51
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Plasma cell leukemia: retrospective review of cases at monter cancer center/northwell health cancer institute, 2014-2019. Curr Probl Cancer 2022; 46:100831. [DOI: 10.1016/j.currproblcancer.2021.100831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 10/09/2021] [Accepted: 12/15/2021] [Indexed: 11/23/2022]
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52
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Osho P, Osho E, Oluwatosin O. Pott's disease and multiple myeloma in the bone marrow: A rare coincidence. NIGERIAN JOURNAL OF MEDICINE 2022. [DOI: 10.4103/njm.njm_72_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
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53
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Youssefi H, Ahnach M, Bendari M, Al Bouzidi A. Primary Plasma Cell Leukemia Revealed by a Mandibular Lesion: A Case Report. Cureus 2021; 13:e20148. [PMID: 35003980 PMCID: PMC8723764 DOI: 10.7759/cureus.20148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2021] [Indexed: 11/05/2022] Open
Abstract
Primary plasma cell leukemia (PCL) is a rare and aggressive hematological malignancy exhibiting a circulating plasma cell count exceeding 20% of peripheral blood leukocytes or an absolute plasma cell count >2000/mm3. We report a case of a 37-year-old woman presented to the Department of Hematology with a two-month history of growth inside the oral cavity in the upper jaw and weakness. The physical examination revealed a voluminous mass involving the left side of the maxillary gingiva. The maxillofacial computerized tomography (CT) scan confirmed the presence of a solid tissue mass at the left upper maxilla. A biopsy sample obtained from the lesion showed a plasma cell infiltration. The laboratory findings revealed anemia, renal impairment with high levels of creatinine and calcium. Serum protein electrophoresis found a monoclonal peak at IgG lambda, a high level of lambda free light. The diagnosis was subsequently confirmed by a peripheral-blood smear revealed 25% of plasma cells and bone marrow aspiration with 50% of plasma cell infiltration. Primary plasma-cell leukemia (pPCL) was confirmed. The patient received VTD chemotherapy (bortezomib, thalidomide, and dexamethasone) followed by autologous stem cell transplant (ASCT), which resulted in complete remission. At the six-month follow-up, the patient relapsed with extramedullary multiple lesions under ineffective rescue therapy. Response to frontline treatments may be significant initially but short-lived with a dismal median overall survival below one year. This case report aims to highlight the need for awareness among clinicians of the relevance of examining other associated clinical features of pPCL, given its aggressive course and rapid progress without the therapy.
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54
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Primary plasma cell leukemia: consensus definition by the International Myeloma Working Group according to peripheral blood plasma cell percentage. Blood Cancer J 2021; 11:192. [PMID: 34857730 PMCID: PMC8640034 DOI: 10.1038/s41408-021-00587-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/10/2021] [Accepted: 11/15/2021] [Indexed: 11/08/2022] Open
Abstract
Primary plasma cell leukemia (PCL) has a consistently ominous prognosis, even after progress in the last decades. PCL deserves a prompt identification to start the most effective treatment for this ultra-high-risk disease. The aim of this position paper is to revisit the diagnosis of PCL according to the presence of circulating plasma cells in patients otherwise meeting diagnostic criteria of multiple myeloma. We could identify two retrospective series where the question about what number of circulating plasma cells in peripheral blood should be used for defining PCL. The presence of ≥5% circulating plasma cells in patients with MM had a similar adverse prognostic impact as the previously defined PCL. Therefore, PCL should be defined by the presence of 5% or more circulating plasma cells in peripheral blood smears in patients otherwise diagnosed with symptomatic multiple myeloma.
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55
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LeBlanc R, Ahmad I, Terra R, Boudreault JS, Ogez D, Lamore K, Delisle JS, Bambace N, Bernard L, Cohen S, Kiss T, Lachance S, Landais S, Lemieux-Blanchard É, Sauvageau G, Sebag M, Roy DC, Roy J. Outcomes in newly diagnosed young or high-risk myeloma patients receiving tandem autologous/allogeneic transplant followed by bortezomib maintenance: a phase II study. Bone Marrow Transplant 2021; 57:252-260. [PMID: 34845367 DOI: 10.1038/s41409-021-01532-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 10/29/2021] [Accepted: 11/15/2021] [Indexed: 01/14/2023]
Abstract
Despite novel drugs and autologous HCT, MM remains incurable, with short survival in patients with poor biological characteristics. Allo HCT may be curative in some patients but is hampered by high rates of toxicity and relapse. We hypothesized that bortezomib (BTZ), with its anti-myeloma and immunologic properties, could improve PFS and cGVHD after allo HCT in newly diagnosed MM patients. In this prospective phase II study, we included 39 young (≤50 years) and high-risk patients who received a tandem auto-allo HCT followed by BTZ. Patients had prospective minimal residual disease (MRD) evaluations using Next-Generation Flow cytometry prior to allo HCT, prior BTZ and every 3 months for 2 years. With a median follow-up of 48 months, we report PFS and OS at 5 years of 41% and 80%, with a non-relapse mortality of 12%. Incidences of grade II-IV aGVHD at 12 months and moderate/severe cGVHD at 2 years were 26% and 57%. In a multivariate analysis model including cytogenetics, ISS and MRD status, MRD positivity prior to allo HCT (HR 3.75, p = 0.037), prior BTZ (HR 11.3, p = 0.018) and 3 months post-BTZ initiation (HR 9.7, p = 0.001) was highly predictive of progression. Peritransplant MRD assessment thus strongly predicts disease progression.
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Affiliation(s)
- Richard LeBlanc
- Division of Hematology, Oncology and Transplantation, Hôpital Maisonneuve-Rosemont, Department of Medicine/Université de Montréal, Montreal, QC, Canada.
| | - Imran Ahmad
- Division of Hematology, Oncology and Transplantation, Hôpital Maisonneuve-Rosemont, Department of Medicine/Université de Montréal, Montreal, QC, Canada
| | - Rafik Terra
- Division of Hematology, Oncology and Transplantation, Hôpital Maisonneuve-Rosemont, Montreal, QC, Canada
| | - Jean-Samuel Boudreault
- Division of Hematology and Oncology, Hôpital du Sacré-Coeur, Department of Medicine/Université de Montréal, Montreal, QC, Canada
| | - David Ogez
- Chronic Pain Clinic, Hôpital Maisonneuve-Rosemont, Department of Anesthesiology and Pain Medicine/Université de Montréal, Montreal, QC, Canada
| | - Kristopher Lamore
- Laboratoire de psychopathologie et processus de santé, Université de Paris, Paris, Boulogne-Billancourt, France
| | - Jean-Sébastien Delisle
- Division of Hematology, Oncology and Transplantation, Hôpital Maisonneuve-Rosemont, Department of Medicine/Université de Montréal, Montreal, QC, Canada
| | - Nadia Bambace
- Division of Hematology, Oncology and Transplantation, Hôpital Maisonneuve-Rosemont, Department of Medicine/Université de Montréal, Montreal, QC, Canada
| | - Léa Bernard
- Division of Hematology, Oncology and Transplantation, Hôpital Maisonneuve-Rosemont, Department of Medicine/Université de Montréal, Montreal, QC, Canada
| | - Sandra Cohen
- Division of Hematology, Oncology and Transplantation, Hôpital Maisonneuve-Rosemont, Department of Medicine/Université de Montréal, Montreal, QC, Canada
| | - Thomas Kiss
- Division of Hematology, Oncology and Transplantation, Hôpital Maisonneuve-Rosemont, Department of Medicine/Université de Montréal, Montreal, QC, Canada
| | - Silvy Lachance
- Division of Hematology, Oncology and Transplantation, Hôpital Maisonneuve-Rosemont, Department of Medicine/Université de Montréal, Montreal, QC, Canada
| | - Séverine Landais
- Division of Hematology, Oncology and Transplantation, Hôpital Maisonneuve-Rosemont, Montreal, QC, Canada
| | - Émilie Lemieux-Blanchard
- Division of Hematology and Oncology, Centre Hospitalier de l'Université de Montréal, Department of Medicine/Université de Montréal, Montreal, QC, Canada
| | - Guy Sauvageau
- Division of Hematology, Oncology and Transplantation, Hôpital Maisonneuve-Rosemont, Department of Medicine/Université de Montréal, Montreal, QC, Canada
| | - Michael Sebag
- Division of Hematology, McGill University Health Center, Department of Medicine/McGill University, Montreal, QC, Canada
| | - Denis Claude Roy
- Division of Hematology, Oncology and Transplantation, Hôpital Maisonneuve-Rosemont, Department of Medicine/Université de Montréal, Montreal, QC, Canada
| | - Jean Roy
- Division of Hematology, Oncology and Transplantation, Hôpital Maisonneuve-Rosemont, Department of Medicine/Université de Montréal, Montreal, QC, Canada
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56
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Ishii H, Yokoyama H, Katsube A, Gunji T, Saito T, Yano S. Severe graft-versus-host disease of the lower intestinal tract after pomalidomide administration in a plasma cell leukemia patient following bone marrow transplantation. BLOOD CELL THERAPY 2021; 4:88-91. [PMID: 36714068 PMCID: PMC9847257 DOI: 10.31547/bct-2021-006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 08/03/2021] [Indexed: 02/01/2023]
Abstract
Posttransplant treatment is performed to treat hematopoietic diseases but can lead to allogeneic-specific complications in addition to those seen in a non-transplant setting. Immunomodulatory drugs (IMiDs) activate cytotoxic T cells and suppress regulatory T cells. The optimal timing and optimal dose of IMiDs after allogeneic transplantation (allo-HSCT) to reduce complications and increase antitumor efficacy are difficult to determine because the degree of recovery of donor immune cells varies depending on the time after allo-HSCT. We experienced a patient with allo-HSCT who developed severe late acute graft-versus-host disease (GVHD) of the lower intestinal tract after receiving pomalidomide as a posttransplant therapy eight months after allo-HSCT. It is possible that pomalidomide induced acute GVHD by altering the activity of donor immune cells. This first case report highlights that the use of pomalidomide after allo-HSCT may lead to severe late acute GVHD. When pomalidomide is used after allo-HSCT, it is desirable to start with a small dose and gradually increase the dose while monitoring cytokine and lymphocyte subsets for the onset of GVHD.
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Affiliation(s)
- Hiroto Ishii
- Division of Clinical Oncology and Hematology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroki Yokoyama
- Division of Clinical Oncology and Hematology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Atsushi Katsube
- Division of Clinical Oncology and Hematology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Tadahiro Gunji
- Division of Clinical Oncology and Hematology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Takeshi Saito
- Division of Clinical Oncology and Hematology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Shingo Yano
- Division of Clinical Oncology and Hematology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
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57
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Pezzolo E, Saraggi D, Naldi L. Metastatic plasma cell leukemia to the skin: A case report with review of the literature. Dermatol Reports 2021; 13:9099. [PMID: 35003568 PMCID: PMC8672117 DOI: 10.4081/dr.2021.9099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 06/20/2021] [Indexed: 11/22/2022] Open
Abstract
Plasma cell leukemia (PCL) is a rare variant of leukemia with an aggressive clinical course and a poor prognosis. The cutaneous involvement in PCL is very rare either at clinical presentation of leukemia, namely leukemia cutis, or in the metastatic PCL to the skin. We present a case of eruptive multiple cutaneous nodules in a 56-year-old man with metastatic PCL. Histologically, a diffuse dermal and subcutaneous infiltration of ovoid cells with amphophilic cytoplasm and eccentrically located nucleus consistent with plasmacytoid morphology was observed. Neoplastic cells showed strong immunoexpression for CD138 and CD38 consistent with plasma cells phenotype, and loss of expression of CD56. Kappa light chain restriction similar to the phenotype of his PCL was demonstrated. We suggest that the evaluation of new skin lesions in leukemic patients should include a histopathologic examination to establish the diagnosis as soon as possible and a correct management of the disease.
