1
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Rasche L, Alapat D, Kumar M, Gershner G, McDonald J, Wardell CP, Samant R, Van Hemert R, Epstein J, Williams AF, Thanendrarajan S, Schinke C, Bauer M, Ashby C, Tytarenko RG, van Rhee F, Walker BA, Zangari M, Barlogie B, Davies FE, Morgan GJ, Weinhold N. Combination of flow cytometry and functional imaging for monitoring of residual disease in myeloma. Leukemia 2018; 33:1713-1722. [PMID: 30573775 PMCID: PMC6586541 DOI: 10.1038/s41375-018-0329-0] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 09/24/2018] [Accepted: 10/10/2018] [Indexed: 02/08/2023]
Abstract
The iliac crest is the sampling site for minimal residual disease (MRD) monitoring in multiple myeloma (MM). However, the disease distribution is often heterogeneous, and imaging can be used to complement MRD detection at a single site. We have investigated patients in complete remission (CR) during first-line or salvage therapy for whom MRD flow cytometry and the two imaging modalities positron emission tomography (PET) and diffusion-weighted magnetic resonance imaging (DW-MRI) were performed at the onset of CR. Residual focal lesions (FLs), detectable in 24% of first-line patients, were associated with short progression-free survival (PFS), with DW-MRI detecting disease in more patients. In some patients, FLs were only PET positive, indicating that the two approaches are complementary. Combining MRD and imaging improved prediction of outcome, with double-negative and double-positive features defining groups with excellent and dismal PFS, respectively. FLs were a rare event (12%) in first-line MRD-negative CR patients. In contrast, patients achieving an MRD-negative CR during salvage therapy frequently had FLs (50%). Multi-region sequencing and imaging in an MRD-negative patient showed persistence of spatially separated clones. In conclusion, we show that DW-MRI is a promising tool for monitoring residual disease that complements PET and should be combined with MRD.
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Affiliation(s)
- L Rasche
- Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, AR, USA.,Department of Internal Medicine 2, University Hospital of Würzburg, Würzburg, Germany
| | - D Alapat
- Pathology Department, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - M Kumar
- Radiology Department, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - G Gershner
- Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - J McDonald
- Radiology Department, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - C P Wardell
- Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - R Samant
- Radiology Department, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - R Van Hemert
- Radiology Department, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - J Epstein
- Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - A F Williams
- Pathology Department, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - S Thanendrarajan
- Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - C Schinke
- Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - M Bauer
- Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - C Ashby
- Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - R G Tytarenko
- Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - F van Rhee
- Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - B A Walker
- Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - M Zangari
- Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - B Barlogie
- Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - F E Davies
- Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - G J Morgan
- Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - N Weinhold
- Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
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2
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Vangsted AJ, Helm-Petersen S, Cowland JB, Jensen PB, Gimsing P, Barlogie B, Knudsen S. Drug response prediction in high-risk multiple myeloma. Gene 2017; 644:80-86. [PMID: 29122646 DOI: 10.1016/j.gene.2017.10.071] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/30/2017] [Accepted: 10/25/2017] [Indexed: 01/05/2023]
Abstract
A Drug Response Prediction (DRP) score was developed based on gene expression profiling (GEP) from cell lines and tumor samples. Twenty percent of high-risk patients by GEP70 treated in Total Therapy 2 and 3A have a progression-free survival (PFS) of more than 10years. We used available GEP data from high-risk patients by GEP70 at diagnosis from Total Therapy 2 and 3A to predict the response by the DRP score of drugs used in the treatment of myeloma patients. The DRP score stratified patients further. High-risk myeloma with a predicted sensitivity to melphalan by the DRP score had a prolonged PFS, HR=2.4 (1.2-4.9, P=0.014) and those with predicted sensitivity to bortezomib had a HR 5.7 (1.2-27, P=0.027). In case of predicted sensitivity to bortezomib, a better response to treatment was found (P=0.022). This method may provide us with a tool for identifying candidates for effective personalized medicine and spare potential non-responders from suffering toxicity.
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Affiliation(s)
- A J Vangsted
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | - S Helm-Petersen
- Granulocyte Research Laboratory, Copenhagen University Hospital, Copenhagen, Denmark
| | - J B Cowland
- Granulocyte Research Laboratory, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Genetics, Copenhagen University Hospital, Copenhagen, Denmark
| | - P B Jensen
- Medical Prognosis Institute, Hørsholm, Hematology-Oncology, Denmark
| | - P Gimsing
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - S Knudsen
- Medical Prognosis Institute, Hørsholm, Hematology-Oncology, Denmark
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3
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Laganà A, Perumal D, Melnekoff D, Readhead B, Kidd BA, Leshchenko V, Kuo PY, Keats J, DeRome M, Yesil J, Auclair D, Lonial S, Chari A, Cho HJ, Barlogie B, Jagannath S, Dudley JT, Parekh S. Integrative network analysis identifies novel drivers of pathogenesis and progression in newly diagnosed multiple myeloma. Leukemia 2017. [DOI: 10.1038/leu.2017.197] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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4
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Chavan SS, He J, Tytarenko R, Deshpande S, Patel P, Bailey M, Stein CK, Stephens O, Weinhold N, Petty N, Steward D, Rasche L, Bauer M, Ashby C, Peterson E, Ali S, Ross J, Miller VA, Stephens P, Thanendrarajan S, Schinke C, Zangari M, van Rhee F, Barlogie B, Mughal TI, Davies FE, Morgan GJ, Walker BA. Bi-allelic inactivation is more prevalent at relapse in multiple myeloma, identifying RB1 as an independent prognostic marker. Blood Cancer J 2017; 7:e535. [PMID: 28234347 PMCID: PMC5386330 DOI: 10.1038/bcj.2017.12] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 01/13/2017] [Indexed: 12/21/2022] Open
Abstract
The purpose of this study is to identify prognostic markers and treatment targets using a clinically certified sequencing panel in multiple myeloma. We performed targeted sequencing of 578 individuals with plasma cell neoplasms using the FoundationOne Heme panel and identified clinically relevant abnormalities and novel prognostic markers. Mutational burden was associated with maf and proliferation gene expression groups, and a high-mutational burden was associated with a poor prognosis. We identified homozygous deletions that were present in multiple myeloma within key genes, including CDKN2C, RB1, TRAF3, BIRC3 and TP53, and that bi-allelic inactivation was significantly enriched at relapse. Alterations in CDKN2C, TP53, RB1 and the t(4;14) were associated with poor prognosis. Alterations in RB1 were predominantly homozygous deletions and were associated with relapse and a poor prognosis which was independent of other genetic markers, including t(4;14), after multivariate analysis. Bi-allelic inactivation of key tumor suppressor genes in myeloma was enriched at relapse, especially in RB1, CDKN2C and TP53 where they have prognostic significance.
