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Zhu H, Liu J, Gu J, Chen M, Kuang L, Huang B, Zou W, Li J. Early M-protein immune reconstitution after autologous haematopoietic stem cell transplantation is a good prognostic marker for patients with high-risk cytogenetic multiple myeloma. Br J Haematol 2024; 204:976-987. [PMID: 38246862 DOI: 10.1111/bjh.19275] [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: 07/17/2023] [Revised: 12/14/2023] [Accepted: 12/16/2023] [Indexed: 01/23/2024]
Abstract
The presence of transient abnormal protein banding (M-protein immune reconstitution) in serum immunofixation electrophoresis after autologous haematopoietic stem cell transplantation in patients with multiple myeloma has been reported. The purpose of this study was to investigate the impact of post-transplant M-protein immune reconstitution on the prognosis of patients with multiple myeloma. M-protein immune reconstitution was observed in 25.9% (75/290) of patients. The CR rate and MRD negativity were higher in the M-protein immune reconstitution group (85.3% vs. 69.3%, p = 0.013, 81.9% vs. 66.5%, p = 0.014). Although there were no significant differences between the groups, the overall median survival time was longer in the M-protein immune reconstruction group (80 vs. 72 m, p = 0.076; not reached vs. 105 m, p = 0.312). Among patients in the cytogenetic high-risk group, the occurrence of M-protein immune reconstitution predicted better PFS and OS (80 vs. 31 m, p = 0.010; not reached vs. 91 m, p = 0.026). Additionally, in revised-International Staging System stage III patients, PFS and OS were better in those who achieved M-protein immune reconstitution (80 vs. 20 m, p = 0.025; 57 vs. 32 m, p = 0.103). The better prognosis of M-protein immune reconstitution patients may be associated with the acquisition of a deeper response. In high-risk patients, early acquisition of M-protein immune reconstitution may suggest a better prognosis.
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Affiliation(s)
- Huihui Zhu
- Haematology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Junru Liu
- Haematology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Jingli Gu
- Haematology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Meilan Chen
- Haematology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Lifen Kuang
- Haematology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Beihui Huang
- Haematology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Waiyi Zou
- Haematology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Juan Li
- Haematology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
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Jin X, Jiang X, Wang W, Liu S, Han B, Han J, Zhuang J. Pure red cell aplasia and minimal residual disease conversion associated with immune reconstitution in a patient with high-risk multiple myeloma. Chronic Dis Transl Med 2023; 9:341-344. [PMID: 37915388 PMCID: PMC10617308 DOI: 10.1002/cdt3.81] [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: 02/13/2023] [Revised: 05/24/2023] [Accepted: 05/29/2023] [Indexed: 11/03/2023] Open
Abstract
A second bone marrow aspiration and biopsy showed pure red cell aplasia in this case.
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Affiliation(s)
- Xianghong Jin
- Department of HematologyPeking Union Medical College Hospital, Chinese Academy of Medical SciencesBeijingChina
- Peking Union Medical College, Chinese Academy and Medical SciencesBeijingChina
| | - Xianyong Jiang
- Department of HematologyPeking Union Medical College Hospital, Chinese Academy of Medical SciencesBeijingChina
| | - Wei Wang
- Department of HematologyPeking Union Medical College Hospital, Chinese Academy of Medical SciencesBeijingChina
| | - Shuangjiao Liu
- Department of HematologyPeking Union Medical College Hospital, Chinese Academy of Medical SciencesBeijingChina
| | - Bing Han
- Department of HematologyPeking Union Medical College Hospital, Chinese Academy of Medical SciencesBeijingChina
| | - Jianhua Han
- Department of Clinical LaboratoryPeking Union Medical College Hospital, Chinese Academy of Medical SciencesBeijingChina
| | - Junling Zhuang
- Department of HematologyPeking Union Medical College Hospital, Chinese Academy of Medical SciencesBeijingChina
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Lu M, Chu B, Wang Y, Shi L, Gao S, Fang L, Xiang Q, Liu X, Ding Y, Chen Y, Zhao X, Wang M, Sun K, Bao L. Clinical characteristics and prognostic significance of immunoglobulin isotype switch in patients with multiple myeloma. CANCER PATHOGENESIS AND THERAPY 2023; 1:149-153. [PMID: 38328401 PMCID: PMC10846323 DOI: 10.1016/j.cpt.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/15/2022] [Accepted: 11/15/2022] [Indexed: 02/09/2024]
Abstract
Immunoglobulin (Ig) isotype switching in multiple myeloma (MM) is a rare form of clonal evolution. The aim of this study was to investigate the clinical features and prognostic significance of Ig isotype switching by observing Ig transformation in patients with relapse. A retrospective analysis was performed on 506 patients with newly diagnosed MM who were treated at our hospital from February 2005 to February 2020. The patients who experienced relapse were divided into the following four groups according to Ig phenotype: original paraprotein, complete isotype switching, light chain escape (LCE),and non-secretory clinical relapse. For comparative purposes with the original paraprotein group, the last three groups were pooled as the transformation group. Among the 506 included patients, 376 (74.3%) relapsed. Among them, 13/376 (3.5%) patients exhibited Ig isotype switching, including 3 with complete isotype switching, 3 with LCE, and 7 with non-secretory clinical relapse. Eleven remained sensitive to therapy, exhibiting at least a partial response. Seven patients survived for at least 20 months after relapse. The median overall survival time of the LCE, clinical relapse, and complete isotype switching groups were 6, 20, and 76 months, respectively, after recurrence. The clinical manifestations and Ig phenotypes of MM recurrence were different from those at the initial diagnosis in the 13 patients exhibiting Ig isotype switching. These differences vividly conveyed the heterogeneity of the clonal populations and provides direct clinical evidence for MM clonal evolution.
