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Khwaja J, Vos JMI, Pluimers TE, Japzon N, Patel A, Salter S, Kwakernaak AJ, Gupta R, Rismani A, Kyriakou C, Wechalekar AD, D'Sa S. Clinical and clonal characteristics of monoclonal immunoglobulin M-associated type I cryoglobulinaemia. Br J Haematol 2024; 204:177-185. [PMID: 37726004 DOI: 10.1111/bjh.19112] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/30/2023] [Accepted: 09/07/2023] [Indexed: 09/21/2023]
Abstract
Monoclonal immunoglobulin M-associated type I cryoglobulinaemia is poorly characterised. We screened 534 patients with monoclonal IgM disorders over a 9-year period and identified 134 patients with IgM type I cryoglobulins. Of these, 76% had Waldenström macroglobulinaemia (WM), 5% had other non-Hodgkin lymphoma (NHL) and 19% had IgM monoclonal gammopathy of undetermined significance (MGUS). Clinically relevant IgM-associated disorders (including cold agglutinin disease [CAD], anti-MAG antibodies, amyloidosis and Schnitzler syndrome) coexisted in 31%, more frequently in MGUS versus WM/NHL (72% vs. 22%/29%, p < 0.001). The majority of those with cryoglobulins and coexistent CAD/syndrome had the molecular characteristics of a CAD clone (wild-type MYD88 in 80%). A half of all patients had active manifestations at cryoglobulin detection: vasomotor (22%), cutaneous (16%), peripheral neuropathy (22%) and hyperviscosity (9%). 16/134 required treatment for cryoglobulin-related symptoms alone at a median of 38 days (range: 6-239) from cryoglobulin detection. At a median follow-up of 3 years (range: 0-10), 3-year cryoglobulinaemia-treatment-free survival was 77% (95% CI: 68%-84%). Age was the only predictor of overall survival. Predictors of cryoglobulinaemia-related treatment/death were hyperviscosity (HR: 73.01; 95% CI: 15.62-341.36, p < 0.0001) and cutaneous involvement (HR: 2.95; 95% CI: 1.13-7.71, p = 0.028). Type I IgM cryoglobulinaemia is more prevalent than previously described in IgM gammopathy and should be actively sought.
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Affiliation(s)
- Jahanzaib Khwaja
- Department of Haematology, University College London Hospital, London, UK
| | - Josephine M I Vos
- Department of Haematology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Tessa E Pluimers
- Department of Haematology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Nicole Japzon
- Department of Haematology, University College London Hospital, London, UK
| | - Aisha Patel
- Department of Haematology, University College London Hospital, London, UK
| | | | - Arjan J Kwakernaak
- Department of Internal Medicine, Clinical Immunology/Allergy and Nephrology Amsterdam UMC, Amsterdam, The Netherlands
| | - Rajeev Gupta
- Department of Haematology, University College London Hospital, London, UK
| | - Ali Rismani
- Department of Haematology, University College London Hospital, London, UK
| | | | | | - Shirley D'Sa
- Department of Haematology, University College London Hospital, London, UK
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4
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Castellani F, Visentin A, Schirinzi E, Salvalaggio A, Cacciavillani M, Candiotto C, Baratè C, Cellini A, Bertorelle R, Siciliano G, Trentin L, Briani C. Mutational Profile in 75 Patients With Anti-Myelin-Associated Glycoprotein Neuropathy: Clinical and Hematologic Therapy Response and Hints on New Therapeutic Targets. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2023; 10:e200122. [PMID: 37137530 PMCID: PMC10155778 DOI: 10.1212/nxi.0000000000200122] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/13/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND AND OBJECTIVES Neuropathy with antibodies to myelin-associated glycoprotein (MAG) is the most common paraproteinemic IgM neuropathy. Recently, the mutational profile of the MYD88 and CXCR4 genes has been included in the diagnostic workup of IgM monoclonal gammopathies. The objective of our study was to assess the prevalence of MYD88 L265P and CXCR4 S338X gene variants in patients with anti-MAG antibody neuropathy. Secondary aims were to evaluate possible correlations between the mutational profile and neuropathy severity, antibody titers, and treatment response. METHODS Seventy-five patients (47 men, mean age at molecular analysis 70.8 ± 10.2 years; mean disease duration 5.1 ± 4.9 years) with anti-MAG antibody neuropathy were recruited. Among them, 38 (50.7%) had IgM monoclonal gammopathy of undetermined significance, 29 (38.7%) Waldenstrom macroglobulinemia (WM), and 8 (10.6%) chronic lymphocytic leukemia/marginal zone lymphoma/hairy cell leukemia variant. Molecular analysis was performed on DNA from the bone marrow mononuclear cells in 55 of 75 patients and from peripheral mononuclear cells in 18 of 75 patients. Forty-five patients were treated with rituximab, 6 with ibrutinib, 2 with obinutuzumab-chlorambucil, and 3 with venetoclax-based therapy. All the patients were assessed with the Inflammatory Neuropathy Cause and Treatment (INCAT) Disability Scale, INCAT Sensory Sum Score, and MRC Sum Score at baseline and follow-up. We considered as responders, patients who improved by at least 1 point in 2 clinical scales. RESULTS Fifty patients (66.7%) carried the MYD88L265P variant, with a higher frequency in WM and naive patients (77.2% vs 33.3%, p = 0.0012). No patients harbored the CXCR4S338X variant. There were no significant differences in hematologic data (IgM levels, M protein, and anti-MAG antibody titers), neuropathy severity, or response to rituximab in MYD88-altered and MYD88 wild-type patients. Nine of 11 (81.8%) patients treated with novel targeted drug, according to the MYD88 status, responded to treatments. DISCUSSION MYD88L265P variant has a high prevalence (66.7%) in anti-MAG antibody neuropathy representing a potential effective mutational target for Bruton tyrosine kinase inhibitors. MYD88L265P variant, however, does not seem to be a prognostic factor of neuropathy severity or response to rituximab. In patients not responding or becoming refractory to rituximab, a tailored therapy with new effective target therapies should be considered.
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Affiliation(s)
- Francesca Castellani
- From the Department of Neurosciences (F.C., A.S., Chiara Briani), Neurology Unit, University of Padova; Hematology and Clinical Immunology Unit (A.V., A.C., L.T.), Department of Medicine, University of Padova; Department of Clinical and Experimental Medicine (E.S., G.S.), Neurological Clinic, University of Pisa; EMG Lab (M.C.), CEMES, Synlab Group, Padova; Immunology and Molecular Oncology (C.C., R.B.), Veneto Institute of Oncology IOV-IRCCS, Padova; and Department of Clinical and Experimental Medicine (Claudia Baratè), Section of Hematology, University of Pisa, Italy
| | - Andrea Visentin
- From the Department of Neurosciences (F.C., A.S., Chiara Briani), Neurology Unit, University of Padova; Hematology and Clinical Immunology Unit (A.V., A.C., L.T.), Department of Medicine, University of Padova; Department of Clinical and Experimental Medicine (E.S., G.S.), Neurological Clinic, University of Pisa; EMG Lab (M.C.), CEMES, Synlab Group, Padova; Immunology and Molecular Oncology (C.C., R.B.), Veneto Institute of Oncology IOV-IRCCS, Padova; and Department of Clinical and Experimental Medicine (Claudia Baratè), Section of Hematology, University of Pisa, Italy
| | - Erika Schirinzi
- From the Department of Neurosciences (F.C., A.S., Chiara Briani), Neurology Unit, University of Padova; Hematology and Clinical Immunology Unit (A.V., A.C., L.T.), Department of Medicine, University of Padova; Department of Clinical and Experimental Medicine (E.S., G.S.), Neurological Clinic, University of Pisa; EMG Lab (M.C.), CEMES, Synlab Group, Padova; Immunology and Molecular Oncology (C.C., R.B.), Veneto Institute of Oncology IOV-IRCCS, Padova; and Department of Clinical and Experimental Medicine (Claudia Baratè), Section of Hematology, University of Pisa, Italy