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Affiliation(s)
- S S Chavan
- The Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - J He
- Foundation Medicine Inc., Cambridge, MA, USA
| | - R Tytarenko
- The Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - S Deshpande
- The Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - P Patel
- The Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - M Bailey
- Foundation Medicine Inc., Cambridge, MA, USA
| | - C K Stein
- The Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - O Stephens
- The Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - N Weinhold
- The Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - N Petty
- The Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - D Steward
- The Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - L Rasche
- The Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - M Bauer
- The Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - C Ashby
- The Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - E Peterson
- The Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - S Ali
- Foundation Medicine Inc., Cambridge, MA, USA
| | - J Ross
- Foundation Medicine Inc., Cambridge, MA, USA.,Albany Medical College, Albany, NY, USA
| | - V A Miller
- Foundation Medicine Inc., Cambridge, MA, USA
| | - P Stephens
- Foundation Medicine Inc., Cambridge, MA, USA
| | - S Thanendrarajan
- The Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - C Schinke
- The Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - M Zangari
- The Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - F van Rhee
- The Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - B Barlogie
- The Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA.,Icahn School of Medicine at Mt. Sinai, New York, NY, USA
| | - T I Mughal
- Foundation Medicine Inc., Cambridge, MA, USA.,Tufts University Medical Center, Boston, MA, USA
| | - F E Davies
- The Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - G J Morgan
- The Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - B A Walker
- The Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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5
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Jethava Y, Mitchell A, Zangari M, Waheed S, Schinke C, Thanendrarajan S, Sawyer J, Alapat D, Tian E, Stein C, Khan R, Heuck CJ, Petty N, Avery D, Steward D, Smith R, Bailey C, Epstein J, Yaccoby S, Hoering A, Crowley J, Morgan G, Barlogie B, van Rhee F. Dose-dense and less dose-intense total therapy 5 for gene expression profiling-defined high-risk multiple myeloma. Blood Cancer J 2016; 6:e471. [PMID: 27635734 PMCID: PMC5056975 DOI: 10.1038/bcj.2016.85] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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6
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Johnson DC, Weinhold N, Mitchell J, Chen B, Stephens OW, Försti A, Nickel J, Kaiser M, Gregory WA, Cairns D, Jackson GH, Hoffmann P, Noethen MM, Hillengass J, Bertsch U, Barlogie B, Davis FE, Hemminki K, Goldschmidt H, Houlston RS, Morgan GJ. Genetic factors influencing the risk of multiple myeloma bone disease. Leukemia 2016; 30:883-8. [PMID: 26669972 PMCID: PMC4832071 DOI: 10.1038/leu.2015.342] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 11/25/2015] [Accepted: 11/30/2015] [Indexed: 01/18/2023]
Abstract
A major complication of multiple myeloma (MM) is the development of osteolytic lesions, fractures and bone pain. To identify genetic variants influencing the development of MM bone disease (MBD), we analyzed MM patients of European ancestry (totaling 3774), which had been radiologically surveyed for MBD. Each patient had been genotyped for ~6 00 000 single-nucleotide polymorphisms with genotypes for six million common variants imputed using 1000 Genomes Project and UK10K as reference. We identified a locus at 8q24.12 for MBD (rs4407910, OPG/TNFRSF11B, odds ratio=1.38, P=4.09 × 10(-9)) and a promising association at 19q13.43 (rs74676832, odds ratio=1.97, P=9.33 × 10(-7)). Our findings demonstrate that germline variation influences MBD and highlights the importance of RANK/RANKL/OPG pathway in MBD development. These findings will contribute to the development of future strategies for prevention of MBD in the early precancerous phases of MM.
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Affiliation(s)
- D C Johnson
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - N Weinhold
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - J Mitchell
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - B Chen
- German Cancer Research Center, Heidelberg, Germany
| | - O W Stephens
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - A Försti
- German Cancer Research Center, Heidelberg, Germany
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - J Nickel
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - M Kaiser
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - W A Gregory
- Leeds Institute of Molecular Medicine, Section of Clinical Trials Research, University of Leeds, Leeds, UK
| | - D Cairns
- Leeds Institute of Molecular Medicine, Section of Clinical Trials Research, University of Leeds, Leeds, UK
| | - G H Jackson
- Department of Haematology, Newcastle University, Newcastle-Upon-Tyne, UK
| | - P Hoffmann
- Institute of Human Genetics, University of Bonn, Bonn, Germany
- Division of Medical Genetics, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - M M Noethen
- Institute of Human Genetics, University of Bonn, Bonn, Germany
- Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany
| | - J Hillengass
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - U Bertsch
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - B Barlogie
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - F E Davis
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - K Hemminki
- German Cancer Research Center, Heidelberg, Germany
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - H Goldschmidt
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
- National Center of Tumor Diseases, Heidelberg, Germany
| | - R S Houlston
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - G J Morgan
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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7
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Pawlyn C, Kaiser M, Heuck C, Melchor L, Wardell C, Murison A, Chavan S, Johnson D, Begum D, Proszek P, Cairns D, Boyle E, Jones J, Cook G, Drayson M, Owen R, Gregory W, Jackson G, Barlogie B, Davies F, Walker B, Morgan G. The spectrum and clinical impact of epigenetic modifier mutations in myeloma. Clinical Lymphoma Myeloma and Leukemia 2015. [DOI: 10.1016/j.clml.2015.07.244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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8
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Heuck CJ, Jethava Y, Khan R, van Rhee F, Zangari M, Chavan S, Robbins K, Miller SE, Matin A, Mohan M, Ali SM, Stephens PJ, Ross JS, Miller VA, Davies F, Barlogie B, Morgan G. Inhibiting MEK in MAPK pathway-activated myeloma. Leukemia 2015; 30:976-80. [PMID: 26228812 PMCID: PMC4832073 DOI: 10.1038/leu.2015.208] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- C J Heuck
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Y Jethava
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - R Khan
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - F van Rhee
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - M Zangari
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - S Chavan
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - K Robbins
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - S E Miller
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - A Matin
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - M Mohan
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - S M Ali
- Foundation Medicine, Inc., Cambridge, MA, USA
| | | | - J S Ross
- Foundation Medicine, Inc., Cambridge, MA, USA.,Department of Pathology, Albany Medical College, Albany, NY, USA
| | - V A Miller
- Foundation Medicine, Inc., Cambridge, MA, USA
| | - F Davies
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - B Barlogie
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - G Morgan
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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9
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Atrash S, Tullos A, Panozzo S, Bhutani M, Van Rhee F, Barlogie B, Usmani SZ. Cardiac complications in relapsed and refractory multiple myeloma patients treated with carfilzomib. Blood Cancer J 2015; 5:e272. [PMID: 25594159 PMCID: PMC4314456 DOI: 10.1038/bcj.2014.93] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- S Atrash
- Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - A Tullos
- Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - S Panozzo
- Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - M Bhutani
- Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC, USA
| | - F Van Rhee
- Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - B Barlogie
- Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - S Z Usmani
- Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC, USA
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10
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Heuck CJ, Qu P, van Rhee F, Waheed S, Usmani SZ, Epstein J, Zhang Q, Edmondson R, Hoering A, Crowley J, Barlogie B. Five gene probes carry most of the discriminatory power of the 70-gene risk model in multiple myeloma. Leukemia 2014; 28:2410-3. [PMID: 25079174 PMCID: PMC4274609 DOI: 10.1038/leu.2014.232] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- C J Heuck
- Myeloma Institute for Research and Therapy, Little Rock, AR, USA
| | - P Qu
- Cancer Research and Biostatistics, Seattle, WA, USA
| | - F van Rhee
- Myeloma Institute for Research and Therapy, Little Rock, AR, USA
| | - S Waheed
- Myeloma Institute for Research and Therapy, Little Rock, AR, USA
| | - S Z Usmani
- Myeloma Institute for Research and Therapy, Little Rock, AR, USA
| | - J Epstein
- Myeloma Institute for Research and Therapy, Little Rock, AR, USA
| | - Q Zhang
- Myeloma Institute for Research and Therapy, Little Rock, AR, USA
| | - R Edmondson
- Myeloma Institute for Research and Therapy, Little Rock, AR, USA
| | - A Hoering
- Cancer Research and Biostatistics, Seattle, WA, USA
| | - J Crowley
- Cancer Research and Biostatistics, Seattle, WA, USA
| | - B Barlogie
- Myeloma Institute for Research and Therapy, Little Rock, AR, USA
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11
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Affiliation(s)
- S Zhao
- 1] Department of Genetics, Yale University, New Haven, CT, USA [2] Howard Hughes Medical Institute, Yale University, New Haven, CT, USA
| | - M Choi
- 1] Department of Genetics, Yale University, New Haven, CT, USA [2] Howard Hughes Medical Institute, Yale University, New Haven, CT, USA [3] Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea
| | - C Heuck
- Myeloma Institute for Research and Therapy, Little Rock, AR, USA
| | - S Mane
- 1] Yale Center for Genome Analysis, Yale University, New Haven, CT, USA [2] Yale Cancer Center, Yale University, New Haven, CT, USA
| | - B Barlogie
- Myeloma Institute for Research and Therapy, Little Rock, AR, USA
| | - R P Lifton
- 1] Department of Genetics, Yale University, New Haven, CT, USA [2] Howard Hughes Medical Institute, Yale University, New Haven, CT, USA [3] Yale Cancer Center, Yale University, New Haven, CT, USA
| | - M V Dhodapkar
- 1] Yale Cancer Center, Yale University, New Haven, CT, USA [2] Section of Hematology, Yale University, New Haven, CT, USA
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12
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Sanchorawala V, Hoering A, Seldin DC, Finn KT, Fennessey SA, Sexton R, Mattar B, Safah HF, Holmberg LA, Dean RM, Orlowski RZ, Barlogie B. Modified high-dose melphalan and autologous SCT for AL amyloidosis or high-risk myeloma: analysis of SWOG trial S0115. Bone Marrow Transplant 2013; 48:1537-42. [PMID: 23852321 DOI: 10.1038/bmt.2013.98] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 06/04/2013] [Accepted: 06/12/2013] [Indexed: 12/22/2022]
Abstract
We designed a trial using two sequential cycles of modified high-dose melphalan at 100 mg/m(2) and autologous SCT (mHDM/SCT) in AL amyloidosis (light-chain amyloidosis, AL), AL with myeloma (ALM) and host-based high-risk myeloma (hM) patients through SWOG-0115. The primary objective was to evaluate OS. From 2004 to 2010, 93 eligible patients were enrolled at 17 centers in the United States (59 with AL, 9 with ALM and 25 with hM). The median OS for patients with AL and ALM was 68 months and 47 months, respectively, and has not been reached for patients with hM. The median PFS for patients with AL and ALM was 38 months and 16 months, respectively, and has not been reached for patients with hM. The treatment-related mortality (TRM) was 12% (11/93) and was observed only in patients with AL after SCT. Grade 3 and higher non-hematologic adverse events were experienced by 81%, 67% and 57% of patients with AL, ALM and hM, respectively, during the first and second HDM/SCT. This experience demonstrates that with careful selection of patients and use of mHDM for SCT in patients with AL, ALM and hM, even in the setting of a multicenter study, OS can be improved with acceptable TRM and morbidity.
