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Feng Y, Wu L, Gu T, Hu Y, Huang H. How can we improve the successful identification of patients suitable for CAR-T cell therapy? Expert Rev Mol Diagn 2024:1-16. [PMID: 39258858 DOI: 10.1080/14737159.2024.2399152] [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: 01/30/2023] [Accepted: 08/28/2024] [Indexed: 09/12/2024]
Abstract
INTRODUCTION In recent years, chimeric antigen receptor T (CAR-T) cell therapy has resulted in a breakthrough in the treatment of patients with refractory or relapsed hematological malignancies. However, the identification of patients suitable for CAR-T cell therapy needs to be improved. AREAS COVERED CAR-T cell therapy has demonstrated excellent efficacy in hematological malignancies; however, views on determining when to apply CAR-T cells in terms of the evaluation of patient characteristics remain controversial. EXPERT OPINION We reviewed the current feasibility and challenges of CAR-T cell therapy in the most common hematological malignancies and classified them according to the disease type and treatment priority, to guide clinicians and researchers in applying and investigating CAR-T cells furtherly.
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Affiliation(s)
- Youqin Feng
- Bone Marrow Transplantation Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, Zhejiang, China
- Institute of Hematology, Zhejiang University, Hangzhou, Zhejiang, China
- Zhejiang Province Engineering Research Center for Stem Cell and Immunity Therapy, Hangzhou, Zhejiang, China
| | - Longyuan Wu
- Bone Marrow Transplantation Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, Zhejiang, China
- Institute of Hematology, Zhejiang University, Hangzhou, Zhejiang, China
- Zhejiang Province Engineering Research Center for Stem Cell and Immunity Therapy, Hangzhou, Zhejiang, China
| | - Tianning Gu
- Bone Marrow Transplantation Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, Zhejiang, China
- Institute of Hematology, Zhejiang University, Hangzhou, Zhejiang, China
- Zhejiang Province Engineering Research Center for Stem Cell and Immunity Therapy, Hangzhou, Zhejiang, China
| | - Yongxian Hu
- Bone Marrow Transplantation Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, Zhejiang, China
- Institute of Hematology, Zhejiang University, Hangzhou, Zhejiang, China
- Zhejiang Province Engineering Research Center for Stem Cell and Immunity Therapy, Hangzhou, Zhejiang, China
| | - He Huang
- Bone Marrow Transplantation Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Institute of Hematology, Zhejiang University, Hangzhou, Zhejiang, China
- Zhejiang Province Engineering Research Center for Stem Cell and Immunity Therapy, Hangzhou, Zhejiang, China
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Gao S, Dong F, Yang P, Chen Y, Wang Y, Wang J, Shi Y, Jing H. 1q21+ is associated with poor prognosis in newly diagnosed multiple myeloma patients with extramedullary disease: a retrospective study. Ann Hematol 2024; 103:1979-1987. [PMID: 38206369 DOI: 10.1007/s00277-023-05588-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 12/12/2023] [Indexed: 01/12/2024]
Abstract
1q21+ is a common cytogenetic abnormality in multiple myeloma (MM) and is considered an independent predictor of poor prognosis; however, its impact on extramedullary disease (EMD) remains unknown. Our study reviewed the clinical relevance and prognostic value of 1q21+ status in 92 patients with NDMM and EMD. 1q21+ was detected in 23.9% (22/92) of patients. Patients with 1q21+ presented with advanced International Staging System stages (P = 0.006), lower level of hemoglobin (P = 0.004), higher percentage of plasma cells in the bone marrow (P < 0.001), higher level of serum β2-microglobulin (7.24 g/L vs. 3.85 g/L, P = 0.003), and higher levels of lactic dehydrogenase (LDH) (206.5 U/L vs. 177 U/L, P = 0.019). The prevalence of soft tissue-related EMD (EMD-S) (54.5% vs. 18.6%, P < 0.001), renal dysfunction (50.5% vs. 17.7%, P = 0.002), and hypercalcemia (27.3% vs. 7.1%, P = 0.011) was also higher. 1q21+ was strongly associated with other high-risk cytogenetic abnormalities, including IgH/FGFR3 (22.7% vs. 4.3%, P = 0.007) and IgH/MAF translocations (22.7% vs. 1.4%, P < 0.001). 1q21+ patients had significantly shorter overall survival (OS) and progression-free survival (PFS) (OS: 24 months vs. 47 months, P = 0.002; PFS: 14 months vs. 38 months, P < 0.001); the poor survival outcomes could not be reversed by autologous hematopoietic stem cell transplantation. Multivariate analysis suggested that 1q21+ , EMD-S, elevated lactate dehydrogenase (LDH) levels, and P53 deletion were independent risk factors for poor prognosis in patients with EMD. In patients with 1q21+ EMD, hypercalcemia, elevated LDH levels, and P53 deletion were independent adverse risk prognostic factors.
