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Guan J, Ma J, Chen B. Clinical and cytogenetic characteristics of primary and secondary plasma cell leukemia under the new IMWG definition criteria: a retrospective study. Hematology 2023; 28:2254556. [PMID: 37732631 DOI: 10.1080/16078454.2023.2254556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 08/29/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Plasma cell leukemia (PCL) is a rare and aggressive plasma cell disorder, exhibiting a more unfavorable prognosis than multiple myeloma. PCL is classified into pPCL and sPCL. Recently, the IMWG has recommended new PCL definition criteria, which require the presence of ≥5% circulating plasma cells in peripheral blood smears. Due to its low incidence, research on pPCL and sPCL is limited. METHODS We conducted a retrospective study and analyzed clinical and cytogenetic data of pPCL and sPCL patients. Overall survival (OS) and progression-free survival (PFS) were assessed by the Kaplan-Meier method, and survival distributions were compared using the log-rank test. RESULTS This is a small cohort comprising 23 pPCL and 9 sPCL patients. Notably, sPCL patients showed a higher incidence of extramedullary infiltration and a higher percentage of bone marrow plasma cells (p = 0.015 and 0.025, respectively). Although no significant difference was found between the two groups in OS and PFS, a trend emerged suggesting a superior survival outcome for pPCL patients, with a higher cumulative 1-year PFS rate (38.3% vs. 13.3%) and a lower early mortality rate (mortality rate at 3 months: 15% vs. 33%). We also suggested that pPCL patients carrying t(11;14) may have a longer median survival time than individuals with other cytogenetic abnormalities, but this was not confirmed due to the small sample size. CONCLUSION Our study revealed clinical and cytogenetic features of pPCL and sPCL patients according to the new diagnostic criteria. The findings suggested a generally better prognosis for pPCL than sPCL and the likelihood of t(11;14) translocation acting as a favorable prognostic factor in pPCL. It is important to note that our study had a limited sample size, which may lead to bias. We hope well-designed studies can be conducted to provide more results.
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Affiliation(s)
- Jiaheng Guan
- Department of Hematology and Oncology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, People's Republic of China
| | - Jinlong Ma
- Department of Hematology and Oncology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, People's Republic of China
| | - Baoan Chen
- Department of Hematology and Oncology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, People's Republic of China
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2
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Peña C, Riva E, Schutz N, Ramírez A, Vásquez J, Del Carpio D, Seehaus C, Ochoa P, Vengoa R, Duarte P, Martínez-Cordero H, Figueredo Y, Ríos RO, Ramírez J, Bove V, Roa M, Russo M, Espinoza M, Rodriguez G, Remaggi G, Enciso ME, Chandía M, Fantl D. Primary plasma cell leukemia in Latin America: demographic, clinical, and prognostic characteristics. A study of GELAMM group. Leuk Lymphoma 2023; 64:816-821. [PMID: 36695519 DOI: 10.1080/10428194.2023.2171266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Primary plasma cell leukemia (pPCL) is an infrequent and aggressive plasma cell disorder. The prognosis is still very poor, and the optimal treatment remains to be established. A retrospective, multicentric, international observational study was performed. Patients from 9 countries of Latin America (LATAM) with a diagnosis of pPCL between 2012 and 2020 were included. 72 patients were included. Treatment was based on thalidomide in 15%, proteasome inhibitors (PI)-based triplets in 38% and chemotherapy plus IMIDs and/or PI in 29%. The mortality rate at 3 months was 30%. The median overall survival (OS) was 18 months. In the multivariate analysis, frontline PI-based triplets, chemotherapy plus IMIDs and/or PI therapy, and maintenance were independent factors of better OS. In conclusion, the OS of pPCL is still poor in LATAM, with high early mortality. PI triplets, chemotherapy plus IMIDs, and/or PI and maintenance therapy were associated with improved survival.
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Affiliation(s)
| | | | - Natalia Schutz
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Jule Vásquez
- Instituto Nacional de Enfermedades Neoplásicas, Lima, Perú
| | | | | | - Paola Ochoa
- Instituto Alexander Fleming, Buenos Aires, Argentina
| | - Rosa Vengoa
- Hospital Alberto Sabogal Sologuren del Callao, Lima, Perú
| | | | | | | | | | | | | | | | - Moisés Russo
- Fundación Arturo López Pérez, Santiago de Chile.,Universidad Diego Portales, Santiago de Chile
| | | | | | | | | | | | - Dorotea Fantl
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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3
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[Update on biology of primary plasma cell leukemia]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2022; 43:603-607. [PMID: 36709141 PMCID: PMC9395563 DOI: 10.3760/cma.j.issn.0253-2727.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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4
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Jung SH, Lee JJ. Update on primary plasma cell leukemia. Blood Res 2022; 57:62-66. [PMID: 35483928 PMCID: PMC9057670 DOI: 10.5045/br.2022.2022033] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/24/2022] [Indexed: 01/01/2023] Open
Abstract
Plasma cell leukemia (PCL) is a rare and highly aggressive plasma cell neoplasm developing in 0.5?4% of patients with multiple myeloma (MM). The diagnostic criteria were recently revised from 20% to ≥5% of circulating plasma cells in peripheral blood smears. PCL is classified as primary or secondary; primary PCL is when it presents in patients with no MM. Primary PCL shows clinical and laboratory features at presentation that differ from MM and exhibits a dismal prognosis even with the use of effective agents against MM. Therefore, intensive chemotherapy should be initiated immediately after diagnosis, and autologous stem cell transplantation is recommended for transplant-eligible patients. Maintenance therapy after transplantation may reduce the rate of early relapses. We reviewed the definitions of PCL, revised diagnostic criteria, clinical features, and appropriate initial treatments for primary PCL.
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Affiliation(s)
- Sung-Hoon Jung
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Je-Jung Lee
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
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5
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Piechotta V, Skoetz N, Engelhardt M, Einsele H, Goldschmidt H, Scheid C. Patients With Multiple Myeloma or Monoclonal Gammopathy of Undetermined Significance. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:253-260. [PMID: 35314026 PMCID: PMC9358349 DOI: 10.3238/arztebl.m2022.0149] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 11/23/2021] [Accepted: 02/10/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Multiple myeloma (MM) is a malignant plasma-cell disease that arises on the basis of a so-called monoclonal gammopathy of undetermined significance (MGUS). The median age at disease onset is over 70. In Germany, there are approximately eight new cases per 100 000 inhabitants per year, or about 6000 new patients nationwide each year. METHODS To prepare this clinical practice guideline, a systematic literature review was carried out in medical databases (MEDLINE, CENTRAL), guideline databases (GIN), and the search portal of the German Institute for Quality and Efficiency in Health Care (IQWiG). The recommendations to be issued were based on two international guidelines, 40 dossier evaluations and systematic reviews, 10 randomized controlled trials, and 37 observational studies and finalized in a structured consensus process. RESULTS Because of its prognostic relevance, the use of the International Staging System (ISS) is recommended to stage MM and related plasma-cell neoplasms. When symptomatic MM is diagnosed, it is recommended to determine the extent of skeletal involvement by whole-body computed tomography. The indications for treatment shall be determined on the basis of the SLiMCRAB criteria; in all patients with MM it is recommended to include the biological (rather than chronological) age in the decisionmaking process. In suitable patients, it is recommended that initial treatment includes high-dose therapy, followed by main - tenance treatment. Even without high-dose treatment, a median progression-free survival of more than three years can be achieved with combination therapies. For the treatment of relapse, combinations of three drugs are more effective than doublet regimens with a median progression-free survival ranging from 10 to 45 months, depending on the study and prior therapy. Following anti-myeloma therapy, it is recommended to promptly offer physical exercise adapted to individual abilities to all patients who have the potential for rehabilitation, so that their quality of life can be sustained and improved. CONCLUSION This new clinical practice guideline addresses, in particular, the modalities of care that can be offered in addition to systemic antineoplastic therapy. In view of the significant recent advances in the treatment of myeloma, affected patients' quality of life now largely depends on optimized interdisciplinary care.
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Affiliation(s)
- Vanessa Piechotta
- Department of Internal Medicine I, Medical Faculty and University Hospital Cologne, Cologne University
| | - Nicole Skoetz
- Department of Internal Medicine I, Medical Faculty and University Hospital Cologne, Cologne University
| | - Monika Engelhardt
- Department for Internal Medicine I – Hematology, Oncology and Stem Cell Transplantation, Freiburg University Hospital
| | - Hermann Einsele
- Medical Clinic and Polyclinic II, University Hospital of Würzburg
| | - Hartmut Goldschmidt
- Department of Internal Medicine V, University Hospital and National Center for Tumor Diseases (NCT), Heidelberg
| | - Christof Scheid
- Department of Internal Medicine I, Medical Faculty and University Hospital Cologne, Cologne University
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6
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Hofste Op Bruinink D, Kuiper R, van Duin M, Cupedo T, van der Velden VHJ, Hoogenboezem R, van der Holt B, Beverloo HB, Valent ET, Vermeulen M, Gay F, Broijl A, Avet-Loiseau H, Munshi NC, Musto P, Moreau P, Zweegman S, van de Donk NWCJ, Sonneveld P. Identification of High-Risk Multiple Myeloma With a Plasma Cell Leukemia-Like Transcriptomic Profile. J Clin Oncol 2022; 40:3132-3150. [PMID: 35357885 PMCID: PMC9509081 DOI: 10.1200/jco.21.01217] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Primary plasma cell leukemia (pPCL) is an aggressive subtype of multiple myeloma, which is distinguished from newly diagnosed multiple myeloma (NDMM) on the basis of the presence of ≥ 20% circulating tumor cells (CTCs). A molecular marker for pPCL is currently lacking, which could help identify NDMM patients with high-risk PCL-like disease, despite not having been recognized as such clinically.
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Affiliation(s)
- Davine Hofste Op Bruinink
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.,Department of Immunology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Rowan Kuiper
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.,SkylineDx, Rotterdam, the Netherlands
| | - Mark van Duin
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Tom Cupedo
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | | | - Remco Hoogenboezem
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Bronno van der Holt
- HOVON Data Center, Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - H Berna Beverloo
- Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Michael Vermeulen
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Francesca Gay
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Annemiek Broijl
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | | | - Nikhil C Munshi
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Pellegrino Musto
- "Aldo Moro" University School of Medicine, Unit of Hematology and Stem Cell Transplantation, AOUC Policlinico, Bari, Italy
| | - Philippe Moreau
- Hematology Department, University Hospital Hôtel-Dieu, Nantes, France
| | - Sonja Zweegman
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Niels W C J van de Donk
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Pieter Sonneveld
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
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7
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Rojas EA, Gutiérrez NC. Genomics of Plasma Cell Leukemia. Cancers (Basel) 2022; 14:cancers14061594. [PMID: 35326746 PMCID: PMC8946729 DOI: 10.3390/cancers14061594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/12/2022] [Accepted: 03/16/2022] [Indexed: 11/30/2022] Open
Abstract
Simple Summary Plasma cell leukemia (PCL) is a very aggressive plasma cell disorder with a dismal prognosis, despite the therapeutic progress made in the last few years. The implementation of genomic high-throughput technologies in the clinical setting has revealed new insights into the genomic landscape of PCL, some of which may have an impact on the development of novel therapeutic approaches. The purpose of this review is to provide a comprehensive overview and update of the genomic studies carried out in PCL. Abstract Plasma cell leukemia (PCL) is a rare and highly aggressive plasma cell dyscrasia characterized by the presence of clonal circulating plasma cells in peripheral blood. PCL accounts for approximately 2–4% of all multiple myeloma (MM) cases. PCL can be classified in primary PCL (pPCL) when it appears de novo and in secondary PCL (sPCL) when it arises from a pre-existing relapsed/refractory MM. Despite the improvement in treatment modalities, the prognosis remains very poor. There is growing evidence that pPCL is a different clinicopathological entity as compared to MM, although the mechanisms underlying its pathogenesis are not fully elucidated. The development of new high-throughput technologies, such as microarrays and new generation sequencing (NGS), has contributed to a better understanding of the peculiar biological and clinical features of this disease. Relevant information is now available on cytogenetic alterations, genetic variants, transcriptome, methylation patterns, and non-coding RNA profiles. Additionally, attempts have been made to integrate genomic alterations with gene expression data. However, given the low frequency of PCL, most of the genetic information comes from retrospective studies with a small number of patients, sometimes leading to inconsistent results.
