1
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Binder M, Szalat RE, Talluri S, Fulciniti M, Avet-Loiseau H, Parmigiani G, Samur MK, Munshi NC. Bone marrow stromal cells induce chromatin remodeling in multiple myeloma cells leading to transcriptional changes. Nat Commun 2024; 15:4139. [PMID: 38755155 PMCID: PMC11098817 DOI: 10.1038/s41467-024-47793-5] [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: 01/06/2023] [Accepted: 04/12/2024] [Indexed: 05/18/2024] Open
Abstract
The natural history of multiple myeloma is characterized by its localization to the bone marrow and its interaction with bone marrow stromal cells. The bone marrow stromal cells provide growth and survival signals, thereby promoting the development of drug resistance. Here, we show that the interaction between bone marrow stromal cells and myeloma cells (using human cell lines) induces chromatin remodeling of cis-regulatory elements and is associated with changes in the expression of genes involved in the cell migration and cytokine signaling. The expression of genes involved in these stromal interactions are observed in extramedullary disease in patients with myeloma and provides the rationale for survival of myeloma cells outside of the bone marrow microenvironment. Expression of these stromal interaction genes is also observed in a subset of patients with newly diagnosed myeloma and are akin to the transcriptional program of extramedullary disease. The presence of such adverse stromal interactions in newly diagnosed myeloma is associated with accelerated disease dissemination, predicts the early development of therapeutic resistance, and is of independent prognostic significance. These stromal cell induced transcriptomic and epigenomic changes both predict long-term outcomes and identify therapeutic targets in the tumor microenvironment for the development of novel therapeutic approaches.
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Affiliation(s)
- Moritz Binder
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Raphael E Szalat
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
- Department of Data Science, Dana Farber Cancer Institute, Boston, MA, USA
| | - Srikanth Talluri
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | | | - Hervé Avet-Loiseau
- University Cancer Center of Toulouse, Institut National de la Santé, Toulouse, France
| | - Giovanni Parmigiani
- Department of Data Science, Dana Farber Cancer Institute, Boston, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Mehmet K Samur
- Department of Data Science, Dana Farber Cancer Institute, Boston, MA, USA.
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Nikhil C Munshi
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA.
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2
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Zanwar S, Gertz MA, Muchtar E, Buadi FK, Kourelis T, Gonsalves W, Go RS, Hayman S, Kapoor P, Binder M, Cook J, Dingli D, Leung N, Lin Y, Warsame R, Fonder A, Hobbs M, Hwa YL, Kyle RA, Rajkumar SV, Kumar S, Dispenzieri A. Treatment patterns for AL amyloidosis after frontline daratumumab, bortezomib, cyclophosphamide, and dexamethasone treatment failures. Leukemia 2024:10.1038/s41375-024-02243-5. [PMID: 38594348 DOI: 10.1038/s41375-024-02243-5] [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: 02/27/2024] [Revised: 03/28/2024] [Accepted: 04/02/2024] [Indexed: 04/11/2024]
Affiliation(s)
| | - Morie A Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, US
| | - Eli Muchtar
- Division of Hematology, Mayo Clinic, Rochester, MN, US
| | | | | | | | - Ronald S Go
- Division of Hematology, Mayo Clinic, Rochester, MN, US
| | | | | | - Moritz Binder
- Division of Hematology, Mayo Clinic, Rochester, MN, US
| | - Joselle Cook
- Division of Hematology, Mayo Clinic, Rochester, MN, US
| | - David Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN, US
| | - Nelson Leung
- Division of Hematology, Mayo Clinic, Rochester, MN, US
| | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN, US
| | - Rahma Warsame
- Division of Hematology, Mayo Clinic, Rochester, MN, US
| | - Amie Fonder
- Division of Hematology, Mayo Clinic, Rochester, MN, US
| | - Miriam Hobbs
- Division of Hematology, Mayo Clinic, Rochester, MN, US
| | - Yi Lisa Hwa
- Division of Hematology, Mayo Clinic, Rochester, MN, US
| | - Robert A Kyle
- Division of Hematology, Mayo Clinic, Rochester, MN, US
| | | | - Shaji Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, US
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3
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Goel U, Charalampous C, Kapoor P, Binder M, Buadi FK, Dingli D, Dispenzieri A, Fonder A, Gertz MA, Gonsalves WI, Hayman SR, Hobbs MA, Hwa YL, Kourelis T, Lacy MQ, Leung N, Lin Y, Warsame RM, Kyle RA, Rajkumar SV, Kumar SK. Outcomes of patients with multiple myeloma refractory to standard dose vs low dose lenalidomide. Blood Cancer J 2024; 14:55. [PMID: 38531841 DOI: 10.1038/s41408-024-01039-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 12/20/2023] [Accepted: 03/12/2024] [Indexed: 03/28/2024] Open
Abstract
Refractoriness to lenalidomide is an important factor determining the choice of therapy at first relapse in multiple myeloma (MM). It remains debatable if resistance to lenalidomide varies among MM refractory to standard doses vs low dose maintenance doses. In this study, we assessed the outcomes with subsequent therapies in patients with MM refractory to standard dose vs low dose lenalidomide. We retrospectively reviewed all patients with MM at our institution who received first line therapy with lenalidomide containing regimens, and assessed progression free survival (PFS) and overall survival for these patients for second line therapy, and with lenalidomide retreatment. For second line therapy, we found no difference in the PFS between standard dose refractory and low dose refractory groups (median PFS 14 months vs 14 months, p = 0.95), while the PFS for both these groups was inferior to the not refractory group (median PFS 30 months, p < 0.001 for both pairs). Similar trends were seen among these groups on lenalidomide retreatment, and on multivariable analysis. These data suggest that refractoriness to lenalidomide is not dose dependent, and definition of lenalidomide refractoriness should not depend on the dose of lenalidomide to which the disease was considered refractory.
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Affiliation(s)
- Utkarsh Goel
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
| | | | | | - Moritz Binder
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - David Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Amie Fonder
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Morie A Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Yi L Hwa
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Martha Q Lacy
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Nelson Leung
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Robert A Kyle
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Shaji K Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.
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4
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Abdallah NH, Lakshman A, Kumar SK, Cook J, Binder M, Kapoor P, Dispenzieri A, Gertz MA, Lacy MQ, Hayman SR, Buadi FK, Dingli D, Lin Y, Kourelis T, Warsame R, Bergsagel L, Rajkumar SV. Mode of progression in smoldering multiple myeloma: a study of 406 patients. Blood Cancer J 2024; 14:9. [PMID: 38228628 PMCID: PMC10791688 DOI: 10.1038/s41408-024-00980-5] [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: 09/23/2023] [Revised: 12/28/2023] [Accepted: 01/05/2024] [Indexed: 01/18/2024] Open
Abstract
The approach to patients with high-risk smoldering multiple myeloma (SMM) varies among clinicians; while some advocate early intervention, others reserve treatment at progression to multiple myeloma (MM). We aimed to describe the myeloma-defining events (MDEs) and clinical presentations leading to MM diagnosis among SMM patients seen at our institution. We included 406 patients diagnosed with SMM between 2013-2022, seen at Mayo Clinic, Rochester, MN. The 2018 Mayo 20/2/20 criteria were used for risk stratification. Median follow-up was 3.9 years. Among high-risk patients who did not receive treatment in the SMM phase (n = 71), 51 progressed by last follow-up; the MDEs included: bone lesions (37%), anemia (35%), hypercalcemia (8%), and renal failure (6%); 24% met MM criteria based on marrow plasmacytosis (≥60%) and/or free light chain ratio (>100); 45% had clinically significant MDEs (hypercalcemia, renal insufficiency, and/or bone lesions). MM diagnosis was made based on surveillance labs/imaging(45%), testing obtained due to provider suspicion for progression (14%), bone pain (20%), and hospitalization/ED presentations due to MM complications/symptoms (4%). The presentation was undocumented in 14%. A high proportion (45%) of patients with high-risk SMM on active surveillance develop end-organ damage at progression. About a quarter of patients who progress to MM are not diagnosed based on routine interval surveillance testing.
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Affiliation(s)
| | | | - Shaji K Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Joselle Cook
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Moritz Binder
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Morie A Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Martha Q Lacy
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | - David Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Rahma Warsame
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
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5
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Abdallah NH, Nagayama H, Takahashi N, Gonsalves W, Fonder A, Dispenzieri A, Dingli D, Buadi FK, Lacy MQ, Hobbs M, Gertz MA, Binder M, Kapoor P, Warsame R, Hayman SR, Kourelis T, Hwa YL, Lin Y, Kyle RA, Rajkumar SV, Broski SM, Kumar SK. Muscle and fat composition in patients with newly diagnosed multiple myeloma. Blood Cancer J 2023; 13:185. [PMID: 38086801 PMCID: PMC10716405 DOI: 10.1038/s41408-023-00934-3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 08/13/2023] [Accepted: 10/24/2023] [Indexed: 12/18/2023] Open
Abstract
Measures of muscle and adipose tissue mass have been associated with outcomes in several malignancies, but studies in multiple myeloma (MM) are inconsistent. The aim of this study was to evaluate the association between muscle and fat areas and radiodensity, and overall survival (OS) in patients with newly diagnosed MM. We included 341 patients diagnosed with MM from 2010-2019 who had an 18F-fluorodeoxyglucose positron emission tomography/computed tomography at diagnosis. A cross-sectional image at the third lumbar vertebrae was segmented into muscle and fat components. Median follow up was 5.7 years. There was no association between sarcopenia and baseline disease characteristics or OS. Low muscle radiodensity was associated with higher disease stage, anemia, and renal failure. OS was 5.6 vs. 9.0 years in patients with muscle radiodensity in the lower vs. middle/upper tertiles, respectively (P = 0.02). High subcutaneous adipose tissue (SAT) radiodensity was associated with higher stage, anemia, thrombocytopenia, hypercalcemia, renal failure, and high LDH. OS was 5.4 years vs. not reached in patients with SAT radiodensity in the upper vs. middle/lower tertiles, respectively (P = 0.001). In conclusion, sarcopenia was not associated with OS in MM patients. High SAT radiodensity and low muscle radiodensity were associated with advanced disease stage and adverse laboratory characteristics.
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Affiliation(s)
| | | | | | | | - Amie Fonder
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - David Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Martha Q Lacy
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Miriam Hobbs
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Morie A Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Moritz Binder
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Rahma Warsame
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Yi L Hwa
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Robert A Kyle
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Shaji K Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.
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6
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Charalampous C, Goel U, Kapoor P, Binder M, Buadi FK, Cook J, Dingli D, Dispenzieri A, Fonder AL, Gertz MA, Gonsalves W, Hayman SR, Hobbs MA, Hwa YL, Kourelis T, Lacy MQ, Leung N, Lin Y, Warsame R, Kyle RA, Rajkumar SV, Kumar SK. Comparison of daratumumab-based regimens as second-line therapy in relapsed/refractory multiple myeloma. Blood Cancer J 2023; 13:183. [PMID: 38072941 PMCID: PMC10711005 DOI: 10.1038/s41408-023-00957-w] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/21/2023] [Accepted: 11/27/2023] [Indexed: 12/18/2023] Open
Affiliation(s)
| | - Utkarsh Goel
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Prashant Kapoor
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Moritz Binder
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Francis K Buadi
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Joselle Cook
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - David Dingli
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Angela Dispenzieri
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Amie L Fonder
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Morie A Gertz
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Wilson Gonsalves
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Suzanne R Hayman
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Miriam A Hobbs
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Yi L Hwa
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Taxiarchis Kourelis
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Martha Q Lacy
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Nelson Leung
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Yi Lin
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Rahma Warsame
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Robert A Kyle
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - S Vincent Rajkumar
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Shaji K Kumar
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
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7
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Yadav U, Kumar SK, Baughn LB, Dispenzieri A, Greipp P, Ketterling R, Jevremovic D, Buadi FK, Dingli D, Lacy MQ, Fonseca R, Bergsagel PL, Ailawadhi S, Roy V, Parrondo R, Sher T, Hayman SR, Kapoor P, Leung N, Cook J, Binder M, Muchtar E, Warsame R, Kourelis TV, Go RS, Lin Y, Seth A, Lester SC, Breen WG, Kyle RA, Gertz MA, Rajkumar SV, Gonsalves WI. Impact of cytogenetic abnormalities on the risk of disease progression in solitary bone plasmacytomas. Blood 2023; 142:1871-1878. [PMID: 37494698 PMCID: PMC10731916 DOI: 10.1182/blood.2023021187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/07/2023] [Accepted: 07/26/2023] [Indexed: 07/28/2023] Open
Abstract
Most patients with solitary bone plasmacytomas (SBP) progress to multiple myeloma (MM) after definitive radiation therapy as their primary treatment. Whether the presence of high-risk (HR) cytogenetic abnormalities by fluorescence in situ hybridization (FISH) in the clonal plasma cells, obtained either directly from the diagnostic SBP tissue or the corresponding bone marrow examination at the time of diagnosis, is associated with a shorter time to progression (TTP) to MM is unknown. This study evaluated all patients diagnosed with SBP at the Mayo Clinic from January 2012 to July 2022. The presence of del(17p), t(14;16), t(4;14), or +1q (gain or amplification) by FISH in clonal plasma cells was defined as HR. A total of 114 patients were included in this cohort, and baseline FISH was available for 55 patients (48%), of which 22 were classified as HR (40%). The median TTP to MM for patients with SBP and HR FISH was 8 months (95% confidence interval [CI], 6.3-26) compared with 42 months (95% CI, 25-not reached [NR]) in patients with SBP without HR FISH (P < .001). In a multivariate analysis, only HR FISH was a significant predictor for shorter TTP to MM, independent of minimal marrow involvement and an abnormal serum free light chain ratio at diagnosis. Deletion (17p) and gain 1q abnormalities were the most common FISH abnormalities responsible for the short TTP to MM. Thus, assessing for HR FISH abnormalities in clonal plasma cells derived from either the diagnostic SBP tissue or the staging bone marrow examination of patients with newly diagnosed SBP is feasible and prognostic for a shorter TTP to MM.
