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Sim S, Kalff A, Tuch G, Mollee P, Ho J, Harrison S, Gibbs S, Prince HM, Spencer A, Joshua D, Lee C, Ling S, Murphy N, Szabo F, Szer J, Weber N, Ward C, Talaulikar D, Zannettino A, Quach H. The Importance of Frailty Assessment in Multiple Myeloma: A Position Statement From The Myeloma Scientific Advisory Group (MSAG) To Myeloma Australia. Intern Med J 2023; 53:819-824. [PMID: 36880355 DOI: 10.1111/imj.16049] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 02/13/2023] [Indexed: 03/08/2023]
Abstract
Multiple myeloma (MM) is a disease of older people, yet factors relating to comorbidity and frailty may threaten treatment tolerability for many of this heterogeneous group. There has been increasing interest in defining specific and clinically relevant frailty assessment tools within the MM population, with the goal of using these frailty scores not just as a prognostic instrument, but also as a predictive tool to allow for a frailty-adapted treatment approach. This paper reviews the various frailty assessment frameworks used in the evaluation of MM patients, including the International Myeloma Working Group Frailty Index (IMWG-FI), the Mayo Frailty Index and the simplified frailty scale. While the IMWG-FI remains the most widely accepted tool, the simplified frailty scale is the most user-friendly in busy day-to-day clinics based on its ease of use. This paper summarises the recommendations from the Myeloma Scientific Advisory group (MSAG) of Myeloma Australia, on the use of frailty assessment tools in clinical practice and propose a frailty-stratified treatment algorithm to aid clinicians in tailoring therapy for this highly heterogeneous patient population. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Shirlene Sim
- Department of Haematology, St Vincent's Hospital, Melbourne, Victoria
| | - Anna Kalff
- Department of Haematology, Alfred Hospital, Melbourne, Victoria
| | - Gina Tuch
- Department of Geriatric Medicine, Alfred Health, Melbourne, Victoria
| | - Peter Mollee
- Department of Haematology, Princess Alexandra Hospital, Queensland.,University of Queensland, Brisbane, Queensland
| | - Joy Ho
- Department of Haematology, Royal Prince Alfred Hospital, Sydney, New South Wales.,University of Sydney, Sydney, New South Wales
| | - Simon Harrison
- Department of Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, Victoria.,The University of Melbourne, Melbourne, Victoria
| | - Simon Gibbs
- Department of Haematology, Eastern Health, Melbourne, Victoria.,Monash University, Melbourne, Victoria
| | - H Miles Prince
- Department of Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, Victoria.,The University of Melbourne, Melbourne, Victoria.,Department of Haematology, Epworth Healthcare, Melbourne, Victoria
| | - Andrew Spencer
- Department of Haematology, Alfred Hospital, Melbourne, Victoria
| | - Douglas Joshua
- Department of Haematology, Royal Prince Alfred Hospital, Sydney, New South Wales.,University of Sydney, Sydney, New South Wales
| | - Cindy Lee
- Department of Clinical Haematology, Royal Adelaide Hospital, Adelaide, South Australia
| | - Silvia Ling
- Department of Haematology, Liverpool Hospital, Sydney, New South Wales
| | - Nick Murphy
- Department of Clinical Haematology, Royal Hobart Hospital, Hobart, Tasmania
| | - Ferenc Szabo
- Department of Haematology, Royal Darwin Hospital, Darwin, Northern Territory
| | - Jeff Szer
- Department of Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, Victoria.,The University of Melbourne, Melbourne, Victoria
| | - Nicholas Weber
- Department of Haematology, Royal Brisbane Hospital, Brisbane, Queensland
| | - Christopher Ward
- Department of Haematology, Royal North Shore Hospital, Sydney, New South Wales
| | - Dipti Talaulikar
- Department of Haematology, The Canberra Hospital, Canberra, Australian Capital Territory
| | - Andrew Zannettino
- Department of Experimental Haematology, University of Adelaide, Adelaide, South Australia
| | - Hang Quach
- Department of Haematology, St Vincent's Hospital, Melbourne, Victoria.,The University of Melbourne, Melbourne, Victoria
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2
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Talaulikar D, Joshua D, Ho PJ, Gibson J, Quach H, Gibbs S, Ling S, Ward C, Augustson B, Trotman J, Harrison SJ, Tam CS, Chair SHV, Vietoria HQ, Viewria MP, Vietria AS, Viewria AK, Vietoria SG, Joshua D, Ho J, Ward C, Ling S, Molle P, Weber N, Horvath N, Zannettino A, Jase W, Lee C, Augustson B, Radesk D, Talaulikar D, Murphy N, Johnston A, Szabo F, Romer K, Chan H. Treatment of Patients with Waldenström Macroglobulinaemia: Clinical practice update from the Myeloma Foundation of Australia Medical and Scientific Advisory Group. Intern Med J 2022; 53:599-609. [PMID: 36441109 DOI: 10.1111/imj.15980] [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] [Received: 06/10/2022] [Accepted: 11/19/2022] [Indexed: 11/29/2022]
