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Cook J, Johnson I, Higgins A, Sidana S, Warsame R, Gonsalves W, Gertz MA, Buadi F, Lacy M, Kapoor P, Dispenzieri A, Kourelis T, Dingli D, Fonder A, Hayman S, Hobbs M, Hwa YL, Kyle R, Leung N, Go R, Rajkumar VS, Kumar S. Outcomes with different administration schedules of bortezomib in bortezomib, lenalidomide and dexamethasone (VRd) as first-line therapy in multiple myeloma. Am J Hematol 2021; 96:330-337. [PMID: 33326116 DOI: 10.1002/ajh.26074] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 12/10/2020] [Accepted: 12/14/2020] [Indexed: 11/10/2022]
Abstract
Induction therapy for multiple myeloma with bortezomib (Velcade), lenalidomide (Revlimid), and dexamethasone (d) (VRd) was traditionally administered as bortezomib given twice weekly on a 3 week cycle. A modified schedule of weekly bortezomib has been adopted over time to decrease treatment burden for patients and reduce treatment-emergent neuropathy. This study evaluates the response rates and outcomes with different schedules of bortezomib in VRd administered for first-line treatment for patients with newly diagnosed MM (NDMM). We retrospectively analyzed patients treated with upfront VRd from June 30th 2008 to December 31st 2018, for variations of bortezomib administration. Five hundred and fifty-five (555) NDMM patients met inclusion criteria; median age 63 years and 61% men. Bortezomib was administered twice weekly every 21 days in 43%, once weekly every 21 days in 41% and once weekly every 28 days in 16%. Though peripheral sensory neuropathy was more frequent with twice weekly dosing (P = .002), this group achieved shorter time to best response (P = .01). Weekly every 21-day treatment saw higher VGPR or better rates (P = .02). However, with median follow up time of 37 months (IQR 22-56), we found no difference in PFS or OS among the groups. While small differences in response rates were found among the varying administration schedules of bortezomib administration, there was no significant effect on PFS or OS. Given that VRd remains a first line standard of care option for newly diagnosed MM, in the absence of a large trial comparing bortezomib dosing schedule modifications, these results are helpful in supporting current practices of once weekly administration.
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Affiliation(s)
- Joselle Cook
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | - Isla Johnson
- Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
| | | | - Surbhi Sidana
- Division of Hematology Mayo Clinic Rochester Minnesota USA
- Department of Medicine Stanford University Stanford California USA
| | - Rahma Warsame
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | | | - Morie A. Gertz
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | - Francis Buadi
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | - Martha Lacy
- 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
| | - Suzanne Hayman
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | - Miriam Hobbs
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | - Yi Lisa Hwa
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | - Robert Kyle
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | - Nelson Leung
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | - Ronald Go
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | | | - Shaji Kumar
- Division of Hematology Mayo Clinic Rochester Minnesota USA
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2
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Sidiqi MH, Aljama M, Kumar SK, Jevremovic D, Buadi FK, Warsame R, Lacy MQ, Dingli D, Gonsalves WI, Fonder AL, Hobbs MA, Hwa YL, Kapoor P, Kourelis T, Leung N, Muchtar E, Lust JA, Kyle RA, Go RS, Rajkumar VS, Gertz MA, Dispenzieri A. The role of bone marrow biopsy in patients with plasma cell disorders: should all patients with a monoclonal protein be biopsied? Blood Cancer J 2020; 10:52. [PMID: 32376870 PMCID: PMC7203099 DOI: 10.1038/s41408-020-0319-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 02/04/2020] [Accepted: 04/17/2020] [Indexed: 01/24/2023] Open
Abstract
We conducted a retrospective review of multiple myeloma (MM), smoldering multiple myeloma (SMM), and monoclonal gammopathy of undetermined significance (MGUS) patients seen at Mayo Clinic to determine whether a bone marrow biopsy (BM) is necessary in all patients diagnosed with a monoclonal protein. A total of 2254 MM, 397 SMM, and 5836 MGUS patients were included in the study. A total of 29 (1.3%) MM patients “without CRAB/FLC” were identified where BM or advanced imaging was critical for diagnosis, 8 (0.3% MM cohort) of whom were diagnosed with MM solely on BM findings (plasma cells > 60%). Without BM or advanced imaging none of these patients would be classified low-risk MGUS. A total of 314 (79%) MGUS-like SMM patients were identified where classification of SMM was based on BM findings. Without BM 97 would be classified as low/low-intermediate-risk MGUS and 151 intermediate or high-risk MGUS; 66 had missing information precluding classification. Only three (<1% SMM cohort) were low-risk MGUS without abnormalities in hemoglobin, calcium, and renal function. In patients presenting with low-risk MGUS and normal hemoglobin, calcium, and renal function, the risk of missing a diagnosis of SMM and MM by omitting BM is <1%. BM should be deferred in these patients in preference to clinical and laboratory monitoring.