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Affiliation(s)
- Minqiu Lu
- Department of Hematology, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, Beijing 100096, China
| | - Bin Chu
- Department of Hematology, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, Beijing 100096, China
| | - Yutong Wang
- Department of Hematology, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, Beijing 100096, China
| | - Lei Shi
- Department of Hematology, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, Beijing 100096, China
| | - Shan Gao
- Department of Hematology, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, Beijing 100096, China
| | - Lijuan Fang
- Department of Hematology, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, Beijing 100096, China
| | - Qiuqing Xiang
- Department of Hematology, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, Beijing 100096, China
| | - Xi Liu
- Department of Hematology, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, Beijing 100096, China
| | - Yuehua Ding
- Department of Hematology, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, Beijing 100096, China
| | - Yuan Chen
- Department of Hematology, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, Beijing 100096, China
| | - Xin Zhao
- Department of Hematology, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, Beijing 100096, China
| | - Mengzhen Wang
- Department of Hematology, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, Beijing 100096, China
| | - Kai Sun
- Department of Hematology, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, Beijing 100096, China
| | - Li Bao
- Department of Hematology, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, Beijing 100096, China
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Ho M, Kourelis T. The burden of myeloma: novel approaches to disease assessment. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2022; 2022:356-362. [PMID: 36485143 PMCID: PMC9820131 DOI: 10.1182/hematology.2022000348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Novel therapies in multiple myeloma (MM) have increased the rates of conventional complete remission (CR) in patients. However, patients in CR can have highly heterogeneous outcomes. Novel and more sensitive methods of assessing residual disease burden after therapy will help prognosticate this group better and, ideally, allow individualized therapy adjustments based on response depth in the future. Here, we review novel bone marrow, peripheral blood, and imaging methods for assessing myeloma burden and discuss the opportunities and limitations of incorporating these in everyday clinical practice.
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Affiliation(s)
- Matthew Ho
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN
| | - Taxiarchis Kourelis
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN
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Tang Y, Yin H, Zhao X, Jin D, Liang Y, Xiong T, Li L, Tang W, Zhang J, Liu M, Yu Z, Liu H, Zang S, Huang Z. High efficacy and safety of CD38 and BCMA bispecific CAR-T in relapsed or refractory multiple myeloma. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2022; 41:2. [PMID: 34980210 PMCID: PMC8722124 DOI: 10.1186/s13046-021-02214-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 12/07/2021] [Indexed: 11/10/2022]
Abstract
Background B-cell maturation antigen (BCMA) chimeric antigen receptor T (CAR-T) cell therapy has obtained promising results in relapsed or refractory multiple myeloma (R/R MM), while some patients do not response, or relapse in short term after treatment. Combining with anti-CD38 might solve the problem of targeting BCMA alone. We aimed to assess the efficacy and safety of BCMA and CD38 (BCMA-CD38) bispecific CAR-T cells in R/R MM patients. Methods We did a single-center, single-arm clinical study at the Second Affiliated Hospital of Yangtze University in China. Patients meeting with the inclusion criteria were administered with fludarabine and cyclophosphamide before CAR-T cells infusion. Response and adverse events were assessed after infusion. This study was registered with the Chinese Clinical Trial Registration Center (ChiCTR1900026286). Results First, we found BCMA-CD38 CAR-T cells exhibited enhanced killing effect on BCMA+CD38+ cells in vitro, compared to BCMA CAR-T and CD38 CAR-T cells. We further demonstrated its anti-tumor activity in vivo. Then, we enrolled 16 R/R MM patients for safety and efficacy analyses. Of the 16 evaluable patients, 14 (87.5%) respond to the treatment, including 13 stringent complete response (sCR) and one partial response (PR), while two patients did not respond. At a median follow-up of 11.5 months, of the 13 patients who achieved sCR, 76.9% (10/13) did not relapse or progress during follow-up. Relapse occurred in 3 patients (Patient 2, 3 and 4) after achieving sCR. In sum, four patients died, of which one died of hemophagocytic lymphohistiocytosis syndrome secondary to severe cytokine release syndrome (CRS) and three died of disease progression or relapse. The 1-year progression-free survival rates was 