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13
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Papanikolaou X, Rosenbaum ER, Tyler LN, Sawyer J, Heuck CJ, Barlogie B, Cottler-Fox M. Hematopoietic progenitor cell collection after autologous transplant for multiple myeloma: low platelet count predicts for poor collection and sole use of resulting graft enhances risk of myelodysplasia. Leukemia 2013; 28:888-93. [PMID: 23852547 DOI: 10.1038/leu.2013.214] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Revised: 06/30/2013] [Accepted: 07/04/2013] [Indexed: 12/21/2022]
Abstract
Collection of hematopoietic progenitor cells (HPC) after previous autologous hematopoietic progenitor cell transplant (aHCT) was studied in 221 patients with multiple myeloma (MM). With a total of 333 collections, the median number of CD34+ cells collected was 4.7 × 10(6) CD34+ cells/kg, and 74% of the patients collected ≥ 2.5 × 10(6) CD34+ cells/kg. Among 26 variables examined, the strongest predictor for poor collection was a platelet count <100 × 10(6)/l before mobilization (P<0.001). A subsequent aHCT was performed in 154 of the 221 patients. Sole use of HPC procured after aHCT in 86 patients was associated with delayed platelet recovery (P<0.001) and linked to development of myelodysplastic syndrome (MDS)-associated cytogenetic abnormalities (MDS-CA; P=0.027, odds ratio (OR) 10.34) and a tendency towards clinical MDS/acute myeloid leukemia (AML; P=0.091, OR 3.57). However, treatment-related mortality (P=0.766) and time to absolute neutrophil count recovery ≥0.5 × 10(9)/l (P=0.879) were similar to when a pre-aHCT graft was used. Indeed, adding HPC collected before any aHCT neutralized the risk of MDS-CA or MDS/AML. Therefore, we advise generous initial HPC collection to broaden the salvage armamentarium for patients with MM.
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Affiliation(s)
- X Papanikolaou
- Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - E R Rosenbaum
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - L N Tyler
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - J Sawyer
- 1] Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, USA [2] Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - C J Heuck
- Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - B Barlogie
- Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - M Cottler-Fox
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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14
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Erdem E, Samant R, Malak SF, Culp WC, Brown A, Peterson L, Lensing S, Barlogie B. Vertebral augmentation in the treatment of pathologic compression fractures in 792 patients with multiple myeloma. Leukemia 2013; 27:2391-3. [PMID: 23728152 PMCID: PMC3865531 DOI: 10.1038/leu.2013.162] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- E Erdem
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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15
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Avet-Loiseau H, Durie BGM, Cavo M, Attal M, Gutierrez N, Haessler J, Goldschmidt H, Hajek R, Lee JH, Sezer O, Barlogie B, Crowley J, Fonseca R, Testoni N, Ross F, Rajkumar SV, Sonneveld P, Lahuerta J, Moreau P, Morgan G. Combining fluorescent in situ hybridization data with ISS staging improves risk assessment in myeloma: an International Myeloma Working Group collaborative project. Leukemia 2012; 27:711-7. [PMID: 23032723 DOI: 10.1038/leu.2012.282] [Citation(s) in RCA: 156] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The combination of serum β2-microglobulin and albumin levels has been shown to be highly prognostic in myeloma as the International Staging System (ISS). The aim of this study was to assess the independent contributions of ISS stage and cytogenetic abnormalities in predicting outcomes. A retrospective analysis of international studies looking at both ISS and cytogenetic abnormalities was performed in order to assess the potential role of combining ISS stage and cytogenetics to predict survival. This international effort used the International Myeloma Working Group database of 12 137 patients treated worldwide for myeloma at diagnosis, of whom 2309 had cytogenetic studies and 5387 had analyses by fluorescent in situ hybridization (iFISH). Comprehensive analyses used 2642 patients with sufficient iFISH data available. Using the comprehensive iFISH data, combining both t(4;14) and deletion (17p), along with ISS stage, significantly improved the prognostic assessment in terms of progression-free survival and overall survival. The additional impact of patient age and use of high-dose therapy was also demonstrated. In conclusion, the combination of iFISH data with ISS staging significantly improves risk assessment in myeloma.
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Affiliation(s)
- H Avet-Loiseau
- Unité de Génomique du Myélome, Laboratoire UGM, University Hospital, CHU Rangueil, Toulouse, France
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16
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Usmani SZ, Crowley J, Hoering A, Mitchell A, Waheed S, Nair B, AlSayed Y, Vanrhee F, Barlogie B. Improvement in long-term outcomes with successive Total Therapy trials for multiple myeloma: are patients now being cured? Leukemia 2012; 27:226-32. [PMID: 22705990 DOI: 10.1038/leu.2012.160] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The concept of applying all active therapeutic agents in Total Therapy (TT) clinical trials for newly diagnosed multiple myeloma was pursued with the intent of developing curative treatment. The results of TT1 (n=231), TT2 (n=668) without or with thalidomide and TT3 with added bortezomib (n=303) have been reported. An update with median follow-up times of 17.1, 8.7 and 5.5 years, respectively, is provided. Conditional overall survival (OS) analysis from a 4-year landmark was applied to account for earlier protocol failure owing to disease aggressiveness and toxicities. Cumulative relative survival was computed in the context of age- and gender-matched US population, and interval-specific relative survival ratios were estimated to determine times to normal survival expectation. Based on Cox model-adjusted statistics, OS, progression-free survival and complete-response duration all improved with the transitions from TT1 to TT2 to TT3; improvement was also evident from time-to-progression estimates, 4-year conditional survival data and cumulative relative survival. Interval-specific relative survival normalized progressively sooner, reaching near-normal levels with TT3 in patients who attained complete response. Thus, a strategy using all myeloma-effective agents up-front seems effective at preventing, in progressively larger patient cohorts over time, the outgrowth of resistant tumor cells that account for ongoing relapses.
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Affiliation(s)
- S Z Usmani
- Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
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17
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Khan R, Apewokin S, Grazziutti M, Yaccoby S, Epstein J, van Rhee F, Rosenthal A, Waheed S, Usmani S, Atrash S, Kumar S, Hoering A, Crowley J, Shaughnessy JD, Barlogie B. Renal insufficiency retains adverse prognostic implications despite renal function improvement following Total Therapy for newly diagnosed multiple myeloma. Leukemia 2012; 29:1195-201. [PMID: 25640885 PMCID: PMC4430702 DOI: 10.1038/leu.2015.15] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 12/31/2014] [Indexed: 11/25/2022]
Abstract
Renal insufficiency (RI) is a frequent complication of multiple myeloma (MM) with negative consequences for patient survival. The improved clinical outcome with successive Total Therapy (TT) protocols was limited to patients without RI. We therefore performed a retrospective analysis of overall survival, progression-free survival and time to progression (TTP) of patients enrolled in TT2 and TT3 in relationship to RI present at baseline and pre-transplant. Glomerular filtration rate was graded in four renal classes (RCs), RC1–RC4 (RC1 ⩾90 ml/min/1.73 m2, RC2 60–89 ml/min/1.73 m2, RC3 30–59 ml/min/1.73 m2 and RC4 <30 ml/min/1.73 m2). RC1–3 had comparable clinical outcomes while RC4 was deleterious, even after improvement to better RC after transplant. Among the 85% of patients with gene expression profiling defined low-risk MM, Cox regression modeling of baseline and pre-transplant features, which also took into consideration RC improvement and MM complete response (CR), identified the presence of metaphase cytogenetic abnormalities and baseline RC4 as independent variables linked to inferior TTP post-transplant, while MM CR reduced the risk of progression and TTP by more than 60%. Failure to improve clinical outcomes despite RI improvement suggested MM-related causes. Although distinguishing RC4 from RC<4, 46 gene probes bore no apparent relationship to MM biology or survival.