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Affiliation(s)
- Elizabeta A. Rojas
- Hematology Department, University Hospital of Salamanca, Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain;
- Cancer Research Center-Institute of Cancer Molecular and Cellular Biology (CIC-IBMCC) (USAL-CSIC), 37007 Salamanca, Spain
| | - Norma C. Gutiérrez
- Hematology Department, University Hospital of Salamanca, Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain;
- Cancer Research Center-Institute of Cancer Molecular and Cellular Biology (CIC-IBMCC) (USAL-CSIC), 37007 Salamanca, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), CB16/12/00233, 28029 Madrid, Spain
- Grupo Español de Mieloma (GEM), 28040 Madrid, Spain
- Correspondence: ; Tel.: +34-923-291-200 (ext. 56617)
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8
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Primary Plasma Cell Leukemia displaying t(11;14) have specific genomic, transcriptional and clinical feature. Blood 2022; 139:2666-2672. [PMID: 35171994 DOI: 10.1182/blood.2021014968] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/02/2022] [Indexed: 11/20/2022] Open
Abstract
Primary plasma cell leukemia (pPCL) is an aggressive form of multiple myeloma (MM) that has not benefited from recent therapeutic advances in the field. Because very rare and heterogeneous, it remains poorly understood at the molecular level. To address this issue, we performed DNA and RNA sequencing of sorted plasma cells from a large cohort of 90 newly diagnosed pPCL, and compared to MM. We observed that pPCL presents a specific genomic landscape with a high prevalence of t(11;14) (about half) and high-risk genomic features such as del(17p), gain 1q, del(1p32). In addition, pPCL displays a specific transcriptome when compared to MM. We then aimed at specifically characterize pPCL with t(11;14). We observed that this sub-entity displayed significantly fewer adverse cytogenetic abnormalities. This translated into better overall survival when compared to pPCL without t(11;14) (39.2 months vs 17.9 months, p=0.002). Finally, pPCL with t(11;14) displayed a specific transcriptome, including differential expression of BCL2 family members. This study is the largest series of patients with pPCL reported so far.
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9
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MacDougall KN, Rafay Khan Niazi M, Rehan M, Xue W, Dhar M. Immunoglobulin D Multiple Myeloma: A Rare Variant. Cureus 2022; 14:e21912. [PMID: 35273861 PMCID: PMC8901155 DOI: 10.7759/cureus.21912] [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] [Accepted: 02/03/2022] [Indexed: 11/16/2022] Open
Abstract
Immunoglobulin D multiple myeloma (IgD MM) is a rare isotype of multiple myeloma (MM), comprising less than 2% of all cases. It is often associated with advanced disease at the time of diagnosis, an aggressive clinical course, and shorter overall survival (OS) than other subtypes of MM. There is an increased frequency of undetectable or small monoclonal (M-) protein levels on electrophoresis, hypercalcemia, anemia, lytic bony lesions, and renal failure. However, given the rarity of the disease, there are few cases of IgD MM described in the literature. Given the very small amount of IgD immunoglobulins, they may form very small or undetectable M spike on electrophoresis, making the diagnostic error in diagnosing this specific subgroup very easy. Treatment for MM has seen significant advancement, especially over the last decade, with the advent of medications such as proteasome inhibitors, immunomodulatory agents, and monoclonal antibodies. It is important to understand how IgD MM responds to these newer agents and why this disease continues to be associated with poor outcomes despite advancements in treatment. Small clinical studies on patients with IgD MM show better outcomes following a combination of high-dose chemotherapy (HDCT) and autologous stem cell transplant (ASCT) compared to standard chemotherapy. Given the rarity of the disease, there are no large studies done to see the effectiveness of these treatments, and most of the data are derived from small case series. We report a case of IgD kappa MM that was incidentally discovered following a traumatic bicycle accident. The patient started treatment with bortezomib and dexamethasone (Vd) as an inpatient while he was in the rehabilitation unit and was later switched to bortezomib, dexamethasone, and lenalidomide (VRd) as an outpatient. He has now completed seven cycles and successfully underwent autologous hematopoietic stem cell transplantation.
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10
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Papadhimitriou SI, Terpos E, Liapis K, Pavlidis D, Marinakis T, Kastritis E, Dimopoulos MA, Tsitsilonis OE, Kostopoulos IV. The Cytogenetic Profile of Primary and Secondary Plasma Cell Leukemia: Etiopathogenetic Perspectives, Prognostic Impact and Clinical Relevance to Newly Diagnosed Multiple Myeloma with Differential Circulating Clonal Plasma Cells. Biomedicines 2022; 10:biomedicines10020209. [PMID: 35203419 PMCID: PMC8869452 DOI: 10.3390/biomedicines10020209] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/08/2022] [Accepted: 01/10/2022] [Indexed: 12/21/2022] Open
Abstract
Plasma cell leukemia (PCL) is a rare and aggressive plasma cell dyscrasia that may appear as de-novo leukemia (pPCL) or on the basis of a pre-existing multiple myeloma (MM), called secondary plasma cell leukemia (sPCL). In this prospective study, we have applied a broad panel of FISH probes in 965 newly diagnosed MM (NDMM) and 44 PCL cases of both types to reveal the particular cytogenetic differences among the three plasma cell dyscrasias. In order to evaluate the frequency and patterns of clonal evolution, the same FISH panel was applied both at diagnosis and at the time of first relapse for 81 relapsed MM patients and both at MM diagnosis and during sPCL transformation for the 19 sPCL cases described here. pPCL was characterized by frequent MYC translocations and t(11;14) with a 11q13 breakpoint centered on the MYEOV gene, not commonly seen in MM. sPCL had a higher number of FISH abnormalities and was strongly associated with the presence of del(17p13), either acquired at the initial MM stage or as a newly acquired lesion upon leukemogenesis in the context of the apparent clonal evolution observed in sPCL. In clinical terms, sPCL showed a shorter overall survival than pPCL with either standard or high-risk (t(4;14) and/or t(14;16) and/or del(17p13) and/or ≥3 concomitant aberrations) abnormalities (median 5 months vs. 21 and 11 months respectively, p < 0.001), suggesting a prognostic stratification based on cytogenetic background. These observations proved relevant in the NDMM setting, where higher levels of circulating plasma cells (CPCs) were strongly associated with high-risk cytogenetics (median frequency of CPCs: 0.11% of peripheral blood nucleated cells for high-risk vs. 0.007% for standard-risk NDMM, p < 0.0001). Most importantly, the combined evaluation of CPCs (higher or lower than a cut-off of 0.03%), together with patients’ cytogenetic status, could be used for an improved prognostic stratification of NDMM patients.
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Affiliation(s)
- Stefanos I. Papadhimitriou
- Department of Laboratory Hematology, Athens Regional General Hospital “Georgios Gennimatas”, 11527 Athens, Greece; (S.I.P.); (D.P.)
| | - Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.T.); (E.K.); (M.-A.D.)
| | - Konstantinos Liapis
- Department of Haematology, University Hospital of Alexandroupolis, Democritus University of Thrace Medical School, 68100 Alexandroupolis, Greece;
| | - Dimitrios Pavlidis
- Department of Laboratory Hematology, Athens Regional General Hospital “Georgios Gennimatas”, 11527 Athens, Greece; (S.I.P.); (D.P.)
| | - Theodoros Marinakis
- Department of Clinical Hematology, Athens Regional General Hospital “Georgios Gennimatas”, 11527 Athens, Greece;
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.T.); (E.K.); (M.-A.D.)
| | - Meletios-Athanasios Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.T.); (E.K.); (M.-A.D.)
| | - Ourania E. Tsitsilonis
- Department of Biology, School of Sciences, National and Kapodistrian University of Athens, Panepistimiopolis, Ilissia, 15784 Athens, Greece;
| | - Ioannis V. Kostopoulos
- Department of Laboratory Hematology, Athens Regional General Hospital “Georgios Gennimatas”, 11527 Athens, Greece; (S.I.P.); (D.P.)
- Department of Biology, School of Sciences, National and Kapodistrian University of Athens, Panepistimiopolis, Ilissia, 15784 Athens, Greece;
- Correspondence: or ; Tel.: +30-210-727-4929; Fax: +30-210-727-4635
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11
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Todoerti K, Taiana E, Puccio N, Favasuli V, Lionetti M, Silvestris I, Gentile M, Musto P, Morabito F, Gianelli U, Bolli N, Baldini L, Neri A, Ronchetti D. Transcriptomic Analysis in Multiple Myeloma and Primary Plasma Cell Leukemia with t(11;14) Reveals Different Expression Patterns with Biological Implications in Venetoclax Sensitivity. Cancers (Basel) 2021; 13:cancers13194898. [PMID: 34638381 PMCID: PMC8508148 DOI: 10.3390/cancers13194898] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 09/25/2021] [Indexed: 12/23/2022] Open
Abstract
Simple Summary The growing interest in BCL2 inhibitors for the treatment of multiple myeloma (MM) has led to the need for biomarkers that are able to predict patient’s sensitivity to the drug. The presence of the chromosomal translocation t(11;14) in MM is mainly associated with sensitivity to venetoclax and good prognosis. The incidence of t(11;14) largely increases in primary Plasma Cell Leukemia (pPCL) in association with an unfavorable outcome. Currently, data concerning pPCL sensitivity to venetoclax are virtually absent. In this context, we investigated the transcriptome of MM and pPCL with t(11;14), evidencing that the two clinical entities are likely responsive to venetoclax based on different molecular programs, thus prompting further studies to elucidate better novel potential predictive biomarkers. Abstract Mechanisms underlying the pathophysiology of primary Plasma Cell Leukemia (pPCL) and intramedullary multiple myeloma (MM) need to be further elucidated, being potentially relevant for improving therapeutic approaches. In such a context, the MM and pPCL subgroups characterized by t(11;14) deserve a focused investigation, as the presence of the translocation is mainly associated with sensitivity to venetoclax. Herein, we investigated a proprietary cohort of MM and pPCL patients, focusing on the transcriptional signature of samples carrying t(11;14), whose incidence increases in pPCL in association with an unfavorable outcome. In addition, we evaluated the expression levels of the BCL2-gene family members and of a panel of B-cell genes recently reported to be associated with sensitivity to venetoclax in MM. Moreover, transcriptional analysis of lncRNAs in the two clinical settings led to the identification of several differentially expressed transcripts, among which the SNGH6 deregulated lncRNA might be relevant in the pathogenesis and prognosis of pPCL with t(11;14). Overall, our data suggest that MMs and pPCLs with t(11;14) might be responsive to venetoclax based on different molecular programs, prompting further studies to elucidate better novel potential predictive biomarkers.
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Affiliation(s)
- Katia Todoerti
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (K.T.); (E.T.); (N.P.); (V.F.); (M.L.); (I.S.); (N.B.); (L.B.)