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Affiliation(s)
- Udit Yadav
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | - Linda B. Baughn
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | | | - Patricia Greipp
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Rhett Ketterling
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Dragan Jevremovic
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | | | - David Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | - Rafael Fonseca
- Division of Hematology and Oncology, Mayo Clinic, Scottsdale, AZ
| | | | | | - Vivek Roy
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL
| | - Ricardo Parrondo
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL
| | - Taimur Sher
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL
| | | | | | - Nelson Leung
- Division of Hematology, Mayo Clinic, Rochester, MN
- Division of Nephrology, Mayo Clinic, Rochester, MN
| | - Joselle Cook
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | - Eli Muchtar
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | - Ronald S. Go
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | - Scott C. Lester
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
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8
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Rajkumar S, Abdallah N, Lakshman A, Kumar S, Cook J, Binder M, Kapoor P, Dispenzieri A, Gertz M, Lacy M, Hayman S, Buadi F, Dingli D, Lin Y, Kourelis T, Warsame R, Bergsagel PL. Mode of Progression in Smoldering Multiple Myeloma: A study of 406 patients. Res Sq 2023:rs.3.rs-3378634. [PMID: 37961238 PMCID: PMC10635305 DOI: 10.21203/rs.3.rs-3378634/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
The approach to patients with high-risk smoldering multiple myeloma (SMM) varies among clinicians; while some advocate early intervention, others reserve treatment at progression to multiple myeloma (MM). We aimed to describe the myeloma-defining events (MDEs) and clinical presentations leading to MM diagnosis among SMM patients seen at our institution. We included 406 patients diagnosed with SMM between 2013-2022, seen at Mayo Clinic, Rochester, MN. The 2018 Mayo 20/2/20 criteria were used for risk stratification. Median follow-up was 3.9 years. Among high-risk patients who did not receive treatment in the SMM phase (n=71), 51 progressed by last follow-up; the MDEs included: bone lesions(37%), anemia(35%), hypercalcemia(8%), and renal failure(6%); 24% met MM criteria based on marrow plasmacytosis (≥60%) and/or free light chain ratio (>100); 45% had clinically significant MDEs (hypercalcemia, renal insufficiency, and/or bone lesions). MM diagnosis was made based on surveillance labs/imaging(45%), testing obtained due to provider suspicion for progression(14%), bone pain(20%), and hospitalization/ED presentations due to MM complications/symptoms(4%). The presentation was undocumented in 14%. A high proportion (45%) of patients with high-risk SMM on active surveillance develop end-organ damage at progression. About a quarter of patients who progress to MM are not diagnosed based on routine interval surveillance testing.
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9
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Zanwar S, Ho M, Lin Y, Kapoor P, Binder M, Buadi FK, Dispenzieri A, Dingli D, Fonder A, Gertz MA, Gonsalves W, Hayman SR, Hwa Y, Hobbs M, Kourelis T, Lacy MQ, Leung N, Muchtar E, Warsame R, Jevremovic D, Kyle RA, Rajkumar SV, Kumar S. Natural history, predictors of development of extramedullary disease, and treatment outcomes for patients with extramedullary multiple myeloma. Am J Hematol 2023; 98:1540-1549. [PMID: 37421603 DOI: 10.1002/ajh.27023] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 07/10/2023]
Abstract
Extramedullary multiple myeloma (EMM) can present either at initial diagnosis (de novo) or at disease relapse (secondary) and confers an aggressive clinical course. Limited data exist for choosing the optimal therapy for EMM and this remains an area of unmet clinical need. After excluding paraskeletal multiple myeloma and primary plasma cell leukemia, we identified 204 (68%) patients with secondary EMM and 95 (32%) with de novo EMM between January 01, 2000 and 31 December, 2021. The median overall survival (OS) was 0.7 (95% CI: 0.6-0.9) years for secondary EMM and 3.6 (95%CI: 2.4-5.6) years for de novo EMM. The median progression-free survival (PFS) with initial therapy was 2.9 months (95% CI: 2.4-3.2 months) for secondary EMM and 12.9 months (95% CI: 6.7-18 months) for de novo EMM. Patients with secondary EMM treated with CAR-T therapy (n = 20) achieved a partial response (PR) or better in 75% with a median PFS of 4.9 months (3.1 months-not reached; NR). Patients with EMM treated with bispecific antibodies (n = 12) achieved a ≥ PR in 33%, with a median PFS of 2.9 months (95%CI: 2.2 months-NR). In a matched cohort, multivariate logistic regression analysis demonstrated younger age at diagnosis, 1q duplication, and t(4;14) at diagnosis of MM to be independent predictors of development of secondary EMM. Presence of EMM was independently associated with inferior OS in the matched cohorts for both de novo (HR 2.9 [95% CI: 1.6-5.4], p = .0007) and secondary EMM (HR 1.5 [95% CI: 1.1-2], p = .001).
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Affiliation(s)
- Saurabh Zanwar
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew Ho
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Prashant Kapoor
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Moritz Binder
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Francis K Buadi
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - David Dingli
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Amie Fonder
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Morie A Gertz
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Yi Hwa
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Miriam Hobbs
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Martha Q Lacy
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Nelson Leung
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
- Division of Nephrology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eli Muchtar
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Rahma Warsame
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Dragan Jevremovic
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert A Kyle
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Shaji Kumar
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
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10
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Abdallah N, Dispenzieri A, Muchtar E, Buadi FK, Kapoor P, Lacy MQ, Hwa YL, Fonder A, Hobbs MA, Hayman SR, Leung N, Dingli D, Go RS, Lin Y, Gonsalves WI, Binder M, Kourelis T, Warsame R, Kyle RA, Rajkumar SV, Gertz MA, Kumar SK. The impact of Post-Transplant doxycycline in AL amyloidosis - updated results after Long-Term follow up. Amyloid 2023; 30:261-267. [PMID: 36533960 DOI: 10.1080/13506129.2022.2155809] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 11/14/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The current treatment paradigm of AL amyloidosis lacks effective fibril-directed therapies. Doxycycline has been shown to have anti-fibril properties in preclinical models. In 2012, we reported that posttransplant prophylaxis with doxycycline was associated with improved survival compared to penicillin in patients with haematologic response. We provide here updated results after long-term follow up. METHODS We included 553 patients who underwent transplant between July 24th, 1996, and June 24th, 2014. Doxycycline 100 mg daily was used for prophylaxis in patients with penicillin allergy; since 2013, doxycycline was used as the standard for prophylaxis. Prophylaxis was typically continued for a year after transplant. RESULTS The median follow-up from transplant was 12.7 years. Doxycycline was used for prophylaxis in 33% of patients; the rest received penicillin. The median time to next treatment was 6.0 (95%CI; 4.4-8.8) years and 6.0 (95%CI; 4.9-7.1) years in the doxycycline and penicillin groups, respectively (p = .89). The median overall survival was 12.0 (95%CI: 11.0-19.6) years and 11.0 (95%CI: 9.6-12.7) years in the 2 groups, respectively (p = .17). There was a minimal trend towards improved survival with doxycycline among patients with ≥ very good partial response and among patients with organ response that was not statistically significant. CONCLUSION After long-term follow-up, there is no clear evidence to support benefit of doxycycline in the post-transplant setting.
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Affiliation(s)
| | | | - Eli Muchtar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Martha Q Lacy
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Yi L Hwa
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Amie Fonder
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Nelson Leung
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
- Division of Nephrology, Mayo Clinic, Rochester, MN, USA
| | - David Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Ronald S Go
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Moritz Binder
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Rahma Warsame
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Robert A Kyle
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Morie A Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Shaji K Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
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11
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Charalampous C, Goel U, Kapoor P, Binder M, Buadi FK, Cook J, Dingli D, Dispenzieri A, Fonder AL, Gertz MA, Gonsalves W, Hayman SR, Hobbs MA, Hwa YL, Kourelis T, Lacy MQ, Leung N, Lin Y, Warsame R, Kyle RA, Rajkumar SV, Kumar SK. Outcomes of patients with primary refractory multiple myeloma in the era of triplet and quadruplet induction therapy. Blood Adv 2023; 7:4371-4380. [PMID: 37603349 PMCID: PMC10432608 DOI: 10.1182/bloodadvances.2023009681] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 01/05/2023] [Revised: 05/01/2023] [Accepted: 05/02/2023] [Indexed: 06/07/2023] Open
Abstract
Patients with multiple myeloma (MM) who do not respond to initial therapy have worse outcomes than primary responders, and effective treatments are lacking in this population. However, the outcomes of primary refractory disease in the modern treatment era have not yet been studied. We reviewed patients with MM treated with triplet/quadruplet therapy at our institution to assess the incidence of primary refractory disease and the impact of salvage therapies in this population. We identified 1127 patients, of whom 1086 were evaluated for hematologic responses after 4 to 6 cycles. Of these, 93.3% (1013) had evidence of response, whereas 6.7% (73) had primary refractory disease. With a median overall survival (OS) of 51.3 months, patients with primary refractory disease had an increased risk of shorter survival in univariable and multivariable analyses (hazard ratio [HR], 3.5 [95% confidence interval (CI), 2.5-4.9]; HR, 4.3 [95% CI, 2.6-6.9], respectively). In the subgroup analysis of patients with primary refractory disease, those who received second-line autologous stem cell transplantation (ASCT) had increased second progression-free survival (20.9 vs 8.1 months; P < .01) and second OS (74.7 vs 31.3 months; P = .02) compared with patients who did not. We conclude that early progression remains a significant factor for shorter OS in the current era, and salvage ASCT could be the most beneficial option for this population.
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Affiliation(s)
| | - Utkarsh Goel
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Prashant Kapoor
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Moritz Binder
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Francis K. Buadi
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Joselle Cook
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - David Dingli
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Angela Dispenzieri
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Amie L. Fonder
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Morie A. Gertz
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Wilson Gonsalves
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Suzanne R. Hayman
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Miriam A. Hobbs
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Yi L. Hwa
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Taxiarchis Kourelis
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Martha Q. Lacy
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Nelson Leung
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Yi Lin
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Rahma Warsame
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Robert A. Kyle
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - S. Vincent Rajkumar
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Shaji K. Kumar
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
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12
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Schmidt WM, Perera ND, Buadi FK, Hayman SR, Kumar SK, Dispenzieri A, Dingli D, Cook J, Lacy MQ, Kapoor P, Leung N, Muchtar E, Warsame RM, Kourelis T, Binder M, Gonsalves WI, Hogan WJ, Gertz MA. Long-term outcomes of allogeneic stem cell transplant in multiple myeloma. Blood Cancer J 2023; 13:126. [PMID: 37591876 PMCID: PMC10435482 DOI: 10.1038/s41408-023-00900-z] [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: 04/03/2023] [Revised: 07/26/2023] [Accepted: 08/03/2023] [Indexed: 08/19/2023] Open
Abstract
Allogeneic stem cell transplant (allo SCT) for multiple myeloma (MM) is potentially curative in some, while toxic in many others. We retrospectively analyzed 85 patients diagnosed with MM who underwent allo SCT as frontline or salvage therapy between 2000 and 2022 at Mayo Clinic Rochester and examined patient outcomes and prognostic markers. Overall survival (OS), progression free survival (PFS), treatment related mortality (TRM), and relapse rates (RR) were estimated using the Kaplan Meier method and competing risk models. Median follow-up was 11.5 years. Median OS and PFS were 1.7 and 0.71 years, respectively. Five-year OS and PFS were 22.2% and 15.1%, respectively. One-year TRM was 23.5%. Twelve patients demonstrated durable overall survival, living 10+ years beyond their allo SCT. This subgroup was more likely to have no or one prior auto SCT (p = 0.03) and to have been transplanted between 2000 and 2010 (p = 0.03). Outcomes were poor in this cohort with long follow-up, with few patients surviving 5 years or more, and most relapsing or dying within 2 years. We would expect better outcomes and tolerability with an expanded array of novel therapeutics and would prefer them to allo SCT.