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Affiliation(s)
- R Khan
- Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - S Apewokin
- Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - M Grazziutti
- Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - S Yaccoby
- Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - J Epstein
- Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - F van Rhee
- Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - A Rosenthal
- Cancer Research and Biostatistics, Seattle, WA, USA
| | - S Waheed
- Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - S Usmani
- 1] Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, USA [2] Levine Cancer Institute/Carolinas Healthcare System, Charlotte, NC, USA
| | - S Atrash
- Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - S Kumar
- Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - A Hoering
- Cancer Research and Biostatistics, Seattle, WA, USA
| | - J Crowley
- Cancer Research and Biostatistics, Seattle, WA, USA
| | | | - B Barlogie
- Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Katragadda L, Alejandro R, Muzaffar J, Kumar NS, Barlogie B, Cottler-Fox M, Anaissie E. Thrombotic Microangiopathy (TMA) Related to Cytomegalovirus (CMV) Is a Rare But Serious Condition After Autologous Hematopoietic Stem Cell Transplantation (ASCT). Biol Blood Marrow Transplant 2012. [DOI: 10.1016/j.bbmt.2011.12.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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19
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Stone K, Woods E, Szmania SM, Stephens O, Garg TK, Moreno-Bost A, Barlogie B, Shaughnessy JD, Hall B, Reddy MP, Van Rhee F. Prevalence of interleukin-6 receptor polymorphism in Castleman disease and association with increased soluble interleukin-6 receptor levels. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.8077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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20
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Usmani SZ, Mitchell A, Szymonifka J, Shaughnessy JD, Hoering A, Alsayed Y, Waheed S, Nair B, Crowley J, Barlogie B. Extramedullary disease (EMD): A common terminal pathway in multiple myeloma (MM) progression. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.8068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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21
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Szymonifka J, Usmani SZ, Sexton R, Panozzo S, Nair BP, Waheed S, Alsayed Y, Crowley J, Barlogie B. Phase II study of carfilzomib (CFZ) in combination with current agents for relapsed and refractory multiple myeloma (RRMM). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.8028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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22
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Katragadda L, Sanathkumar N, Veeraputhiran M, Restrepo A, Haider S, Muzaffar J, Barlogie B, Anaissie EJ. Bortezomib (BZB)-associated adverse events (AE) in patients with multiple myeloma (MM). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e18565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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23
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Sanchorawala V, Bolejack V, Crowley J, Hoering A, Finn KT, Fennessey S, Seldin DC, Barlogie B. Modified high-dose melphalan and autologous stem cell transplantation (mHDM/SCT) in the treatment of AL amyloidosis (AL) and/or high-risk myeloma (hM): Analysis of a Southwest Oncology Group trial. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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24
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Crowley J, Shaughnessy JD, Bolejack V, Anaissie EJ, Van Rhee F, Barlogie B. Cure fractions (CF) modeled from event-free survival and complete response duration plots in total therapy (TT) trials for newly diagnosed multiple myeloma (MM). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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25
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Alsayed Y, Nair BP, Kauffman M, Petty N, Waheed S, Van Rhee F, Szymonifka J, Barlogie B. Carfilzomib (CFZ) in combination with DEX and other agents (Dox, Thal, DDP, vorinostat) for far advanced and refractory multiple myeloma (FARMM). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e18504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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26
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Sawyer J, Shaughnessy JD, Haessler J, Hoering A, Barlogie B. Gene expression profiling (GEP) in multiple myeloma (MM): Distinguishing relapses with high-risk transformation from those with sustained low risk. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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27
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Van Rhee F, Barlogie B, Szymonifka J, Anaissie EJ, Nair BP, Waheed S, Alsayed Y, Petty N, Shaughnessy JD, Hoering A, Crowley J. Total therapy 3 (TT3) for multiple myeloma (MM): Contributions to survival outcomes of dosing of maintenance components dexamethasone (D), thalidomide (T) and bortezomib (V). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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28
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Waheed S, Alsayed Y, Sexton R, Hoering A, Barlogie B. Predicting 10+ year survivors in total therapy 1 (TT1) for multiple myeloma (MM). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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29
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Haessler J, Nair BP, Sawyer J, Hoering A, Shaughnessy JD, Barlogie B. Metaphase cytogenetic abnormalities (M-CA) in multiple myeloma (MM): Examining number of M-CA for survival in total therapy protocols (TT1, TT2, TT3). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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30
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Nair BP, Petty N, Waheed S, Hoering A, Van Rhee F, Anaissie EJ, Lorsbach R, Bailey C, Barlogie B. Primary plasma cell leukemia (PCL): Clinical and laboratory presentation and clinical outcome with total therapy (TT) protocols. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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31
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Hoering A, Shaughnessy JD, Haessler J, Sexton R, Van Rhee F, Alsayed Y, Waheed S, Nair BP, Crowley J, Barlogie B. Genomic evolution in total therapy 2 (TT2) and total therapy 3 (TT3) for newly diagnosed multiple myeloma (MM): Comparison of baseline (BL) and relapse (REL) gene expression profiling (GEP) signatures. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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32
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Qiang Y, van Hemert R, Brown T, Shaughnessy JD, Van Rhee F, Hoering A, Barlogie B. Gene expression profiling (GEP) analysis of CD138-purified plasma cells (PC) obtained from MRI-defined focal lesions (FL) under CT guidance: Applying the 70 gene risk model and comparison with data generated on random samples (RS) from multiple myeloma (MM) treated with total therapy 2, 3, 4, and 5 (TT2, TT3, TT4, and TT5). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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33
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Barlogie B, Shaughnessy JD, Haessler J, Hoering A, Van Rhee F, Anaissie EJ, Crowley J. Defining the prognostic variables in gene expression profiling (GEP)-defined high-risk multiple myeloma (MM): Distinguishing early failures (EF) from sustained control (SC). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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34
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Szymonifka J, Shaughnessy JD, Hoering A, Alsayed Y, Waheed S, Nair BP, Crowley J, Barlogie B. Effect of race, age, and gender on prognosis in total therapy protocols for multiple myeloma. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e18502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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35
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Shaughnessy JD, Qu P, Tian E, Edmondson R, Nair BP, Waheed S, Alsayed Y, Van Rhee F, Haessler J, Crowley J, Barlogie B. Outcome with total therapy 3 (TT3) compared to total therapy 2 (TT2): Role of GEP70-defined high-risk disease with trisomy of 1q21 and activation of the proteasome gene PSMD4. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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36
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Anaissie EJ, Grazziutti M, Szymonifka J, Nair BP, Van Rhee F, Alsayed Y, Waheed S, Hoering A, Barlogie B. The Arkansas experience with autotransplantation (AT) for older patients (OP, age > 65) with multiple myeloma (MM). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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37
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Veeraputhiran M, Singh Z, Barlogie B, Cottler-Fox M. Stromal elements and engraftment (ENG) in autologous hematopoietic progenitor cell transplant (autoHCT) for myeloma. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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38
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Veeraputhiran M, Singh Z, Barlogie B, Cottler-Fox M. Stromal Elements And Engraftment In Autologous Hematopoietic Progenitor Cell (HPC) Transplant For Myeloma. Biol Blood Marrow Transplant 2010. [DOI: 10.1016/j.bbmt.2009.12.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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39
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Fonseca R, Bergsagel PL, Drach J, Shaughnessy J, Gutierrez N, Stewart AK, Morgan G, Van Ness B, Chesi M, Minvielle S, Neri A, Barlogie B, Kuehl WM, Liebisch P, Davies F, Chen-Kiang S, Durie BGM, Carrasco R, Sezer O, Reiman T, Pilarski L, Avet-Loiseau H. International Myeloma Working Group molecular classification of multiple myeloma: spotlight review. Leukemia 2009; 23:2210-21. [PMID: 19798094 DOI: 10.1038/leu.2009.174] [Citation(s) in RCA: 624] [Impact Index Per Article: 41.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Myeloma is a malignant proliferation of monoclonal plasma cells. Although morphologically similar, several subtypes of the disease have been identified at the genetic and molecular level. These genetic subtypes are associated with unique clinicopathological features and dissimilar outcome. At the top hierarchical level, myeloma can be divided into hyperdiploid and non-hyperdiploid subtypes. The latter is mainly composed of cases harboring IgH translocations, generally associated with more aggressive clinical features and shorter survival. The three main IgH translocations in myeloma are the t(11;14)(q13;q32), t(4;14)(p16;q32) and t(14;16)(q32;q23). Trisomies and a more indolent form of the disease characterize hyperdiploid myeloma. A number of genetic progression factors have been identified including deletions of chromosomes 13 and 17 and abnormalities of chromosome 1 (1p deletion and 1q amplification). Other key drivers of cell survival and proliferation have also been identified such as nuclear factor- B-activating mutations and other deregulation factors for the cyclin-dependent pathways regulators. Further understanding of the biological subtypes of the disease has come from the application of novel techniques such as gene expression profiling and array-based comparative genomic hybridization. The combination of data arising from these studies and that previously elucidated through other mechanisms allows for most myeloma cases to be classified under one of several genetic subtypes. This paper proposes a framework for the classification of myeloma subtypes and provides recommendations for genetic testing. This group proposes that genetic testing needs to be incorporated into daily clinical practice and also as an essential component of all ongoing and future clinical trials.