- Hematology, Fondazione Cà Granda IRCCS Policlinico, 20122 Milan, Italy
| | - Elisa Taiana
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (K.T.); (E.T.); (N.P.); (V.F.); (M.L.); (I.S.); (N.B.); (L.B.)
- Hematology, Fondazione Cà Granda IRCCS Policlinico, 20122 Milan, Italy
| | - Noemi Puccio
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (K.T.); (E.T.); (N.P.); (V.F.); (M.L.); (I.S.); (N.B.); (L.B.)
| | - Vanessa Favasuli
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (K.T.); (E.T.); (N.P.); (V.F.); (M.L.); (I.S.); (N.B.); (L.B.)
- Hematology, Fondazione Cà Granda IRCCS Policlinico, 20122 Milan, Italy
| | - Marta Lionetti
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (K.T.); (E.T.); (N.P.); (V.F.); (M.L.); (I.S.); (N.B.); (L.B.)
- Hematology, Fondazione Cà Granda IRCCS Policlinico, 20122 Milan, Italy
| | - Ilaria Silvestris
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (K.T.); (E.T.); (N.P.); (V.F.); (M.L.); (I.S.); (N.B.); (L.B.)
- Hematology, Fondazione Cà Granda IRCCS Policlinico, 20122 Milan, Italy
| | - Massimo Gentile
- Hematology Unit, “Annunziata” Hospital of Cosenza, 87100 Cosenza, Italy;
| | - Pellegrino Musto
- Department of Emergency and Organ Transplantation, “Aldo Moro” University School of Medicine, 70124 Bari, Italy;
- Unit of Hematology and Stem Cell Transplantation, AOUC Policlinico, 70124 Bari, Italy
| | - Fortunato Morabito
- Hematology and Bone Marrow Transplant Unit, Hemato-Oncology Department, Augusta Victoria Hospital, East Jerusalem 91191, Israel;
- Biotechnology Research Unit, Azienda Ospedaliera di Cosenza, 87100 Cosenza, Italy
| | - Umberto Gianelli
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy;
- Division of Pathology, Fondazione Cà Granda IRCCS Policlinico, 20122 Milan, Italy
| | - Niccolò Bolli
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (K.T.); (E.T.); (N.P.); (V.F.); (M.L.); (I.S.); (N.B.); (L.B.)
- Hematology, Fondazione Cà Granda IRCCS Policlinico, 20122 Milan, Italy
| | - Luca Baldini
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (K.T.); (E.T.); (N.P.); (V.F.); (M.L.); (I.S.); (N.B.); (L.B.)
- Hematology, Fondazione Cà Granda IRCCS Policlinico, 20122 Milan, Italy
| | - Antonino Neri
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (K.T.); (E.T.); (N.P.); (V.F.); (M.L.); (I.S.); (N.B.); (L.B.)
- Hematology, Fondazione Cà Granda IRCCS Policlinico, 20122 Milan, Italy
- Correspondence: (A.N.); (D.R.)
| | - Domenica Ronchetti
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (K.T.); (E.T.); (N.P.); (V.F.); (M.L.); (I.S.); (N.B.); (L.B.)
- Hematology, Fondazione Cà Granda IRCCS Policlinico, 20122 Milan, Italy
- Correspondence: (A.N.); (D.R.)
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12
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Gowin K, Skerget S, Keats JJ, Mikhael J, Cowan AJ. Plasma cell leukemia: A review of the molecular classification, diagnosis, and evidenced-based treatment. Leuk Res 2021; 111:106687. [PMID: 34425325 DOI: 10.1016/j.leukres.2021.106687] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/22/2021] [Accepted: 08/15/2021] [Indexed: 12/11/2022]
Abstract
Plasma cell leukemia is a rare and aggressive plasma cell dyscrasia associated with dismal outcomes. It may arise de novo, primary plasma cell leukemia, or evolve from an antecedent diagnosis of multiple myeloma, secondary plasma cell leukemia. Despite highly effective therapeutics, survival for plasma cell leukemia patients remains poor. Molecular knowledge of plasma cell leukemia has recently expanded with use of gene expression profiling and whole exome sequencing, lending new insights into prognosis and therapeutic development. In this review, we describe the molecular knowledge, clinical characteristics, evidenced-based therapeutic approaches and treatment outcomes of plasma cell leukemia.
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Affiliation(s)
- Krisstina Gowin
- University of Arizona, Department of Bone Marrow Transplant and Cellular Therapy, Tucson, AZ, United States.
| | - Sheri Skerget
- Translational Genomics Research Institute (TGen), Integrated Cancer Genomics Division, Phoenix, AZ, United States
| | - Jonathan J Keats
- Translational Genomics Research Institute (TGen), Integrated Cancer Genomics Division, Phoenix, AZ, United States
| | - Joseph Mikhael
- Translational Genomics Research Institute (TGen), Applied Cancer Research and Drug Discovery Division, Phoenix, AZ, United States
| | - Andrew J Cowan
- University of Washington, Department of Hematology Oncology, Seattle, WA, United States
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13
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Visram A, Suska A, Jurczyszyn A, Gonsalves WI. Practical management and assessment of primary plasma cell leukemia in the novel agent era. Cancer Treat Res Commun 2021; 28:100414. [PMID: 34174530 DOI: 10.1016/j.ctarc.2021.100414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 05/08/2021] [Accepted: 05/27/2021] [Indexed: 10/21/2022]
Affiliation(s)
- A Visram
- University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | - A Suska
- Department of Hematology, Jagiellonian University Medical College, Kopernika 17, Krakow 31-501, Poland
| | - A Jurczyszyn
- Department of Hematology, Jagiellonian University Medical College, Kopernika 17, Krakow 31-501, Poland
| | - W I Gonsalves
- Division of Hematology, Mayo Clinic, Rochester, MN, United States.
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14
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A clinical perspective on plasma cell leukemia; current status and future directions. Blood Cancer J 2021; 11:23. [PMID: 33563906 PMCID: PMC7873074 DOI: 10.1038/s41408-021-00414-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/15/2020] [Accepted: 01/14/2021] [Indexed: 02/08/2023] Open
Abstract
Primary plasma cell leukemia (pPCL) is an aggressive plasma cell disorder with a guarded prognosis. The diagnosis is confirmed when peripheral blood plasma cells (PCs) exceed 20% of white blood cells or 2000/μL. Emerging data demonstrates that patients with lower levels of circulating (PCs) have the same adverse prognosis, challenging the clinical disease definition, but supporting the adverse impact of circulating PCs. The cornerstone of treatment consists of combination therapy incorporating a proteasome inhibitor, an immunomodulatory agent, steroids, and/or anthracyclines and alkylators as part of more-intensive chemotherapy, followed by consolidative autologous hematopoietic cell transplantation in eligible patients and then maintenance therapy. Monoclonal antibodies are also currently being evaluated in this setting with a strong rationale for their use based on their activity in multiple myeloma (MM). Due to limited therapeutic studies specifically evaluating pPCL, patients with pPCL should be considered for clinical trials. In contrast to MM, the outcomes of patients with pPCL have only modestly improved with novel therapies, and secondary PCL arising from MM in particular is associated with a dismal outlook. Newer drug combinations, immunotherapy, and cellular therapy are under investigation, and these approaches hopefully will demonstrate efficacy to improve the prognosis of pPCL.
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15
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Zeissig MN, Zannettino ACW, Vandyke K. Tumour Dissemination in Multiple Myeloma Disease Progression and Relapse: A Potential Therapeutic Target in High-Risk Myeloma. Cancers (Basel) 2020; 12:cancers12123643. [PMID: 33291672 PMCID: PMC7761917 DOI: 10.3390/cancers12123643] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/02/2020] [Accepted: 12/02/2020] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Like in solid cancers, the process of dissemination is a critical feature of disease progression in the blood cancer multiple myeloma. At diagnosis, myeloma patients have cancer that has spread throughout the bone marrow, with patients with more disseminatory myeloma having worse outcomes for their disease. In this review, we discuss the current understanding of the mechanisms that underpin the dissemination process in multiple myeloma. Furthermore, we discuss the potential for the use of therapies that target the dissemination process as a novel means of improving outcomes for multiple myeloma patients. Abstract Multiple myeloma (MM) is a plasma cell (PC) malignancy characterised by the presence of MM PCs at multiple sites throughout the bone marrow. Increased numbers of peripheral blood MM PCs are associated with rapid disease progression, shorter time to relapse and are a feature of advanced disease. In this review, the current understanding of the process of MM PC dissemination and the extrinsic and intrinsic factors potentially driving it are addressed through analysis of patient-derived MM PCs and MM cell lines as well as mouse models of homing and dissemination. In addition, we discuss how patient cytogenetic subgroups that present with highly disseminated disease, such as t(4;14), t(14;16) and t(14;20), suggest that intrinsic properties of MM PC influence their ability to disseminate. Finally, we discuss the possibility of using therapeutic targeting of tumour dissemination to slow disease progression and prevent overt relapse.
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Affiliation(s)
- Mara N. Zeissig
- Myeloma Research Laboratory, Faculty of Health and Medical Sciences, Adelaide Medical School, The University of Australia, Adelaide 5005, Australia; (M.N.Z.); (A.C.W.Z.)
- Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide 5000, Australia
| | - Andrew C. W. Zannettino
- Myeloma Research Laboratory, Faculty of Health and Medical Sciences, Adelaide Medical School, The University of Australia, Adelaide 5005, Australia; (M.N.Z.); (A.C.W.Z.)
- Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide 5000, Australia
- Central Adelaide Local Health Network, Adelaide 5000, Australia
- Centre for Cancer Biology, University of South Australia, Adelaide 5000, Australia
| | - Kate Vandyke
- Myeloma Research Laboratory, Faculty of Health and Medical Sciences, Adelaide Medical School, The University of Australia, Adelaide 5005, Australia; (M.N.Z.); (A.C.W.Z.)
- Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide 5000, Australia
- Correspondence: ; Tel.: +61-8-8128-4694
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16
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Suska A, Vesole DH, Castillo JJ, Kumar SK, Parameswaran H, Mateos MV, Facon T, Gozzetti A, Mikala G, Szostek M, Mikhael J, Hajek R, Terpos E, Jurczyszyn A. Plasma Cell Leukemia - Facts and Controversies: More Questions than Answers? Clin Hematol Int 2020; 2:133-142. [PMID: 34595454 PMCID: PMC8432408 DOI: 10.2991/chi.k.200706.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/01/2020] [Indexed: 11/18/2022] Open
Abstract
Plasma cell leukemia (PCL) is an aggressive hematological malignancy characterized by an uncontrolled clonal proliferation of plasma cells (PCs) in the bone marrow and peripheral blood. PCL has been defined by an absolute number of circulating PCs exceeding 2.0 × 109/L and/or >20% PCs in the total leucocyte count. It is classified as primary PCL, which develops de novo, and secondary PCL, occurring at the late and advanced stages of multiple myeloma (MM). Primary and secondary PCL are clinically and biologically two distinct entities. After the diagnosis, treatment should be immediate and should include a proteasome inhibitor and immunomodulator-based combination regimens as induction, followed by stem cell transplantation (SCT) in transplant-eligible individuals who have cleared the peripheral blood of circulating PCs. Due to the rarity of the condition, there have been very few clinical trials. Furthermore, virtually all of the myeloma trials exclude patients with active PCL. The evaluation of response has been defined by the International Myeloma Working Group and consists of both acute leukemia and MM criteria. With conventional chemotherapy, the prognosis of primary PCL has been ominous, with reported overall survival (OS) ranging from 6.8 to 12.6 months. The use of novel agents and autologous SCT appears to be associated with deeper response and an improved survival, although it still remains low. The PCL prognostic index provides a simple score to risk-stratify PCL. The prognosis of secondary PCL is extremely poor, with OS of only 1 month.