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Affiliation(s)
- M Hasib Sidiqi
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.,Department of Hematology, Fiona Stanley Hospital, Perth, WA, Australia
| | - Mohammed Aljama
- Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
| | - Shaji K Kumar
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Dragan Jevremovic
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Francis K Buadi
- 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
| | - Martha Q Lacy
- 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
| | - Wilson I Gonsalves
- 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
| | - Miriam A Hobbs
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Yi Lisa Hwa
- 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
| | - Taxiarchis Kourelis
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Nelson Leung
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.,Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Eli Muchtar
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - John A Lust
- 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
| | - Ronald S Go
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Vincent S Rajkumar
- 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
| | - Angela Dispenzieri
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
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3
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Leung N, Bridoux F, Batuman V, Chaidos A, Cockwell P, D'Agati VD, Dispenzieri A, Fervenza FC, Fermand JP, Gibbs S, Gillmore JD, Herrera GA, Jaccard A, Jevremovic D, Kastritis E, Kukreti V, Kyle RA, Lachmann HJ, Larsen CP, Ludwig H, Markowitz GS, Merlini G, Mollee P, Picken MM, Rajkumar VS, Royal V, Sanders PW, Sethi S, Venner CP, Voorhees PM, Wechalekar AD, Weiss BM, Nasr SH. The evaluation of monoclonal gammopathy of renal significance: a consensus report of the International Kidney and Monoclonal Gammopathy Research Group. Nat Rev Nephrol 2019; 15:45-59. [PMID: 30510265 PMCID: PMC7136169 DOI: 10.1038/s41581-018-0077-4] [Citation(s) in RCA: 266] [Impact Index Per Article: 53.2] [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] [Indexed: 02/07/2023]
Abstract
The term monoclonal gammopathy of renal significance (MGRS) was introduced by the International Kidney and Monoclonal Gammopathy Research Group (IKMG) in 2012. The IKMG met in April 2017 to refine the definition of MGRS and to update the diagnostic criteria for MGRS-related diseases. Accordingly, in this Expert Consensus Document, the IKMG redefines MGRS as a clonal proliferative disorder that produces a nephrotoxic monoclonal immunoglobulin and does not meet previously defined haematological criteria for treatment of a specific malignancy. The diagnosis of MGRS-related disease is established by kidney biopsy and immunofluorescence studies to identify the monotypic immunoglobulin deposits (although these deposits are minimal in patients with either C3 glomerulopathy or thrombotic microangiopathy). Accordingly, the IKMG recommends a kidney biopsy in patients suspected of having MGRS to maximize the chance of correct diagnosis. Serum and urine protein electrophoresis and immunofixation, as well as analyses of serum free light chains, should also be performed to identify the monoclonal immunoglobulin, which helps to establish the diagnosis of MGRS and might also be useful for assessing responses to treatment. Finally, bone marrow aspiration and biopsy should be conducted to identify the lymphoproliferative clone. Flow cytometry can be helpful in identifying small clones. Additional genetic tests and fluorescent in situ hybridization studies are helpful for clonal identification and for generating treatment recommendations. Treatment of MGRS was not addressed at the 2017 IKMG meeting; consequently, this Expert Consensus Document does not include any recommendations for the treatment of patients with MGRS. This Expert Consensus Document from the International Kidney and Monoclonal Gammopathy Research Group includes an updated definition of monoclonal gammopathy of renal significance (MGRS) and recommendations for the use of kidney biopsy and other modalities for evaluating suspected MGRS
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Affiliation(s)
- Nelson Leung
- Division of Nephrology, Hematology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - Frank Bridoux
- Department of Nephrology, Centre Hospitalier Universitaire et Université de Poitiers, Poitiers, France; CNRS UMR7276, Limoges, France; and Centre de Référence Amylose AL et Autres Maladies par Dépôt d'Immunoglobulines Monoclonales, Poitiers, France
| | - Vecihi Batuman
- Veterans Administration Medical Center, New Orleans, LA, USA and Tulane University Medical School, Tulane, LA, USA
| | - Aristeidis Chaidos
- Centre for Haematology, Department of Medicine, Imperial College London and Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Paul Cockwell
- Department of Nephrology, Renal Medicine - University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - Vivette D D'Agati
- Department of Pathology, Renal Pathology Laboratory, Columbia University, College of Physicians and Surgeons, New York, NY, USA
| | - Angela Dispenzieri
- Division of Nephrology, Hematology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Fernando C Fervenza
- Division of Nephrology, Hematology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Jean-Paul Fermand
- Department of Haematology and Immunology, University Hospital St Louis, Paris, France
| | - Simon Gibbs
- The Victorian and Tasmanian Amyloidosis Service, Department of Haematology, Monash Univerity Easter Health Clinical School, Melbourne, Victoria, Australia
| | - Julian D Gillmore
- National Amyloidosis Centre, Centre for Amyloidosis and Acute Phase Proteins, Division of Medicine, Royal Free Campus, University College London, London, UK
| | - Guillermo A Herrera
- Department of Pathology and Translational Pathobiology, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Arnaud Jaccard
- Service d'Hématologie et de Thérapie Cellulaire, Centre de Référence des Amyloses Primitives et des Autres Maladies par Dépôts d'Immunoglobuline, CHU Limoges, Limoges, France
| | - Dragan Jevremovic
- Division of Nephrology, Hematology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, School of Medicine National and Kapodistrian University of Athens Alexandra Hospital, Athens, Greece
| | - Vishal Kukreti
- University Health Network, Princess Margaret Cancer Centre, Toronto, Canada
| | - Robert A Kyle