Abstract
Waldenström macroglobulinaemia (WM) is an indolent B-cell malignancy characterised by the presence of IgM paraprotein, bone marrow infiltration by clonal small B lymphocytes with plasmacytic differentiation and the MYD88 L265P mutation in >90% of cases. Traditionally, WM has been treated with chemoimmunotherapy. Recent trials have demonstrated the efficacy and safety of Bruton tyrosine kinase inhibitors in WM, both as monotherapy and in combination with other drugs. There is emerging evidence on use of other agents including BCL2 inhibitors and on treatment of rare presentations of WM. In this update, the Medical and Scientific Advisory Group of Myeloma Australia review the available evidence on the treatment of WM since the last publication in 2017 and provide specific recommendations to assist Australian clinicians in the management of this disease.
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Affiliation(s)
- Dipti Talaulikar
- ACT Pathology, Canberra Hospital Canberra Australia
- Australian National University Canberra Australia
| | - D Joshua
- Institute of Haematology, Royal Prince Alfred Hospital Camperdown NSW
| | - P J Ho
- Institute of Haematology, Royal Prince Alfred Hospital Camperdown NSW
- University of Sydney Camperdown NSW
| | - J. Gibson
- Institute of Haematology, Royal Prince Alfred Hospital Camperdown NSW
- University of Sydney Camperdown NSW
| | - H Quach
- St Vincent's Hospital, Fitzroy Victoria
- Faculty of Medicine, Dentistry and Health Sciences University of Melbourne Parkville Australia
| | - S Gibbs
- Department of Haematology Eastern Health Box Hill VIC
- Eastern Clinical Research Unit Monash University
| | - S Ling
- Liverpool Hospital Liverpool NSW
| | - C Ward
- Royal North Shore Hospital St Leonards NSW
| | - B Augustson
- Department of Haematology Sir Charles Gairdner Hospital Nedlands WA
| | - Judith Trotman
- University of Sydney Camperdown NSW
- Concord Repatriation General Hospital Concord NSW
| | - S J Harrison
- Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne Vic
- Sir Peter MacCallum Dept of Oncology University of Melbourne, Parkville Vic
| | - Constantine S. Tam
- Faculty of Medicine, Dentistry and Health Sciences University of Melbourne Parkville Australia
- Alfred Hospital, Melbourne Victoria
- Central Clinical School, Monash University, Melbourne Victoria
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3
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Cheah S, Bassett JK, Bruinsma FJ, Cozen W, Hopper JL, Jayasekara H, Joshua D, MacInnis RJ, Prince HM, Vajdic CM, van Leeuwen MT, Doo NW, Harrison SJ, English DR, Giles GG, Milne RL. Alcohol and tobacco use and risk of multiple myeloma: A case-control study. EJHaem 2022; 3:109-120. [PMID: 35846225 PMCID: PMC9175849 DOI: 10.1002/jha2.337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/15/2021] [Accepted: 10/16/2021] [Indexed: 11/08/2022]
Abstract
Multiple myeloma (MM) is the second most common hematological cancer and causes significant mortality and morbidity. Knowledge regarding modifiable risk factors for MM remains limited. This analysis of an Australian population-based case-control family study investigates whether smoking or alcohol consumption is associated with risk of MM and related diseases. Incident cases (n = 789) of MM were recruited via cancer registries in Victoria and New South Wales. Controls (n = 1,113) were either family members of cases (n = 696) or controls recruited for a similarly designed study of renal cancers (n = 417). Adjusted odds ratios (OR) and 95% confidence intervals (CI) were estimated using unconditional multivariable logistic regression. Heavy intake (>20 g ethanol/day) of alcohol had a lower risk of MM compared with nondrinkers (OR = 0.68, 95% CI: 0.50-0.93), and there was an inverse dose-response relationship for average daily alcohol intake (OR per 10 g ethanol per day = 0.92, 95% CI: 0.86-0.99); there was no evidence of an interaction with sex. There was no evidence of an association with MM risk for smoking-related exposures (p > 0.18). The associations between smoking and alcohol with MM are similar to those with non-Hodgkin lymphoma. Further research into potential underlying mechanisms is warranted.