| | - Alessandro Salvalaggio
- From the Department of Neurosciences (F.C., A.S., Chiara Briani), Neurology Unit, University of Padova; Hematology and Clinical Immunology Unit (A.V., A.C., L.T.), Department of Medicine, University of Padova; Department of Clinical and Experimental Medicine (E.S., G.S.), Neurological Clinic, University of Pisa; EMG Lab (M.C.), CEMES, Synlab Group, Padova; Immunology and Molecular Oncology (C.C., R.B.), Veneto Institute of Oncology IOV-IRCCS, Padova; and Department of Clinical and Experimental Medicine (Claudia Baratè), Section of Hematology, University of Pisa, Italy
| | - Mario Cacciavillani
- From the Department of Neurosciences (F.C., A.S., Chiara Briani), Neurology Unit, University of Padova; Hematology and Clinical Immunology Unit (A.V., A.C., L.T.), Department of Medicine, University of Padova; Department of Clinical and Experimental Medicine (E.S., G.S.), Neurological Clinic, University of Pisa; EMG Lab (M.C.), CEMES, Synlab Group, Padova; Immunology and Molecular Oncology (C.C., R.B.), Veneto Institute of Oncology IOV-IRCCS, Padova; and Department of Clinical and Experimental Medicine (Claudia Baratè), Section of Hematology, University of Pisa, Italy
| | - Cinzia Candiotto
- From the Department of Neurosciences (F.C., A.S., Chiara Briani), Neurology Unit, University of Padova; Hematology and Clinical Immunology Unit (A.V., A.C., L.T.), Department of Medicine, University of Padova; Department of Clinical and Experimental Medicine (E.S., G.S.), Neurological Clinic, University of Pisa; EMG Lab (M.C.), CEMES, Synlab Group, Padova; Immunology and Molecular Oncology (C.C., R.B.), Veneto Institute of Oncology IOV-IRCCS, Padova; and Department of Clinical and Experimental Medicine (Claudia Baratè), Section of Hematology, University of Pisa, Italy
| | - Claudia Baratè
- From the Department of Neurosciences (F.C., A.S., Chiara Briani), Neurology Unit, University of Padova; Hematology and Clinical Immunology Unit (A.V., A.C., L.T.), Department of Medicine, University of Padova; Department of Clinical and Experimental Medicine (E.S., G.S.), Neurological Clinic, University of Pisa; EMG Lab (M.C.), CEMES, Synlab Group, Padova; Immunology and Molecular Oncology (C.C., R.B.), Veneto Institute of Oncology IOV-IRCCS, Padova; and Department of Clinical and Experimental Medicine (Claudia Baratè), Section of Hematology, University of Pisa, Italy
| | - Alessandro Cellini
- From the Department of Neurosciences (F.C., A.S., Chiara Briani), Neurology Unit, University of Padova; Hematology and Clinical Immunology Unit (A.V., A.C., L.T.), Department of Medicine, University of Padova; Department of Clinical and Experimental Medicine (E.S., G.S.), Neurological Clinic, University of Pisa; EMG Lab (M.C.), CEMES, Synlab Group, Padova; Immunology and Molecular Oncology (C.C., R.B.), Veneto Institute of Oncology IOV-IRCCS, Padova; and Department of Clinical and Experimental Medicine (Claudia Baratè), Section of Hematology, University of Pisa, Italy
| | - Roberta Bertorelle
- From the Department of Neurosciences (F.C., A.S., Chiara Briani), Neurology Unit, University of Padova; Hematology and Clinical Immunology Unit (A.V., A.C., L.T.), Department of Medicine, University of Padova; Department of Clinical and Experimental Medicine (E.S., G.S.), Neurological Clinic, University of Pisa; EMG Lab (M.C.), CEMES, Synlab Group, Padova; Immunology and Molecular Oncology (C.C., R.B.), Veneto Institute of Oncology IOV-IRCCS, Padova; and Department of Clinical and Experimental Medicine (Claudia Baratè), Section of Hematology, University of Pisa, Italy