- Division of Nephrology, Hematology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Helen J Lachmann
- National Amyloidosis Centre, Centre for Amyloidosis and Acute Phase Proteins, Division of Medicine, Royal Free Campus, University College London, London, UK
| | | | - Heinz Ludwig
- Wilhelminen Cancer Research Institute, Wilhelminenspital, Vienna, Austria
| | - Glen S Markowitz
- Department of Pathology, Renal Pathology Laboratory, Columbia University, College of Physicians and Surgeons, New York, NY, USA
| | - Giampaolo Merlini
- Amyloidosis Research and Treatment Center, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Peter Mollee
- Haematology Department, Princess Alexandra Hospital and School of Medicine, University of Queensland, Brisbane, Australia
| | - Maria M Picken
- Department of Pathology, Loyola University Medical Center, Maywood, IL, USA
| | - Vincent S Rajkumar
- Division of Nephrology, Hematology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Virginie Royal
- Department of Pathology, Hôpital Maisonneuve-Rosemont, Université de Montreal, Montreal, Quebec, Canada
| | - Paul W Sanders
- Department of Medicine, University of Alabama at Birmingham and Department of Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Sanjeev Sethi
- Division of Nephrology, Hematology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | - Peter M Voorhees
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium System, Charlotte, NC, USA
| | - Ashutosh D Wechalekar
- National Amyloidosis Centre, Centre for Amyloidosis and Acute Phase Proteins, Division of Medicine, Royal Free Campus, University College London, London, UK
| | - Brendan M Weiss
- Abramson Cancer Center, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Samih H Nasr
- Division of Nephrology, Hematology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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4
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Sidiqi MH, Dasari S, McPhail ED, Buadi FK, Warsame R, Lacy MQ, Dingli D, Gonsalves WI, Kapoor P, Kourelis T, Leung N, Muchtar E, Grogan M, Lust JA, Kumar S, Kyle RA, Rajkumar VS, Gertz M, Dispenzieri A. Monoclonal gammopathy plus positive amyloid biopsy does not always equal AL amyloidosis. Am J Hematol 2019; 94:E141-E143. [PMID: 30773682 DOI: 10.1002/ajh.25440] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 02/11/2019] [Accepted: 02/12/2019] [Indexed: 01/25/2023]
Affiliation(s)
- M Hasib Sidiqi
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Rochester Minnesota
| | - Surendra Dasari
- Department of Health Sciences ResearchMayo Clinic Rochester Rochester Minnesota
| | - Ellen D. McPhail
- Department of Laboratory Medicine and PathologyMayo Clinic Rochester Rochester Minnesota
| | - Francis K. Buadi
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Rochester Minnesota
| | - Rahma Warsame
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Rochester Minnesota
| | - Martha Q. Lacy
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Rochester Minnesota
| | - David Dingli
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Rochester Minnesota
| | - Wilson I. Gonsalves
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Rochester Minnesota
| | - Prashant Kapoor
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Rochester Minnesota
| | - Taxiarchis Kourelis
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Rochester Minnesota
| | - Nelson Leung
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Rochester Minnesota
- Division of Nephrology and HypertensionMayo Clinic Rochester Rochester Minnesota
| | - Eli Muchtar
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Rochester Minnesota
| | - Martha Grogan
- Department of Cardiovascular MedicineMayo Clinic Rochester Rochester Minnesota
| | - John A. Lust
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Rochester Minnesota
| | - Shaji Kumar
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Rochester Minnesota
| | - Robert A. Kyle
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Rochester Minnesota
| | - Vincent S. Rajkumar
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Rochester Minnesota
| | - Morie Gertz
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Rochester Minnesota
| | - Angela Dispenzieri
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Rochester Minnesota
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5
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Leung N, Bridoux F, Batuman V, Chaidos A, Cockwell P, D'Agati VD, Dispenzieri A, Fervenza FC, Fermand JP, Gibbs S, Gillmore JD, Herrera GA, Jaccard A, Jevremovic D, Kastritis E, Kukreti V, Kyle RA, Lachmann HJ, Larsen CP, Ludwig H, Markowitz GS, Merlini G, Mollee P, Picken MM, Rajkumar VS, Royal V, Sanders PW, Sethi S, Venner CP, Voorhees PM, Wechalekar AD, Weiss BM, Nasr SH. Publisher Correction: The evaluation of monoclonal gammopathy of renal significance: a consensus report of the International Kidney and Monoclonal Gammopathy Research Group. Nat Rev Nephrol 2018; 15:121. [PMID: 30568288 PMCID: PMC7608309 DOI: 10.1038/s41581-018-0102-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Nelson Leung
- Division of Nephrology, Hematology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - Frank Bridoux
- Department of Nephrology, Centre Hospitalier Universitaire et Université de Poitiers, Poitiers, France; CNRS UMR7276, Limoges, France; and Centre de Référence Amylose AL et Autres Maladies par Dépôt d'Immunoglobulines Monoclonales, Poitiers, France
| | - Vecihi Batuman
- Veterans Administration Medical Center, New Orleans, LA, USA and Tulane University Medical School, Tulane, LA, USA
| | - Aristeidis Chaidos
- Centre for Haematology, Department of Medicine, Imperial College London and Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Paul Cockwell
- Department of Nephrology, Renal Medicine - University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - Vivette D D'Agati
- Department of Pathology, Renal Pathology Laboratory, Columbia University, College of Physicians and Surgeons, New York, NY, USA
| | - Angela Dispenzieri
- Division of Nephrology, Hematology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Fernando C Fervenza
- Division of Nephrology, Hematology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Jean- Paul Fermand
- Department of Haematology and Immunology, University Hospital St Louis, Paris, France
| | - Simon Gibbs
- The Victorian and Tasmanian Amyloidosis Service, Department of Haematology, Monash Univerity Easter Health Clinical School, Melbourne, Victoria, Australia
| | - Julian D Gillmore