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Affiliation(s)
- Simon Cheah
- Cancer Epidemiology DivisionCancer Council VictoriaMelbourneAustralia
- Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global HealthUniversity of MelbourneMelbourneAustralia
| | - Julie K. Bassett
- Cancer Epidemiology DivisionCancer Council VictoriaMelbourneAustralia
| | - Fiona J. Bruinsma
- Cancer Epidemiology DivisionCancer Council VictoriaMelbourneAustralia
- Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global HealthUniversity of MelbourneMelbourneAustralia
| | - Wendy Cozen
- Department of Preventive MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - John L. Hopper
- Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global HealthUniversity of MelbourneMelbourneAustralia
| | - Harindra Jayasekara
- Cancer Epidemiology DivisionCancer Council VictoriaMelbourneAustralia
- Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global HealthUniversity of MelbourneMelbourneAustralia
| | - Douglas Joshua
- Royal Prince Alfred HospitalSydney Medical SchoolUniversity of SydneySydneyAustralia
| | - Robert J. MacInnis
- Cancer Epidemiology DivisionCancer Council VictoriaMelbourneAustralia
- Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global HealthUniversity of MelbourneMelbourneAustralia
| | - H. Miles Prince
- Sir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneAustralia
- Epworth HealthcareMelbourneAustralia
| | - Claire M. Vajdic
- Centre for Big Data Research in HealthThe University of New South WalesSydneyAustralia
| | - Marina T. van Leeuwen
- Centre for Big Data Research in HealthThe University of New South WalesSydneyAustralia
| | | | - Simon J. Harrison
- Sir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneAustralia
- Clinical HaematologyPeter MacCallum Cancer Centre and Royal Melbourne HospitalParkvilleAustralia
| | - Dallas R. English
- Cancer Epidemiology DivisionCancer Council VictoriaMelbourneAustralia
- Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global HealthUniversity of MelbourneMelbourneAustralia
| | - Graham G. Giles
- Cancer Epidemiology DivisionCancer Council VictoriaMelbourneAustralia
- Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global HealthUniversity of MelbourneMelbourneAustralia
- School of Clinical Sciences at Monash HealthPrecision MedicineMonash UniversityClaytonMelbourneAustralia
| | - Roger L. Milne
- Cancer Epidemiology DivisionCancer Council VictoriaMelbourneAustralia
- Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global HealthUniversity of MelbourneMelbourneAustralia
- School of Clinical Sciences at Monash HealthPrecision MedicineMonash UniversityClaytonMelbourneAustralia
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4
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Creeper K, Augustson B, Kusel K, Fulham MJ, Ho J, Quach H, Mollee P, Weber N, Talaulikar D, Johnston A, Murphy N, Joshua D, Ward C, Ling S, Gibson J, Szer J, Harrison S, Zannettino A, Jaksic W, Lee C, Spencer A, Kalff A, Szabo F, Romeril K, Chan H, Gibbs S, Horvath N, Prince HM. Imaging of patients with multiple myeloma and associated plasma cell disorders: consensus practice statement by the Medical Scientific Advisory Group to Myeloma Australia. Intern Med J 2021; 51:1707-1712. [PMID: 34664367 DOI: 10.1111/imj.15457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/29/2021] [Revised: 06/24/2021] [Accepted: 06/30/2021] [Indexed: 11/30/2022]
Abstract
Imaging modalities for multiple myeloma (MM) have evolved to enable earlier detection of disease. Furthermore, the diagnosis of MM requiring therapy has recently changed to include disease prior to bone destruction, specifically the detection of focal bone lesions. Focal lesions are early, abnormal areas in the bone marrow, which may signal the development of subsequent lytic lesions that typically occur within the next 18-24 months. Cross-sectional imaging modalities are more sensitive for the detection and monitoring of bone and bone marrow disease and are now included in the International Myeloma Working Group current consensus criteria for initial diagnosis and treatment response assessment. The aim of this consensus practice statement is to review the evidence supporting these modalities. A more detailed Position Statement can be found on the Myeloma Australia website.