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Affiliation(s)
- Shuang Gao
- Department of Hematology, Lymphoma Center, Third Hospital, Peking University, Beijing, China
| | - Fei Dong
- Department of Hematology, Lymphoma Center, Third Hospital, Peking University, Beijing, China
| | - Ping Yang
- Department of Hematology, Lymphoma Center, Third Hospital, Peking University, Beijing, China
| | - Yingtong Chen
- Department of Hematology, Lymphoma Center, Third Hospital, Peking University, Beijing, China
| | - Yanfang Wang
- Department of Hematology, Lymphoma Center, Third Hospital, Peking University, Beijing, China
| | - Jing Wang
- Department of Hematology, Lymphoma Center, Third Hospital, Peking University, Beijing, China
| | - Yanyan Shi
- Research Center of Clinical Epidemiology, Third Hospital, Peking University, Beijing, China
| | - Hongmei Jing
- Department of Hematology, Lymphoma Center, Third Hospital, Peking University, Beijing, China.
- Research Center of Clinical Epidemiology, Third Hospital, Peking University, Beijing, China.
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Wang J, Song X, Zhang X, Liu H, Zang M, Qi D, Zhang J, Sun L. Negative effect of paraskeletal plasmacytoma on survival of patients with transplant-ineligible newly diagnosed multiple myeloma. Ann Hematol 2024; 103:1411-1414. [PMID: 38228774 DOI: 10.1007/s00277-024-05622-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/10/2024] [Indexed: 01/18/2024]
Affiliation(s)
- Junzhe Wang
- Department of Hematology, Hebei Medical University Third Hospital, Shijiazhuang, 050051, China
| | - Xiaoning Song
- Department of Hematology, Hebei Medical University Third Hospital, Shijiazhuang, 050051, China
| | - Xian Zhang
- Department of Hematology, Hebei Medical University Third Hospital, Shijiazhuang, 050051, China
| | - Han Liu
- Department of Hematology, Hebei Medical University Third Hospital, Shijiazhuang, 050051, China
| | - Meirong Zang
- Department of Hematology, Hebei Medical University Third Hospital, Shijiazhuang, 050051, China
| | - Dianwen Qi
- Department of Bone and Soft Tissue Oncology, Hebei Medical University Third Hospital, Shijiazhuang, 050051, China
| | - Jinqiao Zhang
- Department of Hematology, Hebei Medical University Third Hospital, Shijiazhuang, 050051, China
| | - Lixia Sun
- Department of Hematology, Hebei Medical University Third Hospital, Shijiazhuang, 050051, China.
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Bangolo AI, Fwelo P, Trivedi C, Sagireddy S, Aljanaahi H, Auda A, Mohamed M, Onyeka S, Fisher M, Thapa J, Tabucanon EJ, Georgiev L, Wishart A, Kumari S, Erikson C, Bangura M, Paddy O, Madhukar R, Gomez EL, Rathod J, Naria M, Hajal B, Awadhalla M, Siegel D, Parmar H, Biran N, Vesole DH, Phull P, Weissman S. Interaction between age and gender on survival outcomes in extramedullary multiple myeloma over the past two decades. World J Clin Oncol 2023; 14:179-189. [PMID: 37124133 PMCID: PMC10134202 DOI: 10.5306/wjco.v14.i4.179] [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: 12/17/2022] [Revised: 02/20/2023] [Accepted: 03/17/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Extramedullary multiple myeloma (MM) (EMM) is a rare and aggressive subentity of MM that can be present at diagnosis or develop anytime during the disease course. There is a paucity of data on the clinical characteristics and overall epidemiology of EMM. Furthermore, there is a scarcity of data on how the interaction of age and gender influences the survival of EMM.