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Affiliation(s)
- Anna Suska
- Department of Hematology, Jagiellonian University Medical College, Kopernika 17, Krakow 31-501, Poland
| | - David H Vesole
- The John Theurer Cancer Center at Hackensack UMC, Hackensack, NJ, USA
| | - Jorge J Castillo
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Shaji K Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Maria V Mateos
- Complejo Asistencial Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (CAUSA/IBSAL), Salamanca, Spain
| | - Thierry Facon
- Service des Maladies du Sang, Hôpital Claude Huriez, Lille, France
| | | | - Gabor Mikala
- Department of Hematology and Stem Cell Transplantation, South-Pest Central Hospital, Natl. Inst. Hematol. Infectol, Budapest, Hungary
| | - Marta Szostek
- Department of Hematology, Jagiellonian University Medical College, Kopernika 17, Krakow 31-501, Poland
| | - Joseph Mikhael
- Translational Genomics Research Institute, City of Hope Cancer Center, Phoenix, Arizona, USA
| | - Roman Hajek
- University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Artur Jurczyszyn
- Department of Hematology, Jagiellonian University Medical College, Kopernika 17, Krakow 31-501, Poland
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17
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Glavey SV, Flanagan L, Bleach R, Kelly C, Quinn J, Ní Chonghaile T, Murphy P. Secondary plasma cell leukaemia treated with single agent venetoclax. Br J Haematol 2020; 190:e242-e245. [PMID: 32525557 DOI: 10.1111/bjh.16858] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Siobhan V Glavey
- Department of Haematology, Royal College of Surgeons in Ireland and Beaumont Hospital, Dublin, Ireland
| | - Lyndsey Flanagan
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Rachel Bleach
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Claire Kelly
- Department of Haematology, Royal College of Surgeons in Ireland and Beaumont Hospital, Dublin, Ireland
| | - John Quinn
- Department of Haematology, Royal College of Surgeons in Ireland and Beaumont Hospital, Dublin, Ireland
| | - Tríona Ní Chonghaile
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Philip Murphy
- Department of Haematology, Royal College of Surgeons in Ireland and Beaumont Hospital, Dublin, Ireland
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18
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Rojas EA, Corchete LA, Mateos MV, García-Sanz R, Misiewicz-Krzeminska I, Gutiérrez NC. Transcriptome analysis reveals significant differences between primary plasma cell leukemia and multiple myeloma even when sharing a similar genetic background. Blood Cancer J 2019; 9:90. [PMID: 31748515 PMCID: PMC6868169 DOI: 10.1038/s41408-019-0253-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 10/17/2019] [Accepted: 10/29/2019] [Indexed: 12/26/2022] Open
Abstract
Primary plasma cell leukemia (pPCL) is a highly aggressive plasma cell dyscrasia characterised by short remissions and very poor survival. Although the 17p deletion is associated with poor outcome and extramedullary disease in MM, its presence does not confer the degree of aggressiveness observed in pPCL. The comprehensive exploration of isoform expression and RNA splicing events may provide novel information about biological differences between the two diseases. Transcriptomic studies were carried out in nine newly diagnosed pPCL and ten MM samples, all of which harbored the 17p deletion. Unsupervised cluster analysis clearly distinguished pPCL from MM samples. In total 3584 genes and 20033 isoforms were found to be deregulated between pPCL and MM. There were 2727 significantly deregulated isoforms of non-differentially expressed genes. Strangely enough, significant differences were observed in the expression of spliceosomal machinery components between pPCL and MM, in respect of the gene, isoform and the alternative splicing events expression. In summary, transcriptome analysis revealed significant differences in the relative abundance of isoforms between pPCL and MM, even when they both had the 17p deletion. The mRNA processing pathway including RNA splicing machinery emerged as one of the most remarkable mechanisms underlying the biological differences between the two entities.
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Affiliation(s)
- Elizabeta A Rojas
- Cancer Research Center-IBMCC (USAL-CSIC), Salamanca, Spain.,Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
| | - Luis A Corchete
- Cancer Research Center-IBMCC (USAL-CSIC), Salamanca, Spain.,Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
| | - María Victoria Mateos
- Cancer Research Center-IBMCC (USAL-CSIC), Salamanca, Spain.,Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Hematology Department, University Hospital of Salamanca, Salamanca, Spain
| | - Ramón García-Sanz
- Cancer Research Center-IBMCC (USAL-CSIC), Salamanca, Spain.,Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Hematology Department, University Hospital of Salamanca, Salamanca, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), CB16/12/00233, Salamanca, Spain
| | - Irena Misiewicz-Krzeminska
- Cancer Research Center-IBMCC (USAL-CSIC), Salamanca, Spain.,Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,National Medicines Institute, Warsaw, Poland
| | - Norma C Gutiérrez
- Cancer Research Center-IBMCC (USAL-CSIC), Salamanca, Spain. .,Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain. .,Hematology Department, University Hospital of Salamanca, Salamanca, Spain. .,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), CB16/12/00233, Salamanca, Spain.
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19
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Sonugür FG, Akbulut H. The Role of Tumor Microenvironment in Genomic Instability of Malignant Tumors. Front Genet 2019; 10:1063. [PMID: 31737046 PMCID: PMC6828977 DOI: 10.3389/fgene.2019.01063] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 10/03/2019] [Indexed: 12/11/2022] Open
Abstract
Genomic instability is an essential feature of cancer cells. The somatic mutation theory suggests that along with inherited ones, the changes in DNA caused by environmental factors may cause cancer. Although approximately 50–60 mutations per tumor are observed in established cancer tissue, it is known that not all of these mutations occur at the beginning of carcinogenesis but also occur later in the disease progression. The high frequency of somatic mutations referring to genomic instability contributes to the intratumoral genetic heterogeneity and treatment resistance. The contribution of the tumor microenvironment to the mutations observed following the acquirement of essential malignant characteristics of a cancer cell is one of the topics that have been extensively investigated in recent years. The frequency of mutations in hematologic tumors is generally less than solid tumors. Although it is a hematologic tumor, multiple myeloma is more similar to solid tumors in terms of the high number of chromosomal abnormalities and genetic heterogeneity. In multiple myeloma, bone marrow microenvironment also plays a role in genomic instability that occurs in the very early stages of the disease. In this review, we will briefly summarize the role of the tumor microenvironment and bone marrow microenvironment in the genomic instability seen in solid tumors and multiple myeloma.
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Affiliation(s)
- F Gizem Sonugür
- Department of Medical Oncology, Ankara University School of Medicine, Ankara, Turkey.,Department of Basic Oncology, Ankara University Cancer Research Institute, Ankara, Turkey
| | - Hakan Akbulut
- Department of Medical Oncology, Ankara University School of Medicine, Ankara, Turkey.,Department of Basic Oncology, Ankara University Cancer Research Institute, Ankara, Turkey
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20
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Janz S, Zhan F, Sun F, Cheng Y, Pisano M, Yang Y, Goldschmidt H, Hari P. Germline Risk Contribution to Genomic Instability in Multiple Myeloma. Front Genet 2019; 10:424. [PMID: 31139207 PMCID: PMC6518313 DOI: 10.3389/fgene.2019.00424] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 04/17/2019] [Indexed: 12/14/2022] Open
Abstract
Genomic instability, a well-established hallmark of human cancer, is also a driving force in the natural history of multiple myeloma (MM) - a difficult to treat and in most cases fatal neoplasm of immunoglobulin producing plasma cells that reside in the hematopoietic bone marrow. Long recognized manifestations of genomic instability in myeloma at the cytogenetic level include abnormal chromosome numbers (aneuploidy) caused by trisomy of odd-numbered chromosomes; recurrent oncogene-activating chromosomal translocations that involve immunoglobulin loci; and large-scale amplifications, inversions, and insertions/deletions (indels) of genetic material. Catastrophic genetic rearrangements that either shatter and illegitimately reassemble a single chromosome (chromotripsis) or lead to disordered segmental rearrangements of multiple chromosomes (chromoplexy) also occur. Genomic instability at the nucleotide level results in base substitution mutations and small indels that affect both the coding and non-coding genome. Sometimes this generates a distinctive signature of somatic mutations that can be attributed to defects in DNA repair pathways, the DNA damage response (DDR) or aberrant activity of mutator genes including members of the APOBEC family. In addition to myeloma development and progression, genomic instability promotes acquisition of drug resistance in patients with myeloma. Here we review recent findings on the genetic predisposition to myeloma, including newly identified candidate genes suggesting linkage of germline risk and compromised genomic stability control. The role of ethnic and familial risk factors for myeloma is highlighted. We address current research gaps that concern the lack of studies on the mechanism by which germline risk alleles promote genomic instability in myeloma, including the open question whether genetic modifiers of myeloma development act in tumor cells, the tumor microenvironment (TME), or in both. We conclude with a brief proposition for future research directions, which concentrate on the biological function of myeloma risk and genetic instability alleles, the potential links between the germline genome and somatic changes in myeloma, and the need to elucidate genetic modifiers in the TME.
