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Kaiser MF, Hall A, Walker K, Sherborne A, De Tute RM, Newnham N, Roberts S, Ingleson E, Bowles K, Garg M, Lokare A, Messiou C, Houlston RS, Jackson G, Cook G, Pratt G, Owen RG, Drayson MT, Brown SR, Jenner MW. Daratumumab, Cyclophosphamide, Bortezomib, Lenalidomide, and Dexamethasone as Induction and Extended Consolidation Improves Outcome in Ultra-High-Risk Multiple Myeloma. J Clin Oncol 2023; 41:3945-3955. [PMID: 37315268 DOI: 10.1200/jco.22.02567] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 04/05/2023] [Accepted: 05/02/2023] [Indexed: 06/16/2023] Open
Abstract
PURPOSE The multicenter OPTIMUM (MUKnine) phase II trial investigated daratumumab, low-dose cyclophosphamide, lenalidomide, bortezomib, and dexamethasone (Dara-CVRd) before and after autologous stem-cell transplant (ASCT) in newly diagnosed patients with molecularly defined ultra-high-risk (UHiR) multiple myeloma (NDMM) or plasma cell leukemia (PCL). To provide clinical context, progression-free survival (PFS) and overall survival (OS) were referenced to contemporaneous outcomes seen in patients with UHiR NDMM treated in the recent Myeloma XI (MyeXI) trial. METHODS Transplant-eligible all-comers NDMM patients were profiled for UHiR disease, defined by presence of ≥2 genetic risk markers t(4;14)/t(14;16)/t(14;20), del(1p), gain(1q), and del(17p), and/or SKY92 gene expression risk signature. Patients with UHiR MM/PCL were offered treatment with Dara-CVRd induction, V-augmented ASCT, extended Dara-VR(d) consolidation, and Dara-R maintenance. UHiR patients treated in MyeXI with carfilzomib, lenalidomide, dexamethasone, and cyclophosphamide, or lenalidomide, dexamethasone, and cyclophosphamide, ASCT, and R maintenance or observation were identified by mirrored molecular screening. OPTIMUM PFS at 18 months (PFS18m) was compared against MyeXI using a Bayesian framework, and patients were followed up to the end of consolidation for PFS and OS. RESULTS Of 412 screened NDMM OPTIMUM patients, 103 were identified as UHiR or PCL and subsequently treated on trial with Dara-CVRd; 117 MyeXI patients identified as UHiR formed the external comparator arm, with comparable clinical and molecular characteristics to OPTIMUM. Comparison of PFS18m per Bayesian framework resulted in a 99.5% chance of OPTIMUM being superior to MyeXI. At 30 months' follow-up, PFS was 77% for OPTIMUM versus 39.8% for MyeXI, and OS 83.5% versus 73.5%, respectively. Extended post-ASCT Dara-VRd consolidation therapy was highly deliverable, with limited toxicity. CONCLUSION Our results suggest that Dara-CVRd induction and extended post-ASCT Dara-VRd consolidation markedly improve PFS for UHiR NDMM patients over conventional management, supporting further evaluation of this strategy.
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Affiliation(s)
- Martin F Kaiser
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, United Kingdom
- Department of Haematology, The Royal Marsden Hospital, London, United Kingdom
| | - Andrew Hall
- Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Katrina Walker
- Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Amy Sherborne
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, United Kingdom
| | - Ruth M De Tute
- Haematological Malignancy Diagnostic Service, Leeds Cancer Centre, Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | - Nicola Newnham
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Sadie Roberts
- Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Emma Ingleson
- Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Kristian Bowles
- Department of Haematology, Norfolk and Norwich University Hospitals NHS Trust, Norwich, United Kingdom
| | - Mamta Garg
- Department of Haematology, Leicester Royal Infirmary, Leicester, United Kingdom
| | - Anand Lokare
- Department of Haematology, Birmingham Heartlands, Birmingham, United Kingdom
| | - Christina Messiou
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, United Kingdom
- Department of Haematology, The Royal Marsden Hospital, London, United Kingdom
| | - Richard S Houlston
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, United Kingdom
| | - Graham Jackson
- Department of Haematology, Newcastle University, Newcastle, United Kingdom
| | - Gordon Cook
- Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
- Leeds Cancer Centre, Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | - Guy Pratt
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Roger G Owen
- Haematological Malignancy Diagnostic Service, Leeds Cancer Centre, Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | - Mark T Drayson
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Sarah R Brown
- Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Matthew W Jenner
- Department of Haematology, University Hospital Southampton, Southampton, United Kingdom
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Roy Choudhury S, Byrum SD, Alkam D, Ashby C, Zhan F, Tackett AJ, Van Rhee F. Expression of integrin β-7 is epigenetically enhanced in multiple myeloma subgroups with high-risk cytogenetics. Clin Epigenetics 2023; 15:18. [PMID: 36737807 PMCID: PMC9898982 DOI: 10.1186/s13148-023-01433-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 01/21/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Oncogenic overexpression of integrin-β7 (ITGB7) in cases of high-risk multiple myeloma (MM) was reported to promote enhanced interactions between neoplastic plasma-B cells and stromal cells to develop cell-adhesion mediated drug resistance. METHODS Expression profiles of adhesion related genes were analyzed in a cohort of MM patients containing major IgH translocations or hyperdiploidies (HY), diagnosed at the premalignant monoclonal gammopathy of undetermined significance (MGUS; n = 103), smoldering multiple myeloma; (SMM; n = 190) or MM (MM; n = 53) stage. Differential expression was integrated with loci-specific alterations in DNA-methylation and chromatin marks in MM patients. A CRISPR-based targeted induction of DNA-methylation at the ITGB7 super-enhancer (SE) in MM.1S cells was employed to intersect the impact of cis-regulatory elements on ITGB7 expression. RESULTS ITGB7 was significantly (p < 0.05) upregulated in patients with t(14;16) and t(14;20) subgroups in all MGUS, SMM and MM stages, but sporadically upregulated in t(4;14) subgroup at the MM stage. We demonstrate a predetermined enhancer state on ITGB7 in primary-B cells that is maintained under bivalent chromatin, which undergoes a process of chromatin-state alterations and develops into an active enhancer in cases of the t(4;14) subgroup or SE in cases of the t(14;16) subgroup. We also demonstrate that while targeted induction of DNA-methylation at the ITGB7-SE further upregulated the gene, inhibition of ITGB7-SE-associated transcription factor bromodomain-4 downregulated expression of the gene. CONCLUSIONS Our findings suggest an epigenetic regulation of oncogenic overexpression of ITGB7 in MM cells, which could be critical in MM progression and an attractive therapeutic target.
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Affiliation(s)
- Samrat Roy Choudhury
- Pediatric Hematology-Oncology, Arkansas Children's Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, 72202, USA.
| | - Stephanie D Byrum
- Pediatric Hematology-Oncology, Arkansas Children's Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, 72202, USA
- Department of Biochemistry and Molecular Biology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Duah Alkam
- Department of Biochemistry and Molecular Biology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Cody Ashby
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Fenghuang Zhan
- Myeloma Center, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Alan J Tackett
- Pediatric Hematology-Oncology, Arkansas Children's Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, 72202, USA
- Department of Biochemistry and Molecular Biology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Frits Van Rhee
- Myeloma Center, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
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Solimando AG, Malerba E, Leone P, Prete M, Terragna C, Cavo M, Racanelli V. Drug resistance in multiple myeloma: Soldiers and weapons in the bone marrow niche. Front Oncol 2022; 12:973836. [PMID: 36212502 PMCID: PMC9533079 DOI: 10.3389/fonc.2022.973836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/05/2022] [Indexed: 11/13/2022] Open
Abstract
Multiple myeloma (MM) is still an incurable disease, despite considerable improvements in treatment strategies, as resistance to most currently available agents is not uncommon. In this study, data on drug resistance in MM were analyzed and led to the following conclusions: resistance occurs via intrinsic and extrinsic mechanisms, including intraclonal heterogeneity, drug efflux pumps, alterations of drug targets, the inhibition of apoptosis, increased DNA repair and interactions with the bone marrow (BM) microenvironment, cell adhesion, and the release of soluble factors. Since MM involves the BM, interactions in the MM-BM microenvironment were examined as well, with a focus on the cross-talk between BM stromal cells (BMSCs), adipocytes, osteoclasts, osteoblasts, endothelial cells, and immune cells. Given the complex mechanisms that drive MM, next-generation treatment strategies that avoid drug resistance must target both the neoplastic clone and its non-malignant environment. Possible approaches based on recent evidence include: (i) proteasome and histone deacetylases inhibitors that not only target MM but also act on BMSCs and osteoclasts; (ii) novel peptide drug conjugates that target both the MM malignant clone and angiogenesis to unleash an effective anti-MM immune response. Finally, the role of cancer stem cells in MM is unknown but given their roles in the development of solid and hematological malignancies, cancer relapse, and drug resistance, their identification and description are of paramount importance for MM management.
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Affiliation(s)
- Antonio Giovanni Solimando
- Department of Biomedical Sciences and Human Oncology, School of Medicine, ‘Aldo Moro’ University of Bari, Bari, Italy
- Istituto di ricovero e cura a carattere scientifico (IRCCS) Istituto Tumori ‘Giovanni Paolo II’ of Bari, Bari, Italy
| | - Eleonora Malerba
- Department of Biomedical Sciences and Human Oncology, School of Medicine, ‘Aldo Moro’ University of Bari, Bari, Italy
| | - Patrizia Leone
- Department of Biomedical Sciences and Human Oncology, School of Medicine, ‘Aldo Moro’ University of Bari, Bari, Italy
| | - Marcella Prete
- Department of Interdisciplinary Medicine, School of Medicine, ‘Aldo Moro’ University of Bari, Bari, Italy
| | - Carolina Terragna
- ’Seràgnoli’ Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
| | - Michele Cavo
- ’Seràgnoli’ Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
| | - Vito Racanelli
- Department of Interdisciplinary Medicine, School of Medicine, ‘Aldo Moro’ University of Bari, Bari, Italy
- *Correspondence: Vito Racanelli,
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Pawlyn C, Cairns D, Menzies T, Jones J, Jenner M, Cook G, Boyd K, Drayson M, Kaiser M, Owen R, Gregory W, Morgan G, Jackson G, Davies F. Autologous stem cell transplantation is safe and effective for fit older myeloma patients: exploratory results from the Myeloma XI trial. Haematologica 2022; 107:231-242. [PMID: 33297668 PMCID: PMC8719065 DOI: 10.3324/haematol.2020.262360] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 11/25/2020] [Indexed: 12/03/2022] Open
Abstract
Autologous stem cell transplant (ASCT) remains standard of care for consolidation after induction therapy for eligible newly diagnosed myeloma patients. In recent clinical trials comparing ASCT to delayed ASCT, patients aged over 65 were excluded. In real-world practice stem cell transplants are not restricted to those aged under 65 and clinicians decide on transplant eligibility based on patient fitness rather than a strict age cut off. Data from the UK NCRI Myeloma XI trial, a large phase III randomised controlled trial with pathways for transplant-eligible (TE) and ineligible (TNE) patients, was used in an exploratory analysis to examine the efficacy and toxicity of ASCT in older patients including analysis using an agematched population to compare outcomes for patients receiving similar induction therapy with or without ASCT. Older patients within the TE pathway were less likely to undergo stem cell harvest at the end of induction than younger patients and of those patients undergoing ASCT there was a reduction in PFS associated with increasing age. ASCT in older patients was well tolerated with no difference in morbidity or mortality between patients aged.
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Affiliation(s)
- Charlotte Pawlyn
- The Institute of Cancer Research, London, UK; The Royal Marsden Hospital, London.
| | - David Cairns
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds
| | - Tom Menzies
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds
| | - John Jones
- Kings Hospital NHS Foundation Trust, London
| | - Matthew Jenner
- University Hospital Southampton NHS Foundation Trust, Southampton
| | - Gordon Cook
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK; Leeds Cancer Centre, Leeds Teaching Hospitals Trust, Leeds
| | | | - Mark Drayson
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham
| | - Martin Kaiser
- The Institute of Cancer Research, London, UK; The Royal Marsden Hospital, London
| | - Roger Owen
- HMDS, Leeds Cancer Centre, Leeds Teaching Hospitals Trust, Leeds
| | - Walter Gregory
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds
| | | | - Graham Jackson
- Department of Haematology, Newcastle University, Newcastle
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Croft J, Ellis S, Sherborne AL, Sharp K, Price A, Jenner MW, Drayson MT, Owen RG, Chown S, Lindsay J, Karunanithi K, Hunter H, Gregory WM, Davies FE, Morgan GJ, Cook G, Atanesyan L, Savola S, Cairns DA, Jackson G, Houlston RS, Kaiser MF. Copy number evolution and its relationship with patient outcome-an analysis of 178 matched presentation-relapse tumor pairs from the Myeloma XI trial. Leukemia 2021; 35:2043-2053. [PMID: 33262523 PMCID: PMC8257500 DOI: 10.1038/s41375-020-01096-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/02/2020] [Accepted: 11/14/2020] [Indexed: 12/25/2022]
Abstract
Structural chromosomal changes including copy number aberrations (CNAs) are a major feature of multiple myeloma (MM), however their evolution in context of modern biological therapy is not well characterized. To investigate acquisition of CNAs and their prognostic relevance in context of first-line therapy, we profiled tumor diagnosis-relapse pairs from 178 NCRI Myeloma XI (ISRCTN49407852) trial patients using digital multiplex ligation-dependent probe amplification. CNA profiles acquired at relapse differed substantially between MM subtypes: hyperdiploid (HRD) tumors evolved predominantly in branching pattern vs. linear pattern in t(4;14) vs. stable pattern in t(11;14). CNA acquisition also differed between subtypes based on CCND expression, with a marked enrichment of acquired del(17p) in CCND2 over CCND1 tumors. Acquired CNAs were not influenced by high-dose melphalan or lenalidomide maintenance randomization. A branching evolution pattern was significantly associated with inferior overall survival (OS; hazard ratio (HR) 2.61, P = 0.0048). As an individual lesion, acquisition of gain(1q) at relapse was associated with shorter OS, independent of other risk markers or time of relapse (HR = 2.00; P = 0.021). There is an increasing need for rational therapy sequencing in MM. Our data supports the value of repeat molecular profiling to characterize disease evolution and inform management of MM relapse.