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Affiliation(s)
| | - Deborah Saraggi
- Department of Pathology, San Bortolo Hospital, Vicenza, Italy
| | - Luigi Naldi
- Department of Dermatology, San Bortolo Hospital, Vicenza, Italy.,Study Center of the Italian Group for Epidemiologic Research in Dermatology (GISED), Bergamo, Italy
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58
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Que Y, Xu M, Xu Y, Almeida VDF, Zhu L, Wang Z, Wang Y, Liu X, Jiang L, Wang D, Li C, Zhou J. Anti-BCMA CAR-T Cell Therapy in Relapsed/Refractory Multiple Myeloma Patients With Extramedullary Disease: A Single Center Analysis of Two Clinical Trials. Front Immunol 2021; 12:755866. [PMID: 34777368 PMCID: PMC8589080 DOI: 10.3389/fimmu.2021.755866] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/13/2021] [Indexed: 11/26/2022] Open
Abstract
Background The prognosis of relapsed/refractory multiple myeloma (RRMM) patients with the extramedullary disease was significantly poor. Extramedullary multiple myeloma (EMM) patients gained limited benefits from traditional drugs. Anti-B cell maturation antigen (BCMA) chimeric antigen receptor (CAR) T-cell therapy seems to be a promising approach to treat RRMM patients. However, very few clinical studies are designed for EMM. Our study aimed to compare and assess the safety, efficacy, and pharmacokinetics of anti-BCMA CAR-T cell therapy in EMM and non-EMM. Methods The results from published anti-BCMA CAR-T clinical trials, in which raw data of EMM patients were available, were reviewed and summarized. Two trials conducted in our clinical centers were analyzed and presented with detailed data. Results According to published anti-BCMA CAR-T clinical trials, the ORR of EMM ranged from 57% to 100%, with the complete remission (CR) rate of 29% to 60%. Between February 22, 2017, and September 26, 2019, a total of 61 subjects (EMM 25; non-EMM 36) received anti-BCMA CAR-T cell infusion. The data-cutoff date was April 1, 2021. There were no statistical differences between EMM and non-EMM groups in adverse events (AEs), including cytokine release syndrome (CRS). The most common AEs of grade ≥ 3 in both groups were hematologic toxicities. There was no significant difference in the objective response rate (ORR) and ≥ complete remission (CR) rate between both groups. However, the ≥ CR rate of the EMM group was lower than the non-EMM group receiving the fully human anti-BCMA CAR-T cell therapy (p = 0.026). The median progression-free survival (PFS) for EMM and the non-EMM group was 121 days and 361 days, respectively (p = 0.001). The median overall survival (OS) for EMM and the non-EMM group was 248 days and 1024 days, respectively (p = 0.005). The Cmax and AUC0-28d for EMM group were lower than non-EMM group (Cmax, p = 0.016; AUC0-28d, p = 0.016). Extramedullary disease was an independent prognostic risk factor for PFS (hazard ratio, 2.576; 95% CI, 1.343 to 4.941; p = 0.004) and OS (hazard ratio, 2.312; 95% CI, 1.165 to 4.592; p = 0.017) in RRMM patients receiving anti-BCMA CAR-T cell therapy. Conclusions Based on our results, EMM patients could benefit from the two anti-BCMA CAR products, although they had a shorter PFS and OS compared with non-EMM patients. Clinical Trial Registration http://www.chictr.org.cn, identifier ChiCTR-OPC-16009113 and ChiCTR1800018137.
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Affiliation(s)
- Yimei Que
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Menglei Xu
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yanjie Xu
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | | | - Li Zhu
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Immunotherapy Research Center for Hematologic Diseases of Hubei Province, Wuhan, China
| | - Zhiqiong Wang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Immunotherapy Research Center for Hematologic Diseases of Hubei Province, Wuhan, China
| | - Ying Wang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Immunotherapy Research Center for Hematologic Diseases of Hubei Province, Wuhan, China
| | - Xian Liu
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Immunotherapy Research Center for Hematologic Diseases of Hubei Province, Wuhan, China
| | - Lijun Jiang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Immunotherapy Research Center for Hematologic Diseases of Hubei Province, Wuhan, China
| | - Di Wang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Immunotherapy Research Center for Hematologic Diseases of Hubei Province, Wuhan, China
| | - Chunrui Li
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Immunotherapy Research Center for Hematologic Diseases of Hubei Province, Wuhan, China
| | - Jianfeng Zhou
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Immunotherapy Research Center for Hematologic Diseases of Hubei Province, Wuhan, China
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59
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LncRNAs LY86-AS1 and VIM-AS1 Distinguish Plasma Cell Leukemia Patients from Multiple Myeloma Patients. Biomedicines 2021; 9:biomedicines9111637. [PMID: 34829867 PMCID: PMC8615960 DOI: 10.3390/biomedicines9111637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/24/2021] [Accepted: 11/04/2021] [Indexed: 12/13/2022] Open
Abstract
Long non-coding RNAs (lncRNAs) are functional RNAs longer than 200 nucleotides. Due to modern genomic techniques, the involvement of lncRNAs in tumorigenesis has been revealed; however, information concerning lncRNA interplay in multiple myeloma (MM) and plasma cell leukemia (PCL) is virtually absent. Herein, we aimed to identify the lncRNAs involved in MM to PCL progression. We investigated representative datasets of MM and PCL patients using next-generation sequencing. In total, 13 deregulated lncRNAs (p < 0.00025) were identified; four of them were chosen for further validation in an independent set of MM and PCL patients by RT-qPCR. The obtained results proved the significant downregulation of lymphocyte antigen antisense RNA 1 (LY86-AS1) and VIM antisense RNA 1 (VIM-AS1) in PCL compared to MM. Importantly, these two lncRNAs could be involved in the progression of MM into PCL; thus, they could serve as promising novel biomarkers of MM progression.
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60
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How I Treat High-risk Multiple Myeloma. Blood 2021; 139:2889-2903. [PMID: 34727187 DOI: 10.1182/blood.2020008733] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/26/2021] [Indexed: 11/20/2022] Open
Abstract
Survival of multiple myeloma (MM) has significantly improved over the last decade; however, a composed group of patients (15-20%), named high-risk (HR) MM, still experience reduced survival. Both tumor biology and suboptimal/absent responses to therapy may underlie HR definition and a clear uniform identification of risk factors is crucial for a proper management of these patients. In biologic-HRMM, MRD negativity attainment and sustain, inside and outside BM, should be the primary goal and therapy should be adapted in patients with frailty to reduce toxicity and improve quality of life. MM treatment has traditionally been tailored on age and more recently frailty or comorbidities, but very rarely on the biology of the disease, mainly because of the lack of a clear benefit derived from a specific drug/combination, inhomogeneity in HR definition and lack of data coming from prospective, properly designed clinical trials. Some attempts have been successfully made recently in this direction. In this review, we are discussing the current different definitions of HR and the need for a consensus, the results of available trials in HR patients and the way through risk-adapted treatment strategies. For this purpose, we are proposing several clinical cases of difficult-to-treat patients throughout different treatment phases.
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61
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Kazmi F, Shrestha N, Booth S, Dodwell D, Aroldi F, Foord T, Nicholson BD, Heesen P, Lord S, Yeoh KW, Blagden S. Next-generation sequencing for guiding matched targeted therapies in people with relapsed or metastatic cancer. Hippokratia 2021. [DOI: 10.1002/14651858.cd014872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Farasat Kazmi
- Department of Oncology; University of Oxford; Oxford UK
| | - Nipun Shrestha
- Department of Primary Care and Mental Health; University of Liverpool; Liverpool UK
| | - Stephen Booth
- Department of Oncology; University of Oxford; Oxford UK
| | - David Dodwell
- Nuffield Department of Population Health; University of Oxford; Oxford UK
| | | | | | - Brian D Nicholson
- Nuffield Department of Primary Care Health Sciences; University of Oxford; Oxford UK
| | | | - Simon Lord
- Department of Oncology; University of Oxford; Oxford UK
| | - Kheng-Wei Yeoh
- Radiation Oncology; National Cancer Centre; Singapore Singapore
| | - Sarah Blagden
- Department of Oncology; University of Oxford; Oxford UK
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62
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Lee Y, Yun J, Jeong D, Ryu S, Kwon SR, Yun H, Kim SM, Park JH, Lee DS. Genetic profile of primary plasma cell leukemia in Korea: comparison with plasma cell myeloma. Leuk Lymphoma 2021; 63:385-394. [PMID: 34592901 DOI: 10.1080/10428194.2021.1983568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Plasma cell leukemia (PCL) is clinically and genetically distinct from multiple myeloma (MM), despite controversies regarding the disease definition. To determine the distinct features of PCL, the genetic property of primary PCL (pPCL) was compared with that of secondary PCL (sPCL) and MM. In patients with pPCL, Eighty-nine non-synonymous mutations were observed in 68 genes. The most frequently mutated genes were TP53, TSC2, and TYK2. In comparison with genetic abnormalities of sPCL and MM, 45 genes were present only in pPCL while 28 genes were only in sPCL and 22 genes only in MM. Among the common genes between pPCL and MM, a higher prevalence of TP53 was observed in pPCL, compared to MM (p < 0.05), while similar, compared to sPCL (p = 0.64). In summary, pPCL patients showed a higher level of genetic heterogeneity and distinctive genetic signature in their mutational profile compared to patients with MM and sPCL.
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Affiliation(s)
- Youngeun Lee
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Jiwon Yun
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Dajeong Jeong
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Sohee Ryu
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Seok Ryun Kwon
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Hongseok Yun
- Department of Genomic Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Sung Min Kim
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Jae Hyeon Park
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Dong Soon Lee
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, South Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
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63
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Bansal R, Rakshit S, Kumar S. Extramedullary disease in multiple myeloma. Blood Cancer J 2021; 11:161. [PMID: 34588423 PMCID: PMC8481260 DOI: 10.1038/s41408-021-00527-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 06/07/2021] [Accepted: 07/07/2021] [Indexed: 02/06/2023] Open
Abstract
When clonal plasma cells grow at anatomic sites distant from the bone marrow or grows contiguous from osseous lesions that break through the cortical bone, it is referred to as extramedullary multiple myeloma (EMD). EMD remains challenging from a therapeutic and biological perspective. The pathogenetic mechanisms are not completely understood and it is generally associated with high-risk cytogenetics which portends poor outcomes. There is a rising incidence of EMD in the era of novel agents, likely a reflection of longer OS, with no standard treatment approach. Patients benefit from aggressive chemotherapy-based approaches, but the OS and prognosis remains poor. RT has been used for palliative care. There is a need for large prospective trials for development of treatment approaches for treatment of EMD.
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Affiliation(s)
- Radhika Bansal
- Division of Hematology, Mayo Clinic, Rochester, MN, USA, 55905
| | - Sagar Rakshit
- Division of Hematology, Mayo Clinic, Rochester, MN, USA, 55905
| | - Shaji Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA, 55905.
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64
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Ahaneku H, Gupta R, Anusim N, Umeh CA, Anderson J, Jaiyesimi I. Leucocytoclastic Vasculitis, Cryoglobulinemia, or Plasma Cell Leukemia: A Diagnostic Conundrum. Cureus 2021; 13:e16832. [PMID: 34513422 PMCID: PMC8409693 DOI: 10.7759/cureus.16832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2021] [Indexed: 11/06/2022] Open
Abstract
Plasma cell leukemia is rare and could be life-threatening. Even rarer and equally life-threatening is cryoglobulinemia. Both of them occurring together paints a grim clinical picture. We present the case of a 63-year-old male with plasma cell leukemia complicated by cryoglobulinemia with skin lesions. The report briefly reviews the clinical and diagnostic characteristics of plasma cell leukemia and well as available treatment options. It also highlights the need to consider non-chemotherapy-based regimens and clinical trials in the care of plasma cell leukemia patients.