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Affiliation(s)
- R Fonseca
- Department of Hematology-Oncology, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AR 85259-5494, USA.
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40
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Abstract
Cancer-causing mutations disrupt coordinated, precise programs of gene expression that govern cell growth and differentiation. Microarray-based gene-expression profiling (GEP) is a powerful tool to globally analyze these changes to study cancer biology and clinical behavior. Despite overwhelming genomic chaos in multiple myeloma (MM), expression patterns within tumor samples are remarkably stable and reproducible. Unique expression patterns associated with recurrent chromosomal translocations and ploidy changes defined molecular classes with differing clinical features and outcomes. Combined molecular techniques also dissected two distinct, reproducible forms of hyperdiploid disease and have molecularly defined MM with high risk for poor clinical outcome. GEP is now used to risk-stratify patients with newly diagnosed MM. Groups with high-risk features are evident in all GEP-defined MM classes, and GEP studies of serial samples showed that risk increases over time, with relapsed disease showing dramatic GEP shifts toward a signature of poor outcomes. This suggests a common mechanism of disease evolution and potentially reflects preferential expansion of therapy-resistant cells. Correlating GEP-defined disease class and risk with outcomes of therapeutic regimens reveals class-specific benefits for individual agents, as well as mechanistic insights into drug sensitivity and resistance. Here, we review modern genomics contributions to understanding MM pathogenesis, prognosis, and therapy.
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Affiliation(s)
- Y Zhou
- Donna D and Donald M Lambert Laboratory for Myeloma Genetics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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41
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Durie BGM, Van Ness B, Ramos C, Stephens O, Haznadar M, Hoering A, Haessler J, Katz MS, Mundy GR, Kyle RA, Morgan GJ, Crowley J, Barlogie B, Shaughnessy J. Genetic polymorphisms of EPHX1, Gsk3beta, TNFSF8 and myeloma cell DKK-1 expression linked to bone disease in myeloma. Leukemia 2009; 23:1913-9. [PMID: 19657367 DOI: 10.1038/leu.2009.129] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Bone disease in myeloma occurs as a result of complex interactions between myeloma cells and the bone marrow microenvironment. A custom-built DNA single nucleotide polymorphism (SNP) chip containing 3404 SNPs was used to test genomic DNA from myeloma patients classified by the extent of bone disease. Correlations identified with a Total Therapy 2 (TT2) (Arkansas) data set were validated with Eastern Cooperative Oncology Group (ECOG) and Southwest Oncology Group (SWOG) data sets. Univariate correlates with bone disease included: EPHX1, IGF1R, IL-4 and Gsk3beta. SNP signatures were linked to the number of bone lesions, log(2) DKK-1 myeloma cell expression levels and patient survival. Using stepwise multivariate regression analysis, the following SNPs: EPHX1 (P=0.0026); log(2) DKK-1 expression (P=0.0046); serum lactic dehydrogenase (LDH) (P=0.0074); Gsk3beta (P=0.02) and TNFSF8 (P=0.04) were linked to bone disease. This assessment of genetic polymorphisms identifies SNPs with both potential biological relevance and utility in prognostic models of myeloma bone disease.
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Affiliation(s)
- B G M Durie
- Hematology/Oncology, Cedars-Sinai Outpatient Cancer Center at the Samuel Oschin Comprehensive Cancer Institute & Aptium Oncology, Los Angeles, CA 90048, USA.
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Fassas ABT, Miceli MH, Grazzlutti M, Dong L, Barlogie B, Anaissie E. Serial measurement of serum C-reactive protein levels can identify patients at risk for severe complications following autologous stem cell transplantation. Leuk Lymphoma 2009; 46:1159-61. [PMID: 16085556 DOI: 10.1080/10428190500086121] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The value of serum C-reactive protein (CRP) levels as a predictor of complications in neutropenic patients needs to be further defined. We sought to identify an association between severe complications and daily CRP levels measured in 104 multiple myeloma patients during the 3 week period following high-dose melphalan and autologous transplant. Significantly higher mean CRP levels and CRP velocity of increase were observed among patients with severe complications. A cut-off point of 100 mg/l (CRP levels) and 15 mg/l/day (CRP velocity) identified patients likely to suffer severe complications with 86 and 75% sensitivity, respectively. Prospective validation of this model is currently underway.
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Affiliation(s)
- A B-T Fassas
- Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
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Giralt S, Stadtmauer EA, Harousseau JL, Palumbo A, Bensinger W, Comenzo RL, Kumar S, Munshi NC, Dispenzieri A, Kyle R, Merlini G, San Miguel J, Ludwig H, Hajek R, Jagannath S, Blade J, Lonial S, Dimopoulos MA, Einsele H, Barlogie B, Anderson KC, Gertz M, Attal M, Tosi P, Sonneveld P, Boccadoro M, Morgan G, Sezer O, Mateos MV, Cavo M, Joshua D, Turesson I, Chen W, Shimizu K, Powles R, Richardson PG, Niesvizky R, Rajkumar SV, Durie BGM. International myeloma working group (IMWG) consensus statement and guidelines regarding the current status of stem cell collection and high-dose therapy for multiple myeloma and the role of plerixafor (AMD 3100). Leukemia 2009; 23:1904-12. [PMID: 19554029 DOI: 10.1038/leu.2009.127] [Citation(s) in RCA: 171] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Multiple myeloma is the most common indication for high-dose chemotherapy with autologous stem cell support (ASCT) in North America today. Stem cell procurement for ASCT has most commonly been performed with stem cell mobilization using colony-stimulating factors with or without prior chemotherapy. The target CD34+ cell dose to be collected as well as the number of apheresis performed varies throughout the country, but a minimum of 2 million CD34+ cells/kg has been traditionally used for the support of one cycle of high-dose therapy. With the advent of plerixafor (AMD3100) (a novel stem cell mobilization agent), it is pertinent to review the current status of stem cell mobilization for myeloma as well as the role of autologous stem cell transplantation in this disease. On June 1, 2008, a panel of experts was convened by the International Myeloma Foundation to address issues regarding stem cell mobilization and autologous transplantation in myeloma in the context of new therapies. The panel was asked to discuss a variety of issues regarding stem cell collection and transplantation in myeloma especially with the arrival of plerixafor. Herein, is a summary of their deliberations and conclusions.
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Affiliation(s)
- S Giralt
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030-4009, USA.