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Affiliation(s)
- James Croft
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - Sidra Ellis
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - Amy L Sherborne
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - Kim Sharp
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - Amy Price
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - Matthew W Jenner
- Department of Haematology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Mark T Drayson
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Roger G Owen
- Haematological Malignancy Diagnostic Service, St. James's University Hospital, Leeds, UK
| | - Sally Chown
- Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | | | | | | | - Walter M Gregory
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, Leeds, UK
| | - Faith E Davies
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | - Gareth J Morgan
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | - Gordon Cook
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | | | | | - David A Cairns
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, Leeds, UK
| | - Graham Jackson
- Department of Haematology, University of Newcastle, Newcastle Upon Tyne, UK
| | - Richard S Houlston
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - Martin F Kaiser
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK.
- Department of Hematology, The Royal Marsden Hospital, London, UK.
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Brown S, Sherratt D, Hinsley S, Flanagan L, Roberts S, Walker K, Hall A, Pratt G, Messiou C, Jenner M, Kaiser M. MUK nine OPTIMUM protocol: a screening study to identify high-risk patients with multiple myeloma suitable for novel treatment approaches combined with a phase II study evaluating optimised combination of biological therapy in newly diagnosed high-risk multiple myeloma and plasma cell leukaemia. BMJ Open 2021; 11:e046225. [PMID: 33762245 PMCID: PMC7993167 DOI: 10.1136/bmjopen-2020-046225] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Multiple myeloma (MM) is a plasma cell tumour with over 5800 new cases each year in the UK. The introduction of biological therapies has improved outcomes for the majority of patients with MM, but in approximately 20% of patients the tumour is characterised by genetic changes which confer a significantly poorer prognosis, generally termed high-risk (HR) MM. It is important to diagnose these genetic changes early and identify more effective first-line treatment options for these patients. METHODS AND ANALYSIS The Myeloma UK nine OPTIMUM trial (MUKnine) evaluates novel treatment strategies for patients with HRMM. Patients with suspected or newly diagnosed MM, fit for intensive therapy, are offered participation in a tumour genetic screening protocol (MUKnine a), with primary endpoint proportion of patients with molecular screening performed within 8 weeks. Patients identified as molecularly HR are invited into the phase II, single-arm, multicentre trial (MUKnine b) investigating an intensive treatment schedule comprising bortezomib, lenalidomide, daratumumab, low-dose cyclophosphamide and dexamethasone, with single high-dose melphalan and autologous stem cell transplantation (ASCT) followed by combination consolidation and maintenance therapy. MUKnine b primary endpoints are minimal residual disease (MRD) at day 100 post-ASCT and progression-free survival. Secondary endpoints include response, safety and quality of life. The trial uses a Bayesian decision rule to determine if this treatment strategy is sufficiently active for further study. Patients identified as not having HR disease receive standard treatment and are followed up in a cohort study. Exploratory studies include longitudinal whole-body diffusion-weighted MRI for imaging MRD testing. ETHICS AND DISSEMINATION Ethics approval London South East Research Ethics Committee (Ref: 17/LO/0022, 17/LO/0023). Results of studies will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER ISRCTN16847817, May 2017; Pre-results.
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Affiliation(s)
- Sarah Brown
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Debbie Sherratt
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Samantha Hinsley
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Louise Flanagan
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Sadie Roberts
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Katrina Walker
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Andrew Hall
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Guy Pratt
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | - Christina Messiou
- Centre for Myeloma Research, Institute of Cancer Research, London, UK
| | - Matthew Jenner
- Department of Haematology, Southampton General Hospital, Southampton, UK
| | - Martin Kaiser
- Centre for Myeloma Research, Institute of Cancer Research, London, UK
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7
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Brown S, Pawlyn C, Tillotson AL, Sherratt D, Flanagan L, Low E, Morgan GJ, Williams C, Kaiser M, Davies FE, Jenner MW. Bortezomib, Vorinostat, and Dexamethasone Combination Therapy in Relapsed Myeloma: Results of the Phase 2 MUK four Trial. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2021; 21:154-161.e3. [DOI: 10.1016/j.clml.2020.11.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 11/26/2020] [Accepted: 11/27/2020] [Indexed: 10/22/2022]
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8
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Ovejero S, Moreaux J. Multi-omics tumor profiling technologies to develop precision medicine in multiple myeloma. EXPLORATION OF TARGETED ANTI-TUMOR THERAPY 2021. [DOI: 10.37349/etat.2020.00034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Multiple myeloma (MM), the second most common hematologic cancer, is caused by accumulation of aberrant plasma cells in the bone marrow. Its molecular causes are not fully understood and its great heterogeneity among patients complicates therapeutic decision-making. In the past decades, development of new therapies and drugs have significantly improved survival of MM patients. However, resistance to drugs and relapse remain the most common causes of mortality and are the major challenges to overcome. The advent of high throughput omics technologies capable of analyzing big amount of clinical and biological data has changed the way to diagnose and treat MM. Integration of omics data (gene mutations, gene expression, epigenetic information, and protein and metabolite levels) with clinical histories of thousands of patients allows to build scores to stratify the risk at diagnosis and predict the response to treatment, helping clinicians to make better educated decisions for each particular case. There is no doubt that the future of MM treatment relies on personalized therapies based on predictive models built from omics studies. This review summarizes the current treatments and the use of omics technologies in MM, and their importance in the implementation of personalized medicine.
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Affiliation(s)
- Sara Ovejero
- Department of Biological Hematology, CHU Montpellier, 34295 Montpellier, France 2Institute of Human Genetics, UMR 9002 CNRS-UM, 34000 Montpellier, France
| | - Jerome Moreaux
- Department of Biological Hematology, CHU Montpellier, 34295 Montpellier, France 2Institute of Human Genetics, UMR 9002 CNRS-UM, 34000 Montpellier, France 3University of Montpellier, UFR Medicine, 34093 Montpellier, France 4 Institut Universitaire de France (IUF), 75000 Paris France
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9
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Ovejero S, Moreaux J. Multi-omics tumor profiling technologies to develop precision medicine in multiple myeloma. EXPLORATION OF TARGETED ANTI-TUMOR THERAPY 2021; 2:65-106. [PMID: 36046090 PMCID: PMC9400753 DOI: 10.37349/etat.2021.00034] [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: 10/17/2020] [Accepted: 01/06/2021] [Indexed: 11/19/2022] Open
Abstract
Multiple myeloma (MM), the second most common hematologic cancer, is caused by accumulation of aberrant plasma cells in the bone marrow. Its molecular causes are not fully understood and its great heterogeneity among patients complicates therapeutic decision-making. In the past decades, development of new therapies and drugs have significantly improved survival of MM patients. However, resistance to drugs and relapse remain the most common causes of mortality and are the major challenges to overcome. The advent of high throughput omics technologies capable of analyzing big amount of clinical and biological data has changed the way to diagnose and treat MM. Integration of omics data (gene mutations, gene expression, epigenetic information, and protein and metabolite levels) with clinical histories of thousands of patients allows to build scores to stratify the risk at diagnosis and predict the response to treatment, helping clinicians to make better educated decisions for each particular case. There is no doubt that the future of MM treatment relies on personalized therapies based on predictive models built from omics studies. This review summarizes the current treatments and the use of omics technologies in MM, and their importance in the implementation of personalized medicine.
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Affiliation(s)
- Sara Ovejero
- Department of Biological Hematology, CHU Montpellier, 34295 Montpellier, France 2Institute of Human Genetics, UMR 9002 CNRS-UM, 34000 Montpellier, France
| | - Jerome Moreaux
- Department of Biological Hematology, CHU Montpellier, 34295 Montpellier, France 2Institute of Human Genetics, UMR 9002 CNRS-UM, 34000 Montpellier, France 3UFR Medicine, University of Montpellier, 34093 Montpellier, France 4Institut Universitaire de France (IUF), 75000 Paris, France
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Jackson GH, Pawlyn C, Cairns DA, de Tute RM, Hockaday A, Collett C, Jones JR, Kishore B, Garg M, Williams CD, Karunanithi K, Lindsay J, Rocci A, Snowden JA, Jenner MW, Cook G, Russell NH, Drayson MT, Gregory WM, Kaiser MF, Owen RG, Davies FE, Morgan GJ. Carfilzomib, lenalidomide, dexamethasone, and cyclophosphamide (KRdc) as induction therapy for transplant-eligible, newly diagnosed multiple myeloma patients (Myeloma XI+): Interim analysis of an open-label randomised controlled trial. PLoS Med 2021; 18:e1003454. [PMID: 33428632 PMCID: PMC7799846 DOI: 10.1371/journal.pmed.1003454] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 11/23/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Carfilzomib is a second-generation irreversible proteasome inhibitor that is efficacious in the treatment of myeloma and carries less risk of peripheral neuropathy than first-generation proteasome inhibitors, making it more amenable to combination therapy. METHODS AND FINDINGS The Myeloma XI+ trial recruited patients from 88 sites across the UK between 5 December 2013 and 20 April 2016. Patients with newly diagnosed multiple myeloma eligible for transplantation were randomly assigned to receive the combination carfilzomib, lenalidomide, dexamethasone, and cyclophosphamide (KRdc) or a triplet of lenalidomide, dexamethasone, and cyclophosphamide (Rdc) or thalidomide, dexamethasone, and cyclophosphamide (Tdc). All patients were planned to receive an autologous stem cell transplantation (ASCT) prior to a randomisation between lenalidomide maintenance and observation. Eligible patients were aged over 18 years and had symptomatic myeloma. The co-primary endpoints for the study were progression-free survival (PFS) and overall survival (OS) for KRdc versus the Tdc/Rdc control group by intention to treat. PFS, response, and safety outcomes are reported following a planned interim analysis. The trial is registered (ISRCTN49407852) and has completed recruitment. In total, 1,056 patients (median age 61 years, range 33 to 75, 39.1% female) underwent induction randomisation to KRdc (n = 526) or control (Tdc/Rdc, n = 530). After a median follow-up of 34.5 months, KRdc was associated with a significantly longer PFS than the triplet control group (hazard ratio 0.63, 95% CI 0.51-0.76). The median PFS for patients receiving KRdc is not yet estimable, versus 36.2 months for the triplet control group (p < 0.001). Improved PFS was consistent across subgroups of patients including those with genetically high-risk disease. At the end of induction, the percentage of patients achieving at least a very good partial response was 82.3% in the KRdc group versus 58.9% in the control group (odds ratio 4.35, 95% CI 3.19-5.94, p < 0.001). Minimal residual disease negativity (cutoff 4 × 10-5 bone marrow leucocytes) was achieved in 55% of patients tested in the KRdc group at the end of induction, increasing to 75% of those tested after ASCT. The most common adverse events were haematological, with a low incidence of cardiac events. The trial continues to follow up patients to the co-primary endpoint of OS and for planned long-term follow-up analysis. Limitations of the study include a lack of blinding to treatment regimen and that the triplet control regimen did not include a proteasome inhibitor for all patients, which would be considered a current standard of care in many parts of the world. CONCLUSIONS The KRdc combination was well tolerated and was associated with both an increased percentage of patients achieving at least a very good partial response and a significant PFS benefit compared to immunomodulatory-agent-based triplet therapy. TRIAL REGISTRATION ClinicalTrials.gov ISRCTN49407852.
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Affiliation(s)
- Graham H. Jackson
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Charlotte Pawlyn
- The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - David A. Cairns
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Ruth M. de Tute
- Haematological Malignancy Diagnostic Service, St James’s University Hospital, Leeds, United Kingdom
| | - Anna Hockaday
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Corinne Collett
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - John R. Jones
- Kings College Hospital NHS Foundation Trust, London, United Kingdom
| | - Bhuvan Kishore
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Mamta Garg
- Leicester Royal Infirmary, Leicester, United Kingdom
| | - Cathy D. Williams
- Centre for Clinical Haematology, Nottingham University Hospital, Nottingham, United Kingdom
| | - Kamaraj Karunanithi
- University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom
| | - Jindriska Lindsay
- East Kent Hospitals University NHS Foundation Trust, Canterbury, United Kingdom
| | - Alberto Rocci
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - John A. Snowden
- Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Matthew W. Jenner
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Gordon Cook
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
- Section of Experimental Haematology, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, United Kingdom
| | - Nigel H. Russell
- Centre for Clinical Haematology, Nottingham University Hospital, Nottingham, United Kingdom
| | - Mark T. Drayson
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Walter M. Gregory
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Martin F. Kaiser
- The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - Roger G. Owen
- Haematological Malignancy Diagnostic Service, St James’s University Hospital, Leeds, United Kingdom
| | - Faith E. Davies
- Perlmutter Cancer Center, NYU Langone Health, New York, New York, United States of America
| | - Gareth J. Morgan
- Perlmutter Cancer Center, NYU Langone Health, New York, New York, United States of America
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11
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Hoang PH, Cornish AJ, Sherborne AL, Chubb D, Kimber S, Jackson G, Morgan GJ, Cook G, Kinnersley B, Kaiser M, Houlston RS. An enhanced genetic model of relapsed IGH-translocated multiple myeloma evolutionary dynamics. Blood Cancer J 2020; 10:101. [PMID: 33057009 PMCID: PMC7560599 DOI: 10.1038/s41408-020-00367-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/15/2020] [Accepted: 09/28/2020] [Indexed: 01/11/2023] Open
Abstract
Most patients with multiple myeloma (MM) die from progressive disease after relapse. To advance our understanding of MM evolution mechanisms, we performed whole-genome sequencing of 80 IGH-translocated tumour-normal newly diagnosed pairs and 24 matched relapsed tumours from the Myeloma XI trial. We identify multiple events as potentially important for survival and therapy-resistance at relapse including driver point mutations (e.g., TET2), translocations (MAP3K14), lengthened telomeres, and increased genomic instability (e.g., 17p deletions). Despite heterogeneous mutational processes contributing to relapsed mutations across MM subtypes, increased AID/APOBEC activity is particularly associated with shorter progression time to relapse, and contributes to higher mutational burden at relapse. In addition, we identify three enhanced major clonal evolution patterns of MM relapse, independent of treatment strategies and molecular karyotypes, questioning the viability of "evolutionary herding" approach in treating drug-resistant MM. Our data show that MM relapse is associated with acquisition of new mutations and clonal selection, and suggest APOBEC enzymes among potential targets for therapy-resistant MM.