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Affiliation(s)
- Katherine Creeper
- Department of Haematology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Bradley Augustson
- Department of Haematology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Kieran Kusel
- Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Michael J Fulham
- Department of Molecular Imaging, Royal Prince Alfred Hospital Camperdown, Sydney, New South Wales, Australia
| | - Joy Ho
- Institute of Haematology, Royal Prince Alfred Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Hang Quach
- Department of Haematology, St Vincent's Hospital and University of Melbourne, Melbourne, Victoria, Australia
| | - Peter Mollee
- Department of Haematology, Princess Alexandra Hospital and University of Queensland, Brisbane, Queensland, Australia
| | - Nicholas Weber
- Department of Haematology, Royal Brisbane Hospital, Brisbane, Queensland, Australia
| | - Dipti Talaulikar
- Department of Haematology, The Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Anna Johnston
- Department of Clinical Haematology, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Nick Murphy
- Department of Clinical Haematology, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Douglas Joshua
- Institute of Haematology, Royal Prince Alfred Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Christopher Ward
- Department of Haematology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Silvia Ling
- Department of Haematology, Liverpool Hospital, Sydney, New South Wales, Australia
| | - John Gibson
- Institute of Haematology, Royal Prince Alfred Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Jeff Szer
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Victoria, Australia
| | - Simon Harrison
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew Zannettino
- Department of Experimental Haematology, University of Adelaide, Adelaide, South Australia, Australia
| | - Wilfrid Jaksic
- Department of Haematology, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Cindy Lee
- Department of Clinical Haematology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Andrew Spencer
- Department of Clinical Haematology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Anna Kalff
- Department of Clinical Haematology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Ferenc Szabo
- Department of Haematology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Ken Romeril
- Bowen Icon Cancer Centre, Wellington, New Zealand
| | - Henry Chan
- Department of Haematology, North Shore Hospital, Auckland, New Zealand
| | - Simon Gibbs
- Department of Clinical Haematology, Monash University Eastern Health Clinical School, Melbourne, Victoria, Australia
| | - Noemi Horvath
- Department of Clinical Haematology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - H Miles Prince
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Victoria, Australia
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5
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Brown R, Suen H, Favaloro J, Yang S, Ho PJ, Gibson J, Joshua D. Trogocytosis generates acquired regulatory T cells adding further complexity to the dysfunctional immune response in multiple myeloma. Oncoimmunology 2021; 1:1658-1660. [PMID: 23264928 PMCID: PMC3525637 DOI: 10.4161/onci.22032] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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] [Indexed: 02/03/2023] Open
Abstract
Trogocytosis, which results in the acquisition of myeloma cell-derived membrane proteins by T cells, and hence generates novel regulatory T cells, adds to the growing list of immune defects of multiple myeloma patients. The increasing complexity of the cancer-associated immune defects must be attentively considered for attempting to improve the so-far unsatisfactory rates of clinical responses to immunotherapy in patients affected by multiple myeloma and other malignancies.
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Affiliation(s)
- Ross Brown
- Institute of Haematology; Royal Prince Alfred Hospital; Sydney, Australia
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6
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Rajeev Krishnan S, De Rubis G, Suen H, Joshua D, Lam Kwan Y, Bebawy M. A liquid biopsy to detect multidrug resistance and disease burden in multiple myeloma. Blood Cancer J 2020; 10:37. [PMID: 32170169 PMCID: PMC7070076 DOI: 10.1038/s41408-020-0304-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 07/09/2019] [Revised: 12/20/2019] [Accepted: 01/03/2020] [Indexed: 12/24/2022] Open
Abstract
Multiple myeloma is an incurable cancer of bone marrow plasma cells, with a 5-year survival rate of 43%. Its incidence has increased by 126% since 1990. Treatment typically involves high-dose combination chemotherapy, but therapeutic response and patient survival are unpredictable and highly variable—attributed largely to the development of multidrug resistance (MDR). MDR is the simultaneous cross-resistance to a range of unrelated chemotherapeutic agents and is associated with poor prognosis and survival. Currently, no clinical procedures allow for a direct, continuous monitoring of MDR. We identified circulating large extracellular vesicles (specifically microparticles (MPs)) that can be used to monitor disease burden, disease progression and development of MDR in myeloma. These MPs differ phenotypically in the expression of four protein biomarkers: a plasma-cell marker (CD138), the MDR protein, P-glycoprotein (P-gp), the stem-cell marker (CD34); and phosphatidylserine (PS), an MP marker and mediator of cancer spread. Elevated levels of P-gp+ and PS+ MPs correlate with disease progression and treatment unresponsiveness. Furthermore, P-gp, PS and CD34 are predominantly expressed in CD138− MPs in advanced disease. In particular, a dual-positive (CD138−P-gp+CD34+) population is elevated in aggressive/unresponsive disease. Our test provides a personalised liquid biopsy with potential to address the unmet clinical need of monitoring MDR and treatment failure in myeloma.