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Hollmig K, Waheed S, Nair B, Haessler J, Petty N, Pineda-Roman M, Alsayed Y, van Rhee F, Crowley J, Barlogie B. MDS-associated cytogenetic abnormalities (MDS-CA) after total therapy (TT) regimens for newly diagnosed multiple myeloma (MM): Apparent surge after introduction of post-transplant consolidation chemotherapy (CONS) in TT2 and TT3. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.8595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8595 Background: We have previously reported on the variables associated with the development of MDS-CA in the context of autologous transplant-supported high-dose therapy regimens for MM (Barlogie et al, Blood 2008). Methods: Due to a perceived increase in MDS-CA frequency, our MM data base was reviewed again to determine the potential effect of CONS introduced in TT2 and retained in TT3 trials. The frequency of MDS-CA post-transplant was determined, using Kaplan-Meier estimate plots, for 183 patients who received TT1, 554 enrolled in TT2 and 305 receiving TT3. Persistence of MDS-CA implied their documentation on 3 successive occasions. Results: 3-year MDS-CA estimates were 2% for both TT1 and TT2 and 4% for TT3 (TT3 v TT2, p=0.04; TT3 v TT1, p=0.11); persistent MDS-CA were also more frequently observed in TT3 in comparison with TT2 and TT1 (2% v 0% v 0%, both p=0.01). Multivariate analysis of features associated with transient and persistent MDS-CA revealed TT3 as an adverse feature (HR=2.84, p=0.043), along with incomplete platelet recovery of <165,000/uL 3mo after 1st transplant. Conclusions: Despite reduced induction chemotherapy prior to and CONS after tandem melphalan (200mg/m2)-based autotransplants from 4 in TT2 to 2 in TT3, overall and persistent MDS-CA increased significantly in TT3. Clinical MDS and AML were rarely observed and a full account of hematopathologic findings will be presented. [Table: see text]
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Affiliation(s)
- K. Hollmig
- University of Arkansas for Medical Sciences, Little Rock, AR; Cancer Research for Biostatistics, Seattle, WA
| | - S. Waheed
- University of Arkansas for Medical Sciences, Little Rock, AR; Cancer Research for Biostatistics, Seattle, WA
| | - B. Nair
- University of Arkansas for Medical Sciences, Little Rock, AR; Cancer Research for Biostatistics, Seattle, WA
| | - J. Haessler
- University of Arkansas for Medical Sciences, Little Rock, AR; Cancer Research for Biostatistics, Seattle, WA
| | - N. Petty
- University of Arkansas for Medical Sciences, Little Rock, AR; Cancer Research for Biostatistics, Seattle, WA
| | - M. Pineda-Roman
- University of Arkansas for Medical Sciences, Little Rock, AR; Cancer Research for Biostatistics, Seattle, WA
| | - Y. Alsayed
- University of Arkansas for Medical Sciences, Little Rock, AR; Cancer Research for Biostatistics, Seattle, WA
| | - F. van Rhee
- University of Arkansas for Medical Sciences, Little Rock, AR; Cancer Research for Biostatistics, Seattle, WA
| | - J. Crowley
- University of Arkansas for Medical Sciences, Little Rock, AR; Cancer Research for Biostatistics, Seattle, WA
| | - B. Barlogie
- University of Arkansas for Medical Sciences, Little Rock, AR; Cancer Research for Biostatistics, Seattle, WA
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Barlogie B, Attal M, Crowley J, Harousseau J. Long-term follow-up of autotransplant (AT)-supported high-dose melphalan (hdm) for multiple myeloma (MM): Update of Intergroup Francophone du Myelome (IFM), Southwest Oncology Group (SWOG), and Arkansas (ARK) Total Therapy (TT) trials. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.8519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8519 Background: Clinical trial outcomes are usually published when statistical protocol objectives have been met, with short median follow-up not exceeding 5 years. Due to treatment innovations, MM survival beyond 10 years has become more common but formal long-term results are seldom reported. Methods: IFM, SWOG and ARK provide an update of their major trials. IFM-90: 1 AT v standard therapy (STD), IFM-94: 2 v 1 AT, IFM-9902: 2AT ± THAL, IFM-9904: 2AT for high-risk MM; SWOG-9321: 1 AT v STD; TT1: 2 AT with interferon, TT2: 2AT ± THAL, TT3: 2AT + THAL + bortezomib. Results: OS clustered in 3 groups with superior outcomes for TT3/TT2/IFM-99 v TT1 v IFM-94/ IFM-90/SWOG-9321 with 5/10/15-yr estimates of 70%/50%/TE v 57%/35%/20% v 43%/25%/15% (p<0.0001). EFS also clustered in 3 groups with superior outcomes for TT3 v TT2 v remainder with estimates of 71%/TE/TE v 50%/35%/TE v 27%/ 15%/10% (p<0.0001). Among phase III trials, added THAL in TT2 increased 10-yr OS/EFS from 40%/25% to 60%/40% (p=0.04/p=0.0005); 10-yr OS was 30% v 8% with 1 v 0 AT in IFM-90 (p=0.005), 31% v 21% with 2 AT v 1 AT in IFM-94 (p=0.08), and 20% for both arms of S9321. On multivariate analysis involving 2962 patients, OS was adversely affected by B2M >=3.5mg/L (p<0.001), LDH >=ULN (p<0.001), hemoglobin <10g/dL (p=0.001) and albumin <3.5g/dL (p=0.02). 2AT (65%) and THAL (21%) both contributed independently to superior OS (p<0.001, p=0.002); among individual trials, IFM-9902 (19%) and TT2/TT3 (33%) both improved OS significantly (both p<0.001). For each of the 3 major OS clusters, 228 patients could be matched on B2M, LDH, hemoglobin and albumin, with 10-yr OS/EFS estimates of 65%/30% for the TT3/TT2/IFM-9902 group significantly exceeding 30%/15% each for the other 2 groups (p=0.001/p=0.001). Conclusions: A 15-yr EFS plateau of 10% with older trials and superior 10-yr EFS/OS estimates of 50%/35% with recent studies emphasize that cure should be a realistic trial objective in contemporary MM therapy, requiring however very long-term follow-up beyond 15 years. [Table: see text]
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Affiliation(s)
- B. Barlogie
- University of Arkansas for Medical Sciences, Little Rock, AR; Centre Hospitalier Universitaire, Cedex, France; Cancer Research and Biostatistics, Seattle, WA
| | - M. Attal
- University of Arkansas for Medical Sciences, Little Rock, AR; Centre Hospitalier Universitaire, Cedex, France; Cancer Research and Biostatistics, Seattle, WA
| | - J. Crowley
- University of Arkansas for Medical Sciences, Little Rock, AR; Centre Hospitalier Universitaire, Cedex, France; Cancer Research and Biostatistics, Seattle, WA
| | - J. Harousseau
- University of Arkansas for Medical Sciences, Little Rock, AR; Centre Hospitalier Universitaire, Cedex, France; Cancer Research and Biostatistics, Seattle, WA
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Srkalovic G, Hussein M, Bolejack V, Hoering A, Zonder J, Barlogie B. A phase II trial of sorafenib in patients with relapsing and resistant multiple myeloma (MM) previously treated with bortezomib (S0434). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e19517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e19517 Background: The multikinase inhibitor sorafenib targets several serine/threonine and receptor tyrosine kinases by blocking RAF kinase, a critical component of the RAF/MEK/ERK signaling pathway regulated by the Ras oncogene, which is mutated both in primary patient samples and in human MM lines (35–50%). As the frequency of these mutations increases with advancing disease and increasing drug resistance, inhibition of the RAF/MEK/ERK signaling pathway, as well the angiogenic VEGFR-2/PDGFR beta cascade by sorafenib may be a useful new approach for the treatment of MM. Methods: SWOG evaluated the effect of sorafenib as a single agent in relapsed/refractory MM patients. In this phase II study we assessed response rate, overall (OS) and progression-free survival (PFS) as well as toxicities associated with this treatment. Twenty-three heavily pretreated MM patients were enrolled in the study. Sorafenib was started at oral dose of 400 mg daily until progression or toxicity. This dose was based on the label for metastatic renal cell carcinoma. Results: The study was closed as planned due to lack of efficacy in first 18 patients who were assessable for toxicity and response. Three patients experienced Grade 4 toxicity consisting of thrombocytopenia, anemia and renal failure. 8 cases suffered Grade 3 toxicities including thrombocytopenia, neutropenia, anemia, hand-foot syndrome, diarrhea and dyspnea. No responses were observed. 3 patients had stable disease (2.4–15.9 months) and the remainder progressed. Median PFS is one month, and OS at 12 months is 50%. Conclusions: Thus, single agent sorafenib did not show activity in this group of heavily pretreated MM patients previously exposed to bortezomib. As the frequency of RAS oncogene mutations increases resulting in resistance to traditional chemotherapeutic agents as well as possibly supporting cytokine resistance to immune modulators, sorafenib might have a supportive role in combination therapy with bortezomib, lenalidomide or everolimus in relapsed/refractory MM which is currently being evaluated in ongoing studies. No significant financial relationships to disclose.