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Affiliation(s)
- Phuc H Hoang
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, SM2 5NG, UK
- Division of Molecular Pathology, The Institute of Cancer Research, London, SM2 5NG, UK
| | - Alex J Cornish
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, SM2 5NG, UK
| | - Amy L Sherborne
- Division of Molecular Pathology, The Institute of Cancer Research, London, SM2 5NG, UK
| | - Daniel Chubb
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, SM2 5NG, UK
| | - Scott Kimber
- Division of Molecular Pathology, The Institute of Cancer Research, London, SM2 5NG, UK
| | - Graham Jackson
- Department of Haematology, University of Newcastle, Newcastle Upon Tyne, UK
| | | | - Gordon Cook
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Ben Kinnersley
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, SM2 5NG, UK
| | - Martin Kaiser
- Division of Molecular Pathology, The Institute of Cancer Research, London, SM2 5NG, UK.
| | - Richard S Houlston
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, SM2 5NG, UK.
- Division of Molecular Pathology, The Institute of Cancer Research, London, SM2 5NG, UK.
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12
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Kapoor R, Kumar R, Dubey AP. Risk Stratification in Multiple Myeloma in Indian Settings. Indian J Hematol Blood Transfus 2020; 36:464-472. [PMID: 32647419 DOI: 10.1007/s12288-019-01240-4] [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] [Received: 09/19/2019] [Accepted: 12/06/2019] [Indexed: 01/03/2023] Open
Abstract
Multiple myeloma (MM) constitutes 10% of all hematological malignancies. The last one decade has seen a phenomenal progress in the therapeutic options available for the management. Although it still remains incurable, with the advent of newer therapies, the median survival in many risk groups is now around 10 years. Conventional karyotyping of bone marrow samples has a positivity rate of 20-30% at diagnosis in patients of Multiple Myeloma. However, array Comparative Genomic Hybridisation (aCGH) has revealed that almost all MM patients have cytogenetic abnormalities which may affect the pathophysiology, selection of therapy and outcomes of the disease. The progress in the field of exploring the genetic landscape of multiple myeloma with multiple tools like Fluorescent in-situ hybridization, aCGH, Next Generation Sequencing, Flow cytometry, etc., combined with the traditional risk stratification markers like albumin, β2 microglobulin and LDH, is gradually leading towards a risk-adapted therapy. The recent R-ISS risk stratification has combined these two group of information to validate a prognostic score which is an improvement over the past tools like DSS and ISS. In view of the plethora of information available on the multitude of cytogenetic markers there is a tendency to evaluate for all of them at diagnosis, especially in research centers. This leads to a significant increase in the cost of therapy of Multiple Myeloma in day-to-day clinical practice and an increased out-of-pocket spending to the patient, especially in resource-limited settings like India. Also, there is a variable approach to pre-therapy cytogenetic evaluation and risk stratification at different Hematology centres in the country, often dictated by financial constraints and availability of specialized tests. This review discusses the risk stratification markers and tools available in MM in 2019 and how it can be adapted in the resource constraint settings so as to derive the maximum prognostic information from a minimal prognostic panel, as well as lead to standardization of the prognostic protocols in resource limited settings across various Hematology centres in India.
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Affiliation(s)
- Rajan Kapoor
- Medicine and Clinical Hematology, Command Hospital (EC), Kolkata, India
| | - Rajiv Kumar
- Department of Medicine and Clinical Hematology, INHS Asvini, R C Church, Colaba, Mumbai, 400005 India
| | - A P Dubey
- Medical Oncology, Clear Medi Hospitals and Cancer Centre, Ghaziabad, UP India
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13
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Pawlyn C, Cairns D, Kaiser M, Striha A, Jones J, Shah V, Jenner M, Drayson M, Owen R, Gregory W, Cook G, Morgan G, Jackson G, Davies F. The relative importance of factors predicting outcome for myeloma patients at different ages: results from 3894 patients in the Myeloma XI trial. Leukemia 2020; 34:604-612. [PMID: 31611625 PMCID: PMC7214257 DOI: 10.1038/s41375-019-0595-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/11/2019] [Accepted: 07/29/2019] [Indexed: 01/16/2023]
Abstract
Disease factors such as tumor burden and molecular risk affect myeloma patient outcomes as well as patient factors that impact the capacity to deliver treatment. How the relative importance of these factors changes with patient age has not previously been investigated comprehensively. We analyzed data from 3894 patients of all ages uniformly treated in a large clinical trial of myeloma patients, Myeloma XI. Even with novel therapeutic approaches progression-free survival (PFS) and overall survival (OS) are affected by age with a stepwise reduction in PFS and OS with each decade increase. Renal function deteriorated with increasing age whilst the frequency of t(4;14) and del(17p) decreased and gain(1q) increased. The relative contribution of performance status, international staging score and molecular risk to progression-free and overall survival varied by age group. Molecular events have a larger effect on outcome in younger patients with their relative contribution diminishing in the elderly. Performance status is important for patient outcome at all ages suggesting that physical frailty may be a more important predictor of outcome than age itself. Significant differences in the factors driving patient outcomes at different ages are important to consider as we design disease segmentation strategies to deliver personalized treatment approaches.
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Affiliation(s)
- Charlotte Pawlyn
- The Institute of Cancer Research, London, UK.
- The Royal Marsden Hospital NHS Foundation Trust, London, UK.
| | - David Cairns
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Martin Kaiser
- The Institute of Cancer Research, London, UK
- The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Alina Striha
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - John Jones
- The Institute of Cancer Research, London, UK
| | | | - Matthew Jenner
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Mark Drayson
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Roger Owen
- Haematological Malignancy Diagnostic Service (HMDS), St James's University Hospital, Leeds, UK
| | - Walter Gregory
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Gordon Cook
- Section of Experimental Haematology, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Gareth Morgan
- Perlmutter Cancer Center, NYU Langone Health, New York, UK
| | - Graham Jackson
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Faith Davies
- Perlmutter Cancer Center, NYU Langone Health, New York, UK
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14
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Jackson GH, Davies FE, Pawlyn C, Cairns DA, Striha A, Collett C, Waterhouse A, Jones JR, Kishore B, Garg M, Williams CD, Karunanithi K, Lindsay J, Wilson JN, Jenner MW, Cook G, Kaiser MF, Drayson MT, Owen RG, Russell NH, Gregory WM, Morgan GJ. Response-adapted intensification with cyclophosphamide, bortezomib, and dexamethasone versus no intensification in patients with newly diagnosed multiple myeloma (Myeloma XI): a multicentre, open-label, randomised, phase 3 trial. Lancet Haematol 2019; 6:e616-e629. [PMID: 31624047 PMCID: PMC7043012 DOI: 10.1016/s2352-3026(19)30167-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/16/2019] [Accepted: 07/17/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Multiple myeloma has been shown to have substantial clonal heterogeneity, suggesting that agents with different mechanisms of action might be required to induce deep responses and improve outcomes. Such agents could be given in combination or in sequence on the basis of previous response. We aimed to assess the clinical value of maximising responses by using therapeutic agents with different modes of action, the use of which is directed by the response to the initial combination therapy. We aimed to assess response-adapted intensification treatment with cyclophosphamide, bortezomib, and dexamethasone (CVD) versus no intensification treatment in patients with newly diagnosed multiple myeloma who had a suboptimal response to initial immunomodulatory triplet treatment which was standard of care in the UK at the time of trial design. METHODS The Myeloma XI trial was an open-label, randomised, phase 3, adaptive design trial done at 110 National Health Service hospitals in the UK. There were three potential randomisations in the study: induction treatment, intensification treatment, and maintenance treatment. Here, we report the results of the randomisation to intensification treatment. Eligible patients were aged 18 years or older and had symptomatic or non-secretory, newly diagnosed multiple myeloma, had completed their assigned induction therapy as per protocol (cyclophosphamide, thalidomide, and dexamethasone or cyclophosphamide, lenalidomide, and dexamethasone) and achieved a partial or minimal response. For the intensification treatment, patients were randomly assigned (1:1) to cyclophosphamide (500 mg daily orally on days 1, 8, and 15), bortezomib (1·3 mg/m2 subcutaneously or intravenously on days 1, 4, 8, and 11), and dexamethasone (20 mg daily orally on days 1, 2, 4, 5, 8, 9, 11, and 12) up to a maximum of eight cycles of 21 days or no treatment. Patients were stratified by allocated induction treatment, response to induction treatment, and centre. The co-primary endpoints were progression-free survival and overall survival, assessed from intensification randomisation to data cutoff, analysed by intention to treat. Safety analysis was per protocol. This study is registered with the ISRCTN registry, number ISRCTN49407852, and clinicaltrialsregister.eu, number 2009-010956-93, and has completed recruitment. FINDINGS Between Nov 15, 2010, and July 28, 2016, 583 patients were enrolled to the intensification randomisation, representing 48% of the 1217 patients who achieved partial or minimal response after initial induction therapy. 289 patients were assigned to CVD treatment and 294 patients to no treatment. After a median follow-up of 29·7 months (IQR 17·0-43·5), median progression-free survival was 30 months (95% CI 25-36) with CVD and 20 months (15-28) with no CVD (hazard ratio [HR] 0·60, 95% CI 0·48-0·75, p<0·0001), and 3-year overall survival was 77·3% (95% Cl 71·0-83·5) in the CVD group and 78·5% (72·3-84·6) in the no CVD group (HR 0·98, 95% CI 0·67-1·43, p=0·93). The most common grade 3 or 4 adverse events for patients taking CVD were haematological, including neutropenia (18 [7%] patients), thrombocytopenia (19 [7%] patients), and anaemia (8 [3%] patients). No deaths in the CVD group were deemed treatment related. INTERPRETATION Intensification treatment with CVD significantly improved progression-free survival in patients with newly diagnosed multiple myeloma and a suboptimal response to immunomodulatory induction therapy compared with no intensification treatment, but did not improve overall survival. The manageable safety profile of this combination and the encouraging results support further investigation of response-adapted approaches in this setting. The substantial number of patients not entering this trial randomisation following induction therapy, however, might support the use of combination therapies upfront to maximise response and improve outcomes as is now the standard of care in the UK. FUNDING Cancer Research UK, Celgene, Amgen, Merck, Myeloma UK.
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Affiliation(s)
- Graham H Jackson
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK.
| | - Faith E Davies
- Perlmutter Cancer Center, NY Langone Health, New York, NY, USA
| | - Charlotte Pawlyn
- The Institute of Cancer Research, London, UK; The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - David A Cairns
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Alina Striha
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Corinne Collett
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Anna Waterhouse
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - John R Jones
- The Institute of Cancer Research, London, UK; The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | | | - Mamta Garg
- Leicester Royal Infirmary, Leicester, UK
| | - Cathy D Williams
- Centre for Clinical Haematology, Nottingham University Hospital, Nottingham, UK
| | | | | | - Jamie N Wilson
- Western Sussex Hospitals NHS Foundation Trust, Chichester, UK
| | - Matthew W Jenner
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Gordon Cook
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK; Section of Experimental Haematology, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Martin F Kaiser
- The Institute of Cancer Research, London, UK; The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Mark T Drayson
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Roger G Owen
- Haematological Malignancy Diagnostic Service, St James's University Hospital, Leeds, UK
| | - Nigel H Russell
- Centre for Clinical Haematology, Nottingham University Hospital, Nottingham, UK
| | - Walter M Gregory
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Gareth J Morgan
- Perlmutter Cancer Center, NY Langone Health, New York, NY, USA
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15
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Jones JR, Weinhold N, Ashby C, Walker BA, Wardell C, Pawlyn C, Rasche L, Melchor L, Cairns DA, Gregory WM, Johnson D, Begum DB, Ellis S, Sherborne AL, Cook G, Kaiser MF, Drayson MT, Owen RG, Jackson GH, Davies FE, Greaves M, Morgan GJ. Clonal evolution in myeloma: the impact of maintenance lenalidomide and depth of response on the genetics and sub-clonal structure of relapsed disease in uniformly treated newly diagnosed patients. Haematologica 2019; 104:1440-1450. [PMID: 30733268 PMCID: PMC6601103 DOI: 10.3324/haematol.2018.202200] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 01/30/2019] [Indexed: 12/27/2022] Open
Abstract
The emergence of treatment resistant sub-clones is a key feature of relapse in multiple myeloma. Therapeutic attempts to extend remission and prevent relapse include maximizing response and the use of maintenance therapy. We used whole exome sequencing to study the genetics of paired samples taken at presentation and at relapse from 56 newly diagnosed patients, following induction therapy, randomized to receive either lenalidomide maintenance or observation as part of the Myeloma XI trial. Patients included were considered high risk, relapsing within 30 months of maintenance randomization. Patients achieving a complete response had predominantly branching evolutionary patterns leading to relapse, characterized by a greater mutational burden, an altered mutational profile, bi-allelic inactivation of tumor suppressor genes, and acquired structural aberrations. Conversely, in patients achieving a partial response, the evolutionary features were predominantly stable with a similar mutational and structural profile seen at both time points. There were no significant differences between patients relapsing after lenalidomide maintenance versus observation. This study shows that the depth of response is a key determinant of the evolutionary patterns seen at relapse. This trial is registered at clinicaltrials.gov identifier: 01554852.