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Affiliation(s)
| | - Ruby Gupta
- Hematology and Oncology, Beaumont Health, Royal Oak, USA
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65
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Bezdekova R, Jelinek T, Kralova R, Stork M, Polackova P, Vsianska P, Brozova L, Jarkovsky J, Almasi M, Boichuk I, Knechtova Z, Penka M, Pour L, Sevcikova S, Hajek R, Rihova L. Necessity of flow cytometry assessment of circulating plasma cells and its connection with clinical characteristics of primary and secondary plasma cell leukaemia. Br J Haematol 2021; 195:95-107. [PMID: 34500493 PMCID: PMC9292932 DOI: 10.1111/bjh.17713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/30/2021] [Indexed: 01/23/2023]
Abstract
Plasma cell leukaemia (PCL) is a rare and very aggressive plasma cell disorder. Preventing a dismal outcome of PCL requires early diagnosis with appropriate analytical tools. Therefore, the investigation of 33 patients with primary and secondary PCL was done when the quantity of circulating plasma cells (PCs) using flow cytometry (FC) and morphology assessment was evaluated. The phenotypic profile of the PCs was also analysed to determine if there is an association with clinical outcomes and to evaluate the prognostic value of analysed markers. Our results revealed that FC is an excellent method for identifying circulating PCs as a significantly higher number was identified by FC than by morphology (26·7% vs. 13·5%, P = 0·02). None of secondary PCL cases expressed CD19 or CD20. A low level of expression with similar positivity of CD27, CD28, CD81 and CD117 was found in both PCL groups. A decrease of CD44 expression was detected only in secondary PCL. Expression of CD56 was present in more than half of PCL cases as well as cytoplasmic nestin. A decreased level of platelets, Eastern Cooperative Oncology Group score of 2-3 and lack of CD20+ PC were associated with a higher risk of death. FC could be incorporated in PCL diagnostics not only to determine the number of circulating PCs, but also to assess their phenotype profile and this information should be useful in patients' diagnosis and possible prognosis.
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Affiliation(s)
- Renata Bezdekova
- Department of Clinical Hematology, University Hospital Brno, Brno, Czech Republic.,Babak Myeloma Group, Department of Pathophysiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Tomas Jelinek
- Department of Hematooncology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Romana Kralova
- Department of Clinical Hematology, University Hospital Brno, Brno, Czech Republic.,Babak Myeloma Group, Department of Pathophysiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Martin Stork
- Department of Internal Medicine - Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - Petra Polackova
- Department of Clinical Hematology, University Hospital Brno, Brno, Czech Republic
| | - Pavla Vsianska
- Department of Clinical Hematology, University Hospital Brno, Brno, Czech Republic.,Babak Myeloma Group, Department of Pathophysiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Lucie Brozova
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jiri Jarkovsky
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Martina Almasi
- Department of Clinical Hematology, University Hospital Brno, Brno, Czech Republic.,Babak Myeloma Group, Department of Pathophysiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Ivanna Boichuk
- Department of Internal Medicine - Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - Zdenka Knechtova
- Department of Internal Medicine - Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - Miroslav Penka
- Department of Clinical Hematology, University Hospital Brno, Brno, Czech Republic
| | - Ludek Pour
- Department of Internal Medicine - Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - Sabina Sevcikova
- Department of Clinical Hematology, University Hospital Brno, Brno, Czech Republic.,Babak Myeloma Group, Department of Pathophysiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Roman Hajek
- Department of Hematooncology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Lucie Rihova
- Department of Clinical Hematology, University Hospital Brno, Brno, Czech Republic.,Babak Myeloma Group, Department of Pathophysiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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66
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Patel D, Mangano A, Moccia D, Esperti S, Udani K, Henderson J, Balanchivadze N. Acute Plasma Cell Leukemia Presenting as Primary Hyperammonemic Encephalopathy. J Med Cases 2021; 11:320-323. [PMID: 34434338 PMCID: PMC8383598 DOI: 10.14740/jmc3559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 08/08/2020] [Indexed: 11/11/2022] Open
Abstract
Primary plasma cell leukemia (PPCL) is a rare form of multiple myeloma (MM) and is a rare aggressive disease with a median overall survival of 6 - 11 months. We present a case of acute hyperammonemic encephalopathy as the initial presentation of PPCL in a 78-year-old woman to highlight an atypical presentation of this disorder.
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Affiliation(s)
- Dveet Patel
- Department of Internal Medicine, Grand Strand Health, Myrtle Beach, SC, USA.,Affiliated Hospital of Grand Strand Medical Center, Myrtle Beach, SC, USA
| | - Andrew Mangano
- Affiliated Hospital of Grand Strand Medical Center, Myrtle Beach, SC, USA
| | - David Moccia
- Affiliated Hospital of Grand Strand Medical Center, Myrtle Beach, SC, USA
| | - Shawn Esperti
- Affiliated Hospital of Grand Strand Medical Center, Myrtle Beach, SC, USA
| | - Kunjan Udani
- Affiliated Hospital of Grand Strand Medical Center, Myrtle Beach, SC, USA
| | - Jordan Henderson
- Affiliated Hospital of Grand Strand Medical Center, Myrtle Beach, SC, USA
| | - Nino Balanchivadze
- Department of Hematology/Oncology, Henry Ford Health System, Detroit, MI, USA
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67
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Gowin K, Skerget S, Keats JJ, Mikhael J, Cowan AJ. Plasma cell leukemia: A review of the molecular classification, diagnosis, and evidenced-based treatment. Leuk Res 2021; 111:106687. [PMID: 34425325 DOI: 10.1016/j.leukres.2021.106687] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/22/2021] [Accepted: 08/15/2021] [Indexed: 12/11/2022]
Abstract
Plasma cell leukemia is a rare and aggressive plasma cell dyscrasia associated with dismal outcomes. It may arise de novo, primary plasma cell leukemia, or evolve from an antecedent diagnosis of multiple myeloma, secondary plasma cell leukemia. Despite highly effective therapeutics, survival for plasma cell leukemia patients remains poor. Molecular knowledge of plasma cell leukemia has recently expanded with use of gene expression profiling and whole exome sequencing, lending new insights into prognosis and therapeutic development. In this review, we describe the molecular knowledge, clinical characteristics, evidenced-based therapeutic approaches and treatment outcomes of plasma cell leukemia.
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Affiliation(s)
- Krisstina Gowin
- University of Arizona, Department of Bone Marrow Transplant and Cellular Therapy, Tucson, AZ, United States.
| | - Sheri Skerget
- Translational Genomics Research Institute (TGen), Integrated Cancer Genomics Division, Phoenix, AZ, United States
| | - Jonathan J Keats
- Translational Genomics Research Institute (TGen), Integrated Cancer Genomics Division, Phoenix, AZ, United States
| | - Joseph Mikhael
- Translational Genomics Research Institute (TGen), Applied Cancer Research and Drug Discovery Division, Phoenix, AZ, United States
| | - Andrew J Cowan
- University of Washington, Department of Hematology Oncology, Seattle, WA, United States
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68
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Tian MR, Yang PY, Yue TT, Li MY, Zhang YJ, Zhang MX, Zhang LM, Yan YR, Hu ZL, Du YZ, Li YY, Jin FY. [A predictive model based on risk factors for early mortality in patients with newly diagnosed multiple myeloma]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2021; 42:666-672. [PMID: 34547873 PMCID: PMC8501273 DOI: 10.3760/cma.j.issn.0253-2727.2021.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
目的 分析影响初治多发性骨髓瘤(NDMM)患者早期死亡(EM)的因素,建立其预测模型,以期识别EM风险。 方法 回顾性分析2009年5月至2017年1月吉林大学白求恩第一医院收治的275例NDMM患者,对6个月(EM6)、12个月(EM12)及24个月(EM24)内死亡患者初诊时基线特征进行单因素分析,并根据多因素分析结果建立EM的预测模型。 结果 本研究中EM6、EM12及EM24的发生率分别是5.5%、12.7%和30.2%;最常见的死亡原因为疾病复发/进展,在EM6、EM12及EM24中分别占60.0%、77.1%及84.3%。影响EM6的因素包括经白蛋白校正的血清钙(校正钙)>2.75 mmol/L和PLT<100×109/L;影响EM12的因素包括年龄>75岁、国际分期系统(ISS) Ⅲ期、修订版国际分期系统(R-ISS) Ⅲ期、校正钙>2.75 mmol/L、血清肌酐>177 µmol/L、PLT<100×109/L及骨髓浆细胞比例≥60%;影响EM24的因素中,除上述影响EM12的因素外,还包括男性和染色体核型1q+。多因素分析尚未发现EM6和EM12的独立预后因素。在EM24的多因素分析中,年龄>75岁、PLT<100×109/L和染色体核型1q+是EM24的独立预后因素。根据Logistic回归系数赋分:年龄>75岁:1分;PLT<100×109/L:2分;染色体核型1q+:1分,建立EM24预测模型,ROC曲线下面积为0.709(95%CI 0.626~0.793)。积分≥3分的患者24个月内死亡风险是0~2分患者的26倍,积分0~4分的NDMM患者中位总生存期分别为59、41、22、17.5及16个月(P<0.001)。 结论 年龄>75岁、PLT<100×109/L和染色体核型1q+为EM24的独立预后因素,依据上述变量构建的EM24预测模型有助于识别EM风险和预测生存,具有较好标准度与区分度。
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Affiliation(s)
- M R Tian
- Department of Hematology, the First Hospital of Jilin University, Changchun 130021, China
| | - P Y Yang
- Department of Hematology, the First Hospital of Jilin University, Changchun 130021, China
| | - T T Yue
- Department of Hematology, the First Hospital of Jilin University, Changchun 130021, China
| | - M Y Li
- Department of Hematology, the First Hospital of Jilin University, Changchun 130021, China
| | - Y J Zhang
- Department of Hematology, the First Hospital of Jilin University, Changchun 130021, China
| | - M X Zhang
- Department of Hematology, the First Hospital of Jilin University, Changchun 130021, China
| | - L M Zhang
- Department of Hematology, the First Hospital of Jilin University, Changchun 130021, China
| | - Y R Yan
- Department of Hematology, the First Hospital of Jilin University, Changchun 130021, China
| | - Z L Hu
- Department of Hematology, the First Hospital of Jilin University, Changchun 130021, China
| | - Y Z Du
- Department of Hematology, the First Hospital of Jilin University, Changchun 130021, China
| | - Y Y Li
- Department of Hematology, the First Hospital of Jilin University, Changchun 130021, China
| | - F Y Jin
- Department of Hematology, the First Hospital of Jilin University, Changchun 130021, China
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69
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Increased expression of IFI16 predicts adverse prognosis in multiple myeloma. THE PHARMACOGENOMICS JOURNAL 2021; 21:520-532. [PMID: 33712724 DOI: 10.1038/s41397-021-00230-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 01/19/2021] [Accepted: 02/18/2021] [Indexed: 01/31/2023]
Abstract
Multiple myeloma (MM) is a malignancy of terminally differentiated plasma cells and does not have sufficient prognostic indicators. Interferon gamma inducible protein 16 (IFI16) plays a crucial role in B-cell differentiation. Several studies have shown that IFI16 predicted prognosis in many cancers. However, the relationship between MM prognosis and IFI16 expression has not been studied. In our study, we analyzed the prognostic role of IFI16 expression and explored the possible mechanism in MM progression by using 4498 myeloma patients and 52 healthy donors from 13 independent gene expression omnibus (GEO) datasets. The IFI16 expression increased with myeloma progression, ISS stage, 1q21 amplification, and relapse (all P < 0.01). MM patients with higher IFI16 expression had shorter survival in six datasets (all P < 0.05). Furthermore, multivariate analysis indicated that enhanced IFI16 expression was an independent poor prognostic factor for EFS and OS (P = 0.007, 0.009, respectively). And PPI, GO, KEGG, and GSEA also confirmed that IFI16 promoted MM progression by participating in tumor-related pathways. In conclusion, our study confirmed that IFI16 was a poor prognostic biomarker in MM.
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70
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Ong'ondi M, Kagotho E. Plasma Cell Leukemia: A Review of 3 Cases Managed in Kenya. Case Rep Hematol 2021; 2021:4843818. [PMID: 34395001 PMCID: PMC8363435 DOI: 10.1155/2021/4843818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/17/2021] [Indexed: 12/03/2022] Open
Abstract
Plasma Cell Leukemia (PCL) is a rare and aggressive form of plasma cell dyscrasia that can arise either de novo (primary plasma cell leukemia) or evolve from previously diagnosed and treated multiple myeloma (secondary PCL). We highlight three clinical cases with very different presentations as a reminder of this diagnosis. The cases also highlight the diversity and variability that cover a patient's journey that is highly dependent on accessibility based on financial capability and social support. The clinical presentation is more aggressive due to the higher tumour burden and more proliferative tumor cells with cytopenias being profound and more organomegaly. The diagnosis is made based on at least 20% of total white blood cells being circulating plasma cells with a peripheral blood absolute plasma cell count of at least 2 × 109/l. Treatment with novel agents followed by autologous stem cell transplant in those who are transplant eligible leads to better outcomes.