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Affiliation(s)
- Sabna Rajeev Krishnan
- Graduate School of Health, Discipline of Pharmacy, University of Technology Sydney, Ultimo, NSW, 2007, Australia
| | - Gabriele De Rubis
- Graduate School of Health, Discipline of Pharmacy, University of Technology Sydney, Ultimo, NSW, 2007, Australia
| | - Hayley Suen
- Institute of Haematology, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia
| | - Douglas Joshua
- Institute of Haematology, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia
| | - Yiu Lam Kwan
- Department of Haematology, Concord Repatriation General Hospital, Concord, NSW, 2139, Australia
| | - Mary Bebawy
- Graduate School of Health, Discipline of Pharmacy, University of Technology Sydney, Ultimo, NSW, 2007, Australia.
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7
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Marsh-Wakefield F, Kruzins A, McGuire HM, Yang S, Bryant C, Fazekas de St Groth B, Nassif N, Byrne SN, Gibson J, Brown C, Larsen S, McCulloch D, Boyle R, Clark G, Joshua D, Ho PJ, Vuckovic S. Mass Cytometry Discovers Two Discrete Subsets of CD39 -Treg Which Discriminate MGUS From Multiple Myeloma. Front Immunol 2019; 10:1596. [PMID: 31428081 PMCID: PMC6688400 DOI: 10.3389/fimmu.2019.01596] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 06/26/2019] [Indexed: 12/13/2022] Open
Abstract
Multiple Myeloma (MM) is preceded by the clinically stable condition monoclonal gammopathy of undetermined significance (MGUS). Critical immune events that discriminate MGUS from newly diagnosed MM (ND)MM patients remain unknown, but may involve changes in the regulatory T cell (Treg) compartment that favor myeloma growth. To address this possibility, we used mass cytometry and the unsupervised clustering algorithm Flow self-organizing map (FlowSOM) to interrogate the distribution of multiple subsets within CD25+CD127low/negTreg in matched bone marrow (BM) and peripheral blood (PB) of MGUS and NDMM patients. Both mass cytometry and flow cytometry confirmed a trend toward prevalence of CD39-Treg within the Treg compartment in BM and PB of NDMM patients compared to CD39-Treg in MGUS patients. FlowSOM clustering displayed a phenotypic organization of Treg into 25 metaclusters that confirmed Treg heterogeneity. It identified two subsets which emerged within CD39-Treg of NDMM patients that were negligible or absent in CD39-Treg of MGUS patients. One subset was found in both BM and PB which phenotypically resembled activated Treg based on CD45RO, CD49d, and CD62L expression; another subset resembled BM-resident Treg based on its tissue-resident CD69+CD62L-CD49d- phenotype and restricted location within the BM. Both subsets co-expressed PD-1 and TIGIT, but PD-1 was expressed at higher levels on BM-resident Treg than on activated Treg. Within BM, both subsets had limited Perforin and Granzyme B production, whilst activated Treg in PB acquired high Perforin and Granzyme B production. In conclusion, the use of mass cytometry and FlowSOM clustering discovered two discrete subsets of CD39-Treg which are discordant in MGUS and NDMM patients and may be permissive of myeloma growth which warrants further study. Understanding the regulatory properties of these subsets may also advance MGUS and MM diagnosis, prognosis, and therapeutic implications for MM patients.