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Affiliation(s)
- Siegfried Janz
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Fenghuang Zhan
- Department of Internal Medicine, The University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, United States.,Holden Comprehensive Cancer Center, The University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, United States
| | - Fumou Sun
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Yan Cheng
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Michael Pisano
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, United States.,Interdisciplinary Graduate Program in Immunology, The University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, United States
| | - Ye Yang
- The Third Affiliated Hospital, Nanjing University of Chinese Medicine, Nanjing, China.,Ministry of Education's Key Laboratory of Acupuncture and Medicine Research, Nanjing University of Chinese Medicine, Nanjing, China
| | - Hartmut Goldschmidt
- Medizinische Klinik V, Universitätsklinikum Heidelberg, Heidelberg, Germany.,Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany
| | - Parameswaran Hari
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, United States
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21
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Jurczyszyn A, Castillo JJ, Avivi I, Czepiel J, Davila J, Vij R, Fiala MA, Gozzetti A, Grząśko N, Milunovic V, Hus I, Mądry K, Waszczuk-Gajda A, Usnarska-Zubkiewicz L, Dębski J, Atilla E, Beksac M, Mele G, Sawicki W, Jayabalan D, Charliński G, Gyula Szabo A, Hajek R, Delforge M, Kopacz A, Fantl D, Waage A, Crusoe E, Hungria V, Richardson P, Laubach J, Guerrero-Garcia T, Liu J, Vesole DH. Secondary plasma cell leukemia: a multicenter retrospective study of 101 patients. Leuk Lymphoma 2018; 60:118-123. [DOI: 10.1080/10428194.2018.1473574] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Artur Jurczyszyn
- Hematology Department, Jagiellonian University Medical College, Cracow, Poland
| | - Jorge J. Castillo
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Irit Avivi
- Tel Aviv Medical Center, Tel Aviv, Israel
| | - Jacek Czepiel
- Department of Infectious and Tropical Diseases, Jagiellonian University Medical College, Cracow, Poland
| | - Julio Davila
- Hospital Universitario de Salamanca, Salamanca, Spain
| | - Ravi Vij
- Washington University School of Medicine, Saint Louis, MO, USA
| | - Mark A. Fiala
- Washington University School of Medicine, Saint Louis, MO, USA
| | | | - Norbert Grząśko
- Department of Hematology, St John’s Cancer Center, Lublin, Poland
- Department of Experimental Hematology, Medical University of Lublin, Lublin, Poland
| | - Vibor Milunovic
- Division of Hematology, Clinical Hospital Merkur, Zagreb, Croatia
| | - Iwona Hus
- Department of Haematology and Bone Marrow Transplantation, Medical University of Lublin, Lublin, Poland
| | - Krzysztof Mądry
- Department of Hematology, Oncology and Internal Medicine, Warsaw Medical University, Warsaw, Poland
| | - Anna Waszczuk-Gajda
- Department of Hematology, Oncology and Internal Medicine, Warsaw Medical University, Warsaw, Poland
| | - Lidia Usnarska-Zubkiewicz
- Department of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - Jakub Dębski
- Department of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - Erden Atilla
- Hematology Department and Bone Marrow Transplantation Unit, Ankara University Medical School, Ankara, Turkey
| | - Meral Beksac
- Hematology Department and Bone Marrow Transplantation Unit, Ankara University Medical School, Ankara, Turkey
| | | | - Waldemar Sawicki
- Department of Internal Medicine and Hematology, Military Institute of Medicine, Warsaw, Poland
| | | | | | | | - Roman Hajek
- Faculty of Medicine, University Hospital Ostrava, University of Ostrava, Ostrava, Czech Republic
| | | | | | - Dorotea Fantl
- Seccion Hematologia Adultos, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Anders Waage
- Norwegian University of Science and Technology, St. Olav’s Hospital, Trondheim, Norway
| | - Edvan Crusoe
- Hospital Universitario Professor Edgar Santos, Salvador, Brazil
| | - Vania Hungria
- Hospital Universitario Professor Edgar Santos, Salvador, Brazil
| | - Paul Richardson
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Jacob Laubach
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Thomas Guerrero-Garcia
- Division of Hematology and Oncology, Dana-Farber Cancer Institute at St. Elizabeth’s Medical Center, Brighton, MA, USA
| | - Jieqi Liu
- Rutgers New Jersey Medical School, Newark, NJ, USA
| | - David H. Vesole
- John Theurer Cancer Center, Myeloma Division, Hackensack University Medical Center, Hackensack, NJ, USA
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22
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Soh KT, Tario JD, Wallace PK. Diagnosis of Plasma Cell Dyscrasias and Monitoring of Minimal Residual Disease by Multiparametric Flow Cytometry. Clin Lab Med 2018; 37:821-853. [PMID: 29128071 DOI: 10.1016/j.cll.2017.08.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Plasma cell dyscrasia (PCD) is a heterogeneous disease that has seen a tremendous change in outcomes due to improved therapies. Over the past few decades, multiparametric flow cytometry has played an important role in the detection and monitoring of PCDs. Flow cytometry is a high-sensitivity assay for early detection of minimal residual disease (MRD) that correlates well with progression-free survival and overall survival. Before flow cytometry can be effectively implemented in the clinical setting, sample preparation, panel configuration, analysis, and gating strategies must be optimized to ensure accurate results. Current consensus methods and reporting guidelines for MRD testing are discussed.
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Affiliation(s)
- Kah Teong Soh
- Department of Flow and Image Cytometry, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA.
| | - Joseph D Tario
- Department of Flow and Image Cytometry, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA
| | - Paul K Wallace
- Department of Flow and Image Cytometry, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA
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23
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Chauhan S, Jaisinghani P, Rathore J, Tariq H, Galan Y, Madhavan A, Rana H, Frenia D. Plasma cell leukemia. J Family Med Prim Care 2018; 7:461-465. [PMID: 30090796 PMCID: PMC6060942 DOI: 10.4103/jfmpc.jfmpc_310_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
We present a rare case report of a patient diagnosed with primary plasma cell leukemia (PCL) who presented with atypical signs and symptoms which acutely evolved into life-threatening multi-organ failure. This case raises questions regarding the latest diagnostic guidelines and therapeutic options in the management of acute PCL and reinforces the need for prompt treatment after diagnosis.
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Affiliation(s)
- Shaylika Chauhan
- Department of Internal Medicine, Saint Peter's University Hospital, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Priya Jaisinghani
- Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Jaivir Rathore
- Department of Neurology, College of Medicine, University of Illinois, Chicago, Illinois, USA
| | - Hassan Tariq
- Department of Neurology, Marshall University, WV, USA
| | - Yesenia Galan
- Department of Internal Medicine, Saint Peter's University Hospital, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Arjun Madhavan
- Department of Pulmonary Medicine, Saint Peter's University Hospital, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Haris Rana
- Department of Pulmonary Medicine, Saint Peter's University Hospital, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Douglas Frenia
- Department of Pulmonary Medicine, Saint Peter's University Hospital, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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24
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Masamatti SS, Narasimha A, Shetty AC, Vijaya C. A Rare Case of Primary Plasma Cell Leukaemia with Monosomy X. J Clin Diagn Res 2017; 11:ED06-ED07. [PMID: 28969143 PMCID: PMC5620783 DOI: 10.7860/jcdr/2017/28512.10367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 05/09/2017] [Indexed: 11/24/2022]
Abstract
Primary Plasma Cell Leukaemia (pPCL) is a very rare and aggressive subtype of plasma cell dyscrasias with a very poor outcome and characterized by presence of >2x109/l circulating plasma cells. Overall incidence being 1%-2% of all malignant plasma cell diseases and 0.9% of all acute leukaemias. Patients with primary and secondary PCL have similar clinical features but differences do exist. Here we report a rare and interesting case diagnosed as primary PCL in a 44-year-old female with unusual clinical presentation and complex karyotyping. Her serum electrophoresis showed a monoclonal IgG component and immunohistochemistry of bone marrow plasma cells showed CD 38 positive and CD 20 negative. The patient initially responded partially for combination chemotherapy, but succumbed after 20 days of diagnosis. We are presenting this case to highlight the importance of early diagnosis of such haematological malignancies in settings where treatment options like stem cell transplantation are limited.
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Affiliation(s)
- Smita Surendra Masamatti
- Assistant Professor, Department of Pathology, Sapthagiri Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India
| | - Aparna Narasimha
- Professor, Department of Pathology, Sapthagiri Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India
| | - Archana C Shetty
- Associate Professor, Department of Pathology, Sapthagiri Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India
| | - C Vijaya
- Professor and Head, Department of Pathology, Sapthagiri Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India
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25
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Jung SH, Lee JJ, Kim K, Suh C, Yoon DH, Min CK, Sohn SK, Choi CW, Lee HS, Kim HJ, Shin HJ, Bang SM, Yoon SS, Park SK, Yhim HY, Kim MK, Jo JC, Mun YC, Lee JH, Kim JS. The role of frontline autologous stem cell transplantation for primary plasma cell leukemia: a retrospective multicenter study (KMM160). Oncotarget 2017; 8:79517-79526. [PMID: 29108331 PMCID: PMC5668064 DOI: 10.18632/oncotarget.18535] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 06/05/2017] [Indexed: 12/13/2022] Open
Abstract
Primary plasma cell leukemia (pPCL) is a rare and aggressive plasma cell neoplasm, with rapidly progressing clinical course. We evaluated the treatment status and survival outcomes of 69 Korean patients with pPCL. Of them, 59 patients were treated; 15 (25.4%) were treated initially with novel agent-based regimens with upfront autologous stem cell transplantation (ASCT), 7 (11.9%) with conventional chemotherapy with upfront ASCT, 21 (35.6%) with novel agent-based regimens only, and 16 (27.1%) were treated with conventional chemotherapy alone. Overall response rates after initial therapy were significantly higher in patients treated with novel agent-based regimens compared with those treated with conventional chemotherapies (75% vs. 43.4%, P = 0.026). Median progression-free survival (PFS) and overall survival (OS) were 12.2 months and 16.1 months, respectively. The median PFS of the four treatment groups–conventional chemotherapy alone, novel agents alone, conventional chemotherapy with ASCT, and novel agents with ASCT–were 1.2, 9.0, 10.5, and 26.4 months, respectively (P < 0.001); the median OS of the four treatment groups were 2.9, 12.3, 14.1, and 31.1 months, respectively (P < 0.001). The median OS was also significantly better in the patients with novel agents with ASCT versus other patients. In a multivariate analysis, an increased lactate dehydrogenase level, low albumin (< 3.5 g/dL), and non-CR after front-line treatment were independently associated with poor PFS and OS. In conclusion, the use of novel agent-based therapy with ASCT and achieving a deep response to front-line treatment are important in expecting improved PFS and OS in patients with pPCL.
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Affiliation(s)
- Sung-Hoon Jung
- Chonnam National University Hwasun Hospital, Hwasun, Jeollanamdo, Republic of Korea
| | - Je-Jung Lee
- Chonnam National University Hwasun Hospital, Hwasun, Jeollanamdo, Republic of Korea
| | - Kihyun Kim
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Cheolwon Suh
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dok Hyun Yoon
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chang-Ki Min
- Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang Kyun Sohn
- Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Chul Won Choi
- Korea University School of Medicine, Seoul, Republic of Korea
| | - Ho Sup Lee
- Kosin University Gospel Hospital, Busan, Republic of Korea
| | - Hyo Jung Kim
- Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Ho-Jin Shin
- Pusan National University Hospital, Busan, Republic of Korea
| | - Soo-Mee Bang
- Seoul National University Bundang Hospital, Seoul, Republic of Korea
| | - Sung-Soo Yoon
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Seong Kyu Park
- Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Ho-Young Yhim
- Chonbuk National University Medical School, Jeonju, Republic of Korea
| | - Min Kyoung Kim
- Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Jae-Cheol Jo
- Ulsan University Hospital, Ulsan, Republic of Korea
| | - Yeung-Chul Mun
- Ewha Womans University School of Medicine, Seoul, Republic of Korea
| | - Jae Hoon Lee
- Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Jin Seok Kim
- Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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26
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Ko PS, Huang YH, Lai CR, Yang CF, Hsiao LT. Diffuse omental cake as an initial presentation of plasma cell leukemia. JOURNAL OF CANCER RESEARCH AND PRACTICE 2017. [DOI: 10.1016/j.jcrpr.2016.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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27
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Abstract
Multiple myeloma is a heterogeneous disease. Its chromosomal abnormalities have been extensively studied with a view to accurate prognostication and personalized therapy. Here, we describe the techniques commonly employed for elucidating chromosomal aberrations, prognostic impact of recurrent chromosomal abnormalities, and recently updated risk stratification systems.
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Affiliation(s)
- Nelson Chun Ngai Chan
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, Hong Kong.
| | - Natalie Pui Ha Chan
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, Hong Kong
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28
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Shin SY, Eom HS, Sohn JY, Lee H, Park B, Joo J, Jang JH, Lee MN, Kim JK, Kong SY. Prognostic Implications of Monosomies in Patients With Multiple Myeloma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2016; 17:159-164.e2. [PMID: 28089441 DOI: 10.1016/j.clml.2016.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 11/21/2016] [Accepted: 12/14/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Cytogenetic analysis aides in risk stratification for patients with multiple myeloma (MM). Although several cytogenetic aberrations have been reported to be prognostic, less is known about the association between the presence of monosomies and prognosis. The present study evaluated the prevalence and prognostic implications of monosomies in patients with MM. MATERIALS AND METHODS Karyotypes were determined using conventional cytogenetics and fluorescence in situ hybridization (FISH). The prognostic effect of monosomies was evaluated by comparison with the clinical factors in MM patients with normal karyotypes. RESULTS Karyotypes were successfully determined in 167 of the 170 patients with MM. Of these 167 patients, 52 (31.1%) had abnormal karyotypes. Univariable analyses showed that a normal karyotype, hypodiploidy, monosomies of chromosomes 13 and 16, deletion or monosomy of 13q14, and loss of X detected by metaphase analysis were each associated with reduced progression-free survival (P < .05 for each). Univariable analyses showed that a normal karyotype, hypodiploidy, monosomies of chromosomes 13 and 16, deletion or monosomy of 13q14 detected by metaphase analysis and FISH-determined RB1 (13q)/TP53 (17p) deletion were each associated with reduced overall survival (P < .05 for each). Multivariable analysis showed that hypodiploidy detected by metaphase analysis was independently prognostic of shorter progression-free survival (P < .05 for each) and that hypodiploidy, monosomy 16, and loss of Y chromosome and FISH-determined TP53 (17p) deletion were associated with reduced overall survival (P < .05 for each). CONCLUSION In addition to known cytogenetic abnormalities, such as monosomy 13, hypodiploidy, and TP53 (17p) deletion, monosomy 16 and loss of the Y chromosome have adverse prognostic implications in patients with MM.
