex (25 mg/day and 40 mg/week) as prolonged treatment in a subsequent phase 2 clinical trial (NCT01450215). In the observational study (N = 133), median time to response was 1.7 (range 0.6-9.6) months. A complete response to all treatments received in both studies was observed in 11% of patients; very good partial response and partial response rates were 31% and 38%, respectively. Corresponding response rates in the subgroup of patients who did not enter the phase 2 trial (n = 71) were 3%, 18%, and 39%, respectively. Rates of disease progression at 2 years in the phase 2 trial were 47% versus 31% for Len versus Len+Dex (P = 0.14). After 36 months median follow-up in surviving patients, median time to progression was not reached with Len+Dex and was 24.9 months (95% confidence interval 12.5-not calculable, P < 0.001) with Len. Three-year OS among the total observational study population was 61% (95% CI, 52-69%). The corresponding rate among patients who entered the phase 2 clinical trial was 73% (95% CI, 60-83%) and was significantly lower among those patients who achieved ≥PR but did not proceed into the phase 2 trial (55%; P = 0.01). In the phase 2 trial, OS was 73% in both treatment arms (P = 0.70). Neutropenia and thrombocytopenia were more common with prolonged (phase 2 trial) versus short-term (observational study) Len administration but remained manageable. Prolonged treatment with Len with or without Dex provides sustained, clinically relevant responses and demonstrates an acceptable safety profile.
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Affiliation(s)
- Johan Lund
- Department of HematologyKarolinska University HospitalStockholmSweden
| | - Astrid Gruber
- Department of HematologyKarolinska University HospitalStockholmSweden
| | - Birgitta Lauri
- Department of Internal MedicineSunderby HospitalLuleåSweden
| | - Adil Doganay Duru
- Department of HematologyKarolinska University HospitalStockholmSweden
- Nova Southeastern University (NSU)Fort LauderdaleFlorida
| | - Cecilie Blimark
- Department of HematologySahlgrenska University HospitalGothenburgSweden
| | - Agneta Swedin
- Department of HematologySkåne University HospitalLundSweden
| | - Markus Hansson
- Department of HematologySkåne University HospitalLundSweden
| | - Karin Forsberg
- Department of HematologyNorrland University HospitalUmeåSweden
| | - Lucia Ahlberg
- Department of HematologyUniversity Hospital of LinköpingLinköpingSweden
| | - Conny Carlsson
- Department of Internal MedicineHallands HospitalHalmstadSweden
| | - Anders Waage
- Department of Cancer Research and Molecular MedicineNorwegian University of Science and TechnologyTrondheimNorway
| | - Peter Gimsing
- Department of HematologyRigshospitaletCopenhagenDenmark
| | - Annette Juul Vangsted
- Department of HematologyRigshospitaletCopenhagenDenmark
- Department of HematologyZealand UniversityRoskildeDenmark
| | - Ulf Frølund
- Department of HematologyZealand UniversityRoskildeDenmark
| | - Erik Holmberg
- Department of OncologyInstitute of Clinical SciencesGothenburgSweden
| | - Gösta Gahrton
- Department of HematologyKarolinska University HospitalStockholmSweden
| | - Evren Alici
- Department of HematologyKarolinska University HospitalStockholmSweden
| | - Mats Hardling
- Department of HematologyUddevalla HospitalUddevallaSweden
| | | | - Hareth Nahi
- Department of HematologyKarolinska University HospitalStockholmSweden
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50
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Jiao H, Olin M, Hansson M, Eggertsen G, Eriksson M, Angelin B, Björkhem I. Unique case of cerebrotendinous xanthomatosis revisited: All the mutations responsible for this disease are present in the CYP27A1 gene. J Intern Med 2018; 283:604-606. [PMID: 29095540 DOI: 10.1111/joim.12709] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- H Jiao
- Clinical Research Centre, Department of Biosciences and Nutrition, Karolinska Institutet at Karolinska University Hospital, Huddinge, Sweden
| | - M Olin
- Division of Clinical Chemistry, Department of Laboratory Medicine, Karolinska Institutet at Karolinska University Hospital, Huddinge, Sweden
| | - M Hansson
- Division of Clinical Chemistry, Department of Laboratory Medicine, Karolinska Institutet at Karolinska University Hospital, Huddinge, Sweden
| | - G Eggertsen
- Division of Clinical Chemistry, Department of Laboratory Medicine, Karolinska Institutet at Karolinska University Hospital, Huddinge, Sweden
| | - M Eriksson
- Metabolism Unit, Center for Endocrinology, Metabolism and Diabetes, Karolinska Institutet at Karolinska University Hospital, Huddinge, Sweden.,Department of Medicine, KI/AZ Integrated CardioMetabolic Centre (ICMC), Karolinska Institutet at Karolinska University Hospital, Huddinge, Sweden
| | - B Angelin
- Metabolism Unit, Center for Endocrinology, Metabolism and Diabetes, Karolinska Institutet at Karolinska University Hospital, Huddinge, Sweden.,Department of Medicine, KI/AZ Integrated CardioMetabolic Centre (ICMC), Karolinska Institutet at Karolinska University Hospital, Huddinge, Sweden
| | - I Björkhem
- Division of Clinical Chemistry, Department of Laboratory Medicine, Karolinska Institutet at Karolinska University Hospital, Huddinge, Sweden
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