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Affiliation(s)
- Felix Marsh-Wakefield
- Discipline of Infectious Diseases and Immunology, Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia.,Discipline of Pathology, Faculty of Medicine and Health, School of Medical Science, The University of Sydney, Sydney, NSW, Australia
| | - Annabel Kruzins
- School of Life Sciences, University of Technology Sydney, Sydney, NSW, Australia
| | - Helen M McGuire
- Ramaciotti Facility for Human Systems Biology, The University of Sydney, Sydney, NSW, Australia.,Discipline of Pathology, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Shihong Yang
- Royal Prince Alfred Hospital, Institute of Haematology, Sydney, NSW, Australia
| | - Christian Bryant
- Royal Prince Alfred Hospital, Institute of Haematology, Sydney, NSW, Australia
| | - Barbara Fazekas de St Groth
- Ramaciotti Facility for Human Systems Biology, The University of Sydney, Sydney, NSW, Australia.,Discipline of Pathology, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Najah Nassif
- School of Life Sciences, University of Technology Sydney, Sydney, NSW, Australia
| | - Scott N Byrne
- Discipline of Infectious Diseases and Immunology, Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - John Gibson
- Royal Prince Alfred Hospital, Institute of Haematology, Sydney, NSW, Australia.,Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Christina Brown
- Royal Prince Alfred Hospital, Institute of Haematology, Sydney, NSW, Australia.,Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Stephen Larsen
- Royal Prince Alfred Hospital, Institute of Haematology, Sydney, NSW, Australia.,Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Derek McCulloch
- Royal Prince Alfred Hospital, Institute of Haematology, Sydney, NSW, Australia.,Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Richard Boyle
- Orthopaedics Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Georgina Clark
- Concord Repatriation General Hospital, ANZAC Research Institute, Concord, NSW, Australia
| | - Douglas Joshua
- Royal Prince Alfred Hospital, Institute of Haematology, Sydney, NSW, Australia.,Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Phoebe Joy Ho
- Royal Prince Alfred Hospital, Institute of Haematology, Sydney, NSW, Australia.,Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Slavica Vuckovic
- Royal Prince Alfred Hospital, Institute of Haematology, Sydney, NSW, Australia.,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
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8
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Horvath N, Spencer A, Kenealy M, Joshua D, Campbell PJ, Lee JJ, Hou J, Qiu L, Kalff A, Khong T, Londhe A, Siggins S, van Kooten Losio M, Eisbacher M, Prince HM. Phase 3 study of subcutaneous bortezomib, thalidomide, and prednisolone consolidation after subcutaneous bortezomib-based induction and autologous stem cell transplantation in patients with previously untreated multiple myeloma: the VCAT study. Leuk Lymphoma 2019; 60:2122-2133. [DOI: 10.1080/10428194.2019.1579322] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Noemi Horvath
- Department of Haematology, Royal Adelaide Hospital, Adelaide, Australia
| | - Andrew Spencer
- Department of Clinical Haematology, Alfred Health-Monash University, Melbourne, Australia
| | - Melita Kenealy
- Cabrini Health, Australia and Monash University, Melbourne, Australia
| | - Douglas Joshua
- Department of Haematology, Royal Prince Alfred Hospital, Camperdown, Australia, and Sydney University, Sydney, Australia
| | - Philip J Campbell
- Department of Haematology, Andrew Love Cancer Centre, Geelong, Australia
| | - Je-Jung Lee
- Department of Hematology–Oncology, Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea
| | - Jian Hou
- Department of Hematology, Shanghai Changzheng Hospital, Shanghai, China
| | - Lugui Qiu
- Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Anna Kalff
- Department of Clinical Haematology, Alfred Health-Monash University, Melbourne, Australia
| | - Tiffany Khong
- Department of Clinical Haematology, Alfred Health-Monash University, Melbourne, Australia
| | - Anil Londhe
- Janssen Research & Development LLC, Titusville, NJ, USA
| | | | | | | | - H. Miles Prince
- Cabrini Health, Australia and Monash University, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
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9
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Goldschmidt H, Moreau P, Ludwig H, Niesvizky R, Chng WJ, Joshua D, Weisel K, Spencer A, Orlowski RZ, Feng S, Iskander KS, Dimopoulos MA. Carfilzomib-dexamethasone versus subcutaneous or intravenous bortezomib in relapsed or refractory multiple myeloma: secondary analysis of the phase 3 ENDEAVOR study. Leuk Lymphoma 2017; 59:1364-1374. [PMID: 28937327 DOI: 10.1080/10428194.2017.1376743] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This is a secondary analysis of the phase 3 ENDEAVOR study comparing relapsed and/or refractory multiple myeloma (RRMM) patients receiving carfilzomib-dexamethasone (Kd) with those receiving subcutaneous (SC) bortezomib with dexamethasone (Vd) or intravenous (IV) Vd. Of Kd-treated patients, 356 Kd were pre-selected (by physician prior to randomization if to be randomized to Vd) for SC Vd (Kd [SC Vd]) and 108 for IV Vd (Kd [IV Vd], respectively. Of Vd-treated patients, 360 received SC Vd and 75 IV Vd. Kd (SC Vd) median PFS was not reached; SC Vd was 9.5 months. Median PFS for Kd (IV Vd) and IV Vd were 22.2 and 8.5 months, respectively. Median PFS was significantly longer and response rates were higher for Kd versus retreatment with bortezomib (SC or IV Vd) and in bortezomib naive patients. Overall, Kd was superior to Vd in RRMM regardless of route of bortezomib administration or prior bortezomib exposure.