- National Amyloidosis Centre, Centre for Amyloidosis and Acute Phase Proteins, Division of Medicine, Royal Free Campus, University College London, London, UK
| | - Guillermo A Herrera
- Department of Pathology and Translational Pathobiology, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Arnaud Jaccard
- Service d'Hématologie et de Thérapie Cellulaire, Centre de Référence des Amyloses Primitives et des Autres Maladies par Dépôts d'Immunoglobuline, CHU Limoges, Limoges, France
| | - Dragan Jevremovic
- Division of Nephrology, Hematology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, School of Medicine National and Kapodistrian University of Athens Alexandra Hospital, Athens, Greece
| | - Vishal Kukreti
- University Health Network, Princess Margaret Cancer Centre, Toronto, Canada
| | - Robert A Kyle
- Division of Nephrology, Hematology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Helen J Lachmann
- National Amyloidosis Centre, Centre for Amyloidosis and Acute Phase Proteins, Division of Medicine, Royal Free Campus, University College London, London, UK
| | | | - Heinz Ludwig
- Wilhelminen Cancer Research Institute, Wilhelminenspital, Vienna, Austria
| | - Glen S Markowitz
- Department of Pathology, Renal Pathology Laboratory, Columbia University, College of Physicians and Surgeons, New York, NY, USA
| | - Giampaolo Merlini
- Amyloidosis Research and Treatment Center, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Peter Mollee
- Haematology Department, Princess Alexandra Hospital and School of Medicine, University of Queensland, Brisbane, Australia
| | - Maria M Picken
- Department of Pathology, Loyola University Medical Center, Maywood, IL, USA
| | - Vincent S Rajkumar
- Division of Nephrology, Hematology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Virginie Royal
- Department of Pathology, Hôpital Maisonneuve- Rosemont, Université de Montreal, Montreal, Quebec, Canada
| | - Paul W Sanders
- Department of Medicine, University of Alabama at Birmingham and Department of Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Sanjeev Sethi
- Division of Nephrology, Hematology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | - Peter M Voorhees
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium System, Charlotte, NC, USA
| | - Ashutosh D Wechalekar
- National Amyloidosis Centre, Centre for Amyloidosis and Acute Phase Proteins, Division of Medicine, Royal Free Campus, University College London, London, UK
| | - Brendan M Weiss
- Abramson Cancer Center, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Samih H Nasr
- Division of Nephrology, Hematology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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6
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Calcinotto A, Brevi A, Chesi M, Ferrarese R, Garcia Perez L, Grioni M, Kumar S, Garbitt VM, Sharik ME, Henderson KJ, Tonon G, Tomura M, Miwa Y, Esplugues E, Flavell RA, Huber S, Canducci F, Rajkumar VS, Bergsagel PL, Bellone M. Microbiota-driven interleukin-17-producing cells and eosinophils synergize to accelerate multiple myeloma progression. Nat Commun 2018; 9:4832. [PMID: 30510245 PMCID: PMC6277390 DOI: 10.1038/s41467-018-07305-8] [Citation(s) in RCA: 133] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 10/15/2018] [Indexed: 12/31/2022] Open
Abstract
The gut microbiota has been causally linked to cancer, yet how intestinal microbes influence progression of extramucosal tumors is poorly understood. Here we provide evidence implying that Prevotella heparinolytica promotes the differentiation of Th17 cells colonizing the gut and migrating to the bone marrow (BM) of transgenic Vk*MYC mice, where they favor progression of multiple myeloma (MM). Lack of IL-17 in Vk*MYC mice, or disturbance of their microbiome delayed MM appearance. Similarly, in smoldering MM patients, higher levels of BM IL-17 predicted faster disease progression. IL-17 induced STAT3 phosphorylation in murine plasma cells, and activated eosinophils. Treatment of Vk*MYC mice with antibodies blocking IL-17, IL-17RA, and IL-5 reduced BM accumulation of Th17 cells and eosinophils and delayed disease progression. Thus, in Vk*MYC mice, commensal bacteria appear to unleash a paracrine signaling network between adaptive and innate immunity that accelerates progression to MM, and can be targeted by already available therapies.
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Affiliation(s)
- Arianna Calcinotto
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, 20132, Italy
- Institute of Oncology Research, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Arianna Brevi
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, 20132, Italy
- Vita-Salute San Raffaele University, 20132, Milan, Italy
| | - Marta Chesi
- Comprehensive Cancer Center, Mayo Clinic Arizona, Scottsdale, AZ, 85259, USA
| | - Roberto Ferrarese
- Laboratory of Microbiology, IRCCS San Raffaele Scientific Institute, Milan, 20132, Italy
| | - Laura Garcia Perez
- Molekulare Immunologie und Gastroenterologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, 20246, Germany
| | - Matteo Grioni
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, 20132, Italy
| | - Shaji Kumar
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN, 55905, USA
| | - Victoria M Garbitt
- Comprehensive Cancer Center, Mayo Clinic Arizona, Scottsdale, AZ, 85259, USA
| | - Meaghen E Sharik
- Comprehensive Cancer Center, Mayo Clinic Arizona, Scottsdale, AZ, 85259, USA
| | | | - Giovanni Tonon
- Division of Molecular Oncology, IRCCS San Raffaele Scientific Institute, Milan, 20132, Italy
| | - Michio Tomura
- Faculty of Pharmacy, Osaka Ohtani University, Osaka, 584-8540, Japan
| | | | - Enric Esplugues
- Department of Immunobiology, School of Medicine, and Howard Hughes Medical Institute Yale University, New Haven, 06520, USA
| | - Richard A Flavell
- Department of Immunobiology, School of Medicine, and Howard Hughes Medical Institute Yale University, New Haven, 06520, USA
| | - Samuel Huber
- Molekulare Immunologie und Gastroenterologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, 20246, Germany
| | - Filippo Canducci
- Laboratory of Microbiology, IRCCS San Raffaele Scientific Institute, Milan, 20132, Italy
- Department of Biotechnology and Life Sciences, University of Insubria, Varese, 21100, Italy
| | - Vincent S Rajkumar
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN, 55905, USA
| | - P Leif Bergsagel
- Comprehensive Cancer Center, Mayo Clinic Arizona, Scottsdale, AZ, 85259, USA
| | - Matteo Bellone
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, 20132, Italy.