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Affiliation(s)
- Matilda Ong'ondi
- Department of Internal Medicine; Hemato-oncology Unit, Kenyatta National Hospital, Nairobi, Kenya
| | - Elizabeth Kagotho
- Department of Pathology and Laboratory Medicine, Aga Khan University hospital, Nairobi, Kenya
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71
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Visram A, Soof C, Rajkumar SV, Kumar SK, Bujarski S, Spektor TM, Kyle RA, Berenson JR, Dispenzieri A. Serum BCMA levels predict outcomes in MGUS and smoldering myeloma patients. Blood Cancer J 2021; 11:120. [PMID: 34168119 PMCID: PMC8225625 DOI: 10.1038/s41408-021-00505-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/24/2021] [Accepted: 05/28/2021] [Indexed: 11/09/2022] Open
Abstract
Soluble BCMA (sBCMA) levels are elevated in monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM). However, the association between sBCMA levels and prognosis in MGUS and SMM has not been studied. We retrospectively analyzed sBCMA levels in stored samples from 99 MGUS and 184 SMM patients. Baseline sBCMA levels were significantly higher in MGUS and SMM patients progressing to MM during clinical follow up. When stratified according to the median baseline sBCMA level for each cohort, higher levels were associated with a shorter PFS for MGUS (HR 3.44 comparing sBCMA ≥77 vs <77 ng/mL [95% CI 2.07-5.73, p < 0.001] and SMM (HR 2.0 comparing sBCMA ≥128 vs <128 ng/mL, 95% 1.45-2.76, p < 0.001) patients. The effect of sBCMA on PFS was similar even after adjusting for the baseline MGUS or SMM risk stratification. We evaluated paired serum samples and found that sBCMA increased significantly in MGUS and SMM patients who eventually progressed to MM, whereas among MGUS non-progressors the sBCMA level remained stable. While our results require independent validation, they suggest that sBCMA may be a useful biomarker to identify MGUS and SMM patients at increased risk of progression to MM independent of the established risk models.
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Affiliation(s)
- A Visram
- Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - C Soof
- Institute for Myeloma & Bone Cancer Research, West Hollywood, CA, California, USA
| | - S V Rajkumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - S K Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - S Bujarski
- Institute for Myeloma & Bone Cancer Research, West Hollywood, CA, California, USA
| | - T M Spektor
- OncoTracker, West Hollywood, CA, California, USA
| | - R A Kyle
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - J R Berenson
- Institute for Myeloma & Bone Cancer Research, West Hollywood, CA, California, USA.,OncoTracker, West Hollywood, CA, California, USA.,Oncotherapeutics, West Hollywood, CA, California, USA.,Berenson Cancer Center, West Hollywood, CA, California, USA
| | - A Dispenzieri
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.
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72
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Allogeneic Stem Cell Transplantation in Patients with High-Risk Multiple Myeloma: Utopia or Continuous Challenge in Aiming for Cure? Curr Treat Options Oncol 2021; 22:65. [PMID: 34110512 DOI: 10.1007/s11864-021-00864-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2021] [Indexed: 10/21/2022]
Abstract
OPINION STATEMENT Nowadays, several novel agents have been introduced in the treatment of multiple myeloma, not only resulting in high response rates and prolonged survival but also offering good quality of life. However, the potential of cure, especially for patients with advanced or unfavorable disease features, remains elusive. Allogeneic hematopoietic stem cell transplantation, based mainly on the graft vs. myeloma effect, can offer prolonged disease control and probability of cure but unfortunately at the cost of considerable transplant-related toxicity rates. Therefore, the role of allogeneic hematopoietic stem cell transplantation in the treatment of multiple myeloma has been called into question. Recently, several studies, particularly those with long-term follow-up, demonstrated a trend of survival superiority for allografted patients with high-risk disease. These data fuel again the interest in allogeneic stem cell transplantation for selected patients with high-risk multiple myeloma, especially if the high remission rates which can be achieved with the currently used treatment protocols could be long-life sustained through the additional exploitation of the long-lasting anti-multiple myeloma effect, originating from the allograft.
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73
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Visram A, Suska A, Jurczyszyn A, Gonsalves WI. Practical management and assessment of primary plasma cell leukemia in the novel agent era. Cancer Treat Res Commun 2021; 28:100414. [PMID: 34174530 DOI: 10.1016/j.ctarc.2021.100414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 05/08/2021] [Accepted: 05/27/2021] [Indexed: 10/21/2022]
Affiliation(s)
- A Visram
- University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | - A Suska
- Department of Hematology, Jagiellonian University Medical College, Kopernika 17, Krakow 31-501, Poland
| | - A Jurczyszyn
- Department of Hematology, Jagiellonian University Medical College, Kopernika 17, Krakow 31-501, Poland
| | - W I Gonsalves
- Division of Hematology, Mayo Clinic, Rochester, MN, United States.
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74
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Sun YJ, Liu XC, Han L, Wu SS, Liu YY, Gao QL, Song YP, Zhou KS. [Treatment of two cases of extramedullary infiltration multiple myeloma with BCMA CAR-T cells]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2021; 42:253-255. [PMID: 33910313 PMCID: PMC8081939 DOI: 10.3760/cma.j.issn.0253-2727.2021.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Y J Sun
- Department of Hematopathy, the Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - X C Liu
- Department of Hematopathy, the Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - L Han
- Department of Hematopathy, the Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - S S Wu
- Department of Hematopathy, the Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - Y Y Liu
- Department of Hematopathy, the Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - Q L Gao
- Department of Hematopathy, the Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - Y P Song
- Department of Hematopathy, the Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - K S Zhou
- Department of Hematopathy, the Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
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75
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Giannakoulas N, Ntanasis-Stathopoulos I, Terpos E. The Role of Marrow Microenvironment in the Growth and Development of Malignant Plasma Cells in Multiple Myeloma. Int J Mol Sci 2021; 22:ijms22094462. [PMID: 33923357 PMCID: PMC8123209 DOI: 10.3390/ijms22094462] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 04/20/2021] [Accepted: 04/22/2021] [Indexed: 12/16/2022] Open
Abstract
The development and effectiveness of novel therapies in multiple myeloma have been established in large clinical trials. However, multiple myeloma remains an incurable malignancy despite significant therapeutic advances. Accumulating data have elucidated our understanding of the genetic background of the malignant plasma cells along with the role of the bone marrow microenvironment. Currently, the interaction among myeloma cells and the components of the microenvironment are considered crucial in multiple myeloma pathogenesis. Adhesion molecules, cytokines and the extracellular matrix play a critical role in the interplay among genetically transformed clonal plasma cells and stromal cells, leading to the proliferation, progression and survival of myeloma cells. In this review, we provide an overview of the multifaceted role of the bone marrow microenvironment in the growth and development of malignant plasma cells in multiple myeloma.
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Affiliation(s)
- Nikolaos Giannakoulas
- Department of Hematology of University Hospital of Larisa, Faculty of Medicine, University of Thessaly, 41110 Larisa, Greece;
| | - Ioannis Ntanasis-Stathopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece;
| | - Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece;
- Correspondence:
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76
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Sive J, Cuthill K, Hunter H, Kazmi M, Pratt G, Smith D. Guidelines on the diagnosis, investigation and initial treatment of myeloma: a British Society for Haematology/UK Myeloma Forum Guideline. Br J Haematol 2021; 193:245-268. [PMID: 33748957 DOI: 10.1111/bjh.17410] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 12/23/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Jonathan Sive
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Hannah Hunter
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Majid Kazmi
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Guy Pratt
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Dean Smith
- Nottingham University Hospitals NHS Trust, Nottingham, UK
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77
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Li C, Cao W, Que Y, Wang Q, Xiao Y, Gu C, Wang D, Wang J, Jiang L, Xu H, Xu J, Zhou X, Hong Z, Wang N, Huang L, Zhang S, Chen L, Mao X, Xiao M, Zhang W, Meng L, Cao Y, Zhang T, Li J, Zhou J. A phase I study of anti-BCMA CAR T cell therapy in relapsed/refractory multiple myeloma and plasma cell leukemia. Clin Transl Med 2021; 11:e346. [PMID: 33784005 PMCID: PMC7943908 DOI: 10.1002/ctm2.346] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 02/10/2021] [Accepted: 02/17/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Relapsed/refractory (R/R) multiple myeloma (MM) patients and primary plasma cell leukemia (PCL) have an unfavorable prognosis and no effective treatment. This study was designed to assess the safety and preliminary efficacy of a novel anti-B-cell maturation antigen (BCMA) chimeric antigen receptor (CAR) T cell in R/R MM and PCL. METHODS Between February 22, 2017, and June 25, 2018, 28 R/R and two R/R primary PCL patients received a median dose of 11.2 × 106 CAR+ cells/kg. The subjects were refractory to a proteasome inhibitor and/or an immunomodulatory agent. Fludarabine and cyclophosphamide were given as lymphodepletion chemotherapy. RESULTS Results for these 30 consecutive patients who received an anti-BCMA CAR T cell infusion are reported. The patients had received a median of four prior lines of therapy. A total of 44 different types of adverse events were recorded, and hematologic toxic effects were the most common events of any grade during treatment. Hematologic toxic effects were also the most common events of grade 3 or higher. A total of 29 patients (96.7%) had cytokine release syndrome, which was of grade 1 or 2 in 24 patients (80%) and grade 3 in five patients (16.7%). Neurologic toxic effects only occurred in one patient (3.3%) and were of grade 1. The objective response rate was 90%, and the complete response rate was 43.3%. With a median follow-up of 12.6 months, the median progression-free survival (PFS) and overall survival were 5.2 months and 14.0 months. One of the two primary PCL achieved a complete response with a PFS of 307 days. The other patients achieved a very good partial response with a PFS of 117 days. CONCLUSIONS Anti-BCMA CAR T cell treatment is safe and highly active in R/R multiple myeloma.