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Affiliation(s)
- Sang-Yong Shin
- Department of Laboratory Medicine, Center for Diagnostic Oncology and Translational Epidemiology Research Branch, Hospital and Research Institute, National Cancer Center, Goyang, Korea
| | - Hyeon-Seok Eom
- Department of Hematology-Oncology, Center for Hematologic Malignancy, National Cancer Center, Goyang, Korea; Department of System Cancer Science, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Ji Yeon Sohn
- Department of Laboratory Medicine, Center for Diagnostic Oncology and Translational Epidemiology Research Branch, Hospital and Research Institute, National Cancer Center, Goyang, Korea
| | - Hyewon Lee
- Department of Hematology-Oncology, Center for Hematologic Malignancy, National Cancer Center, Goyang, Korea; Hematologic Malignancy Branch, Research Institute, National Cancer Center, Goyang, Korea
| | - Boram Park
- Biometric Research Branch, Research Institute, National Cancer Center, Goyang, Korea
| | - Jungnam Joo
- Biometric Research Branch, Research Institute, National Cancer Center, Goyang, Korea
| | | | - Mi-Na Lee
- Green Cross Laboratories, Yongin, Korea
| | - Jung Kwon Kim
- Department of Laboratory Medicine, Center for Diagnostic Oncology and Translational Epidemiology Research Branch, Hospital and Research Institute, National Cancer Center, Goyang, Korea
| | - Sun-Young Kong
- Department of Laboratory Medicine, Center for Diagnostic Oncology and Translational Epidemiology Research Branch, Hospital and Research Institute, National Cancer Center, Goyang, Korea; Department of Hematology-Oncology, Center for Hematologic Malignancy, National Cancer Center, Goyang, Korea; Department of System Cancer Science, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea; Translational Epidemiology Research Branch, Research Institute, National Cancer Center, Goyang, Korea.
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29
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Mina R, D’Agostino M, Cerrato C, Gay F, Palumbo A. Plasma cell leukemia: update on biology and therapy. Leuk Lymphoma 2016; 58:1538-1547. [DOI: 10.1080/10428194.2016.1250263] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Roberto Mina
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Mattia D’Agostino
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Chiara Cerrato
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Francesca Gay
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Antonio Palumbo
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
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30
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Neri A, Todoerti K, Lionetti M, Simeon V, Barbieri M, Nozza F, Vona G, Pompa A, Baldini L, Musto P. Primary plasma cell leukemia 2.0: advances in biology and clinical management. Expert Rev Hematol 2016; 9:1063-1073. [DOI: 10.1080/17474086.2016.1244002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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31
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Våtsveen TK, Børset M, Dikic A, Tian E, Micci F, Lid AHB, Meza-Zepeda LA, Coward E, Waage A, Sundan A, Kuehl WM, Holien T. VOLIN and KJON-Two novel hyperdiploid myeloma cell lines. Genes Chromosomes Cancer 2016; 55:890-901. [PMID: 27311012 DOI: 10.1002/gcc.22388] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 06/12/2016] [Indexed: 12/21/2022] Open
Abstract
Multiple myeloma can be divided into two distinct genetic subgroups: hyperdiploid (HRD) or nonhyperdiploid (NHRD) myeloma. Myeloma cell lines are important tools to study myeloma cell biology and are commonly used for preclinical screening and testing of new drugs. With few exceptions human myeloma cell lines are derived from NHRD patients, even though about half of the patients have HRD myeloma. Thus, there is a need for cell lines of HRD origin to enable more representative preclinical studies. Here, we present two novel myeloma cell lines, VOLIN and KJON. Both of them were derived from patients with HRD disease and shared the same genotype as their corresponding primary tumors. The cell lines' chromosomal content, genetic aberrations, gene expression, immunophenotype as well as some of their growth characteristics are described. Neither of the cell lines was found to harbor immunoglobulin heavy chain translocations. The VOLIN cell line was established from a bone marrow aspirate and KJON from peripheral blood. We propose that these unique cell lines may be used as tools to increase our understanding of myeloma cell biology. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Thea Kristin Våtsveen
- K.G. Jebsen Center for Myeloma Research, Department of Cancer Research and Molecular Medicine, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.,Department of Pathology and Medical Genetics, St. Olav's University Hospital, Trondheim, Norway
| | - Magne Børset
- K.G. Jebsen Center for Myeloma Research, Department of Cancer Research and Molecular Medicine, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.,Department of Immunology and Transfusion Medicine, St. Olav's University Hospital, Trondheim, Norway
| | - Aida Dikic
- K.G. Jebsen Center for Myeloma Research, Department of Cancer Research and Molecular Medicine, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Erming Tian
- K.G. Jebsen Center for Myeloma Research, Department of Cancer Research and Molecular Medicine, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Francesca Micci
- Section for Cancer Cytogenetics, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Ana H B Lid
- Department of Core Facilities, Oslo University Hospital, Oslo, Norway
| | - Leonardo A Meza-Zepeda
- Department of Core Facilities, Oslo University Hospital, Oslo, Norway.,Department of Tumor Biology, Oslo University Hospital, Oslo, Norway
| | - Eivind Coward
- Bioinformatics Core Facility, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
| | - Anders Waage
- K.G. Jebsen Center for Myeloma Research, Department of Cancer Research and Molecular Medicine, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.,Department of Hematology, St. Olav's University Hospital, Trondheim, Norway
| | - Anders Sundan
- K.G. Jebsen Center for Myeloma Research, Department of Cancer Research and Molecular Medicine, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.,Centre of Molecular Inflammation Research, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Toril Holien
- K.G. Jebsen Center for Myeloma Research, Department of Cancer Research and Molecular Medicine, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.
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32
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Cifola I, Lionetti M, Pinatel E, Todoerti K, Mangano E, Pietrelli A, Fabris S, Mosca L, Simeon V, Petrucci MT, Morabito F, Offidani M, Di Raimondo F, Falcone A, Caravita T, Battaglia C, De Bellis G, Palumbo A, Musto P, Neri A. Whole-exome sequencing of primary plasma cell leukemia discloses heterogeneous mutational patterns. Oncotarget 2016; 6:17543-58. [PMID: 26046463 PMCID: PMC4627327 DOI: 10.18632/oncotarget.4028] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 05/11/2015] [Indexed: 02/04/2023] Open
Abstract
Primary plasma cell leukemia (pPCL) is a rare and aggressive form of plasma cell dyscrasia and may represent a valid model for high-risk multiple myeloma (MM). To provide novel information concerning the mutational profile of this disease, we performed the whole-exome sequencing of a prospective series of 12 pPCL cases included in a Phase II multicenter clinical trial and previously characterized at clinical and molecular levels. We identified 1, 928 coding somatic non-silent variants on 1, 643 genes, with a mean of 166 variants per sample, and only few variants and genes recurrent in two or more samples. An excess of C > T transitions and the presence of two main mutational signatures (related to APOBEC over-activity and aging) occurring in different translocation groups were observed. We identified 14 candidate cancer driver genes, mainly involved in cell-matrix adhesion, cell cycle, genome stability, RNA metabolism and protein folding. Furthermore, integration of mutation data with copy number alteration profiles evidenced biallelically disrupted genes with potential tumor suppressor functions. Globally, cadherin/Wnt signaling, extracellular matrix and cell cycle checkpoint resulted the most affected functional pathways. Sequencing results were finally combined with gene expression data to better elucidate the biological relevance of mutated genes. This study represents the first whole-exome sequencing screen of pPCL and evidenced a remarkable genetic heterogeneity of mutational patterns. This may provide a contribution to the comprehension of the pathogenetic mechanisms associated with this aggressive form of PC dyscrasia and potentially with high-risk MM.
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Affiliation(s)
- Ingrid Cifola
- Institute for Biomedical Technologies, National Research Council, Milan, Italy
| | - Marta Lionetti
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Hematology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Eva Pinatel
- Institute for Biomedical Technologies, National Research Council, Milan, Italy
| | - Katia Todoerti
- Laboratory of Pre-Clinical and Translational Research, IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero in Vulture (PZ), Italy
| | - Eleonora Mangano
- Institute for Biomedical Technologies, National Research Council, Milan, Italy
| | | | - Sonia Fabris
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Hematology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Laura Mosca
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Hematology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Vittorio Simeon
- Laboratory of Pre-Clinical and Translational Research, IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero in Vulture (PZ), Italy
| | - Maria Teresa Petrucci
- Hematology, Department of Cellular Biotechnologies and Hematology, La Sapienza University, Rome, Italy
| | | | - Massimo Offidani
- Hematologic Clinic, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - Francesco Di Raimondo
- Department of Biomedical Sciences, Division of Hematology, Ospedale Ferrarotto, University of Catania, Catania, Italy
| | - Antonietta Falcone
- Hematology Unit, IRCCS "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Italy
| | - Tommaso Caravita
- Department of Hematology, Ospedale S. Eugenio, Tor Vergata University, Rome, Italy
| | - Cristina Battaglia
- Institute for Biomedical Technologies, National Research Council, Milan, Italy.,Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | - Gianluca De Bellis
- Institute for Biomedical Technologies, National Research Council, Milan, Italy
| | - Antonio Palumbo
- Division of Hematology, University of Torino, A.O.U. San Giovanni Battista, Torino, Italy
| | - Pellegrino Musto
- Scientific Direction, IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero in Vulture (PZ), Italy
| | - Antonino Neri
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Hematology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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33
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Royer B, Minvielle S, Diouf M, Roussel M, Karlin L, Hulin C, Arnulf B, Macro M, Cailleres S, Brion A, Brechignac S, Belhadj K, Chretien ML, Wetterwald M, Chaleteix C, Tiab M, Leleu X, Frenzel L, Garderet L, Choquet S, Fuzibet JG, Dauriac C, Forneker LM, Benboubker L, Facon T, Moreau P, Avet-Loiseau H, Marolleau JP. Bortezomib, Doxorubicin, Cyclophosphamide, Dexamethasone Induction Followed by Stem Cell Transplantation for Primary Plasma Cell Leukemia: A Prospective Phase II Study of the Intergroupe Francophone du Myélome. J Clin Oncol 2016; 34:2125-32. [PMID: 27114594 DOI: 10.1200/jco.2015.63.1929] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Primary plasma cell leukemia (pPCL) is a rare and aggressive malignancy with a poor prognosis. With conventional chemotherapy, patients typically die within 1 year. In all but one of the retrospective studies reported to date, bortezomib and lenalidomide seem to improve survival. We conducted a prospective phase II trial in patients with pPCL to assess the efficacy of an alternate regimen that combines standard chemotherapy, a proteasome inhibitor, and high-dose melphalan and autologous stem cell transplantation (HDM/ASCT) followed by either allogeneic transplantation or bortezomib/lenalidomide maintenance. PATIENTS AND METHODS Patients 70 years old and younger with newly diagnosed pPCL received four alternating cycles of bortezomib, dexamethasone plus doxorubicin or cyclophosphamide. Peripheral blood stem cells were collected from responding patients with < 1% of circulating plasma cells before HDM/ASCT. As consolidation, young patients received a reduced-intensity conditioning allograft, whereas the remaining patients underwent a second HDM/ASCT followed by 1 year of bortezomib, lenalidomide, dexamethasone. The primary end point was progression-free survival (PFS). RESULTS Forty patients (median age, 57 years; range, 27 to 71 years) were enrolled. The median follow-up was 28.7 months. In the intention-to-treat analysis, the median PFS and overall survival were 15.1 (95% CI, 8.4; -) and 36.3 (95% CI, 25.6; -) months, respectively. The overall response rate to induction was 69%. One patient underwent a syngeneic allograft and 25 HDM/ASCT (16 of whom subsequently received a reduced-intensity conditioning allograft and seven a second ASCT followed by maintenance). CONCLUSION In this prospective trial in patients with pPCL, we show that bortezomib, dexamethasone plus doxorubicin or cyclophosphamide induction followed by transplantation induces high response rates and appears to significantly improve PFS.