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Affiliation(s)
- John R Jones
- Department of Haematology, The Royal Marsden Hospital NHS Foundation Trust, London, UK
- The Institute of Cancer Research, London, UK
| | - Niels Weinhold
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Cody Ashby
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Brian A Walker
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Chris Wardell
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Charlotte Pawlyn
- Department of Haematology, The Royal Marsden Hospital NHS Foundation Trust, London, UK
- The Institute of Cancer Research, London, UK
| | - Leo Rasche
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | - David A Cairns
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, UK
| | - Walter M Gregory
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, UK
| | | | - Dil B Begum
- The Institute of Cancer Research, London, UK
| | - Sidra Ellis
- The Institute of Cancer Research, London, UK
| | - Amy L Sherborne
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Gordon Cook
- Leeds Institute of Cancer and Pathology, University of Leeds, UK
| | - Martin F Kaiser
- Department of Haematology, The Royal Marsden Hospital NHS Foundation Trust, London, UK
- The Institute of Cancer Research, London, UK
| | - Mark T Drayson
- Clinical Immunology, School of Immunity and Infection, University of Birmingham, UK
| | - Roger G Owen
- Leeds Institute of Cancer and Pathology, University of Leeds, UK
| | - Graham H Jackson
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Faith E Davies
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Mel Greaves
- The Institute of Cancer Research, London, UK
| | - Gareth J Morgan
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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16
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Jackson GH, Davies FE, Pawlyn C, Cairns DA, Striha A, Collett C, Hockaday A, Jones JR, Kishore B, Garg M, Williams CD, Karunanithi K, Lindsay J, Jenner MW, Cook G, Russell NH, Kaiser MF, Drayson MT, Owen RG, Gregory WM, Morgan GJ. Lenalidomide maintenance versus observation for patients with newly diagnosed multiple myeloma (Myeloma XI): a multicentre, open-label, randomised, phase 3 trial. Lancet Oncol 2019; 20:57-73. [PMID: 30559051 PMCID: PMC6318225 DOI: 10.1016/s1470-2045(18)30687-9] [Citation(s) in RCA: 233] [Impact Index Per Article: 46.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 09/06/2018] [Accepted: 09/10/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Patients with multiple myeloma treated with lenalidomide maintenance therapy have improved progression-free survival, primarily following autologous stem-cell transplantation. A beneficial effect of lenalidomide maintenance therapy on overall survival in this setting has been inconsistent between individual studies. Minimal data are available on the effect of maintenance lenalidomide in more aggressive disease states, such as patients with cytogenetic high-risk disease or patients ineligible for transplantation. We aimed to assess lenalidomide maintenance versus observation in patients with newly diagnosed multiple myeloma, including cytogenetic risk and transplantation status subgroup analyses. METHODS The Myeloma XI trial was an open-label, randomised, phase 3, adaptive design trial with three randomisation stages done at 110 National Health Service hospitals in England, Wales, and Scotland. There were three potential randomisations in the study: induction treatment (allocation by transplantation eligibility status); intensification treatment (allocation by response to induction therapy); and maintenance treatment. Here, we report the results of the randomisation to maintenance treatment. Eligible patients for maintenance randomisation were aged 18 years or older and had symptomatic or non-secretory multiple myeloma, had completed their assigned induction therapy as per protocol and had achieved at least a minimal response to protocol treatment, including lenalidomide. Patients were randomly assigned (1:1 from Jan 13, 2011, to Jun 27, 2013, and 2:1 from Jun 28, 2013, to Aug 11, 2017) to lenalidomide maintenance (10 mg orally on days 1-21 of a 28-day cycle) or observation, and stratified by allocated induction and intensification treatment, and centre. The co-primary endpoints were progression-free survival and overall survival, analysed by intention to treat. Safety analysis was per protocol. This study is registered with the ISRCTN registry, number ISRCTN49407852, and clinicaltrialsregister.eu, number 2009-010956-93, and has completed recruitment. FINDINGS Between Jan 13, 2011, and Aug 11, 2017, 1917 patients were accrued to the maintenance treatment randomisation of the trial. 1137 patients were assigned to lenalidomide maintenance and 834 patients to observation. After a median follow-up of 31 months (IQR 18-50), median progression-free survival was 39 months (95% CI 36-42) with lenalidomide and 20 months (18-22) with observation (hazard ratio [HR] 0·46 [95% CI 0·41-0·53]; p<0·0001), and 3-year overall survival was 78·6% (95% Cl 75·6-81·6) in the lenalidomide group and 75·8% (72·4-79·2) in the observation group (HR 0·87 [95% CI 0·73-1·05]; p=0·15). Progression-free survival was improved with lenalidomide compared with observation across all prespecified subgroups. On prespecified subgroup analyses by transplantation status, 3-year overall survival in transplantation-eligible patients was 87·5% (95% Cl 84·3-90·7) in the lenalidomide group and 80·2% (76·0-84·4) in the observation group (HR 0·69 [95% CI 0·52-0·93]; p=0·014), and in transplantation-ineligible patients it was 66·8% (61·6-72·1) in the lenalidomide group and 69·8% (64·4-75·2) in the observation group (1·02 [0·80-1·29]; p=0·88). By cytogenetic risk group, in standard-risk patients, 3-year overall survival was 86·4% (95% CI 80·0-90·9) in the lenalidomide group compared with 81·3% (74·2-86·7) in the observation group, and in high-risk patients, it was 74.9% (65·8-81·9) in the lenalidomide group compared with 63·7% (52·8-72·7) in the observation group; and in ultra-high-risk patients it was 62·9% (46·0-75·8) compared with 43·5% (22·2-63·1). Since these subgroup analyses results were not powered they should be interpreted with caution. The most common grade 3 or 4 adverse events for patients taking lenalidomide were haematological, including neutropenia (362 [33%] patients), thrombocytopenia (72 [7%] patients), and anaemia (42 [4%] patients). Serious adverse events were reported in 494 (45%) of 1097 patients receiving lenalidomide compared with 150 (17%) of 874 patients on observation. The most common serious adverse events were infections in both the lenalidomide group and the observation group. 460 deaths occurred during maintenance treatment, 234 (21%) in the lenalidomide group and 226 (27%) in the observation group, and no deaths in the lenalidomide group were deemed treatment related. INTERPRETATION Maintenance therapy with lenalidomide significantly improved progression-free survival in patients with newly diagnosed multiple myeloma compared with observation, but did not improve overall survival in the intention-to-treat analysis of the whole trial population. The manageable safety profile of this drug and the encouraging results in subgroup analyses of patients across all cytogenetic risk groups support further investigation of maintenance lenalidomide in this setting. FUNDING Cancer Research UK, Celgene, Amgen, Merck, and Myeloma UK.
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Affiliation(s)
- Graham H Jackson
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK.
| | - Faith E Davies
- The Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Charlotte Pawlyn
- The Institute of Cancer Research, London, UK; The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - David A Cairns
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Alina Striha
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Corinne Collett
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Anna Hockaday
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - John R Jones
- The Institute of Cancer Research, London, UK; The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | | | - Mamta Garg
- Leicester Royal Infirmary, Leicester, UK
| | - Cathy D Williams
- Centre for Clinical Haematology, Nottingham University Hospital, Nottingham, UK
| | | | | | - Matthew W Jenner
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Gordon Cook
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK; Section of Experimental Haematology, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Nigel H Russell
- Centre for Clinical Haematology, Nottingham University Hospital, Nottingham, UK
| | - Martin F Kaiser
- The Institute of Cancer Research, London, UK; The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Mark T Drayson
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Roger G Owen
- Haematological Malignancy Diagnostic Service, St James's University Hospital, Leeds, UK
| | - Walter M Gregory
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Gareth J Morgan
- The Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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17
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Kaur G, Gupta R, Mathur N, Rani L, Kumar L, Sharma A, Singh V, Gupta A, Sharma OD. Clinical impact of chromothriptic complex chromosomal rearrangements in newly diagnosed multiple myeloma. Leuk Res 2018; 76:58-64. [PMID: 30576858 DOI: 10.1016/j.leukres.2018.12.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/12/2018] [Accepted: 12/14/2018] [Indexed: 11/26/2022]
Abstract
Complex Chromosomal Rearrangements (CCRs) are increasingly being reported as genetic risk factors of clinical significance in cancer owing to their identification using high resolution whole genome profiling technologies. This study employed high resolution CGH + SNP microarrays for whole genome copy number variations (CNV) profiling and identified CCRs in 11/107(10%) newly diagnosed Multiple Myeloma (MM) patients. Six patients exhibited Chromothripsis (CTH) among seven chromosomes that were confirmed with automated CTLPscanner web tool and; five cases displayed chromoplexy (CPL) which involved multiple chromosomes. Presence of chromothripsis in chromosome 17 in three out of six patients indicate a link between TP53 aberrations and incidence of CTH. Multivariable Cox regression model demonstrated a significant association of CTH with poor PFS (HR = 3.09, p = 0.010) and OS (HR = 3.31, p = 0.024) which suggests that CTH is an additional independent prognostic marker in multiple myeloma. Addition of CTH in risk stratification models in clinical setting in multiple myeloma may help in upfront identification of high risk patients for suitable customized therapy.
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Affiliation(s)
- Gurvinder Kaur
- Laboratory Oncology Unit, Dr. B.R.A.IRCH, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ritu Gupta
- Laboratory Oncology Unit, Dr. B.R.A.IRCH, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
| | - Nitin Mathur
- Laboratory Oncology Unit, Dr. B.R.A.IRCH, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Lata Rani
- Laboratory Oncology Unit, Dr. B.R.A.IRCH, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Lalit Kumar
- Department of Medical Oncology, Dr. B.R.A.IRCH, AIIMS, New Delhi, India
| | - Atul Sharma
- Department of Medical Oncology, Dr. B.R.A.IRCH, AIIMS, New Delhi, India
| | | | - Anubha Gupta
- Department of Electronics & Communications, Indraprastha Institute of Information Technology (IIIT), New Delhi, India
| | - Om Dutt Sharma
- Laboratory Oncology Unit, Dr. B.R.A.IRCH, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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18
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Chapman MA, Sive J, Ambrose J, Roddie C, Counsell N, Lach A, Abbasian M, Popat R, Cavenagh JD, Oakervee H, Streetly MJ, Schey S, Koh M, Willis F, Virchis AE, Crowe J, Quinn MF, Cook G, Crawley CR, Pratt G, Cook M, Braganza N, Adedayo T, Smith P, Clifton-Hadley L, Owen RG, Sonneveld P, Keats JJ, Herrero J, Yong K. RNA-seq of newly diagnosed patients in the PADIMAC study leads to a bortezomib/lenalidomide decision signature. Blood 2018; 132:2154-2165. [PMID: 30181174 PMCID: PMC6310235 DOI: 10.1182/blood-2018-05-849893] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 07/28/2018] [Indexed: 01/29/2023] Open
Abstract
Improving outcomes in multiple myeloma will involve not only development of new therapies but also better use of existing treatments. We performed RNA sequencing on samples from newly diagnosed patients enrolled in the phase 2 PADIMAC (Bortezomib, Adriamycin, and Dexamethasone Therapy for Previously Untreated Patients with Multiple Myeloma: Impact of Minimal Residual Disease in Patients with Deferred ASCT) study. Using synthetic annealing and the large margin nearest neighbor algorithm, we developed and trained a 7-gene signature to predict treatment outcome. We tested the signature in independent cohorts treated with bortezomib- and lenalidomide-based therapies. The signature was capable of distinguishing which patients would respond better to which regimen. In the CoMMpass data set, patients who were treated correctly according to the signature had a better progression-free survival (median, 20.1 months vs not reached; hazard ratio [HR], 0.40; confidence interval [CI], 0.23-0.72; P = .0012) and overall survival (median, 30.7 months vs not reached; HR, 0.41; CI, 0.21-0.80; P = .0049) than those who were not. Indeed, the outcome for these correctly treated patients was noninferior to that for those treated with combined bortezomib, lenalidomide, and dexamethasone, arguably the standard of care in the United States but not widely available elsewhere. The small size of the signature will facilitate clinical translation, thus enabling more targeted drug regimens to be delivered in myeloma.
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Affiliation(s)
- Michael A Chapman
- Department of Haematology, University of Cambridge, Cambridge, United Kingdom
- Department of Haematology, Addenbrookes Hospital, Cambridge, United Kingdom
| | - Jonathan Sive
- Department of Haemato-oncology, St. Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - John Ambrose
- Bill Lyons Informatics Centre, UCL Cancer Institute, University College London, London, United Kingdom
| | - Claire Roddie
- Department of Haematology, University College London Hospitals, London, United Kingdom
| | - Nicholas Counsell
- Cancer Research UK and UCL Cancer Trials Centre, London, United Kingdom
| | - Anna Lach
- Department of Haematology, UCL Cancer Institute, University College London, London, United Kingdom
| | - Mahnaz Abbasian
- Department of Haematology, UCL Cancer Institute, University College London, London, United Kingdom
| | - Rakesh Popat
- Department of Haematology, University College London Hospitals, London, United Kingdom
| | - Jamie D Cavenagh
- Department of Haemato-oncology, St. Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Heather Oakervee
- Department of Haemato-oncology, St. Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Matthew J Streetly
- Department of Haematology, Guys and St. Thomas' Hospital, London, United Kingdom
| | - Stephen Schey
- Department of Haematology, Kings College Hospital, London, United Kingdom
| | - Mickey Koh
- Department of Haematology, St. George's Hospital, London, United Kingdom
| | - Fenella Willis
- Department of Haematology, St. George's Hospital, London, United Kingdom
| | - Andres E Virchis
- Department of Haematology, Royal Free London, Barnet and Chase Farm Hospitals, London, United Kingdom
| | - Josephine Crowe
- Department of Haematology, Royal United Hospitals Bath, Bath, United Kingdom
| | - Michael F Quinn
- Department of Haematology, Belfast City Hospital, Belfast, United Kingdom
| | - Gordon Cook
- Department of Haematology, St. James's University Hospital, Leeds, United Kingdom
| | - Charles R Crawley
- Department of Haematology, Addenbrookes Hospital, Cambridge, United Kingdom
| | - Guy Pratt
- Centre for Clinical Haematology, University Hospitals Birmingham, Birmingham, United Kingdom
| | - Mark Cook
- Centre for Clinical Haematology, University Hospitals Birmingham, Birmingham, United Kingdom
| | - Nivette Braganza
- Cancer Research UK and UCL Cancer Trials Centre, London, United Kingdom
| | - Toyin Adedayo
- Cancer Research UK and UCL Cancer Trials Centre, London, United Kingdom
| | - Paul Smith
- Cancer Research UK and UCL Cancer Trials Centre, London, United Kingdom
| | | | - Roger G Owen
- Haematological Malignancy Diagnostic Service, St. James' University Hospital, Leeds, United Kingdom
| | | | - Jonathan J Keats
- Integrated Cancer Genomics Division, Translational Genomics Research Institute, Phoenix, AZ
| | - Javier Herrero
- Bill Lyons Informatics Centre, UCL Cancer Institute, University College London, London, United Kingdom
| | - Kwee Yong
- Department of Haematology, UCL Cancer Institute, University College London, London, United Kingdom
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19
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Subclonal TP53 copy number is associated with prognosis in multiple myeloma. Blood 2018; 132:2465-2469. [PMID: 30373884 DOI: 10.1182/blood-2018-06-857250] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 10/03/2018] [Indexed: 02/03/2023] Open
Abstract
Multiple myeloma (MM) is a genetically heterogeneous cancer of bone marrow plasma cells with variable outcome. To assess the prognostic relevance of clonal heterogeneity of TP53 copy number, we profiled tumors from 1777 newly diagnosed Myeloma XI trial patients with multiplex ligation-dependent probe amplification (MLPA). Subclonal TP53 deletions were independently associated with shorter overall survival, with a hazard ratio of 1.8 (95% confidence interval, 1.2-2.8; P = .01). Clonal, but not subclonal, TP53 deletions were associated with clinical markers of advanced disease, specifically lower platelet counts (P < .001) and increased lactate dehydrogenase (P < .001), as well as a higher frequency of features indicative of genomic instability, del(13q) (P = .002) or del(1p) (P = .006). Biallelic TP53 loss-of-function by mutation and deletion was rare (2.4%) and associated with advanced disease. We present a framework for identifying subclonal TP53 deletions by MLPA, to improve patient stratification in MM and tailor therapy, enabling management strategies.