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Affiliation(s)
| | - Nirosha D Perera
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Francis K Buadi
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Suzanne R Hayman
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Shaji K Kumar
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Angela Dispenzieri
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - David Dingli
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Joselle Cook
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Martha Q Lacy
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Prashant Kapoor
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Nelson Leung
- Department of Internal Medicine, Division of Nephrology, Mayo Clinic, Rochester, MN, USA
| | - Eli Muchtar
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Rahma M Warsame
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Taxiarchis Kourelis
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Moritz Binder
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Wilson I Gonsalves
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - William J Hogan
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Morie A Gertz
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
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13
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Letson CT, Balasis ME, Newman H, Binder M, Vedder A, Kinose F, Ball M, Kruer T, Quintana A, Lasho TL, Finke CM, Almada LL, Grants JM, Zhang G, Fernandez-Zapico ME, Gaspar-Maia A, Lancet J, Komrokji R, Haura E, Sallman DA, Reuther GW, Karsan A, Rix U, Patnaik MM, Padron E. Targeting BET Proteins Downregulates miR-33a To Promote Synergy with PIM Inhibitors in CMML. Clin Cancer Res 2023; 29:2919-2932. [PMID: 37223910 PMCID: PMC10524644 DOI: 10.1158/1078-0432.ccr-22-3929] [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: 12/22/2022] [Revised: 04/19/2023] [Accepted: 05/19/2023] [Indexed: 05/25/2023]
Abstract
PURPOSE Preclinical studies in myeloid neoplasms have demonstrated efficacy of bromodomain and extra-terminal protein inhibitors (BETi). However, BETi demonstrates poor single-agent activity in clinical trials. Several studies suggest that combination with other anticancer inhibitors may enhance the efficacy of BETi. EXPERIMENTAL DESIGN To nominate BETi combination therapies for myeloid neoplasms, we used a chemical screen with therapies currently in clinical cancer development and validated this screen using a panel of myeloid cell line, heterotopic cell line models, and patient-derived xenograft models of disease. We used standard protein and RNA assays to determine the mechanism responsible for synergy in our disease models. RESULTS We identified PIM inhibitors (PIMi) as therapeutically synergistic with BETi in myeloid leukemia models. Mechanistically, we show that PIM kinase is increased after BETi treatment, and that PIM kinase upregulation is sufficient to induce persistence to BETi and sensitize cells to PIMi. Furthermore, we demonstrate that miR-33a downregulation is the underlying mechanism driving PIM1 upregulation. We also show that GM-CSF hypersensitivity, a hallmark of chronic myelomonocytic leukemia (CMML), represents a molecular signature for sensitivity to combination therapy. CONCLUSIONS Inhibition of PIM kinases is a potential novel strategy for overcoming BETi persistence in myeloid neoplasms. Our data support further clinical investigation of this combination.
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Affiliation(s)
| | | | - Hannah Newman
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Moritz Binder
- Division of Hematology, Mayo Clinic, Rochester, MN
- Epigenomics Program, Center for Individualized Medicine, Mayo Clinic, Rochester, MN, USA
| | - Alexis Vedder
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Fumi Kinose
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Markus Ball
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Traci Kruer
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Ariel Quintana
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Terra L. Lasho
- Epigenomics Program, Center for Individualized Medicine, Mayo Clinic, Rochester, MN, USA
| | - Christy M. Finke
- Epigenomics Program, Center for Individualized Medicine, Mayo Clinic, Rochester, MN, USA
| | - Luciana L. Almada
- Schulze Center for Novel Therapeutics, Division of Oncology Research, Department of Oncology, Mayo Clinic, Rochester, MN
| | | | - Guolin Zhang
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | | | - Alexandre Gaspar-Maia
- Division of Hematology, Mayo Clinic, Rochester, MN
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Jeffrey Lancet
- Malignant Hematology Department, Moffitt Cancer Center, Tampa, FL
| | - Rami Komrokji
- Malignant Hematology Department, Moffitt Cancer Center, Tampa, FL
| | - Eric Haura
- Department of Drug Discovery, H Lee Moffitt Cancer Center, Tampa, FL
| | - David A. Sallman
- Malignant Hematology Department, Moffitt Cancer Center, Tampa, FL
| | - Gary W. Reuther
- Department of Molecular Oncology, H Lee Moffitt Cancer Center, Tampa, FL
| | - Aly Karsan
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC
| | - Uwe Rix
- Department of Drug Discovery, H Lee Moffitt Cancer Center, Tampa, FL
| | - Mrinal M. Patnaik
- Division of Hematology, Mayo Clinic, Rochester, MN
- Epigenomics Program, Center for Individualized Medicine, Mayo Clinic, Rochester, MN, USA
| | - Eric Padron
- Malignant Hematology Department, Moffitt Cancer Center, Tampa, FL
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14
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Visram A, Hayman SR, Dispenzieri A, Kapoor P, Lacy MQ, Gertz MA, Buadi FK, Dingli D, Warsame R, Kourelis T, Cook J, Binder M, Gonsalves W, Muchtar E, Leung N, Roy V, Rajkumar SV, Kumar S. A phase 1/2 of carfilzomib and melphalan conditioning for autologous stem cell transplantation for multiple myeloma (CARAMEL). Am J Hematol 2023. [PMID: 37334773 DOI: 10.1002/ajh.26990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 04/17/2023] [Accepted: 05/18/2023] [Indexed: 06/20/2023]
Abstract
In this phase 1/2 study, carfilzomib was added to high-dose melphalan conditioning prior to autologous stem cell transplantation (ASCT) in patients with multiple myeloma that had been treated with ≤2 prior lines of therapy. Carfilzomib was escalated at doses of 27, 36, 45, and 56 mg/m2 on days -6, -5, -2, and -1 before ASCT in the phase 1 component of the study. In addition, all the patients received melphalan 100 mg/m2 on days -4 and -3. The primary endpoint of the phase 1 component was to identify the maximum tolerated dose, and the primary endpoint of the phase 2 component was the rates of complete response (≥CR) at 1 year after ASCT. The phase 1 dose escalation cohort included 14 patients, and 35 patients were included in the phase 2 cohort. The maximum tested dose was 56 mg/m2 (MTD). The median time from diagnosis to study enrollment was 5.8 (range 3.4-88.4) months, and 16% of patients had obtained a ≥CR prior to ASCT. The best response within 1 year after ASCT was a ≥ CR rate in 22% for the entire cohort, and 22% for patients treated at the MTD. The ≥VGPR rates improved from 41% before ASCT to 77% by 1 year after ASCT. One patient had a grade 3 renal adverse event, and renal function returned to baseline with supportive care. The rate of grade 3-4 cardiovascular toxicity was 16%. The addition of carfilzomib to melphalan conditioning was safe and resulted in deep responses after ASCT.
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Affiliation(s)
- Alissa Visram
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Suzanne R Hayman
- Division of Hematology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Angela Dispenzieri
- Division of Hematology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Prashant Kapoor
- Division of Hematology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Martha Q Lacy
- Division of Hematology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Morie A Gertz
- Division of Hematology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Francis K Buadi
- Division of Hematology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - David Dingli
- Division of Hematology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Rahma Warsame
- Division of Hematology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | | | - Joselle Cook
- Division of Hematology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Moritz Binder
- Division of Hematology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Wilson Gonsalves
- Division of Hematology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Eli Muchtar
- Division of Hematology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Nelson Leung
- Division of Nephrology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Vivek Roy
- Division of Hematology, Mayo Clinic, Jacksonville, Florida, USA
| | - S Vincent Rajkumar
- Division of Hematology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Shaji Kumar
- Division of Hematology, Mayo Clinic Rochester, Rochester, Minnesota, USA
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15
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Sandoval L, Mohammed Ismail W, Mazzone A, Dumbrava M, Fernandez J, Munankarmy A, Lasho T, Binder M, Simon V, Kim KH, Chia N, Lee JH, Weroha SJ, Patnaik M, Gaspar-Maia A. Characterization and Optimization of Multiomic Single-Cell Epigenomic Profiling. Genes (Basel) 2023; 14:1245. [PMID: 37372428 PMCID: PMC10297939 DOI: 10.3390/genes14061245] [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: 04/30/2023] [Revised: 06/01/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
The snATAC + snRNA platform allows epigenomic profiling of open chromatin and gene expression with single-cell resolution. The most critical assay step is to isolate high-quality nuclei to proceed with droplet-base single nuclei isolation and barcoding. With the increasing popularity of multiomic profiling in various fields, there is a need for optimized and reliable nuclei isolation methods, mainly for human tissue samples. Herein we compared different nuclei isolation methods for cell suspensions, such as peripheral blood mononuclear cells (PBMC, n = 18) and a solid tumor type, ovarian cancer (OC, n = 18), derived from debulking surgery. Nuclei morphology and sequencing output parameters were used to evaluate the quality of preparation. Our results show that NP-40 detergent-based nuclei isolation yields better sequencing results than collagenase tissue dissociation for OC, significantly impacting cell type identification and analysis. Given the utility of applying such techniques to frozen samples, we also tested frozen preparation and digestion (n = 6). A paired comparison between frozen and fresh samples validated the quality of both specimens. Finally, we demonstrate the reproducibility of scRNA and snATAC + snRNA platform, by comparing the gene expression profiling of PBMC. Our results highlight how the choice of nuclei isolation methods is critical for obtaining quality data in multiomic assays. It also shows that the measurement of expression between scRNA and snRNA is comparable and effective for cell type identification.
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Affiliation(s)
- Leticia Sandoval
- Division of Experimental Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA; (L.S.); (W.M.I.); (A.M.); (M.D.); (A.M.); (J.-H.L.)
- Epigenomics Program, Center for Individualized Medicine, Mayo Clinic, Rochester, MN 55905, USA; (M.B.); (K.H.K.); (M.P.)
| | - Wazim Mohammed Ismail
- Division of Experimental Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA; (L.S.); (W.M.I.); (A.M.); (M.D.); (A.M.); (J.-H.L.)
- Epigenomics Program, Center for Individualized Medicine, Mayo Clinic, Rochester, MN 55905, USA; (M.B.); (K.H.K.); (M.P.)
| | - Amelia Mazzone
- Division of Experimental Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA; (L.S.); (W.M.I.); (A.M.); (M.D.); (A.M.); (J.-H.L.)
- Epigenomics Program, Center for Individualized Medicine, Mayo Clinic, Rochester, MN 55905, USA; (M.B.); (K.H.K.); (M.P.)
| | - Mihai Dumbrava
- Division of Experimental Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA; (L.S.); (W.M.I.); (A.M.); (M.D.); (A.M.); (J.-H.L.)
- Epigenomics Program, Center for Individualized Medicine, Mayo Clinic, Rochester, MN 55905, USA; (M.B.); (K.H.K.); (M.P.)
- Mayo Clinic Medical Scientist Training Program, Mayo Clinic Alix School of Medicine and Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN 55905, USA
| | - Jenna Fernandez
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA; (J.F.); (T.L.)
| | - Amik Munankarmy
- Division of Experimental Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA; (L.S.); (W.M.I.); (A.M.); (M.D.); (A.M.); (J.-H.L.)
- Epigenomics Program, Center for Individualized Medicine, Mayo Clinic, Rochester, MN 55905, USA; (M.B.); (K.H.K.); (M.P.)
| | - Terra Lasho
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA; (J.F.); (T.L.)
| | - Moritz Binder
- Epigenomics Program, Center for Individualized Medicine, Mayo Clinic, Rochester, MN 55905, USA; (M.B.); (K.H.K.); (M.P.)
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA; (J.F.); (T.L.)
| | - Vernadette Simon
- Medical Genome Facility, Genome Analysis Core, Mayo Clinic, Rochester, MN 55905, USA;
| | - Kwan Hyun Kim
- Epigenomics Program, Center for Individualized Medicine, Mayo Clinic, Rochester, MN 55905, USA; (M.B.); (K.H.K.); (M.P.)
| | - Nicholas Chia
- Microbiome Program, Center for Individualized Medicine, Mayo Clinic, Rochester, MN 55905, USA;
| | - Jeong-Heon Lee
- Division of Experimental Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA; (L.S.); (W.M.I.); (A.M.); (M.D.); (A.M.); (J.-H.L.)
- Epigenomics Program, Center for Individualized Medicine, Mayo Clinic, Rochester, MN 55905, USA; (M.B.); (K.H.K.); (M.P.)
| | - S. John Weroha
- Department of Medical Oncology, Mayo Clinic, Rochester, MN 55905, USA;
| | - Mrinal Patnaik
- Epigenomics Program, Center for Individualized Medicine, Mayo Clinic, Rochester, MN 55905, USA; (M.B.); (K.H.K.); (M.P.)
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA; (J.F.); (T.L.)
| | - Alexandre Gaspar-Maia
- Division of Experimental Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA; (L.S.); (W.M.I.); (A.M.); (M.D.); (A.M.); (J.-H.L.)
- Epigenomics Program, Center for Individualized Medicine, Mayo Clinic, Rochester, MN 55905, USA; (M.B.); (K.H.K.); (M.P.)