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Affiliation(s)
- Chunrui Li
- Department of Hematology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
- Immunotherapy Research Center for Hematologic Diseases of Hubei ProvinceWuhanHubeiChina
| | - Wenyue Cao
- Department of Hematology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
- Immunotherapy Research Center for Hematologic Diseases of Hubei ProvinceWuhanHubeiChina
| | - Yimei Que
- Department of Hematology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
- Immunotherapy Research Center for Hematologic Diseases of Hubei ProvinceWuhanHubeiChina
| | | | - Yi Xiao
- Department of Hematology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
- Immunotherapy Research Center for Hematologic Diseases of Hubei ProvinceWuhanHubeiChina
| | - Chaojiang Gu
- College of Life Science and HealthWuhan University of Science and TechnologyWuhanHubeiChina
- Wuhan Bio‐Raid Biotechnology Co., Ltd.WuhanHubeiChina
| | - Di Wang
- Department of Hematology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
- Immunotherapy Research Center for Hematologic Diseases of Hubei ProvinceWuhanHubeiChina
| | - Jue Wang
- Department of Hematology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
- Immunotherapy Research Center for Hematologic Diseases of Hubei ProvinceWuhanHubeiChina
| | - Lijun Jiang
- Department of Hematology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
- Immunotherapy Research Center for Hematologic Diseases of Hubei ProvinceWuhanHubeiChina
| | - Hao Xu
- Department of Hematology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
- Immunotherapy Research Center for Hematologic Diseases of Hubei ProvinceWuhanHubeiChina
| | - Jinhuan Xu
- Department of Hematology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
- Immunotherapy Research Center for Hematologic Diseases of Hubei ProvinceWuhanHubeiChina
| | - Xiaoxi Zhou
- Department of Hematology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
- Immunotherapy Research Center for Hematologic Diseases of Hubei ProvinceWuhanHubeiChina
| | - Zhenya Hong
- Department of Hematology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
- Immunotherapy Research Center for Hematologic Diseases of Hubei ProvinceWuhanHubeiChina
| | - Na Wang
- Department of Hematology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
- Immunotherapy Research Center for Hematologic Diseases of Hubei ProvinceWuhanHubeiChina
| | - Liang Huang
- Department of Hematology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
- Immunotherapy Research Center for Hematologic Diseases of Hubei ProvinceWuhanHubeiChina
| | - Shangkun Zhang
- College of Life Science and HealthWuhan University of Science and TechnologyWuhanHubeiChina
- Wuhan Bio‐Raid Biotechnology Co., Ltd.WuhanHubeiChina
| | - Liting Chen
- Department of Hematology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
- Immunotherapy Research Center for Hematologic Diseases of Hubei ProvinceWuhanHubeiChina
| | - Xia Mao
- Department of Hematology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
- Immunotherapy Research Center for Hematologic Diseases of Hubei ProvinceWuhanHubeiChina
| | - Min Xiao
- Department of Hematology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
- Immunotherapy Research Center for Hematologic Diseases of Hubei ProvinceWuhanHubeiChina
| | - Wei Zhang
- Department of Hematology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
- Immunotherapy Research Center for Hematologic Diseases of Hubei ProvinceWuhanHubeiChina
| | - Li Meng
- Department of Hematology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
- Immunotherapy Research Center for Hematologic Diseases of Hubei ProvinceWuhanHubeiChina
| | - Yang Cao
- Department of Hematology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
- Immunotherapy Research Center for Hematologic Diseases of Hubei ProvinceWuhanHubeiChina
| | - Tongcun Zhang
- College of Life Science and HealthWuhan University of Science and TechnologyWuhanHubeiChina
- Wuhan Bio‐Raid Biotechnology Co., Ltd.WuhanHubeiChina
| | - Jian Li
- Department of HematologyPeking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Jianfeng Zhou
- Department of Hematology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
- Immunotherapy Research Center for Hematologic Diseases of Hubei ProvinceWuhanHubeiChina
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78
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Dimopoulos MA, Moreau P, Terpos E, Mateos MV, Zweegman S, Cook G, Delforge M, Hájek R, Schjesvold F, Cavo M, Goldschmidt H, Facon T, Einsele H, Boccadoro M, San-Miguel J, Sonneveld P, Mey U. Multiple myeloma: EHA-ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up †. Ann Oncol 2021; 32:309-322. [PMID: 33549387 DOI: 10.1016/j.annonc.2020.11.014] [Citation(s) in RCA: 302] [Impact Index Per Article: 100.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/12/2020] [Accepted: 11/15/2020] [Indexed: 02/07/2023] Open
Affiliation(s)
- M A Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - P Moreau
- Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France
| | - E Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - M V Mateos
- University Hospital of Salamanca, IBSAL, Cancer Research Center, Salamanca, Spain
| | - S Zweegman
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - G Cook
- Leeds Cancer Centre and University of Leeds, Leeds, UK
| | - M Delforge
- Department of Hematology, University Hospital Leuven, Leuven, Belgium
| | - R Hájek
- Faculty of Medicine, University Hospital Ostrava, Ostrava, Czech Republic
| | - F Schjesvold
- Oslo Myeloma Center, Oslo University Hospital, Oslo; KG Jebsen Center for B Cell Malignancies, University of Oslo, Oslo, Norway
| | - M Cavo
- Seràgnoli Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
| | - H Goldschmidt
- University Hospital Heidelberg, Internal Medicine V and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - T Facon
- Hôpital Claude Huriez, Lille University Hospital, Lille, France
| | - H Einsele
- Department of Internal Medicine II, University Hospital Wurzburg, Wurzburg, Germany
| | - M Boccadoro
- Division of Hematology, University of Torino, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - J San-Miguel
- Clinica Universidad de Navarra, CIMA, IDISNA, CIBERONC, Pamplona, Spain
| | - P Sonneveld
- Erasmus Medical Center Cancer Institute, Rotterdam, Netherlands
| | - U Mey
- Department of Oncology and Hematology, Kantonsspital Graubünden, Chur, Switzerland
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79
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Nandakumar B, Kumar SK, Dispenzieri A, Buadi FK, Dingli D, Lacy MQ, Hayman SR, Kapoor P, Leung N, Fonder A, Hobbs M, Hwa YL, Muchtar E, Warsame R, Kourelis TV, Russell S, Lust JA, Lin Y, Siddiqui M, Go RS, Jevremovic D, Kyle RA, Gertz MA, Rajkumar SV, Gonsalves WI. Clinical Characteristics and Outcomes of Patients With Primary Plasma Cell Leukemia in the Era of Novel Agent Therapy. Mayo Clin Proc 2021; 96:677-687. [PMID: 33673918 PMCID: PMC7939118 DOI: 10.1016/j.mayocp.2020.06.060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/02/2020] [Accepted: 06/05/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To evaluate the clinical outcomes of patients with primary plasma cell leukemia (pPCL) defined by 5% or greater clonal circulating plasma cells on peripheral blood smear and treated with novel agent induction therapies. PATIENTS AND METHODS A cohort of 68 patients with pPCL diagnosed at the Mayo Clinic in Rochester, Minnesota, from January 1, 2000, to December 31, 2019, and treated with novel agent induction therapies was evaluated. RESULTS The median follow-up was 46 (95% CI, 41 to 90) months. The median bone marrow plasma cell content was 85% (range, 10% to 100%) and median clonal circulaitng plasma cell percentage on the peripheral blood smear was 26% (range, 5% to 93%). There was a preponderance of t(11;14) primary cytogenetic abnormality in this cohort. The median time to next therapy (TTNT) and overall survival (OS) for all patients with pPCL patients in this cohort was 13 (95% CI, 9 to 17) and 23 (95% CI, 19 to 38) months, respectively. However, when stratified by cytogenetic risk, the median TTNT and OS were 16 and 51 months for standard risk vs 9 and 19 months for high risk (P=.01 for OS). CONCLUSION Primary plasma cell leukemia remains an aggressive disease with poor prognosis despite novel agent-based therapies. Some patients have better than expected survival and this phenomenon may be influenced by the absence of high-risk cytogenetics. Newer treatment regimens are needed to improve the prognosis of this devastating disease.
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Affiliation(s)
| | | | | | | | - David Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | | | - Nelson Leung
- Division of Hematology, Mayo Clinic, Rochester, MN; Department of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Amie Fonder
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Miriam Hobbs
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Yi Lisa Hwa
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Eli Muchtar
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | | | - John A Lust
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | - Ronald S Go
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Dragan Jevremovic
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
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80
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Chaulagain CP, Diacovo MJ, Van A, Martinez F, Fu CL, Jimenez Jimenez AM, Ahmed W, Anwer F. Management of Primary Plasma Cell Leukemia Remains Challenging Even in the Era of Novel Agents. Clin Med Insights Blood Disord 2021; 14:2634853521999389. [PMID: 33716516 PMCID: PMC7917418 DOI: 10.1177/2634853521999389] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 02/02/2021] [Indexed: 06/12/2023]
Abstract
Primary plasma cell leukemia (PCL) is a rare and aggressive variant of multiple myeloma (MM). PCL is characterized by peripheral blood involvement by malignant plasma cells and an aggressive clinical course leading to poor survival. There is considerable overlap between MM and PCL with respect to clinical, immunophenotypic, and cytogenetic features, but circulating plasma cell count exceeding 20% of peripheral blood leukocytes or an absolute plasma cell count of >2000/mm3 distinguishes it from MM. After initial stabilization and diagnosis confirmation, treatment of PCL in a fit patient typically includes induction combination chemotherapy containing novel agents typically, with proteasome inhibitors (such as bortezomib) and immunomodulatory drugs (eg, lenalidomide), followed by autologous hematopoietic stem cell transplant (HSCT) and multidrug maintenance therapy using novel agents post-HSCT. Long-term outcomes have improved employing this strategy but the prognosis for non-HSCT candidates remains poor and new approaches are needed for such PCL patients not eligible for HSCT. Here, we report a case of primary PCL, and a comprehensive and up to date review of the literature for diagnosis and management of PCL. We also present the findings of Positron Emission Tomography (PET) scan. Since PCL is often associated with extra-medulary disease, including PET scan at the time of staging and restaging may be a novel approach particularly to evaluate the extra-medullary disease sites.
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Affiliation(s)
- Chakra P Chaulagain
- Department of Hematology and Oncology, Maroone Cancer Center, Myeloma and Amyloidosis Program, Cleveland Clinic Florida, Weston, FL, USA
| | | | - Amy Van
- Department of Internal Medicine, Cleveland Clinic Florida, Weston FL, USA
| | - Felipe Martinez
- Department of Radiology, Cleveland Clinic Florida, Weston, FL, USA
| | - Chieh-Lin Fu
- Department of Hematology and Oncology, Maroone Cancer Center, Myeloma and Amyloidosis Program, Cleveland Clinic Florida, Weston, FL, USA
| | - Antonio Martin Jimenez Jimenez
- Division of Stem Cell Transplant & Cell Therapy, Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Wesam Ahmed
- Department of Hematology and Oncology, Maroone Cancer Center, Myeloma and Amyloidosis Program, Cleveland Clinic Florida, Weston, FL, USA
| | - Faiz Anwer
- Multiple Myeloma Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
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81
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Mirzaei H, Bagheri H, Ghasemi F, Khoi JM, Pourhanifeh MH, Heyden YV, Mortezapour E, Nikdasti A, Jeandet P, Khan H, Sahebkar A. Anti-Cancer Activity of Curcumin on Multiple Myeloma. Anticancer Agents Med Chem 2021; 21:575-586. [PMID: 32951583 DOI: 10.2174/1871520620666200918113625] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 06/26/2020] [Accepted: 06/30/2020] [Indexed: 12/24/2022]
Abstract
Multiple Myeloma (MM) is the third most common and deadly hematological malignancy, which is characterized by a progressive monoclonal proliferation within the bone marrow. MM is cytogenetically heterogeneous with numerous genetic and epigenetic alterations, which lead to a wide spectrum of signaling pathways and cell cycle checkpoint aberrations. MM symptoms can be attributed to CRAB features (hyperCalcemia, Renal failure, Anemia, and Bone lesion), which profoundly affect both the Health-Related Quality of Life (HRQoL) and the life expectancy of patients. Despite all enhancement and improvement in therapeutic strategies, MM is almost incurable, and patients suffering from this disease eventually relapse. Curcumin is an active and non-toxic phenolic compound, isolated from the rhizome of Curcuma longa L. It has been widely studied and has a confirmed broad range of therapeutic properties, especially anti-cancer activity, and others, including anti-proliferation, anti-angiogenesis, antioxidant and anti-mutation activities. Curcumin induces apoptosis in cancerous cells and prevents Multidrug Resistance (MDR). Growing evidence concerning the therapeutic properties of curcumin caused a pharmacological impact on MM. It is confirmed that curcumin interferes with various signaling pathways and cell cycle checkpoints, and with oncogenes. In this paper, we summarized the anti- MM effects of curcumin.
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Affiliation(s)
- Hamed Mirzaei
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Institute for Basic Sciences, Kashan University of Medical Sciences, Kashan, Iran
| | - Hossein Bagheri
- Molecular and Medicine Research Center, Department of Biotechnology, Faculty of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Faezeh Ghasemi
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Next to Milad Tower, Tehran, Iran
| | | | | | - Yvan V Heyden
- Department of Analytical Chemistry, Applied Chemometrics and Molecular Modelling, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Erfan Mortezapour
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Institute for Basic Sciences, Kashan University of Medical Sciences, Kashan, Iran
| | - Ali Nikdasti
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Institute for Basic Sciences, Kashan University of Medical Sciences, Kashan, Iran
| | - Philippe Jeandet
- Research Unit, Induced Resistance and Plant Bioprotection, EA 4707, SFR Condorcet FR CNRS 3417, Faculty of Sciences, University of Reims Champagne-Ardenne, PO Box 1039, 51687 Reims Cedex 2, France
| | - Haroon Khan
- Department of Pharmacy, Abdul Wali Khan University Mardan, 23200, Pakistan
| | - Amirhossein Sahebkar
- Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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82
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Yang Y, Fu LJ, Chen CM, Hu MW. Venetoclax in combination with chidamide and dexamethasone in relapsed/refractory primary plasma cell leukemia without t(11;14): A case report. World J Clin Cases 2021; 9:1175-1183. [PMID: 33644182 PMCID: PMC7896656 DOI: 10.12998/wjcc.v9.i5.1175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/04/2020] [Accepted: 12/16/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Conventional therapies for primary plasma cell leukemia (pPCL) are usually ineffective, with a short remission time with the use of multiple myeloma medications, showing aggressiveness of pPCL. B-cell lymphoma-2 inhibitor venetoclax is usually used for relapsed/refractory multiple myeloma (RRMM) with t(11;14). There are very few studies published on the use of venetoclax in pPCL without t(11;14). Similarly, histone deacetylase inhibitors are considered effective for the treatment of RRMM, but there are no reports on their use in pPCL.