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20
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Gupta R, Kaur G, Kumar L, Rani L, Mathur N, Sharma A, Dahiya M, Shekhar V, Khan S, Mookerjee A, Sharma OD. Nucleic acid based risk assessment and staging for clinical practice in multiple myeloma. Ann Hematol 2018; 97:2447-2454. [PMID: 30056581 DOI: 10.1007/s00277-018-3457-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 07/23/2018] [Indexed: 12/11/2022]
Abstract
The recently introduced Revised International Staging System (R-ISS) for multiple myeloma (MM) integrates albumin, β2 microglobulin, lactate dehydrogenase (LDH) with high-risk cytogenetic aberrations (CA), i.e., t(4;14) and t(14;16) and del17p using fluorescent in situ hybridization (FISH). We evaluated utility of nucleic acid-based tests of multiplex ligation-based probe amplification (MLPA) and quantitative real-time polymerase chain reaction (qRT-PCR) to define the CA and the R-ISS categories as per this approach were evaluated for their ability to predict outcome in terms of response, progression-free (PFS), and overall survival (OS). In this study (n = 180), 17 (9.4%), 118 (65.6%), and 45 (25%) patients were assigned to R-ISS1, R-ISS2, and R-ISS3 categories with statistically significant differences in median PFS (p = 0.02) and OS (p < 0.001).On univariate analysis, serum creatinine, LDH, 17p deletion, chromosome 1q gain, and response after first induction therapy were associated with statistically significant differences (p < 0.05) in PFS and in addition, age> 65 years and use of triplet therapy with OS. On multivariate analysis, only serum creatinine, LDH, and response after first induction therapy retained significance for predicting PFS and in addition, use of triplet therapy retained significance for the OS. The proposed nucleic acid-based algorithm using qRT-PCR and MLPA for R-ISS is resource-effective in terms of small quantities of sample required; feasibility of batch processing and reduced overall cost for the total number of regions evaluated and retained the prognostic significance of R-ISS, making it suitable for clinical practice for molecular characterization of MM.
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Affiliation(s)
- Ritu Gupta
- Laboratory Oncology Unit, Dr. B.R.A.IRCH, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029, India.
| | - Gurvinder Kaur
- Laboratory Oncology Unit, Dr. B.R.A.IRCH, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029, India
| | - Lalit Kumar
- Department of Medical Oncology, Dr. B.R.A.IRCH, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029, India
| | - Lata Rani
- Laboratory Oncology Unit, Dr. B.R.A.IRCH, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029, India
| | - Nitin Mathur
- Laboratory Oncology Unit, Dr. B.R.A.IRCH, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029, India
| | - Atul Sharma
- Department of Medical Oncology, Dr. B.R.A.IRCH, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029, India
| | - Meetu Dahiya
- Laboratory Oncology Unit, Dr. B.R.A.IRCH, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029, India
| | - Varun Shekhar
- Laboratory Oncology Unit, Dr. B.R.A.IRCH, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029, India
| | - Sadaf Khan
- Laboratory Oncology Unit, Dr. B.R.A.IRCH, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029, India
| | - Anjali Mookerjee
- Department of Medical Oncology, Dr. B.R.A.IRCH, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029, India
| | - Om Dutt Sharma
- Laboratory Oncology Unit, Dr. B.R.A.IRCH, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029, India
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21
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Vangsted AJ, Helm-Petersen S, Cowland JB, Jensen PB, Gimsing P, Barlogie B, Knudsen S. Drug response prediction in high-risk multiple myeloma. Gene 2017; 644:80-86. [PMID: 29122646 DOI: 10.1016/j.gene.2017.10.071] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/30/2017] [Accepted: 10/25/2017] [Indexed: 01/05/2023]
Abstract
A Drug Response Prediction (DRP) score was developed based on gene expression profiling (GEP) from cell lines and tumor samples. Twenty percent of high-risk patients by GEP70 treated in Total Therapy 2 and 3A have a progression-free survival (PFS) of more than 10years. We used available GEP data from high-risk patients by GEP70 at diagnosis from Total Therapy 2 and 3A to predict the response by the DRP score of drugs used in the treatment of myeloma patients. The DRP score stratified patients further. High-risk myeloma with a predicted sensitivity to melphalan by the DRP score had a prolonged PFS, HR=2.4 (1.2-4.9, P=0.014) and those with predicted sensitivity to bortezomib had a HR 5.7 (1.2-27, P=0.027). In case of predicted sensitivity to bortezomib, a better response to treatment was found (P=0.022). This method may provide us with a tool for identifying candidates for effective personalized medicine and spare potential non-responders from suffering toxicity.
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Affiliation(s)
- A J Vangsted
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | - S Helm-Petersen
- Granulocyte Research Laboratory, Copenhagen University Hospital, Copenhagen, Denmark
| | - J B Cowland
- Granulocyte Research Laboratory, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Genetics, Copenhagen University Hospital, Copenhagen, Denmark
| | - P B Jensen
- Medical Prognosis Institute, Hørsholm, Hematology-Oncology, Denmark
| | - P Gimsing
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - S Knudsen
- Medical Prognosis Institute, Hørsholm, Hematology-Oncology, Denmark
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22
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Neutral tumor evolution in myeloma is associated with poor prognosis. Blood 2017; 130:1639-1643. [PMID: 28827410 DOI: 10.1182/blood-2016-11-750612] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 08/07/2017] [Indexed: 12/24/2022] Open
Abstract
Recent studies suggest that the evolutionary history of a cancer is important in forecasting clinical outlook. To gain insight into the clonal dynamics of multiple myeloma (MM) and its possible influence on patient outcomes, we analyzed whole exome sequencing tumor data for 333 patients from Myeloma XI, a UK phase 3 trial and 434 patients from the CoMMpass study, all of which had received immunomodulatory drug (IMiD) therapy. By analyzing mutant allele frequency distributions in tumors, we found that 17% to 20% of MM is under neutral evolutionary dynamics. These tumors are associated with poorer patient survival in nonintensively treated patients, which is consistent with the reduced therapeutic efficacy of microenvironment-modulating IMiDs. Our findings provide evidence that knowledge of the evolutionary history of MM has relevance for predicting patient outcomes and personalizing therapy.
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23
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Shah V, Sherborne AL, Walker BA, Johnson DC, Boyle EM, Ellis S, Begum DB, Proszek PZ, Jones JR, Pawlyn C, Savola S, Jenner MW, Drayson MT, Owen RG, Houlston RS, Cairns DA, Gregory WM, Cook G, Davies FE, Jackson GH, Morgan GJ, Kaiser MF. Prediction of outcome in newly diagnosed myeloma: a meta-analysis of the molecular profiles of 1905 trial patients. Leukemia 2017; 32:102-110. [PMID: 28584253 PMCID: PMC5590713 DOI: 10.1038/leu.2017.179] [Citation(s) in RCA: 166] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 05/11/2017] [Accepted: 05/25/2017] [Indexed: 12/11/2022]
Abstract
Robust establishment of survival in multiple myeloma (MM) and its relationship to recurrent genetic aberrations is required as outcomes are variable despite apparent similar staging. We assayed copy number alterations (CNA) and translocations in 1036 patients from the NCRI Myeloma XI trial and linked these to overall survival (OS) and progression-free survival. Through a meta-anlysis of these data with data from MRC Myeloma IX trial, totalling 1905 newly diagnosed MM patients (NDMM), we confirm the association of t(4;14), t(14;16), t(14;20), del(17p) and gain(1q21) with poor prognosis with hazard ratios (HRs) for OS of 1.60 (P=4.77 × 10-7), 1.74 (P=0.0005), 1.90 (P=0.0089), 2.10 (P=8.86 × 10-14) and 1.68 (P=2.18 × 10-14), respectively. Patients with 'double-hit' defined by co-occurrence of at least two adverse lesions have an especially poor prognosis with HRs for OS of 2.67 (P=8.13 × 10-27) for all patients and 3.19 (P=1.23 × 10-18) for intensively treated patients. Using comprehensive CNA and translocation profiling in Myeloma XI we also demonstrate a strong association between t(4;14) and BIRC2/BIRC3 deletion (P=8.7 × 10-15), including homozygous deletion. Finally, we define distinct sub-groups of hyperdiploid MM, with either gain(1q21) and CCND2 overexpression (P<0.0001) or gain(11q25) and CCND1 overexpression (P<0.0001). Profiling multiple genetic lesions can identify MM patients likely to relapse early allowing stratification of treatment.
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Affiliation(s)
- V Shah
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - A L Sherborne
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - B A Walker
- MIRT, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - D C Johnson
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - E M Boyle
- Department of Haematology, Hopital Huriez, CHRU, Lille, France
| | - S Ellis
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - D B Begum
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - P Z Proszek
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - J R Jones
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - C Pawlyn
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - S Savola
- MRC Holland, Amsterdam, The Netherlands
| | - M W Jenner
- Department of Haematology, University Hospital Southampton, Southampton, UK
| | - M T Drayson
- Clinical Immunology, School of Immunity & Infection, University of Birmingham, Birmingham, UK
| | - R G Owen
- Department of Haematology, St James's University Hospital, Leeds, UK
| | - R S Houlston
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - D A Cairns
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - W M Gregory
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - G Cook
- Section of Experimental Haematology, Leeds Institute of Cancer & Pathology, University of Leeds, Leeds, UK
| | - F E Davies
- MIRT, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - G H Jackson
- Department of Haematology, Newcastle University, Newcastle upon Tyne, UK
| | - G J Morgan
- MIRT, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - M F Kaiser
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
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24
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Overexpression of EZH2 in multiple myeloma is associated with poor prognosis and dysregulation of cell cycle control. Blood Cancer J 2017; 7:e549. [PMID: 28362441 PMCID: PMC5380911 DOI: 10.1038/bcj.2017.27] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 02/23/2017] [Indexed: 12/31/2022] Open
Abstract
Myeloma is heterogeneous at the molecular level with subgroups of patients characterised by features of epigenetic dysregulation. Outcomes for myeloma patients have improved over the past few decades except for molecularly defined high-risk patients who continue to do badly. Novel therapeutic approaches are, therefore, required. A growing number of epigenetic inhibitors are now available including EZH2 inhibitors that are in early-stage clinical trials for treatment of haematological and other cancers with EZH2 mutations or in which overexpression has been correlated with poor outcomes. For the first time, we have identified and validated a robust and independent deleterious effect of high EZH2 expression on outcomes in myeloma patients. Using two chemically distinct small-molecule inhibitors, we demonstrate a reduction in myeloma cell proliferation with EZH2 inhibition, which leads to cell cycle arrest followed by apoptosis. This is mediated via upregulation of cyclin-dependent kinase inhibitors associated with removal of the inhibitory H3K27me3 mark at their gene loci. Our results suggest that EZH2 inhibition may be a potential therapeutic strategy for the treatment of myeloma and should be investigated in clinical studies.
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Therapeutics Targeting FGF Signaling Network in Human Diseases. Trends Pharmacol Sci 2016; 37:1081-1096. [DOI: 10.1016/j.tips.2016.10.003] [Citation(s) in RCA: 136] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 10/06/2016] [Accepted: 10/06/2016] [Indexed: 12/14/2022]
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Walker BA, Boyle EM, Wardell CP, Murison A, Begum DB, Dahir NM, Proszek PZ, Johnson DC, Kaiser MF, Melchor L, Aronson LI, Scales M, Pawlyn C, Mirabella F, Jones JR, Brioli A, Mikulasova A, Cairns DA, Gregory WM, Quartilho A, Drayson MT, Russell N, Cook G, Jackson GH, Leleu X, Davies FE, Morgan GJ. Mutational Spectrum, Copy Number Changes, and Outcome: Results of a Sequencing Study of Patients With Newly Diagnosed Myeloma. J Clin Oncol 2015; 33:3911-20. [PMID: 26282654 PMCID: PMC6485456 DOI: 10.1200/jco.2014.59.1503] [Citation(s) in RCA: 411] [Impact Index Per Article: 45.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE At the molecular level, myeloma is characterized by copy number abnormalities and recurrent translocations into the immunoglobulin heavy chain locus. Novel methods, such as massively parallel sequencing, have begun to describe the pattern of tumor-acquired mutations, but their clinical relevance has yet to be established. METHODS We performed whole-exome sequencing for 463 patients who presented with myeloma and were enrolled onto the National Cancer Research Institute Myeloma XI trial, for whom complete molecular cytogenetic and clinical outcome data were available. RESULTS We identified 15 significantly mutated genes: IRF4, KRAS, NRAS, MAX, HIST1H1E, RB1, EGR1, TP53, TRAF3, FAM46C, DIS3, BRAF, LTB, CYLD, and FGFR3. The mutational spectrum is dominated by mutations in the RAS (43%) and nuclear factor-κB (17%) pathways, but although they are prognostically neutral, they could be targeted therapeutically. Mutations in CCND1 and DNA repair pathway alterations (TP53, ATM, ATR, and ZNFHX4 mutations) are associated with a negative impact on survival. In contrast, those in IRF4 and EGR1 are associated with a favorable overall survival. We combined these novel mutation risk factors with the recurrent molecular adverse features and international staging system to generate an international staging system mutation score that can identify a high-risk population of patients who experience relapse and die prematurely. CONCLUSION We have refined our understanding of genetic events in myeloma and identified clinically relevant mutations that may be used to better stratify patients at presentation.