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Affiliation(s)
- G. Srkalovic
- Sparrow Cancer Center, Lansing, MI; Celgene Pharmaceuticals, Warren, NJ; Southwest Oncology Group Statistical Center, Seattle, WA; Karmanos Cancer Institute, Detroit, MI; University of Arkansas for Medical Sciences, Little Rock, AR
| | - M. Hussein
- Sparrow Cancer Center, Lansing, MI; Celgene Pharmaceuticals, Warren, NJ; Southwest Oncology Group Statistical Center, Seattle, WA; Karmanos Cancer Institute, Detroit, MI; University of Arkansas for Medical Sciences, Little Rock, AR
| | - V. Bolejack
- Sparrow Cancer Center, Lansing, MI; Celgene Pharmaceuticals, Warren, NJ; Southwest Oncology Group Statistical Center, Seattle, WA; Karmanos Cancer Institute, Detroit, MI; University of Arkansas for Medical Sciences, Little Rock, AR
| | - A. Hoering
- Sparrow Cancer Center, Lansing, MI; Celgene Pharmaceuticals, Warren, NJ; Southwest Oncology Group Statistical Center, Seattle, WA; Karmanos Cancer Institute, Detroit, MI; University of Arkansas for Medical Sciences, Little Rock, AR
| | - J. Zonder
- Sparrow Cancer Center, Lansing, MI; Celgene Pharmaceuticals, Warren, NJ; Southwest Oncology Group Statistical Center, Seattle, WA; Karmanos Cancer Institute, Detroit, MI; University of Arkansas for Medical Sciences, Little Rock, AR
| | - B. Barlogie
- Sparrow Cancer Center, Lansing, MI; Celgene Pharmaceuticals, Warren, NJ; Southwest Oncology Group Statistical Center, Seattle, WA; Karmanos Cancer Institute, Detroit, MI; University of Arkansas for Medical Sciences, Little Rock, AR
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Shaughnessy JD, Qu P, Haessler J, Crowley J, Barlogie B. Use of bortezomib (BOR) pharmacogenomics (PG) to identify mechanisms of drug resistance and predict survival in multiple myeloma (MM) treated with total therapy 3 (TT3). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.8538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8538 Background: The prognosis of patients with MM is best captured by gene expression profiling (GEP) analysis of CD138-purified plasma cells (PC), distinguishing a high-risk group of 15% with dismal survival using a 70-gene baseline risk model (BLR). Translational research in TT3 was designed to investigate whether short-term BOR-induced GEP alterations could advance our understanding of BOR's novel mechanism of action. Methods: PG studies were performed as part of two TT3 trials (TT3a, n=303; TT3b, n=177), obtaining PC prior to and 48hr after a BOR test-dose (1.0mg/m2), which was accomplished in 142 patients in TT3a (training set) and 127 in TT3b (test set). Among 1051 genes significantly altered post-BOR in TT3a, 80 were identified as being significantly associated with EFS. A continuous risk score was calculated and an optimal cut-point for EFS separation determined. The independent prognostic power of the binary risk score was tested in TT3b. Multivariate analyses (MV) were employed to determine post-BOR risk (PBR) in relationship to standard prognostic variables and BLR. Results: The discriminatory power in TT3a (3-yr OS: 95% v 45%, p<0.0001; 3-yr EFS: 90% v 35%, p<0.0001) was confirmed in TT3b (18-mo OS: 100% v 65%, p=0.0004; 18-mo EFS: 95% v 45%, p<0.0001). Evaluating PBR in the context of BLR, 12/26 in TT3a and 7/21 in TT3b deemed as having low BLR had high PBR; conversely, 8/126 in TT3a and 14/106 in TT3b deemed as having high BLR had low PBR. In the context of our 8 molecular subgroup model, high PBR was over-represented in the Proliferation (PR) subgroup (7/15 in TT3a, 8/18 in TT3b) and absent in the Low Bone disease (LB) group (0/28). On MV, PBR was an independent adverse variable for both OS and EFS in TT3a (OS: HR=3.17, p=0.006, R2=55%; EFS: HR=4.40, p<0.001, R2=48%) and in TT3b (OS: HR=13.00, p=0.002, R2=48%; EFS: HR=15.57, p<0.001, R2=55%). Proteasome genes ranked first among those differentially up-regulated by BOR. Conclusions: PG identified a powerful 80-gene PBR model with unprecedented prognosis-discriminating power, dispelling BLR from MV analysis by altering BLR designation mainly from low to high risk. High PBR (18%) could be traced to up-regulation of proteasome genes, the target of BOR. [Table: see text]
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Affiliation(s)
- J. D. Shaughnessy
- Myeloma Institute for Research and Therapy, Little Rock, AR; Cancer Research and Biostatistics, Seattle, WA
| | - P. Qu
- Myeloma Institute for Research and Therapy, Little Rock, AR; Cancer Research and Biostatistics, Seattle, WA
| | - J. Haessler
- Myeloma Institute for Research and Therapy, Little Rock, AR; Cancer Research and Biostatistics, Seattle, WA
| | - J. Crowley
- Myeloma Institute for Research and Therapy, Little Rock, AR; Cancer Research and Biostatistics, Seattle, WA
| | - B. Barlogie
- Myeloma Institute for Research and Therapy, Little Rock, AR; Cancer Research and Biostatistics, Seattle, WA
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Crowley J, Bolejack V, Robert K, Anderson K, Barlogie B. Prognostic factor analyses of myeloma (MM) survival outcomes on intergroup trial S9321 (int 0141): Examining whether different variables govern different time segments of survival. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.8599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8599 Background: MM survival varies enormously from few months to more than a decade. Baseline prognostic factors (PF) have been identified that are linked to survival outcomes, especially B2M and albumin. MM survival plots are typically characterized by 3 segments of slopes with decreasing steepness, suggesting that different PF may govern these time segments. Methods: We therefore examined, in S9321, PF that were associated with overall survival (OS) from baseline (BL) and from 3 subsequent landmarks 3, 5, and 7 years later (LM3, LM5, LM7). With a median follow-up of 9 years, OS and EFS were virtually identical in transplant and standard therapy arms so that the data were pooled. Results: Median OS and EFS for 817 eligible patients are 48 and 22 months. The BL model identified age (>60yr), hemoglobin (<10g/gL), platelet count (<130,000/uL), albumin (<3.5g/dL), B2M (>3.5g/dL), calcium (>10mg/dL), creatinine (>2mg/dL), LDH (>190U/L), performance status (PS, >1), IL-6 level (>140mg/L) and plasma cell labeling index (PCLI, >1%) as being univariately associated with short OS, while age (p=0.002), platelet count (p=0.04), calcium (p<0.001), B2M (p=0.002), LDH (p=0.010) and PCLI (p<0.001) retained significance in multivariate analysis. For the LM3 analyses, age (p=0.006) and B2M (p=0.009) were independently associated with poor OS, whereas PCLI was the only PF associated with LM5 (p=0.026) and age with LM7 (p<0.001). While associated univariately with OS from BL, CRP, platelet count, hemoglobin, albumin, calcium, creatinine, LDH, IL6 and PS all failed to affect OS from later LM times. Conclusions: Whereas the initial 3 years of OS are governed by a combination of features related to disease aggressiveness (LDH, calcium, albumin, CRP), tumor burden (hemoglobin, platelet count) and host tolerance (PS, creatinine), B2M and PCLI as reflectors of tumor burden and proliferation have sustained long-term OS implications. The age factor figures in partly due to death from other causes. In an era of ever-improving survival outcomes, such LM-based PF analysis may reveal trial-specific differences and thus provide guidance toward individualizing therapy. [Table: see text]
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Affiliation(s)
- J. Crowley
- Cancer Research and Biostatistics, Seattle, WA; Mayo Clinic, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; University of Arkansas for Medical Sciences, Little Rock, AR
| | - V. Bolejack
- Cancer Research and Biostatistics, Seattle, WA; Mayo Clinic, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; University of Arkansas for Medical Sciences, Little Rock, AR
| | - K. Robert
- Cancer Research and Biostatistics, Seattle, WA; Mayo Clinic, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; University of Arkansas for Medical Sciences, Little Rock, AR