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16
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Abdallah NH, Smith AN, Geyer S, Binder M, Greipp PT, Kapoor P, Dispenzieri A, Gertz MA, Baughn LB, Lacy MQ, Hayman SR, Buadi FK, Dingli D, Hwa YL, Lin Y, Kourelis T, Warsame R, Kyle RA, Rajkumar SV, Kumar SK. Conditional survival in multiple myeloma and impact of prognostic factors over time. Blood Cancer J 2023; 13:78. [PMID: 37188699 DOI: 10.1038/s41408-023-00852-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/22/2023] [Accepted: 05/03/2023] [Indexed: 05/17/2023] Open
Abstract
Overall survival estimates from diagnosis are valuable for guiding treatment, but do not consider the years already survived. Conditional survival (CS) provides dynamic survival predictions over time. This study was conducted to estimate CS at 1-8 years from diagnosis and the impact of baseline prognostic factors on CS in multiple myeloma (MM) patients. This is a retrospective study including 2556 MM patients diagnosed between 2004 and 2019. CS (t | s) was defined as the probability of surviving t years given survival of s years. Median age was 64 years. Median follow-up was 6.2 years and median overall survival from diagnosis was 7.5 years. The 5-year CS estimates at s = 0, 1, 2, 3, and 5 years were 0.64, 0.61, 0.61, 0.61, and 0.58, respectively. On multivariate analysis, age ≥ 65 and proteasome inhibitor+immunomodulatory-based induction were associated with decreased survival and increased survival, respectively, retained at 5 years. The adverse impact of 1q gain/amplification, high-risk IgH translocation, and ISS-3 was significant at 1 and 3 years but not 5 years. Chromosome 17 abnormality was associated with decreased survival only at 1 year. Among MM patients, 5-year CS was stable at 1-5 years from diagnosis. The prognostic impact of high-risk cytogenetic factors decreased with additional years survived.
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Affiliation(s)
| | | | - Susan Geyer
- Department of biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Moritz Binder
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Patricia T Greipp
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Morie A Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Linda B Baughn
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Martha Q Lacy
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | - David Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Yi L Hwa
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Rahma Warsame
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Robert A Kyle
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Shaji K Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.
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17
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Soontrapa P, Klein CJ, Dyck PB, Berini SE, McPhail ED, Binder M, Chompoopong P, Engelstad J, Shouman K. Amyloid-like IgM deposition neuropathy with multiple mononeuropathies and generalized neuropathy. Neuromuscul Disord 2023; 33:391-395. [PMID: 37028153 DOI: 10.1016/j.nmd.2023.02.012] [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] [Received: 12/27/2022] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 04/08/2023]
Abstract
Amyloid-like IgM deposition neuropathy is a distinct entity in the setting of IgM monoclonal gammopathy in which endoneurial perivascular entire IgM-particle accumulation leads to a painful sensory followed by motor peripheral neuropathy. We report a 77-year-old man presenting with progressive multiple mononeuropathies starting with painless right foot drop. Electrodiagnostic studies showed severe axonal sensory-motor neuropathy superimposed by multiple mononeuropathies. Laboratory investigations were remarkable for biclonal gammopathy of IgM kappa, IgA lambda and severe sudomotor and mild cardiovagal autonomic dysfunction. A right sural nerve biopsy showed multifocal axonal neuropathy, prominent microvasculitis, and prominent large endoneurial deposits of Congo-red negative amorphous material. Laser dissected mass spectrometry-based proteomics identified IgM kappa deposit without serum amyloid-P protein. This case has several distinctive features, including motor preceding sensory involvement, prominent IgM-kappa proteinaceous deposits replacing most of the endoneurium, a prominent inflammatory component, and improvement of motor strength after immunotherapy.
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18
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Panakkal V, Lakshman A, Shi M, Olteanu H, Horna P, Timm MM, Otteson GE, Baughn LB, Greipp PT, Gonsalves WI, Kapoor P, Gertz MA, Binder M, Buadi FK, Dispenzieri A, Rajkumar SV, Kumar SK, Jevremovic D. Utility of flow cytometry screening before MRD testing in multiple myeloma. Blood Cancer J 2023; 13:55. [PMID: 37080968 PMCID: PMC10119092 DOI: 10.1038/s41408-023-00832-8] [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: 01/23/2023] [Revised: 03/31/2023] [Accepted: 04/06/2023] [Indexed: 04/22/2023] Open
Affiliation(s)
- Vandana Panakkal
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Arjun Lakshman
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Min Shi
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - Horatiu Olteanu
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - Pedro Horna
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - Michael M Timm
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | | | - Linda B Baughn
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Patricia T Greipp
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Wilson I Gonsalves
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Prashant Kapoor
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Morie A Gertz
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Moritz Binder
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Francis K Buadi
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Angela Dispenzieri
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - S Vincent Rajkumar
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Shaji K Kumar
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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19
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Binder M, Lasho TL, Ismail WM, Ben-Crentsil NA, Fernandez JA, Kim M, Geyer SM, Mazzone A, Finke CM, Mangaonkar AA, Lee JH, Kim KH, Simon VA, Rohakthar FR, Munankarmy A, Schwager SM, Harrington JJ, Snyder MR, Droin NM, Solary E, Robertson KD, Wieben ED, Padron E, Chia N, Gaspar-Maia A, Patnaik MM. Abstract 806: Enhancer deregulation in TET2-mutant clonal hematopoiesis is associated with increased COVID-19 severity and mortality. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Abstract
Background: COVID-19 causes significant morbidity and mortality, albeit with considerable heterogeneity among affected individuals. It remains unclear which host factors determine disease severity and survival. Given the propensity of clonal hematopoiesis (CH) to promote inflammation in healthy individuals, we investigated its effect on COVID-19 outcomes.
Methods: We performed a multi-omics interrogation of the genome, epigenome, transcriptome, and proteome of peripheral blood mononuclear cells from COVID-19 patients (n=227). We obtained clinical data, laboratory studies, and survival outcomes. We determined CH status and TET2-related DNA methylation. We performed single-cell proteogenomics to understand clonal composition in relation to cell phenotype. We interrogated single-cell gene expression in isolation and in conjunction with DNA accessibility. We integrated these multi-omics data to understand the effect of CH on clonal composition, gene expression, methylation of cis-regulatory elements, and lineage commitment in COVID-19 patients. We performed shRNA knockdowns to validate the effect of one candidate transcription factor in myeloid cell lines.
Results: The presence of CH was strongly associated with COVID-19 severity and all-cause mortality, independent of age (HR 3.48, 95% CI 1.45-8.36, p=0.005). Differential methylation of promoters and enhancers was prevalent in TET2-mutant, but not DNMT3A-mutant CH. TET2-mutant CH was associated with enhanced classical/intermediate monocytosis and single-cell proteogenomics confirmed an enrichment of TET2 mutations in these cell types. We identified cell-type specific gene expression changes associated with TET2 mutations in 102,072 single cells (n=34). Single-cell RNA-seq confirmed the skewing of hematopoiesis towards classical and intermediate monocytes and demonstrated the downregulation of EGR1 (a transcription factor important for monocyte differentiation) along with up-regulation of the lncRNA MALAT1 in monocytes. Combined scRNA-/scATAC-seq in 43,160 single cells (n=18) confirmed the skewing of hematopoiesis and up-regulation of MALAT1 in monocytes along with decreased accessibility of EGR1 motifs in known cis-regulatory elements. Using myeloid cell lines for functional validation, shRNA knockdowns of EGR1 confirmed the up-regulation of MALAT1 (in comparison to wildtype controls).
Conclusions: CH is an independent prognostic factor in COVID-19 and skews hematopoiesis towards monocytosis. TET2-mutant CH is characterized by differential methylation and accessibility of enhancers binding myeloid transcriptions factors including EGR1. The ensuing loss of EGR1 expression in monocytes causes MALAT1 overexpression, a factor known to promote monocyte differentiation and inflammation. These data provide a mechanistic insight to the adverse prognostic impact of CH in COVID-19.
Citation Format: Moritz Binder, Terra L. Lasho, Wazim Mohammed Ismail, Nana A. Ben-Crentsil, Jenna A. Fernandez, Minsuk Kim, Susan M. Geyer, Amelia Mazzone, Christy M. Finke, Abhishek A. Mangaonkar, Jeong-Heon Lee, Kwan Hyun Kim, Vernadette A. Simon, Fariborz Rakhshan Rohakthar, Amik Munankarmy, Susan M. Schwager, Jonathan J. Harrington, Melissa R. Snyder, Nathalie M. Droin, Eric Solary, Keith D. Robertson, Eric D. Wieben, Eric Padron, Nicholas Chia, Alexandre Gaspar-Maia, Mrinal M. Patnaik. Enhancer deregulation inTET2-mutant clonal hematopoiesis is associated with increased COVID-19 severity and mortality [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 806.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Eric Solary
- 3Gustave Roussy Cancer Center, Villejuif, France
| | | | | | - Eric Padron
- 2H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
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20
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Wang YH, Yao CY, Lin CC, Gurashi K, Amaral FMR, Bossenbroek H, Jerez A, Somervaille TCP, Binder M, Patnaik MM, Hou HA, Chou WC, Batta K, Wiseman DH, Tien HF. A three-gene leukaemic stem cell signature score is robustly prognostic in chronic myelomonocytic leukaemia. Br J Haematol 2023; 201:302-307. [PMID: 36746431 DOI: 10.1111/bjh.18681] [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: 11/11/2022] [Revised: 01/09/2023] [Accepted: 01/20/2023] [Indexed: 02/08/2023]
Abstract
Leukaemic stem cell (LSC) gene expression has recently been linked to prognosis in patients with acute myeloid leukaemia (17-gene LSC score, LSC-17) and myelodysplastic syndromes. Although chronic myelomonocytic leukaemia (CMML) is regarded as a stem cell disorder, the clinical and biological impact of LSCs on CMML patients remains elusive. Making use of multiple independent validation cohorts, we here describe a concise three-gene expression signature (LSC-3, derived from the LSC-17 score) as an independent and robust prognostic factor for leukaemia-free and overall survival in CMML. We propose that LSC-3 could be used to supplement existing risk stratification systems, to improve prognostic performance and guide management decisions.
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Affiliation(s)
- Yu-Hung Wang
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
- Division of Hematology, National Taiwan University Hospital, Taipei, Taiwan
- Leukaemia Biology Laboratory, Cancer Research UK Manchester Institute, Manchester, UK
| | - Chi-Yuan Yao
- Division of Hematology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chien-Chin Lin
- Division of Hematology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Kristian Gurashi
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
| | - Fabio M R Amaral
- Leukaemia Biology Laboratory, Cancer Research UK Manchester Institute, Manchester, UK
| | - Hasse Bossenbroek
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
| | - Andres Jerez
- Haematology Department, Hospital Morales Meseguer, Murcia, Spain
| | - Tim C P Somervaille
- Leukaemia Biology Laboratory, Cancer Research UK Manchester Institute, Manchester, UK
| | - Moritz Binder
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mrinal M Patnaik
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Hsin-An Hou
- Division of Hematology, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Chien Chou
- Division of Hematology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Kiran Batta
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
| | - Daniel H Wiseman
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
| | - Hwei-Fang Tien
- Division of Hematology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, Fra-Eastern Memorial Hospital, New Taipei City, Taiwan
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21
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Goldman-Mazur S, Visram A, Kapoor P, Dispenzieri A, Lacy MQ, Gertz MA, Buadi FK, Hayman SR, Dingli D, Kourelis T, Gonsalves W, Warsame R, Muchtar E, Leung N, Binder M, Fonder A, Hobbs M, Hwa YL, Kyle RA, Rajkumar SV, Kumar SK. Outcomes after biochemical or clinical progression in patients with multiple myeloma. Blood Adv 2023; 7:909-917. [PMID: 35413102 PMCID: PMC10025108 DOI: 10.1182/bloodadvances.2022007082] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 01/18/2022] [Revised: 03/28/2022] [Accepted: 03/30/2022] [Indexed: 11/20/2022] Open
Abstract
Almost all patients with multiple myeloma (MM) eventually relapse, either asymptomatically or with end-organ damage. However, it remains unclear whether initiating therapy at the time of biochemical progression (BP) improves the outcomes compared with initiating therapy at the clinical progression (CP) stage. Here, we retrospectively assessed 1347 patients with relapsed MM. Most progressions were BP (60.4%); 39.6% had CP. The most prevalent symptoms at relapse were new or evolving bone disease (80.9%), anemia (38.0%), and renal failure (12.7%). Patients with BP had longer median time from second-line treatment to the next treatment compared with patients who had CP (17.0 vs 9.6 months; P < .001) as well as longer median overall survival from first relapse (59.4 vs 26.2 months; P < .001). Male sex (odds ratio [OR], 1.49; 95% confidence interval [CI], 1.02-2.18; P = .04), plasma cell labeling index ≥2% (OR, 1.58; 95% CI, 1.02-2.45; P = .04), and extramedullary disease at diagnosis (OR, 1.84; 95% CI, 1.08-3.13; P = .03) were associated with higher risk of CP, whereas very good partial remission or better had decreased risk of CP (OR, 0.62; 95% CI, 0.43-0.91; P = .02). To conclude, patients with CP have inferior postprogression outcomes compared with patients who have BP. Patients with deeper response to first-line therapy are less likely to develop CP. The presence of a specific CRAB (C, hypercalcemia; R, renal failure; A, anemia; B, bone disease) symptom at diagnosis predicts for the development of similar CRAB symptoms at relapse.