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Affiliation(s)
- Brian A Walker
- Brian A. Walker, Eileen M. Boyle, Christopher P. Wardell, Alex Murison, Dil B. Begum, Nasrin M. Dahir, Paula Z. Proszek, David C. Johnson, Martin F. Kaiser, Lorenzo Melchor, Lauren I. Aronson, Charlotte Pawlyn, Fabio Mirabella, John R. Jones, Annamaria Brioli, Faith E. Davies, and Gareth J. Morgan, The Institute of Cancer Research, London; Matthew Scales, The Institute of Cancer Research, Surrey; David A. Cairns, Walter M. Gregory, and Ana Quartilho, University of Leeds; Gordon Cook, St James's University Hospital, Leeds; Mark T. Drayson, University of Birmingham, Birmingham; Nigel Russell, Nottingham University Hospital, Nottingham; Graham H. Jackson, Newcastle University, Newcastle upon Tyne, United Kingdom; Aneta Mikulasova, Masaryk University, Brno, Czech Republic; and Xavier Leleu, Hôpital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Eileen M Boyle
- Brian A. Walker, Eileen M. Boyle, Christopher P. Wardell, Alex Murison, Dil B. Begum, Nasrin M. Dahir, Paula Z. Proszek, David C. Johnson, Martin F. Kaiser, Lorenzo Melchor, Lauren I. Aronson, Charlotte Pawlyn, Fabio Mirabella, John R. Jones, Annamaria Brioli, Faith E. Davies, and Gareth J. Morgan, The Institute of Cancer Research, London; Matthew Scales, The Institute of Cancer Research, Surrey; David A. Cairns, Walter M. Gregory, and Ana Quartilho, University of Leeds; Gordon Cook, St James's University Hospital, Leeds; Mark T. Drayson, University of Birmingham, Birmingham; Nigel Russell, Nottingham University Hospital, Nottingham; Graham H. Jackson, Newcastle University, Newcastle upon Tyne, United Kingdom; Aneta Mikulasova, Masaryk University, Brno, Czech Republic; and Xavier Leleu, Hôpital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Christopher P Wardell
- Brian A. Walker, Eileen M. Boyle, Christopher P. Wardell, Alex Murison, Dil B. Begum, Nasrin M. Dahir, Paula Z. Proszek, David C. Johnson, Martin F. Kaiser, Lorenzo Melchor, Lauren I. Aronson, Charlotte Pawlyn, Fabio Mirabella, John R. Jones, Annamaria Brioli, Faith E. Davies, and Gareth J. Morgan, The Institute of Cancer Research, London; Matthew Scales, The Institute of Cancer Research, Surrey; David A. Cairns, Walter M. Gregory, and Ana Quartilho, University of Leeds; Gordon Cook, St James's University Hospital, Leeds; Mark T. Drayson, University of Birmingham, Birmingham; Nigel Russell, Nottingham University Hospital, Nottingham; Graham H. Jackson, Newcastle University, Newcastle upon Tyne, United Kingdom; Aneta Mikulasova, Masaryk University, Brno, Czech Republic; and Xavier Leleu, Hôpital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Alex Murison
- Brian A. Walker, Eileen M. Boyle, Christopher P. Wardell, Alex Murison, Dil B. Begum, Nasrin M. Dahir, Paula Z. Proszek, David C. Johnson, Martin F. Kaiser, Lorenzo Melchor, Lauren I. Aronson, Charlotte Pawlyn, Fabio Mirabella, John R. Jones, Annamaria Brioli, Faith E. Davies, and Gareth J. Morgan, The Institute of Cancer Research, London; Matthew Scales, The Institute of Cancer Research, Surrey; David A. Cairns, Walter M. Gregory, and Ana Quartilho, University of Leeds; Gordon Cook, St James's University Hospital, Leeds; Mark T. Drayson, University of Birmingham, Birmingham; Nigel Russell, Nottingham University Hospital, Nottingham; Graham H. Jackson, Newcastle University, Newcastle upon Tyne, United Kingdom; Aneta Mikulasova, Masaryk University, Brno, Czech Republic; and Xavier Leleu, Hôpital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Dil B Begum
- Brian A. Walker, Eileen M. Boyle, Christopher P. Wardell, Alex Murison, Dil B. Begum, Nasrin M. Dahir, Paula Z. Proszek, David C. Johnson, Martin F. Kaiser, Lorenzo Melchor, Lauren I. Aronson, Charlotte Pawlyn, Fabio Mirabella, John R. Jones, Annamaria Brioli, Faith E. Davies, and Gareth J. Morgan, The Institute of Cancer Research, London; Matthew Scales, The Institute of Cancer Research, Surrey; David A. Cairns, Walter M. Gregory, and Ana Quartilho, University of Leeds; Gordon Cook, St James's University Hospital, Leeds; Mark T. Drayson, University of Birmingham, Birmingham; Nigel Russell, Nottingham University Hospital, Nottingham; Graham H. Jackson, Newcastle University, Newcastle upon Tyne, United Kingdom; Aneta Mikulasova, Masaryk University, Brno, Czech Republic; and Xavier Leleu, Hôpital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Nasrin M Dahir
- Brian A. Walker, Eileen M. Boyle, Christopher P. Wardell, Alex Murison, Dil B. Begum, Nasrin M. Dahir, Paula Z. Proszek, David C. Johnson, Martin F. Kaiser, Lorenzo Melchor, Lauren I. Aronson, Charlotte Pawlyn, Fabio Mirabella, John R. Jones, Annamaria Brioli, Faith E. Davies, and Gareth J. Morgan, The Institute of Cancer Research, London; Matthew Scales, The Institute of Cancer Research, Surrey; David A. Cairns, Walter M. Gregory, and Ana Quartilho, University of Leeds; Gordon Cook, St James's University Hospital, Leeds; Mark T. Drayson, University of Birmingham, Birmingham; Nigel Russell, Nottingham University Hospital, Nottingham; Graham H. Jackson, Newcastle University, Newcastle upon Tyne, United Kingdom; Aneta Mikulasova, Masaryk University, Brno, Czech Republic; and Xavier Leleu, Hôpital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Paula Z Proszek
- Brian A. Walker, Eileen M. Boyle, Christopher P. Wardell, Alex Murison, Dil B. Begum, Nasrin M. Dahir, Paula Z. Proszek, David C. Johnson, Martin F. Kaiser, Lorenzo Melchor, Lauren I. Aronson, Charlotte Pawlyn, Fabio Mirabella, John R. Jones, Annamaria Brioli, Faith E. Davies, and Gareth J. Morgan, The Institute of Cancer Research, London; Matthew Scales, The Institute of Cancer Research, Surrey; David A. Cairns, Walter M. Gregory, and Ana Quartilho, University of Leeds; Gordon Cook, St James's University Hospital, Leeds; Mark T. Drayson, University of Birmingham, Birmingham; Nigel Russell, Nottingham University Hospital, Nottingham; Graham H. Jackson, Newcastle University, Newcastle upon Tyne, United Kingdom; Aneta Mikulasova, Masaryk University, Brno, Czech Republic; and Xavier Leleu, Hôpital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - David C Johnson
- Brian A. Walker, Eileen M. Boyle, Christopher P. Wardell, Alex Murison, Dil B. Begum, Nasrin M. Dahir, Paula Z. Proszek, David C. Johnson, Martin F. Kaiser, Lorenzo Melchor, Lauren I. Aronson, Charlotte Pawlyn, Fabio Mirabella, John R. Jones, Annamaria Brioli, Faith E. Davies, and Gareth J. Morgan, The Institute of Cancer Research, London; Matthew Scales, The Institute of Cancer Research, Surrey; David A. Cairns, Walter M. Gregory, and Ana Quartilho, University of Leeds; Gordon Cook, St James's University Hospital, Leeds; Mark T. Drayson, University of Birmingham, Birmingham; Nigel Russell, Nottingham University Hospital, Nottingham; Graham H. Jackson, Newcastle University, Newcastle upon Tyne, United Kingdom; Aneta Mikulasova, Masaryk University, Brno, Czech Republic; and Xavier Leleu, Hôpital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Martin F Kaiser
- Brian A. Walker, Eileen M. Boyle, Christopher P. Wardell, Alex Murison, Dil B. Begum, Nasrin M. Dahir, Paula Z. Proszek, David C. Johnson, Martin F. Kaiser, Lorenzo Melchor, Lauren I. Aronson, Charlotte Pawlyn, Fabio Mirabella, John R. Jones, Annamaria Brioli, Faith E. Davies, and Gareth J. Morgan, The Institute of Cancer Research, London; Matthew Scales, The Institute of Cancer Research, Surrey; David A. Cairns, Walter M. Gregory, and Ana Quartilho, University of Leeds; Gordon Cook, St James's University Hospital, Leeds; Mark T. Drayson, University of Birmingham, Birmingham; Nigel Russell, Nottingham University Hospital, Nottingham; Graham H. Jackson, Newcastle University, Newcastle upon Tyne, United Kingdom; Aneta Mikulasova, Masaryk University, Brno, Czech Republic; and Xavier Leleu, Hôpital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Lorenzo Melchor
- Brian A. Walker, Eileen M. Boyle, Christopher P. Wardell, Alex Murison, Dil B. Begum, Nasrin M. Dahir, Paula Z. Proszek, David C. Johnson, Martin F. Kaiser, Lorenzo Melchor, Lauren I. Aronson, Charlotte Pawlyn, Fabio Mirabella, John R. Jones, Annamaria Brioli, Faith E. Davies, and Gareth J. Morgan, The Institute of Cancer Research, London; Matthew Scales, The Institute of Cancer Research, Surrey; David A. Cairns, Walter M. Gregory, and Ana Quartilho, University of Leeds; Gordon Cook, St James's University Hospital, Leeds; Mark T. Drayson, University of Birmingham, Birmingham; Nigel Russell, Nottingham University Hospital, Nottingham; Graham H. Jackson, Newcastle University, Newcastle upon Tyne, United Kingdom; Aneta Mikulasova, Masaryk University, Brno, Czech Republic; and Xavier Leleu, Hôpital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Lauren I Aronson
- Brian A. Walker, Eileen M. Boyle, Christopher P. Wardell, Alex Murison, Dil B. Begum, Nasrin M. Dahir, Paula Z. Proszek, David C. Johnson, Martin F. Kaiser, Lorenzo Melchor, Lauren I. Aronson, Charlotte Pawlyn, Fabio Mirabella, John R. Jones, Annamaria Brioli, Faith E. Davies, and Gareth J. Morgan, The Institute of Cancer Research, London; Matthew Scales, The Institute of Cancer Research, Surrey; David A. Cairns, Walter M. Gregory, and Ana Quartilho, University of Leeds; Gordon Cook, St James's University Hospital, Leeds; Mark T. Drayson, University of Birmingham, Birmingham; Nigel Russell, Nottingham University Hospital, Nottingham; Graham H. Jackson, Newcastle University, Newcastle upon Tyne, United Kingdom; Aneta Mikulasova, Masaryk University, Brno, Czech Republic; and Xavier Leleu, Hôpital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Matthew Scales
- Brian A. Walker, Eileen M. Boyle, Christopher P. Wardell, Alex Murison, Dil B. Begum, Nasrin M. Dahir, Paula Z. Proszek, David C. Johnson, Martin F. Kaiser, Lorenzo Melchor, Lauren I. Aronson, Charlotte Pawlyn, Fabio Mirabella, John R. Jones, Annamaria Brioli, Faith E. Davies, and Gareth J. Morgan, The Institute of Cancer Research, London; Matthew Scales, The Institute of Cancer Research, Surrey; David A. Cairns, Walter M. Gregory, and Ana Quartilho, University of Leeds; Gordon Cook, St James's University Hospital, Leeds; Mark T. Drayson, University of Birmingham, Birmingham; Nigel Russell, Nottingham University Hospital, Nottingham; Graham H. Jackson, Newcastle University, Newcastle upon Tyne, United Kingdom; Aneta Mikulasova, Masaryk University, Brno, Czech Republic; and Xavier Leleu, Hôpital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Charlotte Pawlyn
- Brian A. Walker, Eileen M. Boyle, Christopher P. Wardell, Alex Murison, Dil B. Begum, Nasrin M. Dahir, Paula Z. Proszek, David C. Johnson, Martin F. Kaiser, Lorenzo Melchor, Lauren I. Aronson, Charlotte Pawlyn, Fabio Mirabella, John R. Jones, Annamaria Brioli, Faith E. Davies, and Gareth J. Morgan, The Institute of Cancer Research, London; Matthew Scales, The Institute of Cancer Research, Surrey; David A. Cairns, Walter M. Gregory, and Ana Quartilho, University of Leeds; Gordon Cook, St James's University Hospital, Leeds; Mark T. Drayson, University of Birmingham, Birmingham; Nigel Russell, Nottingham University Hospital, Nottingham; Graham H. Jackson, Newcastle University, Newcastle upon Tyne, United Kingdom; Aneta Mikulasova, Masaryk University, Brno, Czech Republic; and Xavier Leleu, Hôpital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Fabio Mirabella
- Brian A. Walker, Eileen M. Boyle, Christopher P. Wardell, Alex Murison, Dil B. Begum, Nasrin M. Dahir, Paula Z. Proszek, David C. Johnson, Martin F. Kaiser, Lorenzo Melchor, Lauren I. Aronson, Charlotte Pawlyn, Fabio Mirabella, John R. Jones, Annamaria Brioli, Faith E. Davies, and Gareth J. Morgan, The Institute of Cancer Research, London; Matthew Scales, The Institute of Cancer Research, Surrey; David A. Cairns, Walter M. Gregory, and Ana Quartilho, University of Leeds; Gordon Cook, St James's University Hospital, Leeds; Mark T. Drayson, University of Birmingham, Birmingham; Nigel Russell, Nottingham University Hospital, Nottingham; Graham H. Jackson, Newcastle University, Newcastle upon Tyne, United Kingdom; Aneta Mikulasova, Masaryk University, Brno, Czech Republic; and Xavier Leleu, Hôpital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - John R Jones