68.8%. The 1-year overall survival rate was 75.0%. Extramedullary lesions were eliminated in 62.5% (5/8) patients. The most common symptoms after CAR-T infusion were cytopenia (16, 100%), fever (10, 62.5%), fatigue (8, 50.0%) and myalgias (8, 50.0%). Twelve patients (75.0%) were observed with various grades of CRS, of which five patients (31.3%) got serious CRS (Grade ≥ 3). The CAR+ cell expansion levels were associated with the severity of CRS. Transient clonal isotype switch was observed after CAR-T infusion. Conclusion Our results confirm that BCMA-CD38 CAR-T cells therapy is feasible in treating R/R MM patients, with high response rate, low recurrence rate and manageable CRS, which will be a promising treatment option for R/R MM. Trial registration ChiCTR1900026286, registered on September 29, 2019, retrospectively registered, URL: https://www.chictr.org.cn/showproj.aspx?proj=43805 Supplementary Information The online version contains supplementary material available at 10.1186/s13046-021-02214-z.
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Affiliation(s)
- Yuanyan Tang
- Department of Hematology, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University, No.60, Jingzhong Road, Jingzhou, 434020, Hubei Province, China
| | - Haisen Yin
- Department of Gastroenterology, Key Laboratory of Hubei Province for Digestive System Diseases, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xinying Zhao
- Department of Hematology, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University, No.60, Jingzhong Road, Jingzhou, 434020, Hubei Province, China
| | - Dan Jin
- Cellyan Therapeutics Co. Ltd, Wuhan, China
| | - Yan Liang
- Department of Hematology, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University, No.60, Jingzhong Road, Jingzhou, 434020, Hubei Province, China
| | - Tao Xiong
- Department of Hematology, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University, No.60, Jingzhong Road, Jingzhou, 434020, Hubei Province, China
| | - Lu Li
- Cellyan Therapeutics Co. Ltd, Wuhan, China
| | - Wen Tang
- Cellyan Therapeutics Co. Ltd, Wuhan, China
| | - Jiangzhao Zhang
- Department of Hematology, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University, No.60, Jingzhong Road, Jingzhou, 434020, Hubei Province, China
| | - Min Liu
- Department of Hematology, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University, No.60, Jingzhong Road, Jingzhou, 434020, Hubei Province, China
| | - Zhuojun Yu
- Department of Hematology, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University, No.60, Jingzhong Road, Jingzhou, 434020, Hubei Province, China
| | - Huimin Liu
- Department of Hematology, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University, No.60, Jingzhong Road, Jingzhou, 434020, Hubei Province, China
| | - Sibin Zang
- Department of Hematology, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University, No.60, Jingzhong Road, Jingzhou, 434020, Hubei Province, China
| | - Zhiping Huang
- Department of Hematology, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University, No.60, Jingzhong Road, Jingzhou, 434020, Hubei Province, China.
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Immunoglobulin Isotype Switch after Anti-BCMA CAR T-Cell Therapy for Relapsed or Refractory Multiple Myeloma. Blood Adv 2021; 6:293-296. [PMID: 34758063 PMCID: PMC8753190 DOI: 10.1182/bloodadvances.2021005814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 10/19/2021] [Indexed: 12/03/2022] Open
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Suzuki K, Nishiwaki K, Yano S. Treatment Strategy for Multiple Myeloma to Improve Immunological Environment and Maintain MRD Negativity. Cancers (Basel) 2021; 13:4867. [PMID: 34638353 PMCID: PMC8508145 DOI: 10.3390/cancers13194867] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/21/2021] [Accepted: 09/24/2021] [Indexed: 02/06/2023] Open
Abstract
Improving the immunological environment and eradicating minimal residual disease (MRD) are the two main treatment goals for long-term survival in patients with multiple myeloma (MM). Immunomodulatory drugs (IMiDs), monoclonal antibody drugs (MoAbs), and autologous grafts for autologous stem cell transplantation (ASCT) can improve the immunological microenvironment. ASCT, MoAbs, and proteasome inhibitors (PIs) may be important for the achievement of MRD negativity. An improved immunological environment may be useful for maintaining MRD negativity, although the specific treatment for persistent MRD negativity is unknown. However, whether the ongoing treatment should be continued or changed if the MRD status remains positive is controversial. In this case, genetic, immunophenotypic, and clinical analysis of residual myeloma cells may be necessary to select the effective treatment for the residual myeloma cells. The purpose of this review is to discuss the MM treatment strategy to "cure MM" based on currently available therapies, including IMiDs, PIs, MoAbs, and ASCT, and expected immunotherapies, such as chimeric antigen receptor T cell (CAR-T) therapy, via improvement of the immunological environment and maintenance of MRD negativity.