| | - Gabriele Siciliano
- From the Department of Neurosciences (F.C., A.S., Chiara Briani), Neurology Unit, University of Padova; Hematology and Clinical Immunology Unit (A.V., A.C., L.T.), Department of Medicine, University of Padova; Department of Clinical and Experimental Medicine (E.S., G.S.), Neurological Clinic, University of Pisa; EMG Lab (M.C.), CEMES, Synlab Group, Padova; Immunology and Molecular Oncology (C.C., R.B.), Veneto Institute of Oncology IOV-IRCCS, Padova; and Department of Clinical and Experimental Medicine (Claudia Baratè), Section of Hematology, University of Pisa, Italy
| | - Livio Trentin
- From the Department of Neurosciences (F.C., A.S., Chiara Briani), Neurology Unit, University of Padova; Hematology and Clinical Immunology Unit (A.V., A.C., L.T.), Department of Medicine, University of Padova; Department of Clinical and Experimental Medicine (E.S., G.S.), Neurological Clinic, University of Pisa; EMG Lab (M.C.), CEMES, Synlab Group, Padova; Immunology and Molecular Oncology (C.C., R.B.), Veneto Institute of Oncology IOV-IRCCS, Padova; and Department of Clinical and Experimental Medicine (Claudia Baratè), Section of Hematology, University of Pisa, Italy
| | - Chiara Briani
- From the Department of Neurosciences (F.C., A.S., Chiara Briani), Neurology Unit, University of Padova; Hematology and Clinical Immunology Unit (A.V., A.C., L.T.), Department of Medicine, University of Padova; Department of Clinical and Experimental Medicine (E.S., G.S.), Neurological Clinic, University of Pisa; EMG Lab (M.C.), CEMES, Synlab Group, Padova; Immunology and Molecular Oncology (C.C., R.B.), Veneto Institute of Oncology IOV-IRCCS, Padova; and Department of Clinical and Experimental Medicine (Claudia Baratè), Section of Hematology, University of Pisa, Italy.
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7
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Milivojevic M, Che X, Bateman L, Cheng A, Garcia BA, Hornig M, Huber M, Klimas NG, Lee B, Lee H, Levine S, Montoya JG, Peterson DL, Komaroff AL, Lipkin WI. Plasma proteomic profiling suggests an association between antigen driven clonal B cell expansion and ME/CFS. PLoS One 2020; 15:e0236148. [PMID: 32692761 PMCID: PMC7373296 DOI: 10.1371/journal.pone.0236148] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 06/30/2020] [Indexed: 02/08/2023] Open
Abstract
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is an unexplained chronic, debilitating illness characterized by fatigue, sleep disturbances, cognitive dysfunction, orthostatic intolerance and gastrointestinal problems. Using ultra performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS), we analyzed the plasma proteomes of 39 ME/CFS patients and 41 healthy controls. Logistic regression models, with both linear and quadratic terms of the protein levels as independent variables, revealed a significant association between ME/CFS and the immunoglobulin heavy variable (IGHV) region 3-23/30. Stratifying the ME/CFS group based on self-reported irritable bowel syndrome (sr-IBS) status revealed a significant quadratic effect of immunoglobulin lambda constant region 7 on its association with ME/CFS with sr-IBS whilst IGHV3-23/30 and immunoglobulin kappa variable region 3-11 were significantly associated with ME/CFS without sr-IBS. In addition, we were able to predict ME/CFS status with a high degree of accuracy (AUC = 0.774-0.838) using a panel of proteins selected by 3 different machine learning algorithms: Lasso, Random Forests, and XGBoost. These algorithms also identified proteomic profiles that predicted the status of ME/CFS patients with sr-IBS (AUC = 0.806-0.846) and ME/CFS without sr-IBS (AUC = 0.754-0.780). Our findings are consistent with a significant association of ME/CFS with immune dysregulation and highlight the potential use of the plasma proteome as a source of biomarkers for disease.