- Brian A. Walker, Eileen M. Boyle, Christopher P. Wardell, Alex Murison, Dil B. Begum, Nasrin M. Dahir, Paula Z. Proszek, David C. Johnson, Martin F. Kaiser, Lorenzo Melchor, Lauren I. Aronson, Charlotte Pawlyn, Fabio Mirabella, John R. Jones, Annamaria Brioli, Faith E. Davies, and Gareth J. Morgan, The Institute of Cancer Research, London; Matthew Scales, The Institute of Cancer Research, Surrey; David A. Cairns, Walter M. Gregory, and Ana Quartilho, University of Leeds; Gordon Cook, St James's University Hospital, Leeds; Mark T. Drayson, University of Birmingham, Birmingham; Nigel Russell, Nottingham University Hospital, Nottingham; Graham H. Jackson, Newcastle University, Newcastle upon Tyne, United Kingdom; Aneta Mikulasova, Masaryk University, Brno, Czech Republic; and Xavier Leleu, Hôpital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Annamaria Brioli
- Brian A. Walker, Eileen M. Boyle, Christopher P. Wardell, Alex Murison, Dil B. Begum, Nasrin M. Dahir, Paula Z. Proszek, David C. Johnson, Martin F. Kaiser, Lorenzo Melchor, Lauren I. Aronson, Charlotte Pawlyn, Fabio Mirabella, John R. Jones, Annamaria Brioli, Faith E. Davies, and Gareth J. Morgan, The Institute of Cancer Research, London; Matthew Scales, The Institute of Cancer Research, Surrey; David A. Cairns, Walter M. Gregory, and Ana Quartilho, University of Leeds; Gordon Cook, St James's University Hospital, Leeds; Mark T. Drayson, University of Birmingham, Birmingham; Nigel Russell, Nottingham University Hospital, Nottingham; Graham H. Jackson, Newcastle University, Newcastle upon Tyne, United Kingdom; Aneta Mikulasova, Masaryk University, Brno, Czech Republic; and Xavier Leleu, Hôpital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Aneta Mikulasova
- Brian A. Walker, Eileen M. Boyle, Christopher P. Wardell, Alex Murison, Dil B. Begum, Nasrin M. Dahir, Paula Z. Proszek, David C. Johnson, Martin F. Kaiser, Lorenzo Melchor, Lauren I. Aronson, Charlotte Pawlyn, Fabio Mirabella, John R. Jones, Annamaria Brioli, Faith E. Davies, and Gareth J. Morgan, The Institute of Cancer Research, London; Matthew Scales, The Institute of Cancer Research, Surrey; David A. Cairns, Walter M. Gregory, and Ana Quartilho, University of Leeds; Gordon Cook, St James's University Hospital, Leeds; Mark T. Drayson, University of Birmingham, Birmingham; Nigel Russell, Nottingham University Hospital, Nottingham; Graham H. Jackson, Newcastle University, Newcastle upon Tyne, United Kingdom; Aneta Mikulasova, Masaryk University, Brno, Czech Republic; and Xavier Leleu, Hôpital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - David A Cairns
- Brian A. Walker, Eileen M. Boyle, Christopher P. Wardell, Alex Murison, Dil B. Begum, Nasrin M. Dahir, Paula Z. Proszek, David C. Johnson, Martin F. Kaiser, Lorenzo Melchor, Lauren I. Aronson, Charlotte Pawlyn, Fabio Mirabella, John R. Jones, Annamaria Brioli, Faith E. Davies, and Gareth J. Morgan, The Institute of Cancer Research, London; Matthew Scales, The Institute of Cancer Research, Surrey; David A. Cairns, Walter M. Gregory, and Ana Quartilho, University of Leeds; Gordon Cook, St James's University Hospital, Leeds; Mark T. Drayson, University of Birmingham, Birmingham; Nigel Russell, Nottingham University Hospital, Nottingham; Graham H. Jackson, Newcastle University, Newcastle upon Tyne, United Kingdom; Aneta Mikulasova, Masaryk University, Brno, Czech Republic; and Xavier Leleu, Hôpital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Walter M Gregory
- Brian A. Walker, Eileen M. Boyle, Christopher P. Wardell, Alex Murison, Dil B. Begum, Nasrin M. Dahir, Paula Z. Proszek, David C. Johnson, Martin F. Kaiser, Lorenzo Melchor, Lauren I. Aronson, Charlotte Pawlyn, Fabio Mirabella, John R. Jones, Annamaria Brioli, Faith E. Davies, and Gareth J. Morgan, The Institute of Cancer Research, London; Matthew Scales, The Institute of Cancer Research, Surrey; David A. Cairns, Walter M. Gregory, and Ana Quartilho, University of Leeds; Gordon Cook, St James's University Hospital, Leeds; Mark T. Drayson, University of Birmingham, Birmingham; Nigel Russell, Nottingham University Hospital, Nottingham; Graham H. Jackson, Newcastle University, Newcastle upon Tyne, United Kingdom; Aneta Mikulasova, Masaryk University, Brno, Czech Republic; and Xavier Leleu, Hôpital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Ana Quartilho
- Brian A. Walker, Eileen M. Boyle, Christopher P. Wardell, Alex Murison, Dil B. Begum, Nasrin M. Dahir, Paula Z. Proszek, David C. Johnson, Martin F. Kaiser, Lorenzo Melchor, Lauren I. Aronson, Charlotte Pawlyn, Fabio Mirabella, John R. Jones, Annamaria Brioli, Faith E. Davies, and Gareth J. Morgan, The Institute of Cancer Research, London; Matthew Scales, The Institute of Cancer Research, Surrey; David A. Cairns, Walter M. Gregory, and Ana Quartilho, University of Leeds; Gordon Cook, St James's University Hospital, Leeds; Mark T. Drayson, University of Birmingham, Birmingham; Nigel Russell, Nottingham University Hospital, Nottingham; Graham H. Jackson, Newcastle University, Newcastle upon Tyne, United Kingdom; Aneta Mikulasova, Masaryk University, Brno, Czech Republic; and Xavier Leleu, Hôpital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Mark T Drayson
- Brian A. Walker, Eileen M. Boyle, Christopher P. Wardell, Alex Murison, Dil B. Begum, Nasrin M. Dahir, Paula Z. Proszek, David C. Johnson, Martin F. Kaiser, Lorenzo Melchor, Lauren I. Aronson, Charlotte Pawlyn, Fabio Mirabella, John R. Jones, Annamaria Brioli, Faith E. Davies, and Gareth J. Morgan, The Institute of Cancer Research, London; Matthew Scales, The Institute of Cancer Research, Surrey; David A. Cairns, Walter M. Gregory, and Ana Quartilho, University of Leeds; Gordon Cook, St James's University Hospital, Leeds; Mark T. Drayson, University of Birmingham, Birmingham; Nigel Russell, Nottingham University Hospital, Nottingham; Graham H. Jackson, Newcastle University, Newcastle upon Tyne, United Kingdom; Aneta Mikulasova, Masaryk University, Brno, Czech Republic; and Xavier Leleu, Hôpital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Nigel Russell
- Brian A. Walker, Eileen M. Boyle, Christopher P. Wardell, Alex Murison, Dil B. Begum, Nasrin M. Dahir, Paula Z. Proszek, David C. Johnson, Martin F. Kaiser, Lorenzo Melchor, Lauren I. Aronson, Charlotte Pawlyn, Fabio Mirabella, John R. Jones, Annamaria Brioli, Faith E. Davies, and Gareth J. Morgan, The Institute of Cancer Research, London; Matthew Scales, The Institute of Cancer Research, Surrey; David A. Cairns, Walter M. Gregory, and Ana Quartilho, University of Leeds; Gordon Cook, St James's University Hospital, Leeds; Mark T. Drayson, University of Birmingham, Birmingham; Nigel Russell, Nottingham University Hospital, Nottingham; Graham H. Jackson, Newcastle University, Newcastle upon Tyne, United Kingdom; Aneta Mikulasova, Masaryk University, Brno, Czech Republic; and Xavier Leleu, Hôpital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Gordon Cook
- Brian A. Walker, Eileen M. Boyle, Christopher P. Wardell, Alex Murison, Dil B. Begum, Nasrin M. Dahir, Paula Z. Proszek, David C. Johnson, Martin F. Kaiser, Lorenzo Melchor, Lauren I. Aronson, Charlotte Pawlyn, Fabio Mirabella, John R. Jones, Annamaria Brioli, Faith E. Davies, and Gareth J. Morgan, The Institute of Cancer Research, London; Matthew Scales, The Institute of Cancer Research, Surrey; David A. Cairns, Walter M. Gregory, and Ana Quartilho, University of Leeds; Gordon Cook, St James's University Hospital, Leeds; Mark T. Drayson, University of Birmingham, Birmingham; Nigel Russell, Nottingham University Hospital, Nottingham; Graham H. Jackson, Newcastle University, Newcastle upon Tyne, United Kingdom; Aneta Mikulasova, Masaryk University, Brno, Czech Republic; and Xavier Leleu, Hôpital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Graham H Jackson
- Brian A. Walker, Eileen M. Boyle, Christopher P. Wardell, Alex Murison, Dil B. Begum, Nasrin M. Dahir, Paula Z. Proszek, David C. Johnson, Martin F. Kaiser, Lorenzo Melchor, Lauren I. Aronson, Charlotte Pawlyn, Fabio Mirabella, John R. Jones, Annamaria Brioli, Faith E. Davies, and Gareth J. Morgan, The Institute of Cancer Research, London; Matthew Scales, The Institute of Cancer Research, Surrey; David A. Cairns, Walter M. Gregory, and Ana Quartilho, University of Leeds; Gordon Cook, St James's University Hospital, Leeds; Mark T. Drayson, University of Birmingham, Birmingham; Nigel Russell, Nottingham University Hospital, Nottingham; Graham H. Jackson, Newcastle University, Newcastle upon Tyne, United Kingdom; Aneta Mikulasova, Masaryk University, Brno, Czech Republic; and Xavier Leleu, Hôpital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Xavier Leleu
- Brian A. Walker, Eileen M. Boyle, Christopher P. Wardell, Alex Murison, Dil B. Begum, Nasrin M. Dahir, Paula Z. Proszek, David C. Johnson, Martin F. Kaiser, Lorenzo Melchor, Lauren I. Aronson, Charlotte Pawlyn, Fabio Mirabella, John R. Jones, Annamaria Brioli, Faith E. Davies, and Gareth J. Morgan, The Institute of Cancer Research, London; Matthew Scales, The Institute of Cancer Research, Surrey; David A. Cairns, Walter M. Gregory, and Ana Quartilho, University of Leeds; Gordon Cook, St James's University Hospital, Leeds; Mark T. Drayson, University of Birmingham, Birmingham; Nigel Russell, Nottingham University Hospital, Nottingham; Graham H. Jackson, Newcastle University, Newcastle upon Tyne, United Kingdom; Aneta Mikulasova, Masaryk University, Brno, Czech Republic; and Xavier Leleu, Hôpital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Faith E Davies
- Brian A. Walker, Eileen M. Boyle, Christopher P. Wardell, Alex Murison, Dil B. Begum, Nasrin M. Dahir, Paula Z. Proszek, David C. Johnson, Martin F. Kaiser, Lorenzo Melchor, Lauren I. Aronson, Charlotte Pawlyn, Fabio Mirabella, John R. Jones, Annamaria Brioli, Faith E. Davies, and Gareth J. Morgan, The Institute of Cancer Research, London; Matthew Scales, The Institute of Cancer Research, Surrey; David A. Cairns, Walter M. Gregory, and Ana Quartilho, University of Leeds; Gordon Cook, St James's University Hospital, Leeds; Mark T. Drayson, University of Birmingham, Birmingham; Nigel Russell, Nottingham University Hospital, Nottingham; Graham H. Jackson, Newcastle University, Newcastle upon Tyne, United Kingdom; Aneta Mikulasova, Masaryk University, Brno, Czech Republic; and Xavier Leleu, Hôpital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Gareth J Morgan
- Brian A. Walker, Eileen M. Boyle, Christopher P. Wardell, Alex Murison, Dil B. Begum, Nasrin M. Dahir, Paula Z. Proszek, David C. Johnson, Martin F. Kaiser, Lorenzo Melchor, Lauren I. Aronson, Charlotte Pawlyn, Fabio Mirabella, John R. Jones, Annamaria Brioli, Faith E. Davies, and Gareth J. Morgan, The Institute of Cancer Research, London; Matthew Scales, The Institute of Cancer Research, Surrey; David A. Cairns, Walter M. Gregory, and Ana Quartilho, University of Leeds; Gordon Cook, St James's University Hospital, Leeds; Mark T. Drayson, University of Birmingham, Birmingham; Nigel Russell, Nottingham University Hospital, Nottingham; Graham H. Jackson, Newcastle University, Newcastle upon Tyne, United Kingdom; Aneta Mikulasova, Masaryk University, Brno, Czech Republic; and Xavier Leleu, Hôpital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France.
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Walker BA, Wardell CP, Murison A, Boyle EM, Begum DB, Dahir NM, Proszek PZ, Melchor L, Pawlyn C, Kaiser MF, Johnson DC, Qiang YW, Jones JR, Cairns DA, Gregory WM, Owen RG, Cook G, Drayson MT, Jackson GH, Davies FE, Morgan GJ. APOBEC family mutational signatures are associated with poor prognosis translocations in multiple myeloma. Nat Commun 2015; 6:6997. [PMID: 25904160 PMCID: PMC4568299 DOI: 10.1038/ncomms7997] [Citation(s) in RCA: 223] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 03/24/2015] [Indexed: 12/12/2022] Open
Abstract
We have sequenced 463 presenting cases of myeloma entered into the UK Myeloma XI study using whole exome sequencing. Here we identify mutations induced as a consequence of misdirected AID in the partner oncogenes of IGH translocations, which are activating and associated with impaired clinical outcome. An APOBEC mutational signature is seen in 3.8% of cases and is linked to the translocation-mediated deregulation of MAF and MAFB, a known poor prognostic factor. Patients with this signature have an increased mutational load and a poor prognosis. Loss of MAF or MAFB expression results in decreased APOBEC3B and APOBEC4 expression, indicating a transcriptional control mechanism. Kataegis, a further mutational pattern associated with APOBEC deregulation, is seen at the sites of the MYC translocation. The APOBEC mutational signature seen in myeloma is, therefore, associated with poor prognosis primary and secondary translocations and the molecular mechanisms involved in generating them.