CASE SUMMARY A 57-year-old woman with severe anemia, thrombocytopenia, multiple bone destruction, impaired renal function, and 42.7% of peripheral plasma cells is reported. After multiple chemotherapy regimens and chimeric antigen receptor T-cell treatment, the disease progressed again. The patient had very good partial response and was maintained for a long time on venetoclax in combination with chidamide and dexamethasone therapy.
CONCLUSION The success of venetoclax-chidamide-dexamethasone combination therapy in achieving a very good partial response suggested that it can be used for refractory/relapsed pPCL patients who have been exhausted with the use of various drug combinations and had poor survival outcomes.
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Affiliation(s)
- Yang Yang
- Department of Hematology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310014, Zhejiang Province, China
| | - Li-Juan Fu
- Department of Hematology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310014, Zhejiang Province, China
| | - Chun-Mei Chen
- Department of Hematology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310014, Zhejiang Province, China
| | - Mei-Wei Hu
- Department of Hematology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310014, Zhejiang Province, China
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83
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Parrondo RD, Moustafa MA, Reeder C, Sher T, Roy V, Muchtar E, Warsame R, Alegria V, Gonsalves W, Dingli D, Hayman S, Kapoor P, Chanan-Khan AA, Ailawadhi S. Efficacy of Daratumumab-Based Regimens for the Treatment of Plasma Cell Leukemia. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2021; 21:355-360. [PMID: 33563579 DOI: 10.1016/j.clml.2021.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 12/26/2020] [Accepted: 01/05/2021] [Indexed: 10/22/2022]
Affiliation(s)
| | | | - Craig Reeder
- Division of Hematology-Oncology, Mayo Clinic, Phoenix, AZ
| | - Taimur Sher
- Divion of Hematology-Oncology, Mayo Clinic, Jacksonville, FL
| | - Vivek Roy
- Divion of Hematology-Oncology, Mayo Clinic, Jacksonville, FL
| | - Eli Muchtar
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | | | - David Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN
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84
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Moser-Katz T, Joseph NS, Dhodapkar MV, Lee KP, Boise LH. Game of Bones: How Myeloma Manipulates Its Microenvironment. Front Oncol 2021; 10:625199. [PMID: 33634031 PMCID: PMC7900622 DOI: 10.3389/fonc.2020.625199] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 12/22/2020] [Indexed: 12/13/2022] Open
Abstract
Multiple myeloma is a clonal disease of long-lived plasma cells and is the second most common hematological cancer behind Non-Hodgkin’s Lymphoma. Malignant transformation of plasma cells imparts the ability to proliferate, causing harmful lesions in patients. In advanced stages myeloma cells become independent of their bone marrow microenvironment and form extramedullary disease. Plasma cells depend on a rich array of signals from neighboring cells within the bone marrow for survival which myeloma cells exploit for growth and proliferation. Recent evidence suggests, however, that both the myeloma cells and the microenvironment have undergone alterations as early as during precursor stages of the disease. There are no current therapies routinely used for treating myeloma in early stages, and while recent therapeutic efforts have improved patients’ median survival, most will eventually relapse. This is due to mutations in myeloma cells that not only allow them to utilize its bone marrow niche but also facilitate autocrine pro-survival signaling loops for further progression. This review will discuss the stages of myeloma cell progression and how myeloma cells progress within and outside of the bone marrow microenvironment.
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Affiliation(s)
- Tyler Moser-Katz
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, United States
| | - Nisha S Joseph
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, United States
| | - Madhav V Dhodapkar
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, United States
| | - Kelvin P Lee
- Department of Immunology, Roswell Park Cancer Institute, Buffalo, NY, United States
| | - Lawrence H Boise
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, United States
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85
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A clinical perspective on plasma cell leukemia; current status and future directions. Blood Cancer J 2021; 11:23. [PMID: 33563906 PMCID: PMC7873074 DOI: 10.1038/s41408-021-00414-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/15/2020] [Accepted: 01/14/2021] [Indexed: 02/08/2023] Open
Abstract
Primary plasma cell leukemia (pPCL) is an aggressive plasma cell disorder with a guarded prognosis. The diagnosis is confirmed when peripheral blood plasma cells (PCs) exceed 20% of white blood cells or 2000/μL. Emerging data demonstrates that patients with lower levels of circulating (PCs) have the same adverse prognosis, challenging the clinical disease definition, but supporting the adverse impact of circulating PCs. The cornerstone of treatment consists of combination therapy incorporating a proteasome inhibitor, an immunomodulatory agent, steroids, and/or anthracyclines and alkylators as part of more-intensive chemotherapy, followed by consolidative autologous hematopoietic cell transplantation in eligible patients and then maintenance therapy. Monoclonal antibodies are also currently being evaluated in this setting with a strong rationale for their use based on their activity in multiple myeloma (MM). Due to limited therapeutic studies specifically evaluating pPCL, patients with pPCL should be considered for clinical trials. In contrast to MM, the outcomes of patients with pPCL have only modestly improved with novel therapies, and secondary PCL arising from MM in particular is associated with a dismal outlook. Newer drug combinations, immunotherapy, and cellular therapy are under investigation, and these approaches hopefully will demonstrate efficacy to improve the prognosis of pPCL.
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86
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Multiple Myeloma: EHA-ESMO Clinical Practice Guidelines for Diagnosis, Treatment and Follow-up. Hemasphere 2021; 5:e528. [PMID: 33554050 PMCID: PMC7861652 DOI: 10.1097/hs9.0000000000000528] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 12/16/2020] [Indexed: 12/24/2022] Open
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87
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Abu Zaanona MI, Patel P. Plasma cell leukaemia with t(11;14) not responsive to venetoclax. BMJ Case Rep 2021; 14:14/1/e238641. [PMID: 33495184 PMCID: PMC7839868 DOI: 10.1136/bcr-2020-238641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
A 70-year-old man with medical history of IgG kappa multiple myeloma, initially diagnosed in 2017, underwent induction therapy with carfilzomib, lenalidomide and dexamethasone followed by autologous haematopoietic stem cell transplantation. Nine months following transplant, disease relapsed in the form of plasma cell leukaemia. Fluorescent in situ hybridisation of malignant plasma cells revealed t(11;14). A combination therapy including venetoclax was used based on efficacy data for Bcl-2 inhibitor venetoclax from available early-phase clinical trials in patients with relapsed multiple myeloma with t(11;14) and other published case studies. Unfortunately, the disease was primary refractory, and after further ineffective therapies, the patient did not have a successful outcome.
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Affiliation(s)
| | - Priyank Patel
- Department of Hematology & Oncology, Carle Foundation Hospital, Urbana, Illinois, USA
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88
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Ueno T, Sugio Y, Ohta T, Uehara Y, Ohno Y. Successful upfront cord blood transplantation for plasma cell leukemia in the first complete response after daratumumab therapy. Int J Hematol 2021; 113:941-944. [PMID: 33483877 DOI: 10.1007/s12185-021-03082-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 01/07/2021] [Accepted: 01/13/2021] [Indexed: 10/22/2022]
Abstract
Plasma cell leukemia (PCL) is a rare and aggressive disease with a poor prognosis. Autologous or allogeneic stem cell transplantation (ASCT or allo-SCT) with intensive chemotherapy is performed for PCL, but their efficacy is still controversial. The efficacy of novel agents such as daratumumab for PCL is also unclear. Here, we report a case of PCL treated successfully with daratumumab and upfront cord blood transplantation (CBT) in the first complete response (CR). A 58-year-old man was diagnosed with PCL based on elevated abnormal plasma cells and IgD levels. After two cycles of bortezomib, lenalidomide, and dexamethasone therapy, some PCL cells remained in the bone marrow. We switched treatment to daratumumab, lenalidomide, and dexamethasone therapy and confirmed an immunophenotypic CR. We then performed CBT with fludarabine, melphalan, and total body irradiation for conditioning 3 months after diagnosis. Acute graft-versus-host disease was observed but controlled with corticosteroid therapy. The patient remained in stringent CR for 1 year after CBT. We successfully treated PCL with daratumumab followed by upfront CBT. Daratumumab was effective in PCL and could be used safely even before allo-SCT. Early use of daratumumab and early upfront allo-SCT may be a useful treatment option for PCL.
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Affiliation(s)
- Toshiyuki Ueno
- Department of Hematology, Kitakyushu Municipal Medical Center, 2-1-1, Bashaku, Kokurakita-ward, Kitakyushu-city, Fukuoka-prefecture, Japan.
| | - Yasuhiro Sugio
- Department of Hematology, Kitakyushu Municipal Medical Center, 2-1-1, Bashaku, Kokurakita-ward, Kitakyushu-city, Fukuoka-prefecture, Japan
| | - Takanori Ohta
- Department of Hematology, Kitakyushu Municipal Medical Center, 2-1-1, Bashaku, Kokurakita-ward, Kitakyushu-city, Fukuoka-prefecture, Japan
| | - Yasufumi Uehara
- Department of Hematology, Kitakyushu Municipal Medical Center, 2-1-1, Bashaku, Kokurakita-ward, Kitakyushu-city, Fukuoka-prefecture, Japan
| | - Yuju Ohno
- Department of Hematology, Kitakyushu Municipal Medical Center, 2-1-1, Bashaku, Kokurakita-ward, Kitakyushu-city, Fukuoka-prefecture, Japan
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Efficacy of Venetoclax and Dexamethasone in Refractory IgM Primary Plasma Cell Leukemia with t(11;14) and TP53 Mutation: A Case Report and Literature Review. Case Rep Hematol 2021; 2020:8823877. [PMID: 33425404 PMCID: PMC7781713 DOI: 10.1155/2020/8823877] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/08/2020] [Accepted: 12/17/2020] [Indexed: 02/06/2023] Open
Abstract
Primary plasma cell leukemia (pPCL) is an uncommon disease. IgM multiple myeloma (MM) is an infrequent subtype that accounts for less than 1 percent of MM cases. IgM pPCL is quite rare with only a few cases published to date. We describe a case of a patient with IgM pPCL who initially presented with hyperviscosity syndrome requiring urgent plasma exchange. His bone marrow biopsy demonstrated t(11;14). He progressed on proteasome inhibitors, immunomodulating agents, and other chemotherapy medications but later achieved very good partial response (VGPR) to venetoclax and dexamethasone. Given the poor prognosis of pPCL, further studies using venetoclax alone or in combination with other novel agents as first-line treatment options are warranted particularly in patients with t(11;14).
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90
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Double-Hit Primary Plasma Cell Leukemia with IGH/MYC and IGH/CCND1 Translocations. Case Rep Hematol 2021; 2020:8811114. [PMID: 33381329 PMCID: PMC7762630 DOI: 10.1155/2020/8811114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 11/27/2020] [Accepted: 12/04/2020] [Indexed: 11/18/2022] Open
Abstract
Primary plasma cell leukemia (pPCL) is an aggressive variant of multiple myeloma (MM). Immunoglobulin heavy chain (IgH) translocations are found in a majority of pPCL cases, supporting a central relation to pathogenesis of pPCL. However, two independent IgH translocations are barely detected at the onset of pPCL, and their significance is yet to be elucidated. Here, we report a case of an aggressive pPCL with simultaneous IGH/MYC and IGH/CCND1 translocations. A 73-year-old man was referred to our hospital with back pain and diagnosed as having pPCL with more than 50% circulating plasma cells. Cytogenetic analysis revealed 47, Y, t (X; 8;14) (q24; q24; q32), t (11; 14) (q13; q32), and +18. IGH/MYC and IGH/CCND1 translocations were confirmed by fluorescence in situ hybridization analysis. Bortezomib and dexamethasone treatment achieved rapid elimination of peripheral malignant plasma cells, and the patient maintained a partial response for 18 months. After biological relapse, he received salvage therapy with ixazomib, lenalidomide, and dexamethasone, followed by pomalidomide and dexamethasone, and exhibited stable disease for an additional 14 months. Although IGH/MYC translocation in association with dysregulation of antiapoptotic pathway leads to worse prognosis in lymphomas, the novel agent-based regimen showed good efficacy, suggesting that IGH/MYC plays a different role in the pathogenesis of MM. IGH/CCND1 and IGH/MYC translocations may have contributed to abrupt onset of pPCL in this case.