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Affiliation(s)
| | - Alissa Visram
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN
- Division of Hematology, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Prashant Kapoor
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN
| | | | - Martha Q. Lacy
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN
| | - Morie A. Gertz
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN
| | | | | | - David Dingli
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN
| | | | | | - Rahma Warsame
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN
| | - Eli Muchtar
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN
| | - Nelson Leung
- Division of Nephrology, Mayo Clinic Rochester, Rochester, MN
| | - Moritz Binder
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN
| | - Amie Fonder
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN
| | - Miriam Hobbs
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN
| | - Yi Lisa Hwa
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN
| | - Robert A. Kyle
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN
| | | | - Shaji K. Kumar
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN
- Correspondence: Shaji K. Kumar, Division of Hematology, Mayo Clinic Rochester, 200 First St SW, Rochester, MN 55905;
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22
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Lasho T, Finke C, Timm M, Tefferi A, Mangaonkar A, Olteanu H, Reichard K, Ketterling R, Gangat N, Xie Z, Fernandez J, Chia N, Gaspar-Maia A, Binder M, Patnaik MM. Single cell proteogenomic analysis of aberrant monocytosis in TET2 mutant premalignant and malignant hematopoiesis. Leukemia 2023:10.1038/s41375-023-01887-z. [PMID: 36966263 DOI: 10.1038/s41375-023-01887-z] [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: 12/05/2022] [Revised: 03/07/2023] [Accepted: 03/21/2023] [Indexed: 03/27/2023]
Affiliation(s)
- Terra Lasho
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Christy Finke
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Michael Timm
- Department of Laboratory Medicine and Pathology, Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - Ayalew Tefferi
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Abhishek Mangaonkar
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Horatiu Olteanu
- Department of Laboratory Medicine and Pathology, Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - Kaaren Reichard
- Department of Laboratory Medicine and Pathology, Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - Rhett Ketterling
- Department of Laboratory Medicine and Pathology, Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - Naseema Gangat
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Zhuoer Xie
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jenna Fernandez
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Nicholas Chia
- Department of Laboratory Medicine and Pathology, Surgical Research, Mayo Clinic, Rochester, MN, USA
| | - Alexandre Gaspar-Maia
- Department of Laboratory Medicine and Pathology, Experimental Pathology, Mayo Clinic, Rochester, MN, USA
| | - Moritz Binder
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Mrinal M Patnaik
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
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23
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Nikoloudis A, Buxhofer-Ausch V, Aichinger C, Binder M, Hasengruber P, Kaynak E, Wipplinger D, Milanov R, Strassl I, Stiefel O, Machherndl-Spandl S, Petzer A, Weltermann A, Clausen J. Adverse impact of a high CD4/CD8 ratio in the allograft may be overcome by methotrexate- but not mycophenolate- or posttransplant cyclophosphamide-based graft versus host disease prophylaxis. Eur J Haematol 2023; 110:715-724. [PMID: 36941654 DOI: 10.1111/ejh.13956] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 12/07/2022] [Revised: 03/11/2023] [Accepted: 03/16/2023] [Indexed: 03/23/2023]
Abstract
INTRODUCTION A high CD4/CD8 T cell ratio in hematopoietic stem cell transplant (HSCT) allografts was observed to predict graft-versus-host disease (GVHD) and non-relapse mortality (NRM) but has not been comparatively examined in settings of various GVHD-prophylaxis regimens. METHODS This retrospective monocentric study included all consecutive HSCT performed with peripheral blood stem cells (PBSC) between January 2000 and June 2021. The impact of the graft CD4/CD8 ratio was analyzed in three cohorts with different GVHD-prophylaxis platforms. RESULTS In the cyclosporine/mycophenolate-mofetil (CSA/MMF) cohort (n = 294, HLA-matched HSCT), a high (> 75th percentile) CD4/CD8 ratio was associated with increased overall mortality (HR 1.56; P=0.01), increased NRM (HR 1.85; P=0.01) and GVHD-associated mortality (HR 2.13; P=0.005). In the post-transplant cyclophosphamide (PTCy)/tacrolimus/MMF cohort (n = 113, haploidentical-related or mismatched-unrelated HSCT), a high CD4/CD8 ratio was associated with increased overall mortality (HR 2.07; P=0.04) and aGVHD3-4 (HR 2.24; P=0.02). By contrast, in the CSA/methotrexate (CSA/MTX) cohort (n = 185, HLA-matched HSCT) the CD4/CD8 ratio had no significant impact on any of the investigated endpoints. CONCLUSION A high CD4/CD8 ratio in the allograft has an adverse impact on GVHD and survival in CSA/MMF- and PTCy-based HSCT, while MTX-based prophylaxis may largely alleviate this important risk factor.
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Affiliation(s)
- A Nikoloudis
- Ordensklinikum Linz - Elisabethinen, Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Linz, Austria
- Johannes Kepler University, Medical Faculty, Linz, Austria
| | - V Buxhofer-Ausch
- Ordensklinikum Linz - Elisabethinen, Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Linz, Austria
- Johannes Kepler University, Medical Faculty, Linz, Austria
| | - C Aichinger
- Ordensklinikum Linz - Elisabethinen, Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Linz, Austria
| | - M Binder
- Ordensklinikum Linz - Elisabethinen, Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Linz, Austria
| | - P Hasengruber
- Ordensklinikum Linz - Elisabethinen, Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Linz, Austria
| | - E Kaynak
- Ordensklinikum Linz - Elisabethinen, Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Linz, Austria
| | - D Wipplinger
- Ordensklinikum Linz - Elisabethinen, Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Linz, Austria
| | - R Milanov
- Ordensklinikum Linz - Elisabethinen, Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Linz, Austria
| | - I Strassl
- Ordensklinikum Linz - Elisabethinen, Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Linz, Austria
- Johannes Kepler University, Medical Faculty, Linz, Austria
| | - O Stiefel
- Ordensklinikum Linz - Elisabethinen, Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Linz, Austria
- Johannes Kepler University, Medical Faculty, Linz, Austria
| | - S Machherndl-Spandl
- Ordensklinikum Linz - Elisabethinen, Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Linz, Austria
- Johannes Kepler University, Medical Faculty, Linz, Austria
| | - A Petzer
- Ordensklinikum Linz - Elisabethinen, Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Linz, Austria
- Johannes Kepler University, Medical Faculty, Linz, Austria
| | - A Weltermann
- Ordensklinikum Linz - Elisabethinen, Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Linz, Austria
- Johannes Kepler University, Medical Faculty, Linz, Austria
| | - J Clausen
- Ordensklinikum Linz - Elisabethinen, Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Linz, Austria
- Johannes Kepler University, Medical Faculty, Linz, Austria
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24
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Charalampous C, Goel U, Kapoor P, Binder M, Buadi FK, Dingli D, Dispenzieri A, Fonder AL, Gertz MA, Gonsalves W, Hayman SR, Hobbs MA, Hwa YL, Kourelis T, Lacy MQ, Leung N, Lin Y, Warsame R, Kyle RA, Rajkumar SV, Kumar S. Thrombosis in multiple myeloma: Risk estimation by induction regimen and association with overall survival. Am J Hematol 2023; 98:413-420. [PMID: 36588396 DOI: 10.1002/ajh.26806] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/27/2022] [Accepted: 11/28/2022] [Indexed: 01/03/2023]
Abstract
Lenalidomide-containing (R) triplet and quadruplet regimens are the standard of care for multiple myeloma (MM) and have been shown to increase the risk of thrombosis. The association between thromboembolism (TE) and survival in the novel multidrug era is not yet delineated. In this study, we evaluated the incidence of TE during the first year of MM diagnosis, its association with the type of induction regimen, and its impact on overall survival. We studied 672 newly diagnosed MM (NDMM) patients who received a triplet or quadruplet lenalidomide-based induction at the Mayo Clinic, Rochester. TE was diagnosed in 83 patients (12.4%). Of these, 56 (8.3%) had a deep venous thrombosis (DVT), 23 (3.4%) had a pulmonary embolism (PE) with or without the DVT, and 4 (0.6%) patients had a stroke. Carfilzomib-Rd (KRd) had the highest risk of TE (21.1%, 18/85), followed by quadruplets (11.1%, 5/45), bortezomib-Rd (9.6%, 51/531), and 0/11 (0%), treated with other lenalidomide-containing regimens. The difference in TE risk between KRd and the other regimens was statistically significant (OR = 2.6, p < .01). Nine patients developed a TE before being exposed to any treatment. Survival was significantly lower among patients that developed a TE (66 vs. 133 months, p < .01). The association of TE with reduced survival demonstrated in univariate analysis (HR = 2.2, 95% CI = 1.6-3.3) was maintained in the multivariable analysis adjusted for high-risk interphase fluorescence in situ hybridization (FISH), sex, age, receipt of an upfront transplant, the response at induction, and the International Staging System (ISS) (HR = 2.61, CI = 1.74-3.9). We conclude that TE is an important aspect of MM management, and effective management is especially relevant in the novel treatment era.
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Affiliation(s)
| | - Utkarsh Goel
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Prashant Kapoor
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Moritz Binder
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Francis K Buadi
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - David Dingli
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Angela Dispenzieri
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Amie L Fonder
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Morie A Gertz
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Wilson Gonsalves
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Suzanne R Hayman
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Miriam A Hobbs
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Yi L Hwa
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Taxiarchis Kourelis
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Martha Q Lacy
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Nelson Leung
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Yi Lin
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Rahma Warsame
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert A Kyle
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - S Vincent Rajkumar
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Shaji Kumar
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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25
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Bansal R, Paludo J, Hathcock MM, Spychalla M, Khurana A, Hampel P, Durani U, Alkhateeb HB, Dingli D, Hayman SR, Kapoor P, Wang Y, Kenderian SS, Binder M, Kourelis T, Kumar S, Shah MV, Warsame R, Bennani DNN, Gertz M, Johnston PB, Ansell S, Siddiqui M, Lin Y. Outpatient Practice Pattern for Recently Approved CAR-T in Patients with Lymphoma and Multiple Myeloma. Transplant Cell Ther 2023. [DOI: 10.1016/s2666-6367(23)00116-1] [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: 02/07/2023]
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26
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Bansal R, Ailawadhi S, Larsen JT, Gertz M, Hathcock MM, Dingli D, Kapoor P, Kourelis T, Hayman SR, Warsame R, Binder M, Parrondo RD, Fonseca R, Bergsagel PL, Kumar S, Lin Y. Prognostic Value of Month 1 Bone Marrow and PET MRD Status in CAR-T Therapy for Myeloma. Transplant Cell Ther 2023. [DOI: 10.1016/s2666-6367(23)00597-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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27
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Goel U, Charalampous C, Kapoor P, Binder M, Buadi FK, Dingli D, Dispenzieri A, Fonder A, Gertz MA, Gonsalves WI, Hayman SR, Hobbs MA, Hwa YL, Kourelis T, Lacy MQ, Leung N, Lin Y, Warsame RM, Kyle RA, Rajkumar SV, Kumar SK. Defining drug/drug class refractoriness vs lines of therapy in relapsed/refractory multiple myeloma. Blood Cancer J 2023; 13:11. [PMID: 36631454 PMCID: PMC9834217 DOI: 10.1038/s41408-023-00785-y] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/23/2022] [Accepted: 01/05/2023] [Indexed: 01/13/2023] Open
Affiliation(s)
- Utkarsh Goel
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Moritz Binder
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - David Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Amie Fonder
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Morie A Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Yi L Hwa
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Martha Q Lacy
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Nelson Leung
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Robert A Kyle
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Shaji K Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.
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28
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Claveau JS, Murray DL, Dispenzieri A, Kapoor P, Binder M, Buadi F, Dingli D, Fonder A, Gertz M, Gonsalves W, Hayman S, Hobbs M, Hwa YL, Kourelis T, Lacy M, Leung N, Lin Y, Warsame R, Kyle RA, Rajkumar V, Kumar SK. Value of bone marrow examination in determining response to therapy in patients with multiple myeloma in the context of mass spectrometry-based M-protein assessment. Leukemia 2023; 37:1-4. [PMID: 36482129 DOI: 10.1038/s41375-022-01779-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 12/14/2022]
Affiliation(s)
| | - David L Murray
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.,Department of Laboratory, Mayo Clinic, Rochester, MN, USA
| | | | | | - Moritz Binder
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Francis Buadi
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - David Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Amie Fonder
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Morie Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Miriam Hobbs
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Yi Lisa Hwa
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Martha Lacy
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Nelson Leung
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Rahma Warsame
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Robert A Kyle
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Shaji K Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.