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Affiliation(s)
- Brian A Walker
- Division of Molecular Pathology, The Institute of Cancer Research, London SM2 5NG, UK
| | - Christopher P Wardell
- Division of Molecular Pathology, The Institute of Cancer Research, London SM2 5NG, UK
| | - Alex Murison
- Division of Molecular Pathology, The Institute of Cancer Research, London SM2 5NG, UK
| | - Eileen M Boyle
- Division of Molecular Pathology, The Institute of Cancer Research, London SM2 5NG, UK
| | - Dil B Begum
- Division of Molecular Pathology, The Institute of Cancer Research, London SM2 5NG, UK
| | - Nasrin M Dahir
- Division of Molecular Pathology, The Institute of Cancer Research, London SM2 5NG, UK
| | - Paula Z Proszek
- Division of Molecular Pathology, The Institute of Cancer Research, London SM2 5NG, UK
| | - Lorenzo Melchor
- Division of Molecular Pathology, The Institute of Cancer Research, London SM2 5NG, UK
| | - Charlotte Pawlyn
- Division of Molecular Pathology, The Institute of Cancer Research, London SM2 5NG, UK
| | - Martin F Kaiser
- Division of Molecular Pathology, The Institute of Cancer Research, London SM2 5NG, UK
| | - David C Johnson
- Division of Molecular Pathology, The Institute of Cancer Research, London SM2 5NG, UK
| | - Ya-Wei Qiang
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA
| | - John R Jones
- Division of Molecular Pathology, The Institute of Cancer Research, London SM2 5NG, UK
| | - David A Cairns
- Clinical Trials Research Unit, University of Leeds, Leeds LS2 9JT, UK
| | - Walter M Gregory
- Clinical Trials Research Unit, University of Leeds, Leeds LS2 9JT, UK
| | - Roger G Owen
- St James's University Hospital, University of Leeds, Leeds LS2 9JT, UK
| | - Gordon Cook
- St James's University Hospital, University of Leeds, Leeds LS2 9JT, UK
| | - Mark T Drayson
- Clinical Immunology, School of Immunity &Infection, University of Birmingham, Birmingham B15 2TT, UK
| | - Graham H Jackson
- Department of Haematology, Newcastle University, Newcastle-Upon-Tyne NE1 7RU, UK
| | - Faith E Davies
- 1] Division of Molecular Pathology, The Institute of Cancer Research, London SM2 5NG, UK [2] Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA
| | - Gareth J Morgan
- 1] Division of Molecular Pathology, The Institute of Cancer Research, London SM2 5NG, UK [2] Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA
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28
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Coexistent hyperdiploidy does not abrogate poor prognosis in myeloma with adverse cytogenetics and may precede IGH translocations. Blood 2014; 125:831-40. [PMID: 25428216 DOI: 10.1182/blood-2014-07-584268] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The acquisition of the cytogenetic abnormalities hyperdiploidy or translocations into the immunoglobulin gene loci are considered as initiating events in the pathogenesis of myeloma and were often assumed to be mutually exclusive. These lesions have clinical significance; hyperdiploidy or the presence of the t(11;14) translocation is associated with a favorable outcome, whereas t(4;14), t(14;16), and t(14;20) are unfavorable. Poor outcomes are magnified when lesions occur in association with other high-risk features, del17p and +1q. Some patients have coexistence of both good and poor prognostic lesions, and there has been no consensus on their risk status. To address this, we have investigated their clinical impact using cases in the Myeloma IX study (ISRCTN68454111) and shown that the coexistence of hyperdiploidy or t(11;14) does not abrogate the poor prognosis associated with adverse molecular lesions, including translocations. We have also used single-cell analysis to study cases with coexistent translocations and hyperdiploidy to determine how these lesions cosegregate within the clonal substructure, and we have demonstrated that hyperdiploidy may precede IGH translocation in a proportion of patients. These findings have important clinical and biological implications, as we conclude patients with coexistence of adverse lesions and hyperdiploidy should be considered high risk and treated accordingly.
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29
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Boyle EM, Proszek PZ, Kaiser MF, Begum D, Dahir N, Savola S, Wardell CP, Leleu X, Ross FM, Chiecchio L, Cook G, Drayson MT, Owen RG, Ashcroft JM, Jackson GH, Anthony Child J, Davies FE, Walker BA, Morgan GJ. A molecular diagnostic approach able to detect the recurrent genetic prognostic factors typical of presenting myeloma. Genes Chromosomes Cancer 2014; 54:91-8. [PMID: 25287954 PMCID: PMC4310140 DOI: 10.1002/gcc.22222] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 09/11/2014] [Indexed: 02/02/2023] Open
Abstract
Risk stratification in myeloma requires an accurate assessment of the presence of a range of molecular abnormalities including the differing IGH translocations and the recurrent copy number abnormalities that can impact clinical behavior. Currently, interphase fluorescence in situ hybridization is used to detect these abnormalities. High failure rates, slow turnaround, cost, and labor intensiveness make it difficult and expensive to use in routine clinical practice. Multiplex ligation-dependent probe amplification (MLPA), a molecular approach based on a multiplex polymerase chain reaction method, offers an alternative for the assessment of copy number changes present in the myeloma genome. Here, we provide evidence showing that MLPA is a powerful tool for the efficient detection of copy number abnormalities and when combined with expression assays, MLPA can detect all of the prognostically relevant molecular events which characterize presenting myeloma. This approach opens the way for a molecular diagnostic strategy that is efficient, high throughput, and cost effective.
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Affiliation(s)
- Eileen M Boyle
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK; Service des maladies du Sang, Hopital Huriez, Centre Hospitalier Regional Universitaire de Lille, Lille, France
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30
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Walker BA, Wardell CP, Brioli A, Boyle E, Kaiser MF, Begum DB, Dahir NB, Johnson DC, Ross FM, Davies FE, Morgan GJ. Translocations at 8q24 juxtapose MYC with genes that harbor superenhancers resulting in overexpression and poor prognosis in myeloma patients. Blood Cancer J 2014; 4:e191. [PMID: 24632883 PMCID: PMC3972699 DOI: 10.1038/bcj.2014.13] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 02/06/2014] [Indexed: 02/06/2023] Open
Abstract
Secondary MYC translocations in myeloma have been shown to be important in the pathogenesis and progression of disease. Here, we have used a DNA capture and massively parallel sequencing approach to identify the partner chromosomes in 104 presentation myeloma samples. 8q24 breakpoints were identified in 21 (20%) samples with partner loci including IGH, IGK and IGL, which juxtapose the immunoglobulin (Ig) enhancers next to MYC in 8/23 samples. The remaining samples had partner loci including XBP1, FAM46C, CCND1 and KRAS, which are important in B-cell maturation or myeloma pathogenesis. Analysis of the region surrounding the breakpoints indicated the presence of superenhancers on the partner chromosomes and gene expression analysis showed increased expression of MYC in these samples. Patients with MYC translocations had a decreased progression-free and overall survival. We postulate that translocation breakpoints near MYC result in colocalization of the gene with superenhancers from loci, which are important in the development of the cell type in which they occur. In the case of myeloma these are the Ig loci and those important for plasma cell development and myeloma pathogenesis, resulting in increased expression of MYC and an aggressive disease phenotype.
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Affiliation(s)
- B A Walker
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - C P Wardell
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - A Brioli
- 1] Division of Molecular Pathology, The Institute of Cancer Research, London, UK [2] Istituto di Ematologia Seràgnoli, Università degli Studi di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - E Boyle
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - M F Kaiser
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - D B Begum
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - N B Dahir
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - D C Johnson
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - F M Ross
- Wessex Regional Genetics Laboratory, Salisbury District Hospital, Salisbury, UK
| | - F E Davies
- Divisions of Molecular Pathology, Cancer Therapeutics and Clinical Sciences, The Institute of Cancer Research, London, UK
| | - G J Morgan
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
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31
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Landgren O, Morgan GJ. Biologic frontiers in multiple myeloma: from biomarker identification to clinical practice. Clin Cancer Res 2013; 20:804-13. [PMID: 24270684 DOI: 10.1158/1078-0432.ccr-13-2159] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Since the mid-1990s, the multiple myeloma treatment landscape has evolved considerably, which has led to improved patient outcomes and prolonged survival. In addition to discovering new, targeted agents or treatment regimens, the identification and validation of biomarkers has the potential to further improve patient outcomes. The International Staging System relies on a number of biochemical parameters to stratify patients into risk categories. Other biologically relevant markers that are indicative of inherited genetic variation (e.g., single-nucleotide polymorphisms) or tumor-acquired genetic events (e.g., chromosomal translocations or mutations) have been studied for their prognostic potential. In patients with high-risk cytogenetics, plasma cells (PC) undergo genetic shifts over time, which may partially explain why high-risk patients relapse and are so difficult to treat. Although novel agents have improved treatment outcomes, identification of markers that will enable clinicians to determine which treatment is most appropriate for high-risk patients following initial diagnosis represents an exciting frontier in the clinical management of multiple myeloma. Biomarkers based on quantitating PCs or factors that are secreted from them (e.g., serum free light chain) may also help to risk-stratify patients with asymptomatic multiple myeloma. Eventually, identification of novel biomarkers may lead to the creation of personalized treatment regimens that are optimized to target clonal PCs that express a specific oncogenomic profile. Although the future is exciting, validation will be necessary before these biologic and molecular beacons can inform decision-making processes in a routine clinical setting.
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Affiliation(s)
- Ola Landgren
- Authors' Affiliations: National Cancer Institute, NIH, Center for Cancer Research, Medical Oncology Branch, Bethesda, Maryland; and The Institute of Cancer Research, Royal Cancer Hospital, London, United Kingdom
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32
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Sarasquete ME, Martínez-López J, Chillón MC, Alcoceba M, Corchete LA, Paiva B, Puig N, Sebastián E, Jiménez C, Mateos MV, Oriol A, Rosiñol L, Palomera L, Teruel AI, González Y, Lahuerta JJ, Bladé J, Gutiérrez NC, Fernández-Redondo E, González M, San Miguel JF, García-Sanz R. Evaluating gene expression profiling by quantitative polymerase chain reaction to develop a clinically feasible test for outcome prediction in multiple myeloma. Br J Haematol 2013; 163:223-34. [PMID: 23952215 DOI: 10.1111/bjh.12519] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 07/05/2013] [Indexed: 11/30/2022]
Abstract
The gene expression profiles (GEPs) of 96 selected genes were analysed by real-time quantitative polymerase chain reaction (qPCR) with a TaqMan low-density array card in isolated tumour plasma cells (PCs) from 157 newly diagnosed multiple myeloma (MM) patients. This qPCR-based GEP correctly classified cases following the Translocation-cyclin D classification. Classic prognostic parameters and qPCR-based GEP predicted MM patient outcome and, although multivariate analyses revealed that cytogenetic risk (standard vs. high risk) was the variable that most strongly predicted prognosis, GEP added significant information for risk stratification. Considering only the standard risk cytogenetic patients, multivariate analyses revealed that high β2-microglobulin, low CDKN1A and high SLC19A1 gene expression levels independently predicted a short time-to-progression (TTP), while high International Staging System stage, low CDKN2B and high TBRG4 gene expression predicted poor overall survival (OS). A gene expression risk score enabled the division of standard risk patients into two groups with different TTPs (83% vs. 38% at 3 years, P < 0·0001) and OS rates (88% vs. 61% at 5 years; P = 0·003). This study demonstrates that quantitative PCR is a robust, accurate and feasible technique for implementing in the daily routine as a surrogate for GEP-arrays.
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Affiliation(s)
- María E Sarasquete
- Servicio de Hematología, Hospital Universitario de Salamanca e Instituto Biosanitario de Salamanca (IBSAL), Universidad de Salamanca, Salamanca, Spain; Centro de Investigación del Cáncer de Salamanca, Salamanca, Spain
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33
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Somatic SETBP1 mutations in myeloid malignancies. Nat Genet 2013; 45:942-6. [PMID: 23832012 PMCID: PMC3729750 DOI: 10.1038/ng.2696] [Citation(s) in RCA: 196] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 06/13/2013] [Indexed: 12/14/2022]
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34
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Intraclonal heterogeneity is a critical early event in the development of myeloma and precedes the development of clinical symptoms. Leukemia 2013; 28:384-390. [PMID: 23817176 PMCID: PMC3916874 DOI: 10.1038/leu.2013.199] [Citation(s) in RCA: 216] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 06/23/2013] [Accepted: 06/24/2013] [Indexed: 01/17/2023]
Abstract
The mechanisms involved in progression from monoclonal gammopathy of undetermined significance (MGUS) and smoldering myeloma (SMM) to malignant multiple myeloma (MM) and plasma cell leukemia (PCL) are poorly understood but believed to involve the sequential acquisition of genetic hits. We performed exome and whole genome sequencing on a series of MGUS (n=4), high risk (HR)-SMM (n=4), MM (n=26) and PCL (n=2) samples, including four cases who transformed from HR-SMM to MM, to determine the genetic factors which drive progression of disease. The pattern and number of non-synonymous mutations show that the MGUS disease stage is less genetically complex than MM, and HR-SMM is similar to presenting MM. Intraclonal heterogeneity is present at all stages and using cases of HR-SMM, which transformed to MM, we show that intraclonal heterogeneity is a typical feature of the disease. At the HR-SMM stage of disease the majority of the genetic changes necessary to give rise to MM are already present. These data suggest that clonal progression is the key feature of transformation of HR-SMM to MM and as such the invasive clinically predominant clone typical of MM is already present at the SMM stage and would be amenable to therapeutic intervention at that stage.
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