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Affiliation(s)
- Hartmut Goldschmidt
- a Division of Multiple Myeloma , Universitatsklinikum Heidelberg , Heidelberg , Germany
| | - Philippe Moreau
- b Department of Hematology , University of Nantes , Nantes , France
| | - Heinz Ludwig
- c Wilhelminen Cancer Research Institute , Wilhelminenspital , Vienna , Austria
| | - Ruben Niesvizky
- d Multiple Myeloma Center, Weill Cornell Medical College , New York Presbyterian Hospital , New York , NY , USA
| | - Wee-Joo Chng
- e Department of Haematology-Oncology , National University Cancer Institute, National University Health System, Singapore and Cancer Science Institute of Singapore, National University of Singapore , Singapore
| | - Douglas Joshua
- f Institute of Haematology , Royal Prince Alfred Hospital, the University of Sydney , Camperdown , New South Wales , Australia
| | - Katja Weisel
- g Department of Hematology, Oncology, Immunology, Rheumatology and Pulmonology , Universitatsklinikum Tubingen , Tubingen , Germany
| | - Andrew Spencer
- h Division of Blood Cancers , Alfred Health-Monash University , Melbourne , Victoria , Australia
| | - Robert Z Orlowski
- i Department of Lymphoma/Myeloma , The University of Texas MD Anderson Cancer Center, The University of Texas , Houston , TX , USA
| | | | | | - Meletios A Dimopoulos
- k Department of Clinical Therapeutics, School of Medicine , National and Kapodistrian University of Athens , Athens , Greece
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10
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Ludwig H, Dimopoulos MA, Moreau P, Chng WJ, Goldschmidt H, Hájek R, Facon T, Pour L, Niesvizky R, Oriol A, Rosiñol L, Suvorov A, Gaidano G, Pika T, Weisel K, Goranova-Marinova V, Palumbo A, Gillenwater HH, Mohamed N, Aggarwal S, Feng S, Joshua D. Carfilzomib and dexamethasone vs bortezomib and dexamethasone in patients with relapsed multiple myeloma: results of the phase 3 study ENDEAVOR (NCT01568866) according to age subgroup. Leuk Lymphoma 2017; 58:2501-2504. [PMID: 28306371 DOI: 10.1080/10428194.2017.1298755] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Heinz Ludwig
- a Wilhelminen Cancer Research Institute, Wilhelminenspital , Vienna , Austria
| | - Meletios A Dimopoulos
- b School of Medicine, National and Kapodistrian University of Athens , Athens , Greece
| | | | - Wee-Joo Chng
- d National University Cancer Institute, Singapore.,e National University Health System, Singapore.,f Cancer Science Institute, Singapore.,g National University of Singapore , Singapore
| | | | - Roman Hájek
- i University Hospital Ostrava and Faculty of Medicine, University of Ostrava , Ostrava , Czech Republic
| | | | - Ludek Pour
- k University Hospital Brno , Brno , Czech Republic
| | - Ruben Niesvizky
- l Weill Cornell Medical College/New York Presbyterian Hospital , New York , NY , USA
| | - Albert Oriol
- m Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol , Barcelona , Spain
| | | | | | - Gianluca Gaidano
- p Department of Translational Medicine , University of Eastern Piedmont , Novara , Italy
| | - Tomas Pika
- q University Hospital Olomouc , Olomouc , Czech Republic
| | - Katja Weisel
- r Universitatsklinikum Tubingen , Tubingen , Germany
| | - Vesselina Goranova-Marinova
- s University Multiprofile Hospital for Active Treatment "Sv. Georgi" and Medical University , Plovdiv , Bulgaria
| | | | - Heidi H Gillenwater
- u Onyx Pharmaceuticals, Inc, an Amgen subsidiary , South San Francisco , CA , USA
| | - Nehal Mohamed
- u Onyx Pharmaceuticals, Inc, an Amgen subsidiary , South San Francisco , CA , USA
| | - Sanjay Aggarwal