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7
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Sidiqi MH, Aljama MA, Jevremovic D, Morice WG, Timm M, Buadi FK, Warsame R, Lacy MQ, Dispenzieri A, Dingli D, Gonsalves WI, Kumar S, Kapoor P, Kourelis T, Leung N, Hogan WJ, Muchtar E, Lust JA, Rajkumar VS, Gertz MA. Plasma cell proliferative index post-transplant is a powerful predictor of prognosis in myeloma patients failing to achieve a complete response. Bone Marrow Transplant 2018; 54:442-447. [PMID: 30087461 DOI: 10.1038/s41409-018-0280-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 06/20/2018] [Accepted: 06/26/2018] [Indexed: 11/09/2022]
Abstract
Myeloma patients failing to achieve a complete response post autologous stem cell transplantation are heterogeneous, some ultimately achieving deeper responses and prolonged remission, whilst others relapse rapidly with poor outcomes. We evaluated the prognostic impact of the plasma cell proliferative index (PCPI) post-therapy, in 382 patients with myeloma failing to achieve complete response at 100 days post-transplant. Sixty percent (n = 230) of patients had zero clonal or too few clonal plasma cells to accurately assess PCPI (No PCPI). The remaining 40% (n = 152) of patients had PCPI performed with 79% (n = 120) having a low PCPI and 21% (n = 32) having an elevated PCPI. Patients with an elevated PCPI had significantly shorter progression free and overall survival. The median PFS was 8 months for elevated PCPI vs. 19 months for low PCPI vs. 24 months for no PCPI (p < 0.0001). The median OS was 27 months for elevated PCPI vs. 79 months for low PCPI vs. not reached for no PCPI, p < 0.0001). On multivariable analysis post-therapy PCPI was an independent predictor of progression free and overall survival. The PCPI post-therapy is a powerful predictor of survival and risk stratifies myeloma patients failing to achieve complete response early in the disease course.
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Affiliation(s)
- M Hasib Sidiqi
- Division of Hematology, Department of Internal Medicine, Mayo Clinic Rochester, Rochester, USA
| | - Mohammed A Aljama
- Division of Hematology, Department of Internal Medicine, Mayo Clinic Rochester, Rochester, USA
| | - Dragan Jevremovic
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, Rochester, USA
| | - William G Morice
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, Rochester, USA
| | - Michael Timm
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, Rochester, USA
| | - Francis K Buadi
- Division of Hematology, Department of Internal Medicine, Mayo Clinic Rochester, Rochester, USA
| | - Rahma Warsame
- Division of Hematology, Department of Internal Medicine, Mayo Clinic Rochester, Rochester, USA
| | - Martha Q Lacy
- Division of Hematology, Department of Internal Medicine, Mayo Clinic Rochester, Rochester, USA
| | - Angela Dispenzieri
- Division of Hematology, Department of Internal Medicine, Mayo Clinic Rochester, Rochester, USA
| | - David Dingli
- Division of Hematology, Department of Internal Medicine, Mayo Clinic Rochester, Rochester, USA
| | - Wilson I Gonsalves
- Division of Hematology, Department of Internal Medicine, Mayo Clinic Rochester, Rochester, USA
| | - Shaji Kumar
- Division of Hematology, Department of Internal Medicine, Mayo Clinic Rochester, Rochester, USA
| | - Prashant Kapoor
- Division of Hematology, Department of Internal Medicine, Mayo Clinic Rochester, Rochester, USA
| | - Taxiarchis Kourelis
- Division of Hematology, Department of Internal Medicine, Mayo Clinic Rochester, Rochester, USA
| | - Nelson Leung
- Division of Nephrology and Hypertension, Mayo Clinic Rochester, Rochester, USA
| | - William J Hogan
- Division of Hematology, Department of Internal Medicine, Mayo Clinic Rochester, Rochester, USA
| | - Eli Muchtar
- Division of Hematology, Department of Internal Medicine, Mayo Clinic Rochester, Rochester, USA
| | - John A Lust
- Division of Hematology, Department of Internal Medicine, Mayo Clinic Rochester, Rochester, USA
| | - Vincent S Rajkumar
- Division of Hematology, Department of Internal Medicine, Mayo Clinic Rochester, Rochester, USA
| | - Morie A Gertz
- Division of Hematology, Department of Internal Medicine, Mayo Clinic Rochester, Rochester, USA.