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29
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Ho M, Zanwar S, Buadi FK, Ailawadhi S, Larsen J, Bergsagel L, Binder M, Chanan‐Khan A, Dingli D, Dispenzieri A, Fonseca R, Gertz MA, Gonsalves W, Go RS, Hayman S, Kapoor P, Kourelis T, Lacy MQ, Leung N, Lin Y, Muchtar E, Roy V, Sher T, Warsame R, Fonder A, Hobbs M, Hwa YL, Kyle RA, Rajkumar SV, Kumar S. Risk factors for severe infection and mortality In patients with COVID-19 in patients with multiple myeloma and AL amyloidosis. Am J Hematol 2023; 98:49-55. [PMID: 36226510 PMCID: PMC9874728 DOI: 10.1002/ajh.26762] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/22/2022] [Accepted: 10/03/2022] [Indexed: 02/04/2023]
Abstract
Patients with multiple myeloma (MM) have a lower efficacy from COVID-19 vaccination and a high rate of mortality from COVID-19 in hospitalized patients. However, the overall rate and severity of COVID-19 infection in all settings (including non-hospitalized patients) and the independent impact of plasma cell-directed therapies on outcomes needs further study. We reviewed the medical records of 9225 patients with MM or AL amyloidosis (AL) seen at Mayo Clinic Rochester, Arizona, and Florida between 12/01/2019 and 8/31/2021 and identified 187 patients with a COVID-19 infection (n = 174 MM, n = 13 AL). The infection rate in our cohort was relatively low at 2% but one-fourth of the COVID-19 infections were severe. Nineteen (10%) patients required intensive care unit (ICU) admission and 5 (3%) patients required mechanical ventilation. The mortality rate among hospitalized patients with COVID-19 was 22% (16/72 patients). Among patients that were fully vaccinated at the time of infection (n = 12), two (17%) developed severe COVID-19 infection, without any COVID-related death. On multivariable analysis, treatment with CD38 antibody within 6 months of COVID-19 infection [Risk ratio (RR) 3.6 (95% CI: 1.2, 10.5), p = .02], cardiac [RR 4.1 (95% CI: 1.3, 12.4), p = .014] or pulmonary comorbidities [RR 3.6 (95% CI 1.1, 11.6); p = .029] were independent predictors for ICU admission. Cardiac comorbidity [RR 2.6 (95% CI: 1.1, 6.5), p = .038] was an independent predictor of mortality whereas MM/AL in remission was associated with lower mortality [RR 0.4 (95% CI: 0.2-0.8); p = .008].
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Affiliation(s)
- Matthew Ho
- Department of Internal MedicineMayo ClinicRochesterMinnesotaUSA
| | - Saurabh Zanwar
- Division of Hematology, Department of Internal MedicineMayo ClinicRochesterMinnesotaUSA
| | - Francis K. Buadi
- Division of Hematology, Department of Internal MedicineMayo ClinicRochesterMinnesotaUSA
| | | | - Jeremy Larsen
- Division of HematologyMayo ClinicScottsdaleArizonaUSA
| | | | - Moritz Binder
- Division of Hematology, Department of Internal MedicineMayo ClinicRochesterMinnesotaUSA
| | | | - David Dingli
- Division of Hematology, Department of Internal MedicineMayo ClinicRochesterMinnesotaUSA
| | - Angela Dispenzieri
- Division of Hematology, Department of Internal MedicineMayo ClinicRochesterMinnesotaUSA
| | | | - Morie A. Gertz
- Division of Hematology, Department of Internal MedicineMayo ClinicRochesterMinnesotaUSA
| | - Wilson Gonsalves
- Division of Hematology, Department of Internal MedicineMayo ClinicRochesterMinnesotaUSA
| | - Ronald S. Go
- Division of Hematology, Department of Internal MedicineMayo ClinicRochesterMinnesotaUSA
| | - Suzanne Hayman
- Division of Hematology, Department of Internal MedicineMayo ClinicRochesterMinnesotaUSA
| | - Prashant Kapoor
- Division of Hematology, Department of Internal MedicineMayo ClinicRochesterMinnesotaUSA
| | - Taxiarchis Kourelis
- Division of Hematology, Department of Internal MedicineMayo ClinicRochesterMinnesotaUSA
| | - Martha Q. Lacy
- Division of Hematology, Department of Internal MedicineMayo ClinicRochesterMinnesotaUSA
| | - Nelson Leung
- Division of Hematology, Department of Internal MedicineMayo ClinicRochesterMinnesotaUSA
| | - Yi Lin
- Division of Hematology, Department of Internal MedicineMayo ClinicRochesterMinnesotaUSA
| | - Eli Muchtar
- Division of Hematology, Department of Internal MedicineMayo ClinicRochesterMinnesotaUSA
| | - Vivek Roy
- Division of HematologyMayo ClinicJacksonvilleFloridaUSA
| | - Taimur Sher
- Division of HematologyMayo ClinicJacksonvilleFloridaUSA
| | - Rahma Warsame
- Division of Hematology, Department of Internal MedicineMayo ClinicRochesterMinnesotaUSA
| | - Amie Fonder
- Division of Hematology, Department of Internal MedicineMayo ClinicRochesterMinnesotaUSA
| | - Miriam Hobbs
- Division of Hematology, Department of Internal MedicineMayo ClinicRochesterMinnesotaUSA
| | - Yi L. Hwa
- Division of Hematology, Department of Internal MedicineMayo ClinicRochesterMinnesotaUSA
| | - Robert A. Kyle
- Division of Hematology, Department of Internal MedicineMayo ClinicRochesterMinnesotaUSA
| | - S. Vincent Rajkumar
- Division of Hematology, Department of Internal MedicineMayo ClinicRochesterMinnesotaUSA
| | - Shaji Kumar
- Division of Hematology, Department of Internal MedicineMayo ClinicRochesterMinnesotaUSA
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30
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Abdallah N, Smith A, Geyer S, Binder M, Greipp P, Kapoor P, Dispenzieri A, Gertz M, Baughn L, Lacy M, Hayman S, Buadi F, Dingli D, Hwa Y, Lin Y, Kourelis T, Warsame R, Kyle R, Rajkumar S, Kumar S. 639P Conditional survival in MM and impact of prognostic factors over time. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.765] [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: 11/30/2022] Open
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31
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Stintzing S, Dechow T, Vehling-Kaiser U, Lorenzen S, Hannig CV, Schwaner I, Fischer von Weikersthal L, Puchtler G, Binder M, Held S, Heinrich K, Heinemann V. 424P Avelumab added to FOLFIRI plus cetuximab followed by avelumab maintenance in patients with previously untreated RAS wild-type colorectal cancer: The phase-II FIRE-6 (AIO KRK-0118). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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32
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Schultheiß C, Claaß L, Scholz R, Paschold L, Simnica D, Heinemann V, Stintzing S, Binder M. 1688P Selection of PD-L1 escape variants in microsatellite stable metastatic colorectal cancer on avelumab treatment. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1767] [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: 11/01/2022] Open
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33
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Ebraheem M, Kumar SK, Dispenzieri A, Jevremovic D, Buadi FK, Dingli D, Cook J, Lacy MQ, Hayman SR, Kapoor P, Leung N, Fonder A, Hobbs M, Hwa YL, Muchtar E, Warsame R, Kourelis TV, Russell S, Binder M, Lin Y, Go RS, Siddiqui MA, Kyle RA, Rajkumar SV, Gonsalves WI, Gertz MA. Deepening Responses after Upfront Autologous Stem Cell Transplantation in Patients with Newly Diagnosed Multiple Myeloma in the Era of Novel Agent Induction Therapy. Transplant Cell Ther 2022; 28:760.e1-760.e5. [DOI: 10.1016/j.jtct.2022.07.030] [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] [Received: 06/14/2022] [Revised: 07/29/2022] [Accepted: 07/31/2022] [Indexed: 11/25/2022]
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34
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Charalampous C, Goel U, Kapoor P, Binder M, Buadi F, Dingli D, Dispenzieri A, Fonder A, Gertz M, Gonsalves W, Hayman S, Hobbs M, Hwa YL, Kourelis T, Lacy M, Leung N, Lin Y, Warsame R, Kyle R, Rajkumar V, Kumar S. P-208: Association of thrombocytopenia with disease burden, high-risk cytogenetics, and survival in newly diagnosed multiple myeloma patients. Clinical Lymphoma Myeloma and Leukemia 2022. [PMCID: PMC9403041 DOI: 10.1016/s2152-2650(22)00538-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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35
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Ebraheem M, Cook J, Kumar S, Jevremovic D, Dispenzieri A, Dingli D, Buadi F, Kapoor P, Lacy M, Kourelis T, Warsame RM, Binder M, Muchtar E, Hayman SR, Go RS, Leung N, Rajkumar SV, Kyle RA, Gonsalves WI, Gertz MA. Impact of high-dose melphalan followed by autologous stem cell transplant in producing MRD negative complete response in newly diagnosed multiple myeloma. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e20001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e20001 Background: High dose melphalan followed by autologous stem cell transplant (HDM-ASCT) remains the standard of care for transplant-eligible patients with newly diagnosed multiple myeloma (NDMM) despite advances in treatments. Achievement of complete response (CR) is associated with improved overall survival (OS) and progression-free survival (PFS); Minimal Residual Disease (MRD) negativity (-) using next generation flow cytometry with a sensitivity of 10-5 is strongly associated with improved PFS and OS. We investigated the rates of conversion to MRD(-), especially MRD(-) CR following HDM-ASCT in patients with NDMM. Methods: We retrospectively reviewed patients with NDMM who underwent early HDM-ASCT at Mayo Clinic Rochester from May 2018 to July 2019. Response assessment was conducted after induction and within 100 days post-ASCT based on 2016 IMWG criteria, except for using Mass-Fix instead of immunofixation. MRD was assessed in bone marrow using the established Euro Flow protocol with sensitivity of 10-5. The FISH assay was used to risk-stratify patients as high-risk (HR) and standard risk (SR) cytogenetics as per the mSMART guidelines. Primary outcome measure was the conversion to MRD(-) CR after ASCT. Secondary outcomes include the overall conversion to MRD(-) irrespective of IMWG response, the impact of HR cytogenetics and pre-ASCT IMWG response on conversion to MRD(-) CR. Results: Two-hundred and ten patients were included; 126 (60%) were male and median age 62 years (range 32–77 years). There were 78 (44%) patients with HR cytogenetics. Pre-ASCT, 23 patients (11%) achieved MRD(-) CR, and 66 (31%) patients achieved MRD(-) CR post ASCT. Of 187 patients not in MRD(-) CR pre-ASCT, 45 (24%) converted to MRD(-) CR. Table provides a breakdown of the conversion rate of pre-ASCT IMWG response category to MRD(-) CR post ASCT and patients with MRD(+) CR had the highest rate (78%) of conversion. The presence of HR cytogenetics did not impact rates of MRD(-) CR achievement post ASCT irrespective of pre-ASCT IMWG response (p = 1.0). Overall, irrespective of IMWG response, 43 (20%) patients were MRD(-) pre-ASCT (19 in VGPR, 24 in CR or better) and 102 (49%) patients were MRD(-) post-ASCT (36 in VGPR, 66 in CR or better). Among 85 patients in VGPR post-ASCT, 36 were MRD(-) of which 8 (22%) progressed, while 49 were MRD(+) of which 24 (49%) progressed (p = 0.014). Conclusions: Upfront HDM-ASCT in patients with NDMM leads to deeper responses with 24% converting to MRD(-) CR and more than doubling of the total rate of MRD(-) irrespective of IMWG response. [Table: see text]
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ronald S. Go
- Division of Hematology, Mayo Clinic, Rochester, MN
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36
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Abdallah N, Murray D, Dispenzieri A, Kapoor P, Gertz MA, Lacy MQ, Hayman SR, Buadi FK, Gonsalves W, Muchtar E, Leung N, Dingli D, Kourelis T, Warsame R, Binder M, Kyle RA, Rajkumar SV, Kumar S. Tracking daratumumab clearance using mass spectrometry: implications on M protein monitoring and reusing daratumumab. Leukemia 2022; 36:1426-1428. [PMID: 35091659 PMCID: PMC9061287 DOI: 10.1038/s41375-021-01501-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 12/13/2021] [Accepted: 12/21/2021] [Indexed: 12/14/2022]
Affiliation(s)
| | - David Murray
- Department of Laboratory Medicine and Pathology, Rochester, MN, USA
| | | | | | - Morie A Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Martha Q Lacy
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Eli Muchtar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Nelson Leung
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
- Division of Nephrology, Mayo Clinic, Rochester, MN, USA
| | - David Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Rahma Warsame
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Moritz Binder
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Robert A Kyle
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Shaji Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.
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37
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Abdallah N, Murray D, Dispenzieri A, Kapoor P, Gertz MA, Lacy MQ, Hayman SR, Buadi FK, Gonsalves W, Muchtar E, Leung N, Dingli D, Kourelis T, Warsame R, Binder M, Kyle RA, Rajkumar SV, Kumar S. Correction: Tracking daratumumab clearance using mass spectrometry: implications on M protein monitoring and reusing daratumumab. Leukemia 2022; 36:1449. [PMID: 35414658 PMCID: PMC9061288 DOI: 10.1038/s41375-022-01567-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - David Murray
- Department of Laboratory Medicine and Pathology, Rochester, MN, USA
| | | | | | - Morie A Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Martha Q Lacy
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Eli Muchtar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Nelson Leung
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.,Division of Nephrology, Mayo Clinic, Rochester, MN, USA
| | - David Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Rahma Warsame
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Moritz Binder
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Robert A Kyle
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Shaji Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.