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Affiliation(s)
- Bruno Royer
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France.
| | - Stéphane Minvielle
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Momar Diouf
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Murielle Roussel
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Lionel Karlin
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Cyrille Hulin
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Bertrand Arnulf
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Margaret Macro
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Sylvie Cailleres
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Annie Brion
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Sabine Brechignac
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Karim Belhadj
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Marie Lorraine Chretien
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Marc Wetterwald
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Carine Chaleteix
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Mourad Tiab
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Xavier Leleu
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Laurent Frenzel
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Laurent Garderet
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Sylvain Choquet
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Jean Gabriel Fuzibet
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Charles Dauriac
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Luc-Matthieu Forneker
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Lotfi Benboubker
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Thierry Facon
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Philippe Moreau
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Hervé Avet-Loiseau
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Jean Pierre Marolleau
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
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Occurrence and prognostic significance of cytogenetic evolution in patients with multiple myeloma. Blood Cancer J 2016; 6:e401. [PMID: 26967818 PMCID: PMC4817098 DOI: 10.1038/bcj.2016.15] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 02/05/2016] [Indexed: 01/09/2023] Open
Abstract
Cytogenetic evaluation at the time of diagnosis is essential for risk stratification in multiple myeloma, however little is known about the occurrence and prognostic significance of cytogenetic evolution during follow-up. We studied 989 patients with multiple myeloma, including 304 patients with at least two cytogenetic evaluations. Multivariable-adjusted regression models were used to assess the associations between the parameters of interest and cytogenetic evolution as well as overall survival. The prognostic significance of baseline cytogenetic abnormalities was most pronounced at the time of diagnosis and attenuated over time. In the patients with serial cytogenetic evaluations, the presence of t(11;14) at the time of diagnosis was associated with decreased odds of cytogenetic evolution during follow-up (odds ratio (OR)=0.22, 95% confidence interval (CI)=0.09–0.56, P=0.001), while the presence of at least one trisomy or tetrasomy was associated with increased odds (OR=2.96, 95% CI=1.37–6.42, P=0.006). The development of additional abnormalities during the 3 years following diagnosis was associated with increased subsequent mortality (hazard ratio=3.31, 95% CI=1.73–6.30, P<0.001). These findings emphasize the importance of the underlying clonal disease process for risk assessment and suggest that selected patients may benefit from repeated risk stratification.
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Mlynarcikova M, Balcarkova J, Mickova P, Scudla V, Pika T, Bacovsky J, Minarik J, Janousova E, Jarosova M. Molecular Cytogenetic Analysis of Chromosome 8 Aberrations in Patients With Multiple Myeloma Examined in 2 Different Stages, at Diagnosis and at Progression/Relapse. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2016; 16:358-65. [PMID: 27052024 DOI: 10.1016/j.clml.2016.02.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 02/09/2016] [Accepted: 02/18/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND The genome of multiple myeloma (MM) clonal plasma cells is characterized by genetic changes of prognostic importance. Disease progression is accompanied by a number of secondary chromosomal aberrations including chromosome 8. We focused on the detection of chromosome 8 aberrations in patients with MM who were examined at 2 different phases: diagnosis and progression/relapse. PATIENTS AND METHODS A total of 62 patients with MM were examined at the time of diagnosis and at relapse/progression. The median age was 64 years (range, 39-78 years); the study included 29 males and 33 females. We analyzed bone marrow samples for detecting aberrations on chromosome 8 by the fluorescence immunophenotyping and interphase cytogenetics as a tool for the investigation of neoplasms (FICTION) and fluorescence in situ hybridization methods with specific probes. RESULTS Chromosome 8 aberrations were detected in 24 (38.7%) patients at diagnosis and in 29 (46.8%) patients at progression/relapse. Only 5 (8%) patients developed additional chromosome 8 changes at progression/relapse. The aberrations were heterogeneous, involving numerical and structural changes of the MYC gene. Aberrations of the short arm of chromosome 8, involving the genes TRAIL-R1/-R2, were less frequent (4 of 62 patients, 6.4%). All aberrations of chromosome 8 were accompanied with additional changes and with an advanced clinical phase of the disease. This finding significantly influenced the overall survival of patients. CONCLUSION In the current study, chromosome 8 aberrations were highly heterogeneous, were presented at diagnosis in patients with advanced clinical stage, and were associated with worse overall survival. We have not confirmed the increase of frequency aberration of chromosome 8 in disease progression. The findings demonstrate the importance of fluorescence in situ hybridization examination of chromosome 8 in newly diagnosed patients with MM.
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Affiliation(s)
| | - Jana Balcarkova
- Department of Hemato-oncology, Palacky University Hospital, Olomouc, Czech Republic
| | - Pavla Mickova
- Department of Hemato-oncology, Palacky University Hospital, Olomouc, Czech Republic
| | - Vlastimil Scudla
- Department of Hemato-oncology, Palacky University Hospital, Olomouc, Czech Republic
| | - Tomas Pika
- Department of Hemato-oncology, Palacky University Hospital, Olomouc, Czech Republic
| | - Jaroslav Bacovsky
- Department of Hemato-oncology, Palacky University Hospital, Olomouc, Czech Republic
| | - Jiri Minarik
- Department of Hemato-oncology, Palacky University Hospital, Olomouc, Czech Republic
| | - Eva Janousova
- Institute of Biostatistics and Analysis, Masaryk University, Brno, Czech Republic
| | - Marie Jarosova
- Department of Hemato-oncology, Palacky University Hospital, Olomouc, Czech Republic.
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Dhakal B, Vesole DH, Hari PN. Allogeneic stem cell transplantation for multiple myeloma: is there a future? Bone Marrow Transplant 2016; 51:492-500. [DOI: 10.1038/bmt.2015.325] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 11/11/2015] [Accepted: 11/14/2015] [Indexed: 12/31/2022]
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Marshall R, Vaughan J, David R, Schapkaitz E, Carmona S, Wiggill T. Primary plasma cell leukaemia in a 22-year-old woman: A case
report. Afr J Lab Med 2015; 4:289. [PMID: 38440312 PMCID: PMC10911651 DOI: 10.4102/ajlm.v4i1.289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 08/18/2015] [Indexed: 03/06/2024] Open
Abstract
Introduction Primary plasma cell leukaemia is a rare and highly aggressive disease that is commonly diagnosed a decade earlier than multiple myeloma, at a median age of 55 years. However, it has also been described in younger patients, as documented in this case report. It often presents with hepatosplenomegaly and lymphadenopathy, whilst the presence of bony lesions are less-commonly seen when compared to multiple myeloma. Case presentation This report describes the case of a young woman who presented with symptoms of anaemia and a history of menorrhagia. On further careful examination, she was found to have additional signs and symptoms and was later diagnosed with primary plasma cell leukaemia. Management and outcome On admission, the patient received supportive care measures, including blood products. At diagnosis, a specific chemotherapy regimen was commenced; however, this failed to induce remission. The decision to continue with supportive care only was made and the patient died seven months later. Discussion This case study is presented because of its rarity, the young age of the patient at presentation and the unusual clinical and laboratory findings. Persistent anaemia unresponsive to standard treatment should raise the index of suspicion and further investigations directed to exclude malignancies should be considered.
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Affiliation(s)
- Robyn Marshall
- Department of Molecular Medicine and Haematology,
University of the Witwatersrand, Johannesburg, South Africa
- National Health Laboratory Service, Johannesburg, South
Africa
| | - Jenifer Vaughan
- Department of Molecular Medicine and Haematology,
University of the Witwatersrand, Johannesburg, South Africa
- National Health Laboratory Service, Johannesburg, South
Africa
| | - Ria David
- Department of Molecular Medicine and Haematology,
University of the Witwatersrand, Johannesburg, South Africa
- Division of Medical Oncology, Department of Internal
Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Elise Schapkaitz
- Department of Molecular Medicine and Haematology,
University of the Witwatersrand, Johannesburg, South Africa
- National Health Laboratory Service, Johannesburg, South
Africa
| | - Sergio Carmona
- Department of Molecular Medicine and Haematology,
University of the Witwatersrand, Johannesburg, South Africa
- National Health Laboratory Service, Johannesburg, South
Africa
| | - Tracey Wiggill
- Department of Molecular Medicine and Haematology,
University of the Witwatersrand, Johannesburg, South Africa
- National Health Laboratory Service, Johannesburg, South
Africa
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Molecular Classification and Pharmacogenetics of Primary Plasma Cell Leukemia: An Initial Approach toward Precision Medicine. Int J Mol Sci 2015; 16:17514-34. [PMID: 26263974 PMCID: PMC4581206 DOI: 10.3390/ijms160817514] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Revised: 07/21/2015] [Accepted: 07/22/2015] [Indexed: 12/20/2022] Open
Abstract
Primary plasma cell leukemia (pPCL) is a rare and aggressive variant of multiple myeloma (MM) which may represent a valid model for high-risk MM. This disease is associated with a very poor prognosis, and unfortunately, it has not significantly improved during the last three decades. New high-throughput technologies have allowed a better understanding of the molecular basis of this disease and moved toward risk stratification, providing insights for targeted therapy studies. This knowledge, added to the pharmacogenetic profile of new and old agents in the analysis of efficacy and safety, could contribute to help clinical decisions move toward a precision medicine and a better clinical outcome for these patients. In this review, we describe the available literature concerning the genomic characterization and pharmacogenetics of plasma cell leukemia (PCL).
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Localized Relapse of Primary Plasma Cell Leukaemia in the Central Nervous System. Case Rep Hematol 2015; 2015:273565. [PMID: 26064713 PMCID: PMC4441999 DOI: 10.1155/2015/273565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 04/17/2015] [Indexed: 12/14/2022] Open
Abstract
Primary plasma cell leukaemia (pPCL) is a rare and aggressive form of plasma cell malignancies with a very poor prognosis. Compared to other plasma cell malignancies the tendency to extramedullary spread is increased; however central nervous system (CNS) involvement is rare and only reported in few cases. We report the case of a 61-year-old man who was diagnosed with pPCL and achieved a complete remission after autologous stem cell transplantation but had a relapse in the CNS without systemic disease.