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8
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Muchtar E, Dispenzieri A, Kumar SK, Buadi FK, Lacy MQ, Zeldenrust S, Hayman SR, Leung N, Chakraborty R, Russell S, Dingli D, Lust JA, Lin Y, Kapoor P, Go R, Kyle RA, Rajkumar VS, Gertz MA. Immunoparesis status in AL amyloidosis at diagnosis affects response and survival by regimen type. Amyloid 2017; 24:44-45. [PMID: 28434304 DOI: 10.1080/13506129.2017.1281117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Eli Muchtar
- a Division of Hematology , Mayo Clinic , Rochester , MN , USA
| | | | - Shaji K Kumar
- a Division of Hematology , Mayo Clinic , Rochester , MN , USA
| | - Francis K Buadi
- a Division of Hematology , Mayo Clinic , Rochester , MN , USA
| | - Martha Q Lacy
- a Division of Hematology , Mayo Clinic , Rochester , MN , USA
| | | | | | - Nelson Leung
- a Division of Hematology , Mayo Clinic , Rochester , MN , USA.,b Hospitalist Services, Essentia Health St. Joseph's Hospital , Brainerd , MN , USA , and
| | - Rajshekhar Chakraborty
- a Division of Hematology , Mayo Clinic , Rochester , MN , USA.,b Hospitalist Services, Essentia Health St. Joseph's Hospital , Brainerd , MN , USA , and.,c Division of Hematopathology , Mayo Clinic , Rochester , MN , USA
| | - Steven Russell
- a Division of Hematology , Mayo Clinic , Rochester , MN , USA
| | - David Dingli
- a Division of Hematology , Mayo Clinic , Rochester , MN , USA
| | - John A Lust
- a Division of Hematology , Mayo Clinic , Rochester , MN , USA
| | - Yi Lin
- a Division of Hematology , Mayo Clinic , Rochester , MN , USA
| | - Prashant Kapoor
- a Division of Hematology , Mayo Clinic , Rochester , MN , USA
| | - Ronald Go
- a Division of Hematology , Mayo Clinic , Rochester , MN , USA
| | - Robert A Kyle
- a Division of Hematology , Mayo Clinic , Rochester , MN , USA
| | | | - Morie A Gertz
- a Division of Hematology , Mayo Clinic , Rochester , MN , USA
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9
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Chakraborty R, Gertz MA, Dispenzieri A, Gonsalves WI, Zeldenrust SR, Russell SJ, Go RS, Kapoor P, Rajkumar VS, Hayman SR, Hwa YL, Lacy MQ, Kyle RA, Leung N, Kumar SK. Natural history of amyloidosis isolated to fat and bone marrow aspirate. Br J Haematol 2016; 179:170-172. [DOI: 10.1111/bjh.14205] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Rajshekhar Chakraborty
- Division of Hematology; Mayo Clinic; Rochester MN USA
- Hospitalist Services; Essentia Health-St. Joseph's Hospital; Brainerd MN USA
| | | | | | | | | | | | - Ronald S. Go
- Division of Hematology; Mayo Clinic; Rochester MN USA
| | | | | | | | - Yi L. Hwa
- Division of Hematology; Mayo Clinic; Rochester MN USA
| | | | | | - Nelson Leung
- Division of Nephrology; Mayo Clinic; Rochester MN USA
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10
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Milani P, Dispenzieri A, Gertz M, Merlini G, Lacy M, Baudi FK, Kumar S, Maurer M, Klarich K, Hayman SR, Leung N, Dingli D, Lust JA, Lin Y, Kapoor P, Go RS, Hwa Y, Zeldenrust S, Kyle R, Rajkumar VS, Grogan M. MYOCARDIAL CONTRACTION FRACTION, A NEW ECHOCARDIOGRAPHIC PARAMETER FOR PREDICTION OF SURVIVAL IN PATIENTS WITH LIGHT-CHAIN AMYLOIDOSIS. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)31602-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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11
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Kourelis TV, Gertz M, Zent C, Lacy M, Kyle R, Kapoor P, Zeldenrust S, Buadi F, Witzig T, Hayman S, Lust J, Russell S, Lin Y, Rajkumar VS, Kumar S, Leung N, Dingli D, Dispenzieri A. Systemic amyloidosis associated with chronic lymphocytic leukemia/small lymphocytic lymphoma. Am J Hematol 2013; 88:375-8. [PMID: 23508840 DOI: 10.1002/ajh.23413] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Revised: 01/26/2013] [Accepted: 02/07/2013] [Indexed: 12/22/2022]
Abstract
To clarify the presentation and course of patients with chronic lymphocytic leukemia (CLL) and amyloidosis. Mayo databases were interrogated for patients who carried a diagnosis of amyloidosis and CLL evaluated at Mayo Clinic, Rochester from January 1974 to October 2012. Charts were abstracted and data analyzed. Of the 33 patients identified, 20 (61%) were diagnosed with AL and 13 (39%) with non-AL. Only four patients had immunoglobulin light chain amyloidosis (AL) that could be solely attributed to the CLL clone; another six had both a plasma cell clone and a CLL clone that shared the same light chain. Median overall survival was 15.6 months for patients with AL and 58.1 months for patients with non-AL. For patients with AL management involved chemotherapy targeted toward monoclonal plasma cells, lymphocytes or both, and for patients with non-AL no specific amyloid treatment was administered. AL is a rare complication of CLL, but in this elderly population of patients non-AL is nearly as common. Distinguishing between these two groups is essential since patients with non-AL amyloidosis have better outcomes and they do not require cytotoxic chemotherapy to treat their amyloidosis.