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38
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Abdallah NH, Habermann T, Buadi FK, Gertz MA, Lacy MQ, Rajkumar SV, Dingli D, Go RS, Hayman SR, Kumar SK, Kourelis T, Warsame R, Kapoor P, Muchtar E, Hwa YL, Fonder AL, Hobbs MA, Lin Y, Leung N, Binder M, Siddiqui MA, Kyle RA, Witzig TE, Dispenzieri A. Multicentric Castleman disease: A single center experience of treatment with a focus on autologous stem cell transplantation. Am J Hematol 2022; 97:401-410. [PMID: 35015310 DOI: 10.1002/ajh.26466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 01/07/2022] [Accepted: 01/09/2022] [Indexed: 11/12/2022]
Abstract
Castleman disease (CD) is a rare lymphoproliferative disease characterized by diverse clinical and pathologic features. Due to its rarity, there are limited studies comparing currently available therapies. The role of autologous stem cell transplantation (ASCT) in CD has not yet been established. In this paper, we describe the clinical characteristics, treatment choices, and outcomes in 34 Mayo Clinic patients diagnosed with multicentric CD from July 1, 2003 to April 30, 2018. Eighteen patients (53%) also met the criteria for POEMS, including 14 with the osteosclerotic variant. The first-line treatments included: steroid monotherapy (4), cytotoxic chemotherapy (6), rituximab alone (8) or with chemotherapy (2), anti-IL6 treatment (3), and ASCT (10). The median follow-up was 4.8 (range: 0.1-15.2) years. The 5- and 10-year overall survival rates were 84% and 71%, respectively. Sixteen patients received high-dose chemotherapy followed by ASCT during their disease course. Among those, 14 had multicentric CD associated with POEMS. There were no transplant-related deaths. All patients had at least a partial response to ASCT, most of whom achieved a complete response. The favorable outcomes seen with ASCT in this cohort suggest that transplantation may have a role in multicentric CD, particularly for patients with multicentric CD associated with POEMS.
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Affiliation(s)
| | | | | | - Morie A. Gertz
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | - Martha Q. Lacy
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | | | - David Dingli
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | - Ronald S. Go
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | | | - Shaji K. Kumar
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | | | - Rahma Warsame
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | | | - Eli Muchtar
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | - Yi L. Hwa
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | - Amie L. Fonder
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | | | - Yi Lin
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | - Nelson Leung
- Division of Hematology Mayo Clinic Rochester Minnesota USA
- Division of Nephrology Mayo Clinic Rochester Minnesota USA
| | - Moritz Binder
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | | | - Robert A. Kyle
- Division of Hematology Mayo Clinic Rochester Minnesota USA
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39
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McLaughlin N, Ruan G, Day CN, Harmsen WS, Smith CJ, Binder M, Gangat N, Go RS, Tefferi A, Shah MV. A population-based study of acute panmyelosis with myelofibrosis in the United States: 2004-2015. Am J Hematol 2022; 97:E144-E147. [PMID: 35025125 DOI: 10.1002/ajh.26467] [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: 11/24/2021] [Revised: 01/08/2022] [Accepted: 01/10/2022] [Indexed: 11/07/2022]
Affiliation(s)
| | - Gordon Ruan
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | - Courtney N. Day
- Division of Biomedical Statistics and Informatics Mayo Clinic Rochester Minnesota USA
| | - William S. Harmsen
- Division of Biomedical Statistics and Informatics Mayo Clinic Rochester Minnesota USA
| | - Caleb J. Smith
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | - Moritz Binder
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | - Naseema Gangat
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | - Ronald S. Go
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | - Ayalew Tefferi
- Division of Hematology Mayo Clinic Rochester Minnesota USA
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40
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Binder M, Carr RM, Lasho TL, Finke CM, Mangaonkar AA, Pin CL, Berger KR, Mazzone A, Potluri S, Ordog T, Robertson KD, Marks DL, Fernandez-Zapico ME, Gaspar-Maia A, Patnaik MM. Oncogenic gene expression and epigenetic remodeling of cis-regulatory elements in ASXL1-mutant chronic myelomonocytic leukemia. Nat Commun 2022; 13:1434. [PMID: 35301312 PMCID: PMC8931048 DOI: 10.1038/s41467-022-29142-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 10/23/2020] [Accepted: 02/24/2022] [Indexed: 12/14/2022] Open
Abstract
Myeloid neoplasms are clonal hematopoietic stem cell disorders driven by the sequential acquisition of recurrent genetic lesions. Truncating mutations in the chromatin remodeler ASXL1 (ASXL1MT) are associated with a high-risk disease phenotype with increased proliferation, epigenetic therapeutic resistance, and poor survival outcomes. We performed a multi-omics interrogation to define gene expression and chromatin remodeling associated with ASXL1MT in chronic myelomonocytic leukemia (CMML). ASXL1MT are associated with a loss of repressive histone methylation and increase in permissive histone methylation and acetylation in promoter regions. ASXL1MT are further associated with de novo accessibility of distal enhancers binding ETS transcription factors, targeting important leukemogenic driver genes. Chromatin remodeling of promoters and enhancers is strongly associated with gene expression and heterogenous among overexpressed genes. These results provide a comprehensive map of the transcriptome and chromatin landscape of ASXL1MT CMML, forming an important framework for the development of novel therapeutic strategies targeting oncogenic cis interactions.
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Affiliation(s)
- Moritz Binder
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
- Epigenomics Program, Center for Individualized Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ryan M Carr
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Terra L Lasho
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Christopher L Pin
- Lawson Health Research Institute, University of Western Ontario, London, ON, Canada
| | - Kurt R Berger
- Lawson Health Research Institute, University of Western Ontario, London, ON, Canada
| | - Amelia Mazzone
- Epigenomics Program, Center for Individualized Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Sandeep Potluri
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Tamas Ordog
- Epigenomics Program, Center for Individualized Medicine, Mayo Clinic, Rochester, MN, USA
| | - Keith D Robertson
- Epigenomics Program, Center for Individualized Medicine, Mayo Clinic, Rochester, MN, USA
| | - David L Marks
- Schulze Center for Novel Therapeutics, Division of Oncology Research, Mayo Clinic, Rochester, MN, USA
| | - Martin E Fernandez-Zapico
- Schulze Center for Novel Therapeutics, Division of Oncology Research, Mayo Clinic, Rochester, MN, USA
| | - Alexandre Gaspar-Maia
- Epigenomics Program, Center for Individualized Medicine, Mayo Clinic, Rochester, MN, USA.
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - Mrinal M Patnaik
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.
- Epigenomics Program, Center for Individualized Medicine, Mayo Clinic, Rochester, MN, USA.
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41
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Kaddoura M, Binder M, Dingli D, Buadi FK, Lacy MQ, Gertz MA, Dispenzieri A, Kapoor P, Hwa L, Fonder A, Hobbs M, Hayman S, Leung N, Go RS, Lin Y, Gonsalves W, Kourelis T, Warsame R, Kyle RA, Rajkumar V, Kumar S. Impact of achieving a complete response to initial therapy of multiple myeloma and predictors of subsequent outcome. Am J Hematol 2022; 97:267-273. [PMID: 34978743 DOI: 10.1002/ajh.26439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/05/2021] [Accepted: 12/15/2021] [Indexed: 11/10/2022]
Abstract
Achievement of a complete response (CR) in multiple myeloma (MM) correlates with improvement in survival outcomes; however, its impact on prognostic variables at baseline outside of clinical trial settings is not well described. We sought to determine the impact of achieving a CR within 2 years from diagnosis, its effect on the prognostic value of fluorescence in situ hybridization (FISH) and International Staging System (ISS) risk, and examined additional predictors of outcome among those achieving a CR in a routine clinical setting. We evaluated 1869 newly diagnosed MM patients who had ≥ 2 monoclonal protein immunofixation studies in the serum and urine available within 24 months from diagnosis, categorizing those with ≥ 2 negative serum and urine immunofixations as achieving CR. With a landmark at 24 months, median progression-free survival (PFS) for CR versus non-CR patients was 29.8 versus 20.9 months (p ≤ .0002); median overall survival (OS) was 104 versus 70 months (p < .0001). The impact of achieving a CR was retained after adjusting for FISH, ISS, sex, transplant status, and involved heavy chain. Baseline FISH and ISS stage were not associated with PFS or OS among patients achieving a CR. The following variables were found as predictors of inferior OS within the CR cohort: age > 75 years, male gender, hypoalbuminemia, and non-immunoglobulin G involved heavy chain. Our study confirms that achievement of CR within 2 years from diagnosis is associated with improvement in survival outcomes and neutralization of the impact of FISH and ISS risk, thereby confirming observations from the clinical trial setting among a clinical practice cohort.
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Affiliation(s)
- Marcella Kaddoura
- Division of Hematology, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
| | - Moritz Binder
- Division of Hematology, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
| | - David Dingli
- Division of Hematology, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
| | - Francis K. Buadi
- Division of Hematology, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
| | - Martha Q. Lacy
- Division of Hematology, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
| | - Morie A. Gertz
- Division of Hematology, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
| | - Angela Dispenzieri
- Division of Hematology, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
| | - Prashant Kapoor
- Division of Hematology, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
| | - Lisa Hwa
- Division of Hematology, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
| | - Amie Fonder
- Division of Hematology, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
| | - Miriam Hobbs
- Division of Hematology, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
| | - Suzanne Hayman
- Division of Hematology, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
| | - Nelson Leung
- Division of Nephrology and Hypertension, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
| | - Ronald S. Go
- Division of Hematology, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
| | - Yi Lin
- Division of Hematology, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
| | - Wilson Gonsalves
- Division of Hematology, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
| | - Taxiarchis Kourelis
- Division of Hematology, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
| | - Rahma Warsame
- Division of Hematology, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
| | - Robert A. Kyle
- Division of Hematology, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
| | - Vincent Rajkumar
- Division of Hematology, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
| | - Shaji Kumar
- Division of Hematology, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
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42
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Loske J, Röhmel J, Lukassen S, Stricker S, Magalhães VG, Liebig J, Chua RL, Thürmann L, Messingschlager M, Seegebarth A, Timmermann B, Klages S, Ralser M, Sawitzki B, Sander LE, Corman VM, Conrad C, Laudi S, Binder M, Trump S, Eils R, Mall MA, Lehmann I. Pre-activated antiviral innate immunity in the upper airways controls early SARS-CoV-2 infection in children. Nat Biotechnol 2022; 40:319-324. [PMID: 34408314 DOI: 10.1038/s41587-021-01037-9] [Citation(s) in RCA: 167] [Impact Index Per Article: 83.5] [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: 04/08/2021] [Accepted: 07/28/2021] [Indexed: 12/20/2022]
Abstract
Children have reduced severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection rates and a substantially lower risk for developing severe coronavirus disease 2019 compared with adults. However, the molecular mechanisms underlying protection in younger age groups remain unknown. Here we characterize the single-cell transcriptional landscape in the upper airways of SARS-CoV-2-negative (n = 18) and age-matched SARS-CoV-2-positive (n = 24) children and corresponding samples from adults (n = 44), covering an age range of 4 weeks to 77 years. Children displayed higher basal expression of relevant pattern recognition receptors such as MDA5 (IFIH1) and RIG-I (DDX58) in upper airway epithelial cells, macrophages and dendritic cells, resulting in stronger innate antiviral responses upon SARS-CoV-2 infection than in adults. We further detected distinct immune cell subpopulations including KLRC1 (NKG2A)+ cytotoxic T cells and a CD8+ T cell population with a memory phenotype occurring predominantly in children. Our study provides evidence that the airway immune cells of children are primed for virus sensing, resulting in a stronger early innate antiviral response to SARS-CoV-2 infection than in adults.
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Affiliation(s)
- J Loske
- Molecular Epidemiology Unit, Berlin Institute of Health at the Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - J Röhmel
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu, Berlin, Germany
| | - S Lukassen
- Center for Digital Health, Berlin Institute of Health at the Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - S Stricker
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu, Berlin, Germany
| | - V G Magalhães
- Research group "Dynamics of Early Viral Infection and the Innate Antiviral Response", division F170, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - J Liebig
- Center for Digital Health, Berlin Institute of Health at the Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - R L Chua
- Center for Digital Health, Berlin Institute of Health at the Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - L Thürmann
- Molecular Epidemiology Unit, Berlin Institute of Health at the Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - M Messingschlager
- Molecular Epidemiology Unit, Berlin Institute of Health at the Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - A Seegebarth
- Molecular Epidemiology Unit, Berlin Institute of Health at the Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - B Timmermann
- Max Planck Institute for Molecular Genetics, Berlin, Germany
| | - S Klages
- Max Planck Institute for Molecular Genetics, Berlin, Germany
| | - M Ralser
- Institute of Biochemistry, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - B Sawitzki
- Institute of Medical Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - L E Sander
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
- German Center for Lung Research (DZL), associated partner, Berlin, Germany
| | - V M Corman
- Institute of Virology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
- German Centre for Infection Research (DZIF), Associated Partner Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - C Conrad
- Center for Digital Health, Berlin Institute of Health at the Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - S Laudi
- Department of Anesthesiology and Intensive Care, University Hospital Leipzig, Leipzig, Germany
| | - M Binder
- Research group "Dynamics of Early Viral Infection and the Innate Antiviral Response", division F170, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - S Trump
- Molecular Epidemiology Unit, Berlin Institute of Health at the Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - R Eils
- Center for Digital Health, Berlin Institute of Health at the Charité - Universitätsmedizin Berlin, Berlin, Germany.
- German Center for Lung Research (DZL), associated partner, Berlin, Germany.