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91
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Zeissig MN, Zannettino ACW, Vandyke K. Tumour Dissemination in Multiple Myeloma Disease Progression and Relapse: A Potential Therapeutic Target in High-Risk Myeloma. Cancers (Basel) 2020; 12:cancers12123643. [PMID: 33291672 PMCID: PMC7761917 DOI: 10.3390/cancers12123643] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/02/2020] [Accepted: 12/02/2020] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Like in solid cancers, the process of dissemination is a critical feature of disease progression in the blood cancer multiple myeloma. At diagnosis, myeloma patients have cancer that has spread throughout the bone marrow, with patients with more disseminatory myeloma having worse outcomes for their disease. In this review, we discuss the current understanding of the mechanisms that underpin the dissemination process in multiple myeloma. Furthermore, we discuss the potential for the use of therapies that target the dissemination process as a novel means of improving outcomes for multiple myeloma patients. Abstract Multiple myeloma (MM) is a plasma cell (PC) malignancy characterised by the presence of MM PCs at multiple sites throughout the bone marrow. Increased numbers of peripheral blood MM PCs are associated with rapid disease progression, shorter time to relapse and are a feature of advanced disease. In this review, the current understanding of the process of MM PC dissemination and the extrinsic and intrinsic factors potentially driving it are addressed through analysis of patient-derived MM PCs and MM cell lines as well as mouse models of homing and dissemination. In addition, we discuss how patient cytogenetic subgroups that present with highly disseminated disease, such as t(4;14), t(14;16) and t(14;20), suggest that intrinsic properties of MM PC influence their ability to disseminate. Finally, we discuss the possibility of using therapeutic targeting of tumour dissemination to slow disease progression and prevent overt relapse.
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Affiliation(s)
- Mara N. Zeissig
- Myeloma Research Laboratory, Faculty of Health and Medical Sciences, Adelaide Medical School, The University of Australia, Adelaide 5005, Australia; (M.N.Z.); (A.C.W.Z.)
- Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide 5000, Australia
| | - Andrew C. W. Zannettino
- Myeloma Research Laboratory, Faculty of Health and Medical Sciences, Adelaide Medical School, The University of Australia, Adelaide 5005, Australia; (M.N.Z.); (A.C.W.Z.)
- Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide 5000, Australia
- Central Adelaide Local Health Network, Adelaide 5000, Australia
- Centre for Cancer Biology, University of South Australia, Adelaide 5000, Australia
| | - Kate Vandyke
- Myeloma Research Laboratory, Faculty of Health and Medical Sciences, Adelaide Medical School, The University of Australia, Adelaide 5005, Australia; (M.N.Z.); (A.C.W.Z.)
- Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide 5000, Australia
- Correspondence: ; Tel.: +61-8-8128-4694
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92
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Costa LJ, Usmani SZ. Defining and Managing High-Risk Multiple Myeloma: Current Concepts. J Natl Compr Canc Netw 2020; 18:1730-1737. [PMID: 33285523 DOI: 10.6004/jnccn.2020.7673] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/15/2020] [Indexed: 11/17/2022]
Abstract
Multiple myeloma is a very heterogeneous disease. Despite advances in diagnostics and therapeutics, a subset of patients still experiences abbreviated responses to therapy, frequent relapses, and short survival and is considered to have high-risk multiple myeloma (HRMM). Stage III diagnosis according to the International Staging System; the presence of del(17p), t(4;14), or t(14;16) by fluorescence in situ hybridization; certain gene expression patterns; high serum lactic dehydrogenase level; and the presence of extramedullary disease at diagnosis are all considered indicators of HRMM. More recent evidence shows that patients who experience response to therapy but with a high burden of measurable residual disease or persistence of abnormal FDG uptake on PET/CT scan after initial therapy also have unfavorable outcomes, shaping the concept of dynamic risk assessment. Triplet therapy with proteasome inhibitors, immunomodulatory agents, and corticosteroids and autologous hematopoietic cell transplantation remain the pillars of HRMM therapy. Recent evidence indicates a benefit of immunotherapy with anti-CD38 monoclonal antibodies in HRMM. Future trials will inform the impact of novel immunotherapeutic approaches, including T-cell engagers, CAR T cells, and nonimmunotherapeutic approaches in HRMM. Those agents are likely to be deployed early in the disease course in the setting of risk- and response-adapted trials.
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Affiliation(s)
- Luciano J Costa
- 1Division of Hematology and Oncology, Department of Medicine, O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama; and
| | - Saad Z Usmani
- 2Plasma Cell Disorders Division, Department of Hematologic Oncology & Blood Disorders, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina
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93
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Risk and Response-Adapted Treatment in Multiple Myeloma. Cancers (Basel) 2020; 12:cancers12123497. [PMID: 33255368 PMCID: PMC7760158 DOI: 10.3390/cancers12123497] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/19/2020] [Accepted: 11/22/2020] [Indexed: 12/28/2022] Open
Abstract
Simple Summary Therapeutic strategies in multiple myeloma have been adapted only to age and comorbidities for a long time. Given the currently available therapeutic and technologic arsenal, the time may have come to refine this adaptation. First, high-risk patients should benefit from the most intensive and efficient combinations from diagnosis. Here, we review these different strategies and how to define and identify high-risk myeloma patients in current clinical practice. In addition, the advent of technologies detecting minimal residual disease gives us this opportunity to define the quality of response to treatment with an unpreceded sensitivity and adapt treatment accordingly. Finally, even if molecular targeting is still nascent in myeloma, some molecular features are interesting to detect at relapse to determine optimal salvage treatments. Abstract Myeloma therapeutic strategies have been adapted to patients’ age and comorbidities for a long time. However, although cytogenetics and clinical presentations (plasmablastic cytology; extramedullary disease) are major prognostic factors, until recently, all patients received the same treatment whatever their initial risk. No strong evidence allows us to use a personalized treatment according to one cytogenetic abnormality in newly diagnosed myeloma. Retrospective studies showed a benefit of a double autologous transplant in high-risk cytogenetics according to the International Myeloma Working Group definition (t(4;14), t(14;16) or del(17p)). Moreover, this definition has to be updated since other independent abnormalities, namely gain 1q, del(1p32), and trisomies 5 or 21, as well as TP53 mutations, are also prognostic. Another very strong predictive tool is the response to treatment assessed by the evaluation of minimal residual disease (MRD). We are convinced that the time has come to use it to adapt the strategy to a dynamic risk. Many trials are ongoing to answer many questions: when and how should we adapt the therapy, its intensity and duration. Nevertheless, we also have to take into account the clinical outcome for one patient, especially adverse events affecting his or her quality of life and his or her preferences for continuous/fixed duration treatment.
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94
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Deep Phenotyping Reveals Distinct Immune Signatures Correlating with Prognostication, Treatment Responses, and MRD Status in Multiple Myeloma. Cancers (Basel) 2020; 12:cancers12113245. [PMID: 33158030 PMCID: PMC7692501 DOI: 10.3390/cancers12113245] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/16/2020] [Accepted: 10/29/2020] [Indexed: 12/16/2022] Open
Abstract
Simple Summary In Multiple Myeloma (MM) malignant cells accumulate in the bone marrow (BM), where they interact with various cell populations. These complex interactions impose mechanisms of tumor growth and proliferation, immune surveillance and immune evasion. The aim of the present study was a detailed immune characterization of MM during the course of the disease, in order to highlight signatures which are clinically relevant. Analyses of both BM and peripheral blood (PB) in matched patients’ samples, we showed that PB cannot representatively reflect the BM microenvironment. Particular immune signatures in BM and PB significantly correlated with established prognostic features and could independently associate with distinct responses to the same induction therapy. Moreover, our data provide evidence of a diverse immune profile according to patients’ MRD status post treatment. Finally, we provide insights that unique PB immune profiles may be used for the prediction of MRD status through a simple non-invasive approach. Abstract Despite recent advances, Multiple Myeloma (MM) remains an incurable disease with apparent heterogeneity that may explain patients’ variable clinical outcomes. While the phenotypic, (epi)genetic, and molecular characteristics of myeloma cells have been thoroughly examined, there is limited information regarding the role of the bone marrow (BM) microenvironment in the natural history of the disease. In the present study, we performed deep phenotyping of 32 distinct immune cell subsets in a cohort of 94 MM patients to reveal unique immune profiles in both BM and peripheral blood (PB) that characterize distinct prognostic groups, responses to induction treatment, and minimal residual disease (MRD) status. Our data show that PB cells do not reflect the BM microenvironment and that the two sites should be studied independently. Adverse ISS stage and high-risk cytogenetics were correlated with distinct immune profiles; most importantly, BM signatures comprised decreased tumor-associated macrophages (TAMs) and erythroblasts, whereas the unique Treg signatures in PB could discriminate those patients achieving complete remission after VRd induction therapy. Moreover, MRD negative status was correlated with a more experienced CD4- and CD8-mediated immunity phenotype in both BM and PB, thus highlighting a critical role of by-stander cells linked to MRD biology.
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95
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Lemieux C, Johnston LJ, Lowsky R, Muffly LS, Craig JK, Shiraz P, Rezvani A, Frank MJ, Weng WK, Meyer E, Shizuru J, Arai S, Negrin R, Miklos DB, Sidana S. Outcomes with Autologous or Allogeneic Stem Cell Transplantation in Patients with Plasma Cell Leukemia in the Era of Novel Agents. Biol Blood Marrow Transplant 2020; 26:e328-e332. [PMID: 32961371 DOI: 10.1016/j.bbmt.2020.08.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/30/2020] [Accepted: 08/31/2020] [Indexed: 12/19/2022]
Abstract
Plasma cell leukemia (PCL) is a rare and very aggressive plasma cell disorder. The optimal treatment approach, including whether to pursue an autologous (auto) or allogeneic (allo) stem cell transplantation (SCT) is not clear, given the lack of clinical trial-based evidence. This single-center retrospective study describes the outcomes of 16 patients with PCL (n = 14 with primary PCL) who underwent either autoSCT (n = 9) or alloSCT (n = 7) for PCL in the era of novel agents, between 2007 and 2019. The median age of the cohort was 58 years. High-risk cytogenetics were found in 50% of the patients. All patients received a proteasome inhibitor and/or immunomodulatory drug-based regimen before transplantation. At the time of transplantation, 10 patients (62%) obtained at least a very good partial response (VGPR). The response after autoSCT (3 months) was at least a VGPR in 6 patients (67%; complete response [CR] in 5). All patients undergoing alloSCT achieved a CR at 3 months. Maintenance therapy was provided to 5 patients (56%) after autoSCT. The median progression-free survival after transplantation was 6 months in the autoSCT group, compared with 18 months in the alloSCT group (P = .09), and median overall survival (OS) after transplantation in the 2 groups was 19 months and 40 months, respectively (P = .41). The median OS from diagnosis was 27 months and 49 months, respectively (P = .50). Of the 11 deaths, 10 patients (91%) died of relapsed disease. AlloSCT was not observed to offer any significant survival advantage over autoSCT in PCL, in agreement with recent reports, and relapse remains the primary cause of death in these patients.
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Affiliation(s)
- Christopher Lemieux
- Stanford Cancer Institute, Stanford University Medical Center, Stanford, California
| | - Laura J Johnston
- Stanford Cancer Institute, Stanford University Medical Center, Stanford, California
| | - Robert Lowsky
- Stanford Cancer Institute, Stanford University Medical Center, Stanford, California
| | - Lori S Muffly
- Stanford Cancer Institute, Stanford University Medical Center, Stanford, California
| | - Juliana K Craig
- Stanford Cancer Institute, Stanford University Medical Center, Stanford, California
| | - Parveen Shiraz
- Stanford Cancer Institute, Stanford University Medical Center, Stanford, California
| | - Andrew Rezvani
- Stanford Cancer Institute, Stanford University Medical Center, Stanford, California
| | - Matthew J Frank
- Stanford Cancer Institute, Stanford University Medical Center, Stanford, California
| | - Wen-Kai Weng
- Stanford Cancer Institute, Stanford University Medical Center, Stanford, California
| | - Everett Meyer
- Stanford Cancer Institute, Stanford University Medical Center, Stanford, California
| | - Judith Shizuru
- Stanford Cancer Institute, Stanford University Medical Center, Stanford, California
| | - Sally Arai
- Stanford Cancer Institute, Stanford University Medical Center, Stanford, California
| | - Robert Negrin
- Stanford Cancer Institute, Stanford University Medical Center, Stanford, California
| | - David B Miklos
- Stanford Cancer Institute, Stanford University Medical Center, Stanford, California
| | - Surbhi Sidana
- Stanford Cancer Institute, Stanford University Medical Center, Stanford, California.