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Affiliation(s)
| | - Morie Gertz
- Division of Hematology; Department of Medicine; Mayo Clinic; Rochester; Minnesota
| | - Clive Zent
- Division of Hematology; Department of Medicine; Mayo Clinic; Rochester; Minnesota
| | - Martha Lacy
- Division of Hematology; Department of Medicine; Mayo Clinic; Rochester; Minnesota
| | - Robert Kyle
- Division of Hematology; Department of Medicine; Mayo Clinic; Rochester; Minnesota
| | - Prashant Kapoor
- Division of Hematology; Department of Medicine; Mayo Clinic; Rochester; Minnesota
| | - Steven Zeldenrust
- Division of Hematology; Department of Medicine; Mayo Clinic; Rochester; Minnesota
| | - Francis Buadi
- Division of Hematology; Department of Medicine; Mayo Clinic; Rochester; Minnesota
| | - Thomas Witzig
- Division of Hematology; Department of Medicine; Mayo Clinic; Rochester; Minnesota
| | - Suzanne Hayman
- Division of Hematology; Department of Medicine; Mayo Clinic; Rochester; Minnesota
| | - John Lust
- Division of Hematology; Department of Medicine; Mayo Clinic; Rochester; Minnesota
| | - Stephen Russell
- Division of Hematology; Department of Medicine; Mayo Clinic; Rochester; Minnesota
| | - Yi Lin
- Division of Hematology; Department of Medicine; Mayo Clinic; Rochester; Minnesota
| | - Vincent S. Rajkumar
- Division of Hematology; Department of Medicine; Mayo Clinic; Rochester; Minnesota
| | - Shaji Kumar
- Division of Hematology; Department of Medicine; Mayo Clinic; Rochester; Minnesota
| | - Nelson Leung
- Division of Hematology; Department of Medicine; Mayo Clinic; Rochester; Minnesota
| | - David Dingli
- Division of Hematology; Department of Medicine; Mayo Clinic; Rochester; Minnesota
| | - Angela Dispenzieri
- Division of Hematology; Department of Medicine; Mayo Clinic; Rochester; Minnesota
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Abstract
In the twenty-first century, melphalan-prednisone can no longer be regarded as the standard treatment of multiple myeloma patients not eligible for high-dose melphalan followed by autologous stem cell transplantation. The introduction of thalidomide, lenalidomide, and bortezomib has improved the arsenal of therapeutic options in multiple myeloma. Indeed, randomized studies have shown that melphalan-prednisone-thalidomide and melphalan-prednisone-bortezomib are superior to melphalan-prednisone alone. In addition, other combinations, including lenalidomide, are under study. In this review, we discuss the role of novel therapies in multiple myeloma in elderly multiple myeloma patients. Important aspects, such as toxicity and the role of prognostic factors, are also addressed.
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Affiliation(s)
- Sigurdur Yngvi Kristinsson
- Division of Hematology, Department of Medicine, Karolinska University Hospital Solna and Karolinska Institutet, Stockholm, Sweden
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13
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Bryce AH, Ketterling RP, Gertz MA, Lacy M, Knudson RA, Kumar S, Kyle RA, Fonseca R, Greipp PR, Lust JA, Rajkumar VS, Hayman SR, Buadi F, Russell SJ, Zeldenrust SR, Dispenzieri A. A novel report of cig-FISH and cytogenetics in POEMS syndrome. Am J Hematol 2008; 83:840-1. [PMID: 18839437 DOI: 10.1002/ajh.21285] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [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] [Indexed: 11/08/2022]
Abstract
POEMS syndrome is a plasma cell proliferative disorder whose pathogenesis is poorly understood. We provide the first report of cytoplasmic immunoglobulin/FISH testing (cIg-FISH) in POEMS syndrome using established myeloma markers. We reviewed all 37 POEMS cases seen at our institution in which cIg-FISH testing had been obtained. Monosomy 13 was seen in 14 of the 37 (38%) cIg-FISH samples. One patient had trisomy 3 and 7. Three patients had IgH translocation t(11;14)(q13;q32). No abnormalities were seen at 17p13(p53). The monosomy 13 is in line with other plasma cell disorders while the low prevalence of hyperdiploidy and abnormalities at 14q32 is unique.
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Affiliation(s)
- Alan H Bryce
- Hematology, Mayo Clinic, Rochester, Minnesota, USA
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14
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Mannheim D, Versari D, Daghini E, Gössl M, Galili O, Chade A, Rajkumar VS, Ritman EL, Lerman LO, Lerman A. Impaired myocardial perfusion reserve in experimental hypercholesterolemia is independent of myocardial neovascularization. Am J Physiol Heart Circ Physiol 2007; 292:H2449-58. [PMID: 17208989 DOI: 10.1152/ajpheart.01215.2006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Our objective was to investigate the functional role of hypercholesterolemia-associated myocardial neovascularization in early atherosclerosis using the antiangiogenic thalidomide. Experimental atherosclerosis is characterized by myocardial neovascularization, associated with a decrease in myocardial perfusion response to challenge, coronary endothelial dysfunction, and high oxidative stress. However, the functional significance of these neovessels is not known. Three groups of pigs (n = 6 each) were studied after 12 wk of normal or hypercholesterolemic diet without (HC) or with thalidomide (HC + Thal). Myocardial perfusion and permeability were assessed at baseline and in response to cardiac challenge, using electron beam computed tomography, and coronary endothelial function was assessed using organ chambers. Myocardial samples were scanned ex vivo with a three-dimensional microscopic computed tomography scanner, and the spatial density of the myocardial microvessels was quantified. Growth factors and oxidative stress were measured in the myocardial tissue. As a results of these procedures, myocardial perfusion response to adenosine and dobutamine was blunted in both HC and HC + Thal pigs compared with normal pigs (P < 0.05, HC and HC + Thal vs. normal) as was the coronary endothelial function. Myocardial permeability response to adenosine was increased in both HC and HC + Thal pigs compared with normal pigs (P < 0.05, HC and HC + Thal vs. normal, and HC + Thal vs. HC). The microvascular density was increased in HC pigs compared with normal pigs but normalized in HC + Thal pigs (P < 0.001 HC vs. normal and HC + Thal). HC + Thal pigs showed decreased expression of Flk-1 and basic FGF but increased expression of VEGF compared with normal and HC pigs. Oxidative stress was increased in both HC and HC + Thal pigs compared with normal pigs. In conclusion, chronic administration of thalidomide attenuates myocardial neovascularization in experimental HC pigs without affecting myocardial perfusion response to stimulation. This suggests that the myocardial neovascularization may not contribute to the attenuated myocardial perfusion response in hypercholesterolemia.