AIM To evaluate the clinical characteristics of patients with EMM over the past 2 decades and to identify epidemiologic characteristics that may impact overall prognosis.
METHODS A total of 858 patients diagnosed with EMM, between 2000 and 2017, were ultimately enrolled in our study by retrieving the Surveillance, Epidemiology, and End Results database. We analyzed demographics, clinical characteristics, and overall mortality (OM) as well as cancer-specific mortality (CSM) of EMM. Variables with a P value < 0.1 in the univariate Cox regression were incorporated into the multivariate Cox model to determine the independent prognostic factors, with a hazard ratio (HR) of greater than 1 representing adverse prognostic factors.
RESULTS From a sample of 858 EMM, the male gender (63.25%), age range 60-79 years (51.05%), and non-Hispanic whites (66.78%) were the most represented. Central Nervous System and the vertebral column was the most affected site (33.10%). Crude analysis revealed higher OM in the age group 80+ [HR = 6.951, 95% confidence interval (95%CI): 3.299-14.647, P = 0], Non-Hispanic Black population (HR = 1.339, 95%CI: 1.02-1.759, P = 0.036), Bones not otherwise specified (NOS) (HR = 1.74, 95%CI: 1.043-2.902, P = 0.034), and widowed individuals (HR = 2.107, 95%CI: 1.511-2.938, P = 0). Skin involvement (HR = 0.241, 95%CI: 0.06-0.974, P = 0.046) and a yearly income of $75000+ (HR = 0.259, 95%CI: 0.125-0.538, P = 0) had the lowest OM in the crude analysis. Crude analysis revealed higher CSM in the age group 80+, Non-Hispanic Black, Bones NOS, and widowed. Multivariate cox proportional hazard regression analyses only revealed higher OM in the age group 80+ (HR = 9.792, 95%CI: 4.403-21.774, P = 0) and widowed individuals (HR = 1.609, 95%CI: 1.101-2.35, P = 0.014). Multivariate cox proportional hazard regression analyses of CSM also revealed higher mortality of the same groups. Eyes, mouth, and ENT involvement had the lowest CSM in the multivariate analysis. There was no interaction between age and gender in the adjusted analysis for OM and CSM.
CONCLUSION EMM is a rare entity. To our knowledge, there is a scarcity of data on the clinical characteristics and prognosis factors of patients with extramedullary multiple myeloma. In this retrospective cohort, using a United States-based population, we found that age, marital status, and tumor site were independent prognostic factors. Furthermore, we found that age and gender did not interact to influence the mortality of patients with EMM.
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Affiliation(s)
- Ayrton I Bangolo
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Pierre Fwelo
- Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health, Houston, TX 77204, United States
| | - Chinmay Trivedi
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Sowmya Sagireddy
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Hamed Aljanaahi
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Auda Auda
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Maryama Mohamed
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Sonia Onyeka
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Miriam Fisher
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Jyoti Thapa
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Erwin J Tabucanon
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Lyuben Georgiev
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Annetta Wishart
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Shilpee Kumari
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Conrad Erikson
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Mary Bangura
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Orent Paddy
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Rashmi Madhukar
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Eugenio L Gomez
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Joshua Rathod
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Mansi Naria
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Basel Hajal
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Mohammad Awadhalla
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - David Siegel
- Division of Myeloma, John Theurer Cancer Center, Hackensack, NJ 07601, United States
| | - Harsh Parmar
- Division of Myeloma, John Theurer Cancer Center, Hackensack, NJ 07601, United States
| | - Noa Biran
- Division of Myeloma, John Theurer Cancer Center, Hackensack, NJ 07601, United States
| | - David H Vesole
- Division of Myeloma, John Theurer Cancer Center, Hackensack, NJ 07601, United States
| | - Pooja Phull
- Division of Myeloma, John Theurer Cancer Center, Hackensack, NJ 07601, United States
| | - Simcha Weissman
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
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