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Affiliation(s)
- Milica Milivojevic
- Center for Infection and Immunity, Columbia University Mailman School of Public Health, New York, NY, United States of America
| | - Xiaoyu Che
- Center for Infection and Immunity, Columbia University Mailman School of Public Health, New York, NY, United States of America
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, United States of America
| | - Lucinda Bateman
- Bateman Horne Center, Salt Lake City, UT, United States of America
| | - Aaron Cheng
- Center for Infection and Immunity, Columbia University Mailman School of Public Health, New York, NY, United States of America
| | - Benjamin A. Garcia
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Mady Hornig
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, United States of America
| | - Manuel Huber
- German Research Center for Environmental Health, Institute for Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
| | - Nancy G. Klimas
- Institute for Neuro Immune Medicine, College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States of America
- Miami VA Medical Center, Miami, FL, United States of America
| | - Bohyun Lee
- Center for Infection and Immunity, Columbia University Mailman School of Public Health, New York, NY, United States of America
| | - Hyoungjoo Lee
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Susan Levine
- Levine Clinic, New York, NY, United States of America
| | - Jose G. Montoya
- Palo Alto Medical Foundation, Jack S. Remington Laboratory for Specialty Diagnostics of Toxoplasmosis, Palo Alto, CA, United States of America
| | - Daniel L. Peterson
- Sierra Internal Medicine at Incline Village, Incline Village, NV, United States of America
| | - Anthony L. Komaroff
- Harvard Medical School, Brigham and Women's Hospital, Boston, MA, United States of America
| | - W. Ian Lipkin
- Center for Infection and Immunity, Columbia University Mailman School of Public Health, New York, NY, United States of America
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8
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Lo Schirico M, Ferrante M, Dogliotti I, Zamò A, Ferrero B, Bertuzzo D, Benevolo G, Omedè P, Cavallo F, Ladetto M, Boccadoro M, Drandi D, Ferrero S. Droplet Digital PCR Assay for MYD88 L265P : Clinical Applications in Waldenström Macroglobulinemia. Hemasphere 2020; 4:e324. [PMID: 32072140 PMCID: PMC7000466 DOI: 10.1097/hs9.0000000000000324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/07/2019] [Accepted: 11/12/2019] [Indexed: 12/17/2022] Open
Affiliation(s)
- Mariella Lo Schirico
- Department of Molecular Biotechnologies and Health sciences, Hematology Division, University of Torino, Italy.,Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Martina Ferrante
- Department of Molecular Biotechnologies and Health sciences, Hematology Division, University of Torino, Italy
| | - Irene Dogliotti
- Department of Molecular Biotechnologies and Health sciences, Hematology Division, University of Torino, Italy.,Division of Hematology 1, AOU "Città della Salute e della Scienza di Torino",Torino, Italy
| | - Alberto Zamò
- Department of Oncology, Pathology Division, University of Torino, Italy
| | - Bruno Ferrero
- Rita Levi Montalcini' Department of Neuroscience, Neurology Division, University of Torino, Torino, Italy
| | - Davide Bertuzzo
- Rita Levi Montalcini' Department of Neuroscience, Neurology Division, University of Torino, Torino, Italy
| | - Giulia Benevolo
- Division of Hematology 2, AOU "Città della Salute e della Scienza di Torino", Torino, Italy
| | - Paola Omedè
- Division of Hematology 1, AOU "Città della Salute e della Scienza di Torino",Torino, Italy
| | - Federica Cavallo
- Department of Molecular Biotechnologies and Health sciences, Hematology Division, University of Torino, Italy.,Division of Hematology 1, AOU "Città della Salute e della Scienza di Torino",Torino, Italy
| | - Marco Ladetto
- Division of Hematology, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Mario Boccadoro
- Department of Molecular Biotechnologies and Health sciences, Hematology Division, University of Torino, Italy.,Division of Hematology 1, AOU "Città della Salute e della Scienza di Torino",Torino, Italy
| | - Daniela Drandi
- Department of Molecular Biotechnologies and Health sciences, Hematology Division, University of Torino, Italy
| | - Simone Ferrero
- Department of Molecular Biotechnologies and Health sciences, Hematology Division, University of Torino, Italy.,Division of Hematology 1, AOU "Città della Salute e della Scienza di Torino",Torino, Italy
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