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Affiliation(s)
- Kazuhito Suzuki
- Department of Internal Medicine, Division of Clinical Oncology and Hematology, The Jikei University Kashiwa Hospital, Tokyo 277-8567, Japan;
- Department of Internal Medicine, Division of Clinical Oncology and Hematology, The Jikei University School of Medicine, Tokyo 105-8461, Japan;
| | - Kaichi Nishiwaki
- Department of Internal Medicine, Division of Clinical Oncology and Hematology, The Jikei University Kashiwa Hospital, Tokyo 277-8567, Japan;
- Department of Internal Medicine, Division of Clinical Oncology and Hematology, The Jikei University School of Medicine, Tokyo 105-8461, Japan;
| | - Shingo Yano
- Department of Internal Medicine, Division of Clinical Oncology and Hematology, The Jikei University School of Medicine, Tokyo 105-8461, Japan;
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Next-Generation Biomarkers in Multiple Myeloma: Understanding the Molecular Basis for Potential Use in Diagnosis and Prognosis. Int J Mol Sci 2021; 22:ijms22147470. [PMID: 34299097 PMCID: PMC8305153 DOI: 10.3390/ijms22147470] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 06/25/2021] [Accepted: 07/02/2021] [Indexed: 12/19/2022] Open
Abstract
Multiple myeloma (MM) is considered to be the second most common blood malignancy and it is characterized by abnormal proliferation and an accumulation of malignant plasma cells in the bone marrow. Although the currently utilized markers in the diagnosis and assessment of MM are showing promising results, the incidence and mortality rate of the disease are still high. Therefore, exploring and developing better diagnostic or prognostic biomarkers have drawn global interest. In the present review, we highlight some of the recently reported and investigated novel biomarkers that have great potentials as diagnostic and/or prognostic tools in MM. These biomarkers include angiogenic markers, miRNAs as well as proteomic and immunological biomarkers. Moreover, we present some of the advanced methodologies that could be utilized in the early and competent diagnosis of MM. The present review also focuses on understanding the molecular concepts and pathways involved in these biomarkers in order to validate and efficiently utilize them. The present review may also help in identifying areas of improvement for better diagnosis and superior outcomes of MM.
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Deepening responses associated with improved progression-free survival with ixazomib versus placebo as posttransplant maintenance in multiple myeloma. Leukemia 2020; 34:3019-3027. [PMID: 32327729 PMCID: PMC7584475 DOI: 10.1038/s41375-020-0819-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/12/2020] [Accepted: 03/27/2020] [Indexed: 01/03/2023]
Abstract
In the TOURMALINE-MM3 study, post-autologous stem cell transplantation maintenance therapy with the oral proteasome inhibitor ixazomib versus placebo significantly improved progression-free survival (PFS), with a favorable safety profile. With ixazomib versus placebo maintenance, deepening responses occurred in 139/302 (46%) versus 60/187 (32%) patients with very good partial response or partial response (VGPR/PR) at study entry (relative risk 1.41, P = 0.004), and median time to best confirmed deepened response was 19.9 versus 30.8 months (24-month rate: 54.2 versus 41.4%; hazard ratio (HR): 1.384; P = 0.0342). Median PFS in patients with VGPR/PR at study entry was 26.2 versus 18.5 months (HR: 0.636, P < 0.001) with ixazomib versus placebo; in a pooled analysis across arms, in patients with versus without deepening responses, the median PFS was not reached versus 15.9 months (HR: 0.245, P < 0.001). In patients with deepening responses, 24-month PFS rate was 77.4 versus 68.3% with ixazomib versus placebo (HR: 0.831; P = 0.466); in patients without deepening responses, median PFS was 17.9 versus 14.1 months (HR: 0.741; P = 0.028). These analyses demonstrate the significantly higher rate of deepening responses with ixazomib versus placebo maintenance and the association between deepening response and prolonged PFS.
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