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Affiliation(s)
- Dallit Mannheim
- Division of Cardiovascular Diseases, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN 55905, USA
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15
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Rajkumar VS. Treatment options and considerations for the newly diagnosed myeloma patient. Oncology (Williston Park) 2005; 19:1260, 1262, 1267 passim. [PMID: 16285223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Affiliation(s)
- Vincent S Rajkumar
- Division of Hematology, Mayo Clinic Medical College, Rochester, Minnesota, USA
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16
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Abstract
OBJECTIVE To determine the temporal and spatial relationship between platelet-derived growth factor beta (PDGFbeta) receptors, PDGF-AB/BB, and activated pericytes across the Raynaud's phenomenon (RP) and systemic sclerosis (SSc; scleroderma) disease spectrum. METHODS Monoclonal antibodies against PDGFbeta receptors, PDGF-AB/BB, and high molecular weight-melanoma-associated antigen (HMW-MAA), a marker for activated pericytes, were used to immunohistochemically analyze serial sections of skin biopsy tissue from patients with RP and from scleroderma patients. To delineate cell-specific PDGFbeta receptor expression, double immunofluorescence-stained sections were analyzed using computer-aided image analysis and confocal microscopy. RESULTS PDGFbeta receptor-expressing cells and HMW-MAA-expressing pericytes were found in biopsy samples from autoimmune RP patients and in both early fibrotic and early nonfibrotic scleroderma skin, but not in normal or primary RP or late-stage scleroderma skin. PDGF-AB/BB was expressed within the epidermis, at the epidermal/dermal junction, and by dermal macrophages. Analysis of juxtaposed serial sections revealed an increased frequency of receptor expression in microvessels from autoimmune RP and early scleroderma skin (P < 0.01). Double-labeling studies using confocal microscopy showed that, in vivo, PDGFbeta receptors were predominantly expressed by microvascular pericytes from both autoimmune RP and early scleroderma skin. CONCLUSION PDGFbeta receptors are expressed by activated microvascular pericytes in patients with autoimmune RP and in early SSc patients, but not in those with primary RP or late-stage scleroderma. These findings suggest that features of autoimmune RP are distinct from those of primary RP, and that microvascular pericytes may be an important link between chronic microvascular damage and fibrosis.
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17
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Abraham DJ, Vancheeswaran R, Dashwood MR, Rajkumar VS, Pantelides P, Xu SW, du Bois RM, Black CM. Increased levels of endothelin-1 and differential endothelin type A and B receptor expression in scleroderma-associated fibrotic lung disease. Am J Pathol 1997; 151:831-41. [PMID: 9284832 PMCID: PMC1857854] [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] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In addition to their vasoactive action, endothelins are potent peptides in the regulation of both cell proliferation and the turnover of extracellular matrix. Using immunohistochemical, autoradiographic, and molecular analyses, we have studied the localization and expression of endothelin-1 and endothelin A (ETA) and B (ETB) receptors in scleroderma-associated fibrotic lung disease. Increased ET-1 immunoreactivity was found in sclerotic tissue compared with control and was associated with the vasculature, pulmonary interstitium, and bronchial and alveolar epithelium. Microautoradiographic analysis after 125I-labeled ET-1 binding showed a two- to threefold increase in the expression of total ET-1 receptors in scleroderma lung tissue localized to the alveolar epithelium and the pulmonary interstitium which was composed of mainly fibroblastic cells with macrophages and some microvessels. RNAse protection assay revealed significantly reduced ETA receptor and slightly raised ETB message levels in systemic sclerosis lung. Surface expression of functional ET receptors was examined by targeted receptor blocking using mixed and receptor-subtype-selective ligands. A consistent decrease in ETA receptor binding sites was noted primarily within the interstitium and vasculature, in contrast to a slight increase in ETB receptors. Elevated ET-1 and the cell-specific pattern of endothelin receptor expression suggest that the endothelins may represent important mediators that influence the pathology of scleroderma-associated lung disease and other fibrotic conditions.
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MESH Headings
- Adult
- Antigens, CD/metabolism
- Antigens, Differentiation, Myelomonocytic/metabolism
- Endothelin-1/metabolism
- Female
- Gene Expression Regulation
- HLA-DR Antigens/metabolism
- Humans
- Immunohistochemistry
- Lung/metabolism
- Lung/pathology
- Middle Aged
- Pulmonary Fibrosis/metabolism
- Pulmonary Fibrosis/pathology
- RNA, Messenger/metabolism
- Receptor, Endothelin A
- Receptor, Endothelin B
- Receptors, Endothelin/genetics
- Receptors, Endothelin/metabolism
- Scleroderma, Systemic/metabolism
- Scleroderma, Systemic/pathology
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Affiliation(s)
- D J Abraham
- Academic Unit of Rheumatology and Connective Tissue Diseases, Royal Free Hospital School of Medicine, London, UK
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