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96
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Zetter DR, Kabir T, Reynolds SB. The Clinical Characteristics of Multiple Myeloma in the Acute Care Setting: Case Presentation and Clinical Recommendations. Cureus 2020; 12:e10463. [PMID: 33083166 PMCID: PMC7566983 DOI: 10.7759/cureus.10463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The acute complications of multiple myeloma can be varied and devastating, including electrolyte derangements, renal failure, and infections amongst others. The varying pathological mechanisms behind these complications make the management of patients presenting with multiple myeloma a complicated and sometimes tenuous process. The patient compliance can further exacerbate these difficulties. The patient discussed in this case initially presented with newly developed altered mental status, fatigue, epistaxis, and an ecchymotic rash. Laboratory testing and imaging would conclude a diagnosis of multiple myeloma, but unfortunately treatment was cut short. Admission at a later date would show rapidly deteriorating condition with new lung consolidations and worsening laboratory findings. Herein the authors discuss the clinical findings of patients with acute manifestations of multiple myeloma, their prognostic value, and the implications of patient compliance and early intervention in the setting of multiple myeloma.
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97
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Papadimitriou K, Kostopoulos IV, Tsopanidou A, Orologas-Stavrou N, Kastritis E, Tsitsilonis OE, Dimopoulos MA, Terpos E. Ex Vivo Models Simulating the Bone Marrow Environment and Predicting Response to Therapy in Multiple Myeloma. Cancers (Basel) 2020; 12:cancers12082006. [PMID: 32707884 PMCID: PMC7463609 DOI: 10.3390/cancers12082006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/10/2020] [Accepted: 07/14/2020] [Indexed: 01/10/2023] Open
Abstract
Multiple myeloma (MM) remains incurable despite the abundance of novel drugs. As it has been previously shown, preclinical 2D models fail to predict disease progression due to their inability to simulate the microenvironment of the bone marrow. In this review, we focus on 3D models and present all currently available ex vivo MM models that fulfil certain criteria, such as development of complex 3D environments using patients' cells and ability to test different drugs in order to assess personalized MM treatment efficacy of various regimens and combinations. We selected models representing the top-notch ex vivo platforms and evaluated them in terms of cost, time-span, and feasibility of the method. Finally, we propose where such a model can be more informative in a patient's treatment timeline. Overall, advanced 3D preclinical models are very promising as they may eventually offer the opportunity to precisely select the optimal personalized treatment for each MM patient.
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Affiliation(s)
- Konstantinos Papadimitriou
- Department of Biology, School of Sciences, National and Kapodistrian University of Athens, 15784 Athens, Greece; (K.P.); (A.T.); (N.O.-S.); (O.E.T.)
| | - Ioannis V. Kostopoulos
- Department of Biology, School of Sciences, National and Kapodistrian University of Athens, 15784 Athens, Greece; (K.P.); (A.T.); (N.O.-S.); (O.E.T.)
- Correspondence: (I.V.K.); (E.T.); Tel.: +30-210-7274929 (I.V.K.); +30-213-216-2846 (E.T.); Fax: +30-210-7274635 (I.V.K.); +30-213-216-2511 (E.T.)
| | - Anastasia Tsopanidou
- Department of Biology, School of Sciences, National and Kapodistrian University of Athens, 15784 Athens, Greece; (K.P.); (A.T.); (N.O.-S.); (O.E.T.)
| | - Nikolaos Orologas-Stavrou
- Department of Biology, School of Sciences, National and Kapodistrian University of Athens, 15784 Athens, Greece; (K.P.); (A.T.); (N.O.-S.); (O.E.T.)
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.K.); (M.A.D.)
| | - Ourania E. Tsitsilonis
- Department of Biology, School of Sciences, National and Kapodistrian University of Athens, 15784 Athens, Greece; (K.P.); (A.T.); (N.O.-S.); (O.E.T.)
| | - Meletios A. Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.K.); (M.A.D.)
| | - Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.K.); (M.A.D.)
- Correspondence: (I.V.K.); (E.T.); Tel.: +30-210-7274929 (I.V.K.); +30-213-216-2846 (E.T.); Fax: +30-210-7274635 (I.V.K.); +30-213-216-2511 (E.T.)
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98
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Suska A, Vesole DH, Castillo JJ, Kumar SK, Parameswaran H, Mateos MV, Facon T, Gozzetti A, Mikala G, Szostek M, Mikhael J, Hajek R, Terpos E, Jurczyszyn A. Plasma Cell Leukemia - Facts and Controversies: More Questions than Answers? Clin Hematol Int 2020; 2:133-142. [PMID: 34595454 PMCID: PMC8432408 DOI: 10.2991/chi.k.200706.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/01/2020] [Indexed: 11/18/2022] Open
Abstract
Plasma cell leukemia (PCL) is an aggressive hematological malignancy characterized by an uncontrolled clonal proliferation of plasma cells (PCs) in the bone marrow and peripheral blood. PCL has been defined by an absolute number of circulating PCs exceeding 2.0 × 109/L and/or >20% PCs in the total leucocyte count. It is classified as primary PCL, which develops de novo, and secondary PCL, occurring at the late and advanced stages of multiple myeloma (MM). Primary and secondary PCL are clinically and biologically two distinct entities. After the diagnosis, treatment should be immediate and should include a proteasome inhibitor and immunomodulator-based combination regimens as induction, followed by stem cell transplantation (SCT) in transplant-eligible individuals who have cleared the peripheral blood of circulating PCs. Due to the rarity of the condition, there have been very few clinical trials. Furthermore, virtually all of the myeloma trials exclude patients with active PCL. The evaluation of response has been defined by the International Myeloma Working Group and consists of both acute leukemia and MM criteria. With conventional chemotherapy, the prognosis of primary PCL has been ominous, with reported overall survival (OS) ranging from 6.8 to 12.6 months. The use of novel agents and autologous SCT appears to be associated with deeper response and an improved survival, although it still remains low. The PCL prognostic index provides a simple score to risk-stratify PCL. The prognosis of secondary PCL is extremely poor, with OS of only 1 month.
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Affiliation(s)
- Anna Suska
- Department of Hematology, Jagiellonian University Medical College, Kopernika 17, Krakow 31-501, Poland
| | - David H Vesole
- The John Theurer Cancer Center at Hackensack UMC, Hackensack, NJ, USA
| | - Jorge J Castillo
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Shaji K Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Maria V Mateos
- Complejo Asistencial Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (CAUSA/IBSAL), Salamanca, Spain
| | - Thierry Facon
- Service des Maladies du Sang, Hôpital Claude Huriez, Lille, France
| | | | - Gabor Mikala
- Department of Hematology and Stem Cell Transplantation, South-Pest Central Hospital, Natl. Inst. Hematol. Infectol, Budapest, Hungary
| | - Marta Szostek
- Department of Hematology, Jagiellonian University Medical College, Kopernika 17, Krakow 31-501, Poland
| | - Joseph Mikhael
- Translational Genomics Research Institute, City of Hope Cancer Center, Phoenix, Arizona, USA
| | - Roman Hajek
- University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Artur Jurczyszyn
- Department of Hematology, Jagiellonian University Medical College, Kopernika 17, Krakow 31-501, Poland
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99
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Gahrton G, Iacobelli S, Garderet L, Yakoub-Agha I, Schönland S. Allogeneic Transplantation in Multiple Myeloma-Does It Still Have a Place? J Clin Med 2020; 9:E2180. [PMID: 32664274 PMCID: PMC7408931 DOI: 10.3390/jcm9072180] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 06/30/2020] [Accepted: 07/06/2020] [Indexed: 02/06/2023] Open
Abstract
Novel drugs have improved survival for patients with multiple myeloma in recent years. However, the disease is still fatal. Allogeneic stem cell transplantation (Allo) has proven to cure some patients with the disease, but its role is controversial due to relatively high transplant-related toxicity and mortality (nonrelapse mortality, NRM). Using nonmyeloablative reduced-intensity conditioning (RIC), both toxicity and NRM can be reduced, and RICAllo is, therefore, an option for subgroups of patients. Upfront tandem autologous/RICAllo (Auto/RICAllo) was shown to be superior to single Auto or tandem Auto/Auto in both progression-free (PFS) and overall survival (OS) in two prospective studies with long-term follow-up, while three similarly designed studies did not detect a difference. A recent update of pooled patient data from four of these studies showed significantly superior PFS and OS with Auto/RICAllo. Importantly, none of these studies showed inferior results with Auto/RICAllo in patients less than 70 years of age. Auto/RICAllo appears to overcome some poor risk cytogenetic markers. Encouraging results have also been seen in treatment of relapsed patients. Combining Allo with new proteasome inhibitors and immunomodulatory drugs may further improve results. Other encouraging new cell therapies such as with CAR T-cells, NK- and CAR NK-cells may well have a place in combination with RICAllo. Such studies are warranted.
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Affiliation(s)
- Gösta Gahrton
- Department of Medicine, Karolinska Institutet, Huddinge, SE 14186 Stockholm, Sweden
| | - Simona Iacobelli
- Department of Biology, University of Rome Tor Vergata, 00133 Rome, Italy;
| | - Laurent Garderet
- Department of Hematology and Cellular Therapy, Hospital Hospital-Pitié Salpêtrière, 75013 Paris, France;
| | - Ibrahim Yakoub-Agha
- CHU de Lille, Université de Lille, INSERM U1286, Infinite, 59000 Lille, France;
| | - Stefan Schönland
- Department of Internal Medicine V, University of Heidelberg, 69120 Heidelberg, Germany;
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100
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Offidani M, Boccadoro M, Di Raimondo F, Petrucci MT, Tosi P, Cavo M. Expert Panel Consensus Statement for Proper Evaluation of First Relapse in Multiple Myeloma. Curr Hematol Malig Rep 2020; 14:187-196. [PMID: 31077067 DOI: 10.1007/s11899-019-00507-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE OF REVIEW A working group of six expert physicians convened to assess the spectrum of multiple myeloma relapse presentations, discussed the features that can define the disease as aggressive and not aggressive, and established whether this information could help in selecting treatment together with the characteristics of disease and of patients and type of prior therapy. RECENT FINDINGS The working group agreed that relapse should be distinguished between biochemical and clinical according to IMWG. Moreover, the expert panel defined "aggressive disease" as a clinical condition that requires therapy able to induce a rapid and as deep as possible response to release symptoms and to avoid impending danger of new events. According to this definition, relapse was considered aggressive if it presents with at least one of the following features: doubling of M protein rate over 2 months, renal insufficiency, hypercalcemia, extramedullary disease, elevated LDH, high plasma cell proliferative index, presence of plasma cells in peripheral blood, or skeletal-related complications. Moreover, the panel agreed that this classification can be useful to choose therapy in first relapse together with other patient, disease, and prior therapy characteristics. So, this item was included in a new therapeutic algorithm. The treatment choice in MM at relapse is wider than in the past with the availability of many new therapeutic regimens leading to increased diversity of approaches and relevant risk of inappropriate treatment decisions. A practical classification of relapses into aggressive or non-aggressive, included in a decisional algorithm on MM management at first relapse, could help to make the appropriate treatment decisions.
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Affiliation(s)
- M Offidani
- Clinica di Ematologia, A.O.U. Ospedali Riuniti di Ancona, via Conca, 71, 60126, Ancona, Italy.
| | - M Boccadoro
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - F Di Raimondo
- Division of Hematology, AOU Policlinico-OVE, University of Catania, Catania, Italy
| | - M T Petrucci
- Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Rome, Italy
| | - P Tosi
- Hematology Unit, Infermi Hospital Rimini, Rimini, Italy
| | - M Cavo
- Institute of Hematology Seragnoli, DIMES, University of Bologna, Bologna, Italy
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