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.
| | - M A Mall
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu, Berlin, Germany
- German Center for Lung Research (DZL), associated partner, Berlin, Germany
| | - I Lehmann
- Molecular Epidemiology Unit, Berlin Institute of Health at the Charité - Universitätsmedizin Berlin, Berlin, Germany
- German Center for Lung Research (DZL), associated partner, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
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43
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Xie Z, Campestri G, Lasho T, Finke C, Li M, Binder M, Fernandez J, Olteanu H, Reichard KK, Ketterling R, Litzow M, Tefferi A, Mangaonkar A, Gangat N, Aref AK, Patnaik MM. Clonal compositions involving epigenetic regulator and splicing mutations in CHIP, CCUS, MDS, and CMML. Leuk Res 2022; 116:106818. [DOI: 10.1016/j.leukres.2022.106818] [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] [Received: 01/16/2022] [Revised: 02/15/2022] [Accepted: 02/19/2022] [Indexed: 10/19/2022]
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Abdallah NH, Binder M, Rajkumar SV, Greipp PT, Kapoor P, Dispenzieri A, Gertz MA, Baughn LB, Lacy MQ, Hayman SR, Buadi FK, Dingli D, Go RS, Hwa YL, Fonder AL, Hobbs MA, Lin Y, Leung N, Kourelis T, Warsame R, Siddiqui MA, Kyle RA, Bergsagel PL, Fonseca R, Ketterling RP, Kumar SK. A simple additive staging system for newly diagnosed multiple myeloma. Blood Cancer J 2022; 12:21. [PMID: 35102148 PMCID: PMC8803917 DOI: 10.1038/s41408-022-00611-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [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: 08/12/2021] [Revised: 12/07/2021] [Accepted: 01/12/2022] [Indexed: 11/21/2022] Open
Abstract
Risk stratification in multiple myeloma is important for prognostication, patient selection for clinical trials, and comparison of treatment approaches. We developed and validated a staging system that incorporates additional FISH abnormalities not included in the R-ISS and reflects the additive effects of co-occurring high-risk disease features. We first evaluated the prognostic value of predefined cytogenetic and laboratory abnormalities in 2556 Mayo Clinic patients diagnosed between February 2004 and June 2019. We then used data from 1327 patients to develop a risk stratification model and validated this in 502 patients enrolled in the MMRF CoMMpass study. On multivariate analysis, high-risk IgH translocations [risk ratio (RR): 1.7], 1q gain/amplification (RR: 1.4), chromosome17 abnormalities (RR: 1.6), ISS III (RR: 1.7), and elevated LDH (RR: 1.3) were independently associated with decreased overall survival (OS). Among 1327 evaluable patients, OS was 11.0 (95% CI: 9.2–12.6), 7.0 (95% CI: 6.3–9.2), and 4.5 (95% CI: 3.7–5.2) years in patients with 0 (stage I), 1 (stage II), and ≥2 (stage III) high-risk factors, respectively. In the MMRF cohort, median OS was 7.8 (95% CI: NR-NR), 6.0 (95% CI: 5.7-NR), and 4.3 (95% CI: 2.7-NR) years in the 3 groups, respectively (P < 0.001). This 5-factor, 3-tier system is easy to implement in practice and improves upon the current R-ISS.
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Affiliation(s)
| | - Moritz Binder
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | - Morie A Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Linda B Baughn
- Department of Laboratory Medicine and Pathology, Rochester, MN, USA
| | - Martha Q Lacy
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | - David Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Ronald S Go
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Yi L Hwa
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Amie L Fonder
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Nelson Leung
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.,Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | | | - Rahma Warsame
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Robert A Kyle
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Shaji K Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.
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45
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Muchtar E, Drake MT, Leung N, Dispenzieri A, Lacy MQ, Buadi FK, Dingli D, Hayman SR, Kapoor P, Hwa YL, Fonder A, Hobbs M, Gonsalves W, Kourelis TV, Warsame R, Russell S, Go RS, Binder M, Kyle RA, Rajkumar SV, Kumar SK, Gertz MA. Hypovitaminosis D Is Prevalent in Patients With Renal AL Amyloidosis and Associated With Renal Outcome. Front Endocrinol (Lausanne) 2022; 13:891712. [PMID: 35800433 PMCID: PMC9253369 DOI: 10.3389/fendo.2022.891712] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Vitamin D deficiency is common, but no data have been reported on vitamin D levels in light chain (AL) amyloidosis. PATIENTS AND METHODS In this exploratory study, stored serum samples from 173 patients with newly diagnosed AL amyloidosis were analyzed for vitamin studies which included 25-hydroxyvitamin D [25(OH)D], 1,25-dihydroxyvitamin D [1,25(OH)2D] and vitamin D binding protein (DBP). Measurements were made by liquid chromatography-tandem mass spectrometry. Kidney survival and overall survival (OS) were assessed in association to vitamin D status. RESULTS Cardiac and kidney involvement occurred in 69% and 63% of patients, respectively. 25(OH)D deficiency (<20 ng/mL) was seen in 56.6% of the patients and was notably found among patients with heavy proteinuria (96%), hypoalbuminemia (84.3%) and morbidly obese patients (68.3%). Heavy proteinuria (>5 gr/24-h) and vitamin D supplementation were independent predictors of 25(OH)D level on nominal multivariate regression analysis. 1,25(0H)2D deficiency was noted in 37.6% of patients and was independently associated with low eGFR and hypoalbuminemia. Progression to ESRD occurred in 23.7% of evaluable patients. Patients who progressed to ESRD had lower serum 25(OH)D and 1,25(OH)2D levels compared to those who did not progress to ESRD. On a multivariate analysis, severe 25(OH)D deficiency was an independent predictor of progression to ESRD as was renal stage, while 1,25(OH)2D deficiency was not. CONCLUSIONS Hypovitaminosis D is common in AL amyloidosis, particularly among patients with heavy proteinuria. Severe 25(OH)D deficiency at time of diagnosis predicts progression to ESRD.
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Affiliation(s)
- Eli Muchtar
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
- *Correspondence: Eli Muchtar,
| | - Matthew T. Drake
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
- Department of Endocrinology and Kogod Center of Aging, Mayo Clinic College of Medicine, Rochester, MN, United States
| | - Nelson Leung
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, United States
| | | | - Martha Q. Lacy
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | - Francis K. Buadi
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | - David Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | | | - Prashant Kapoor
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | - Yi Lisa Hwa
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | - Amie Fonder
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | - Miriam Hobbs
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | - Wilson Gonsalves
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | | | - Rahma Warsame
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | - Stephen Russell
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | - Ronald S. Go
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | - Moritz Binder
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | - Robert A. Kyle
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | | | - Shaji K. Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | - Morie A. Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
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46
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You J, Bachmann C, Belardi V, Binder M, Bowden D, Calabrò G, Fanelli P, Fursdon M, Garkusha I, Gerashchenko S, Hunger K, de Luca R, Makhlai V, Mantel N, Maviglia F, Müller AV, Nemati N, Roberts J, Vivio F, Vizvary Z, Zhang K. Limiters for DEMO wall protection: Initial design concepts & technology options. Fusion Engineering and Design 2022. [DOI: 10.1016/j.fusengdes.2021.112988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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47
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Binder M, Nandakumar B, Rajkumar SV, Kapoor P, Buadi FK, Dingli D, Lacy MQ, Gertz MA, Hayman SR, Leung N, Fonder A, Hobbs M, Hwa YL, Muchtar E, Warsame R, Kourelis TV, Gonsalves WI, Russell S, Lin Y, Siddiqui M, Kyle RA, Dispenzieri A, Kumar SK. Mortality trends in multiple myeloma after the introduction of novel therapies in the United States. Leukemia 2021; 36:801-808. [PMID: 34702976 DOI: 10.1038/s41375-021-01453-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/12/2021] [Accepted: 10/14/2021] [Indexed: 11/09/2022]
Abstract
Advances in the understanding of disease biology, drug development, and supportive care have led to improved outcomes in multiple myeloma. Given that these improvements have been reported in clinical trial and referral center populations, questions remain about the generalizability of this observation to patients treated in the community. Contrasting the overall survival experience of 3783 patients seen at Mayo Clinic and 57,654 patients followed in the Surveillance, Epidemiology, and End Results Program (SEER) between 2004 and 2018, we observed different mortality trends across patient populations and subgroups. Early mortality decreased and estimated 5-year overall survival increased over time in both patient populations. Excess mortality (compared to the general population) declined over time in Mayo Clinic patients and remained largely unchanged in SEER patients. Improvements over time were primarily observed in patients with favorable disease characteristics and older patients with multiple myeloma remain a vulnerable population with significant excess mortality compared to the United States general population. Patients with unfavorable disease characteristics have derived disproportionately less benefit from recent advances in the field. Future efforts need to focus on the development of safe and effective therapies for these patients and on increasing timely access to specialized care for patients in the community.
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Affiliation(s)
- Moritz Binder
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | - David Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Martha Q Lacy
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Morie A Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Nelson Leung
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Amie Fonder
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Miriam Hobbs
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Yi Lisa Hwa
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Eli Muchtar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Rahma Warsame
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Robert A Kyle
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Shaji K Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.
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48
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Sharma N, Smadbeck JB, Abdallah N, Zepeda-Mendoza C, Binder M, Pearce KE, Asmann YW, Peterson JF, Ketterling RP, Greipp PT, Leif Bergsagel P, Vincent Rajkumar S, Kumar SK, Baughn LB. The Prognostic Role of MYC Structural Variants Identified by NGS and FISH in Multiple Myeloma. Clin Cancer Res 2021; 27:5430-5439. [PMID: 34233962 PMCID: PMC8738776 DOI: 10.1158/1078-0432.ccr-21-0005] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 01/02/2021] [Revised: 03/16/2021] [Accepted: 07/01/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE Structural variants (SV) of the MYC gene region are common in multiple myeloma and influence disease progression. However, the prognostic significance of different MYC SVs in multiple myeloma has not been clearly established. EXPERIMENTAL DESIGN We conducted a retrospective study of multiple myeloma comparing MYC SV subtypes identified by next-generation sequencing (NGS) and FISH to MYC expression and disease survival using 140 cases from Mayo Clinic and 658 cases from the MMRF CoMMpass study. RESULTS MYC SVs were found in 41% of cases and were classified into nine subtypes. A correlation between the presence of a MYC SV and increased MYC expression was identified. Among the nine MYC subtypes, the non-immunoglobulin (non-Ig) insertion subtype was independently associated with improved outcomes, while the Ig insertion subtype, specifically involving the IgL gene partner, was independently associated with poorer outcomes compared with other MYC SV subtypes. Although the FISH methodology failed to detect approximately 70% of all MYC SVs, those detected by FISH were associated with elevated MYC gene expression and poor outcomes suggesting a different pathogenic role for FISH-detected MYC subtypes compared with other MYC subtypes. CONCLUSIONS Understanding the impact of different MYC SVs on disease outcome is necessary for the reliable interpretation of MYC SVs in multiple myeloma. NGS approaches should be considered as a replacement technique for a more comprehensive evaluation of the multiple myeloma clone.
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Affiliation(s)
- Neeraj Sharma
- Division of Laboratory Genetics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - James B. Smadbeck
- Division of Computational Biology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Nadine Abdallah
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | | | - Moritz Binder
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Kathryn E. Pearce
- Division of Laboratory Genetics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Yan W. Asmann
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL
| | - Jess F. Peterson
- Division of Laboratory Genetics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN,Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Rhett P. Ketterling
- Division of Laboratory Genetics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN,Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Patricia T. Greipp
- Division of Laboratory Genetics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN,Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - P. Leif Bergsagel
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ
| | - S. Vincent Rajkumar
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Shaji K. Kumar
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Linda B. Baughn
- Division of Laboratory Genetics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN,Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
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Kusne Y, Lasho T, Mangaonkar A, Tefferi A, Gangat N, Finke C, Binder M, Chia N, Patnaik MM. Remarkable stability in clonal hematopoiesis involving leukemia-driver genes in patients without underlying myeloid neoplasms. Am J Hematol 2021; 96:E392-E396. [PMID: 34289145 DOI: 10.1002/ajh.26297] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/14/2021] [Accepted: 07/15/2021] [Indexed: 12/19/2022]
Affiliation(s)
- Yael Kusne
- Department of Internal Medicine Mayo Clinic Scottsdale Arizona USA
| | - Terra Lasho
- Division of Hematology, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
| | - Abhishek Mangaonkar
- Division of Hematology, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
| | - Ayalew Tefferi
- Division of Hematology, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
| | - Naseema Gangat
- Division of Hematology, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
| | - Christy Finke
- Division of Hematology, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
| | - Moritz Binder
- Division of Hematology, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
| | - Nicholas Chia
- Department of Surgery and Pharmacology Mayo Clinic Rochester Minnesota USA
| | - Mrinal M. Patnaik
- Division of Hematology, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
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50
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Stein A, Paschold L, Tintelnot J, Goekkurt E, Thuss-Patience P, Lorenzen S, Ettrich T, Knorrenschild JR, Jacobasch L, Kretzschmar A, Kubicka S, Al-Batran SE, Reinacher-Schick A, Pink D, Sinn M, Lindig U, Hinke A, Hegewisch Becker S, Binder M. LBA54 Ipilimumab or FOLFOX in combination with nivolumab and trastuzumab in previously untreated HER2 positive locally advanced or metastastic esophagogastric adenocarcinoma (EGA): Results of the randomized phase II INTEGA trial (AIO STO 0217). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.2134] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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