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Plasma cell leukemia: Clinicopathologic, immunophenotypic and cytogenetic characteristics of 4 cases. Hematol Oncol Stem Cell Ther 2015; 8:71-7. [PMID: 25929729 DOI: 10.1016/j.hemonc.2015.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 03/28/2015] [Accepted: 04/04/2015] [Indexed: 12/19/2022] Open
Abstract
Plasma cell leukemia (PCL) is a rare hematologic malignancy with very poor outcome. It is defined by the presence of >2 × 10(9)/L plasma cells or >20% plasmacytosis of the differential white cell count in the peripheral blood. Primary PCL is first diagnosed in the leukemic phase, while secondary PCL corresponds to the leukemic transformation of a previously diagnosed multiple myeloma (MM). The incidence of PCL ranges between 2-4% of patients with MM and 0.9% of patients with acute leukemia. In this case series, we describe the clinicopathologic, immunophenotypic, and cytogenetic findings of four patients diagnosed with PCL within a ten-year period (2002-2012) at King Faisal Specialist Hospital and Research Centre (General Organization), Riyadh, Saudi Arabia.
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Jelinek T, Kryukov F, Rihova L, Hajek R. Plasma cell leukemia: from biology to treatment. Eur J Haematol 2015; 95:16-26. [DOI: 10.1111/ejh.12533] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2014] [Indexed: 12/15/2022]
Affiliation(s)
- Tomas Jelinek
- University Hospital Ostrava; Department of Haematooncology; Ostrava Czech Republic
| | - Fedor Kryukov
- University of Ostrava; Faculty of Medicine; Ostrava Czech Republic
| | - Lucie Rihova
- University Hospital Brno; Department of Clinical Haematology; Brno Czech Republic
| | - Roman Hajek
- University Hospital Ostrava; Department of Haematooncology; Ostrava Czech Republic
- University of Ostrava; Faculty of Medicine; Ostrava Czech Republic
- University Hospital Brno; Department of Clinical Haematology; Brno Czech Republic
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Igala M, Bopaka RG, Khtabi W, Benchekroun S, Quessar A. Primary plasma cell leukemia presenting as a thoracic mass. Pan Afr Med J 2015; 19:39. [PMID: 25667701 PMCID: PMC4314143 DOI: 10.11604/pamj.2014.19.39.4546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 08/13/2014] [Indexed: 11/11/2022] Open
Abstract
Primary Plasma cell leukaemia (pPCL) is a rare plasma cell (PC) malignancy. The strict criteria for the diagnosis is an absolute PC number greater 2 × 10(9)/L or a plasmocytosis accounting for > 20% of the differential white cell count that does not arise from a pre-existing multiple myeloma. pPCL was associated with aggressive clinic-biological features. Primary Plasma cell leukaemia is more characterised by an extra medullar involvement such as hepatomegaly, splenomegaly, lymphadenopathy, lepto-meningeal infiltration or extramedullary plasmocytomas. The prognosis of pPCL is very poor. We report the case of a fifty eight year-old man directed to the haematology department for diagnosis of pPCL revealed by a thoracic plasmocytomas mimicking a thoracic neoplasm. The patient received chemotherapy including a classic treatment for multiple myeloma but developed a pulmonary embolism. This case illustrates an uncommon presentation of pPCL the difficulty treating by multiple myeloma chemotherapy.
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Affiliation(s)
- Marielle Igala
- Hematology Department, CHU IBN Rochd, Faculty of Medicine and Pharmacy, Universite Ain Chock, Casablanca Morocco
| | - Regis Gothar Bopaka
- Pneumology Department, CHU IBN Rochd, Faculty of Medicine and Pharmacy, Universite Ain Chock, Casablanca Morocco
| | - Wiam Khtabi
- Pneumology Department, CHU IBN Rochd, Faculty of Medicine and Pharmacy, Universite Ain Chock, Casablanca Morocco
| | - Said Benchekroun
- Hematology Department, CHU IBN Rochd, Faculty of Medicine and Pharmacy, Universite Ain Chock, Casablanca Morocco
| | - Asma Quessar
- Hematology Department, CHU IBN Rochd, Faculty of Medicine and Pharmacy, Universite Ain Chock, Casablanca Morocco
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Vyhlídalová I, Uherková L, Pleschnerová M, Špička I, Březinová J, Michalová K, Čermáková K, Polanská V, Jedelský PL, Hamšíková E, Kuželová K, Stöckbauer P. Characterization of a new human plasma cell leukemia cell line UHKT-944. Eur J Haematol 2015; 95:352-60. [PMID: 25600340 DOI: 10.1111/ejh.12505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE A new interleukin-6 (IL-6)-dependent plasma cell leukemia cell line UHKT-944 was established from bone marrow cells derived from a 55-yr-old man with plasma cell leukemia. RESULTS The cell line possesses phenotypic characteristics of plasma cells including the production of a monoclonal immunoglobulin IgA1-kappa. VH3-9 region of IgVH genes was rearranged and somatically hypermutated. The UHKT-944 cells were found to be negative for most of tested B-cell, T-cell, and myeloid markers. According to cytogenetic analysis, the cells were classified as near tetraploid with several numerical and structural abnormalities including the t(14;20) involving IgH locus. CONCLUSION The established permanent plasma cell leukemia cell line is a suitable model for the study of cellular and molecular mechanisms of pathogenesis of this rare malignant disease.
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Affiliation(s)
- Ilona Vyhlídalová
- Department of Cellular Biochemistry, Institute of Hematology and Blood Transfusion (IHBT), Prague, Czech Republic.,Department of Biochemistry, Faculty of Science, Charles University, Prague, Czech Republic
| | - Lenka Uherková
- Department of Cellular Biochemistry, Institute of Hematology and Blood Transfusion (IHBT), Prague, Czech Republic
| | - Markéta Pleschnerová
- Department of Immunology, Faculty of Science, Charles University, Prague, Czech Republic
| | - Ivan Špička
- 1st Department of Internal Medicine, Division of Hematology, General Faculty Hospital, Charles University, Prague, Czech Republic
| | - Jana Březinová
- Department of Cytogenetics, IHBT, Prague, Czech Republic
| | - Kyra Michalová
- Department of Cytogenetics, IHBT, Prague, Czech Republic
| | - Kamila Čermáková
- Leukemia PCR Diagnostics Laboratory, IHBT, Prague, Czech Republic
| | | | - Petr L Jedelský
- Faculty of Science, Charles University, Prague, Czech Republic.,Faculty of Arts, Charles University, Prague, Czech Republic
| | - Eva Hamšíková
- Department of Experimental Virology, IHBT, Prague, Czech Republic
| | - Kateřina Kuželová
- Department of Cellular Biochemistry, Institute of Hematology and Blood Transfusion (IHBT), Prague, Czech Republic
| | - Petr Stöckbauer
- Department of Cellular Biochemistry, Institute of Hematology and Blood Transfusion (IHBT), Prague, Czech Republic
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An G, Qin X, Acharya C, Xu Y, Deng S, Shi L, Zang M, Sui W, Yi S, Li Z, Hao M, Feng X, Jin F, Zou D, Qi J, Zhao Y, Tai YT, Wang J, Qiu L. Multiple myeloma patients with low proportion of circulating plasma cells had similar survival with primary plasma cell leukemia patients. Ann Hematol 2014; 94:257-64. [DOI: 10.1007/s00277-014-2211-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 09/03/2014] [Indexed: 10/24/2022]
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Trends in survival of patients with primary plasma cell leukemia: a population-based analysis. Blood 2014; 124:907-12. [PMID: 24957143 DOI: 10.1182/blood-2014-03-565051] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Primary plasma cell leukemia (pPCL) is a rare malignancy with an aggressive course and poor outcome. There has been significant improvement in the survival of multiple myeloma patients over the past decade as a result of incorporating autologous stem cell transplantation (ASCT) and novel agents into treatment regimens. However, it is unknown whether these therapies have had a similar impact on the survival of patients with pPCL. We conducted an analysis of the Surveillance, Epidemiology, and End Results database to evaluate the trends in survival of 445 patients with pPCL between 1973 and 2009. The widespread availability of ASCT and use of novel agents in the upfront setting of multiple myeloma and pPCL began after 1995 and 2006, respectively. The median overall survival based on periods of diagnosis were 5, 6, 4, and 12 months for those diagnosed during 1973-1995, 1996-2000, 2001-2005, and 2006-2009, respectively (P = .001). Thus, the current study confirms the recent survival improvement in pPCL within a large US population that may be associated with the use of better therapeutic strategies.
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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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Kim GY, Gabrea A, Demchenko YN, Bergsagel L, Roschke AV, Kuehl WM. Complex IGH rearrangements in multiple myeloma: Frequent detection discrepancies among three different probe sets. Genes Chromosomes Cancer 2014; 53:467-74. [PMID: 24585545 DOI: 10.1002/gcc.22158] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 01/29/2014] [Accepted: 02/03/2014] [Indexed: 11/07/2022] Open
Abstract
Primary IGH translocations involving seven recurrent partner loci and oncogenes are present in about 40% of multiple myeloma tumors. Secondary IGH rearrangements, which occur in a smaller fraction of tumors, usually are complex structures, including insertions or translocations that can involve three chromosomes, and often with involvement of MYC. The main approach to detect IGH rearrangements is interphase-but sometimes metaphase-FISH strategies that use a telomeric variable region probe and a centromeric constant region/ Eα enhancer or 3' flanking probe to detect a separation of these two probes, or a fusion of these probes with probes located at nonrandom partner sites in the genome. We analyzed 18 myeloma cell lines for detection discrepancies among Vysis, Cytocell, and in-house IGH probe sets that hybridize with differing sequences in the IGH locus. There were no detection discrepancies for the three telomeric IGH probes, or for unrearranged IGH loci or primary IGH translocations using the centromeric IGH probes. However, the majority of complex IGH rearrangements had detection discrepancies among the three centromeric IGH probes.
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Affiliation(s)
- Gina Y Kim
- Genetics Branch, National Cancer Institute, Bethesda, MD
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Sekiguchi N, Ootsubo K, Wagatsuma M, Midorikawa K, Nagata A, Noto S, Yamada K, Takezako N. Impact of C-Myc gene-related aberrations in newly diagnosed myeloma with bortezomib/dexamethasone therapy. Int J Hematol 2014; 99:288-95. [PMID: 24496825 DOI: 10.1007/s12185-014-1514-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 01/08/2014] [Accepted: 01/15/2014] [Indexed: 12/28/2022]
Abstract
Recent studies have suggested that c-Myc over-expression may be a factor indicating poor prognosis in multiple myeloma (MM), although c-Myc gene-related abnormalities, including translocation and gene amplification, have not been fully investigated in the novel agent era. Additional chromosome 8 may be considered as aggressive disease in the 1990s. To clarify the impact of these aberrations, we retrospectively analyzed newly diagnosed MM (NDMM) and relapsed/refractory MM (RRMM) with bortezomib and dexamethasone induction therapy. In the present study, the high-risk group was defined as having at least one of the following present: non-hyperdiploidy, IgH/FGFR3, and del p53. Forty NDMM cases were analyzed. At the median follow-up duration of 14.1 months, 14 RRMM were recognized. The proportions of patients in the high-risk, c-Myc gene-related aberrations, and additional chromosome 8 groups at diagnosis were 45.5, 22.5, and 10 %, respectively. The proportions of patients who developed RRMM in the high-risk, c-Myc gene-related aberrations, and additional chromosome 8 groups were 41.7, 77.7, and 50 %, respectively. Furthermore, patients with c-Myc gene-related abnormalities tended to exhibit inferior progression-free survival (PFS), and those with c-Myc gene-related abnormalities and/or additional chromosome 8 showed statistically shorter PFS. Therefore, c-Myc gene-related abnormalities and additional chromosome 8 may be related to a poorer prognosis.
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Affiliation(s)
- Naohiro Sekiguchi
- Division of Hematology, National Hospital Organization Disaster Medical Center, 3256 Midori-cho, Tachikawa, Tokyo, 190-0014, Japan,
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