| | - K. Anderson
- Cancer Research and Biostatistics, Seattle, WA; Mayo Clinic, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; University of Arkansas for Medical Sciences, Little Rock, AR
| | - B. Barlogie
- Cancer Research and Biostatistics, Seattle, WA; Mayo Clinic, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; University of Arkansas for Medical Sciences, Little Rock, AR
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Dhodapkar MV, Bolejack V, Shaughnessy J, Matthews P, Pickering R, Qu P, Hoering A, Crowley J, Barlogie B. Role of T-cell immunity to embryonal stem (ES) cell antigen SOX2 in the progression of myeloma. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.8522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8522 Background: Clinical outcome in patients (pts) with asymptomatic plasma-proliferative disorders, monoclonal gammopathy of undetermined significance (MGUS) and asymptomatic myeloma (AMM), is highly variable. There is a need to identify specific tumor or host related features that predict the risk of disease progression. In prior studies, we have shown that patients with MGUS commonly mount a T cell immune response against SOX2, an antigen critical for pluripotency of ES cells. Methods: Patients with MGUS/AMM were enrolled in a prospective observational clinical protocol (SWOG S0120). All patients underwent detailed staging evaluation at registration and were observed without therapy. The presence of T cell immunity to SOX2 in freshly isolated blood / marrow mononuclear cells was analyzed using an overlapping peptide library at study entry. Results: Anti-SOX2 T cell responses were detected in 39/109 (36%) pts tested. Progression to symptomatic MM was observed in only 2 of 39 patients with anti-SOX2 immunity compared to 17 of 59 pts lacking these responses, resulting in 2-yr progression-free survival 96 v 63% (p=0.003). Responses to viral antigens and polyclonal mitogens as controls were preserved in patients lacking SOX2 immunity indicating that the absence of immunity to SOX2 was not due to global immune-suppression. Immunity to SOX2 correlated with features of lower risk including serum-M component < 1.5 g/dL (p=0.008), marrow plasmacytosis < 10% (p<0.001) and normal serum free light chain ratio (p=0.01). Conclusions: These data demonstrate in the context of a prospective trial that T cell immunity to stem cell genes strongly correlates with a reduced risk of progression to clinical myeloma. These data point to SOX2 as a potential target for the prevention of disease progression in MGUS/AMM. No significant financial relationships to disclose.
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Affiliation(s)
- M. V. Dhodapkar
- Yale University, New Haven, CT; Cancer Research and Biostatistics, Seattle, WA; University of Arkansas, Little Rock, AR; Rockefeller University, New York, NY; Southwest Oncology Group
| | - V. Bolejack
- Yale University, New Haven, CT; Cancer Research and Biostatistics, Seattle, WA; University of Arkansas, Little Rock, AR; Rockefeller University, New York, NY; Southwest Oncology Group
| | - J. Shaughnessy
- Yale University, New Haven, CT; Cancer Research and Biostatistics, Seattle, WA; University of Arkansas, Little Rock, AR; Rockefeller University, New York, NY; Southwest Oncology Group
| | - P. Matthews
- Yale University, New Haven, CT; Cancer Research and Biostatistics, Seattle, WA; University of Arkansas, Little Rock, AR; Rockefeller University, New York, NY; Southwest Oncology Group
| | - R. Pickering
- Yale University, New Haven, CT; Cancer Research and Biostatistics, Seattle, WA; University of Arkansas, Little Rock, AR; Rockefeller University, New York, NY; Southwest Oncology Group
| | - P. Qu
- Yale University, New Haven, CT; Cancer Research and Biostatistics, Seattle, WA; University of Arkansas, Little Rock, AR; Rockefeller University, New York, NY; Southwest Oncology Group
| | - A. Hoering
- Yale University, New Haven, CT; Cancer Research and Biostatistics, Seattle, WA; University of Arkansas, Little Rock, AR; Rockefeller University, New York, NY; Southwest Oncology Group
| | - J. Crowley
- Yale University, New Haven, CT; Cancer Research and Biostatistics, Seattle, WA; University of Arkansas, Little Rock, AR; Rockefeller University, New York, NY; Southwest Oncology Group
| | - B. Barlogie
- Yale University, New Haven, CT; Cancer Research and Biostatistics, Seattle, WA; University of Arkansas, Little Rock, AR; Rockefeller University, New York, NY; Southwest Oncology Group
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Nair B, Shaughnessy J, Alsayed Y, Haessler J, van Rhee F, Hollmig K, Pineda-Roman M, Crowley J, Barlogie B. Gene expression profiling (GEP)-defined risk and molecular subgroups assessed at baseline and at relapse: Collective impact on post-relapse survival of multiple myeloma (MM) treated with total therapies 2 and 3. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.8589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8589 Background: GEP-defined risk has evolved as the most robust predictor of overall and event-free survival (OS, EFS) in MM with TT2 and TT3 protocols, distinguishing 85% with low-risk (LR) and 15% with high-risk (HR). Upon relapse, the original risk designation may change typically in the direction LR to HR. Here we examine, among patients with available GEP data at baseline (BL) and relapse (REL), the contributions of both observations on post-relapse survival (PRS). Methods: Paired REL-BL GEP data were available in 77 patients, while information on metaphase cytogenetic abnormalities (CA) was obtained in 76 patients at both time-points. Results: PRS was significantly affected by both BL and REL HR status so that, among the 52 patients with LR at BL, HR status at REL conferred significantly poorer outcome compared to those with LR at REL (p=0.0005) with 30-mo estimates of 71% v 13%; likewise, among the 25 patients with HR at baseline, HR present also at relapse further diminished PRS (p=0.09) with 30-mo estimates in both settings of less than 20%. Similar considerations for CA status revealed, among the 29 patients without CA at BL, marked attrition of PRS with CA v no CA at REL with 30-mo estimates of 29% v 81% (p=0.04); for the 47 patients with CA at BL, CA also at REL further diminished the poor PRS from 46% to 22% (p=0.06). When all standard BL and REL prognostic factors were examined in a multivariate model, GEP-derived HR contributed to poor PRS both when present at BL (HR=2.79, p=0.005) and at REL (HR=2.77, p=0.002), in addition to CA at BL (HR=2.44, p=0.018). Conclusions: In estimating PRS in TT protocols, genetic characteristics at BL (HR, CA) have enduring adverse consequences aggravated further by HR status at REL. Therefore, in HR/CA BL settings, aiming at REL prevention appears as the best overall treatment strategy. [Table: see text]
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Affiliation(s)
- B. Nair
- University of Arkansas for Medical Sciences, Little Rock, AR; Cancer Research and Biostatistics, Seattle, WA
| | - J. Shaughnessy
- University of Arkansas for Medical Sciences, Little Rock, AR; Cancer Research and Biostatistics, Seattle, WA
| | - Y. Alsayed
- University of Arkansas for Medical Sciences, Little Rock, AR; Cancer Research and Biostatistics, Seattle, WA
| | - J. Haessler
- University of Arkansas for Medical Sciences, Little Rock, AR; Cancer Research and Biostatistics, Seattle, WA
| | - F. van Rhee
- University of Arkansas for Medical Sciences, Little Rock, AR; Cancer Research and Biostatistics, Seattle, WA
| | - K. Hollmig
- University of Arkansas for Medical Sciences, Little Rock, AR; Cancer Research and Biostatistics, Seattle, WA
| | - M. Pineda-Roman
- University of Arkansas for Medical Sciences, Little Rock, AR; Cancer Research and Biostatistics, Seattle, WA
| | - J. Crowley
- University of Arkansas for Medical Sciences, Little Rock, AR; Cancer Research and Biostatistics, Seattle, WA
| | - B. Barlogie
- University of Arkansas for Medical Sciences, Little Rock, AR; Cancer Research and Biostatistics, Seattle, WA
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