- u Onyx Pharmaceuticals, Inc, an Amgen subsidiary , South San Francisco , CA , USA
| | - Shibao Feng
- u Onyx Pharmaceuticals, Inc, an Amgen subsidiary , South San Francisco , CA , USA
| | - Douglas Joshua
- v Royal Prince Alfred Hospital , Camperdown , New South Wales , Australia
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Talaulikar D, Tam CS, Joshua D, Ho JP, Szer J, Quach H, Spencer A, Harrison S, Mollee P, Roberts AW, Horvath N, Lee C, Zannettino A, Brown R, Augustson B, Jaksic W, Gibson J, Kalff A, Johnston A, Trotman J, Kalro A, Grigoriadis G, Ward C, Prince HM. Treatment of patients with Waldenström macroglobulinaemia: clinical practice guidelines from the Myeloma Foundation of Australia Medical and Scientific Advisory Group. Intern Med J 2017; 47:35-49. [DOI: 10.1111/imj.13311] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/17/2016] [Accepted: 10/09/2016] [Indexed: 11/30/2022]
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Moreau P, Joshua D, Chng WJ, Palumbo A, Goldschmidt H, Hájek R, Facon T, Ludwig H, Pour L, Niesvizky R, Oriol A, Rosiñol L, Suvorov A, Gaidano G, Pika T, Weisel K, Goranova-Marinova V, Gillenwater HH, Mohamed N, Aggarwal S, Feng S, Dimopoulos MA. Impact of prior treatment on patients with relapsed multiple myeloma treated with carfilzomib and dexamethasone vs bortezomib and dexamethasone in the phase 3 ENDEAVOR study. Leukemia 2017; 31:115-122. [PMID: 27491641 PMCID: PMC5220137 DOI: 10.1038/leu.2016.186] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 06/22/2016] [Indexed: 01/15/2023]
Abstract
The randomized phase 3 ENDEAVOR study (N=929) compared carfilzomib and dexamethasone (Kd) with bortezomib and dexamethasone (Vd) in relapsed multiple myeloma (RMM). We performed a subgroup analysis from ENDEAVOR in patients categorized by number of prior lines of therapy or by prior treatment. Median progression-free survival (PFS) for patients with one prior line was 22.2 months for Kd vs 10.1 months for Vd, and median PFS for patients with ⩾2 prior lines was 14.9 months for Kd vs 8.4 months for Vd. For patients with prior bortezomib exposure, the median PFS was 15.6 months for Kd vs 8.1 months for Vd, and for patients with prior lenalidomide exposure the median PFS was 12.9 months for Kd vs 7.3 months for Vd. Overall response rates (Kd vs Vd) were 81.9 vs 65.5% (one prior line), 72.0 vs 59.7% (⩾2 prior lines), 71.2 vs 60.3% (prior bortezomib) and 70.1 vs 59.3% (prior lenalidomide). The safety profile in the prior lines subgroups was qualitatively similar to that in the broader ENDEAVOR population. In RMM, outcomes are improved when receiving treatment with carfilzomib compared with bortezomib, regardless of the number of prior therapy lines or prior exposure to bortezomib or lenalidomide.
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Affiliation(s)
- P Moreau
- University of Nantes, Nantes, France
| | - D Joshua
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - W-J Chng
- National University Cancer Institute, National University Health System; Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | | | | | - R Hájek
- University Hospital Ostrava, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - T Facon
- CHRU Lille Hôpital Claude Huriez, Lille, France
| | - H Ludwig
- Wilhelminen Cancer Research Institute, Wilhelminenspital, Vienna, Austria
| | - L Pour
- University Hospital Brno, Brno, Czech Republic
| | - R Niesvizky
- Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA
| | - A Oriol
- Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol, Barcelona, Spain
| | - L Rosiñol
- Hospital Clínic de Barcelona, Barcelona, Spain
| | - A Suvorov
- Hematological Department, First Republican Clinical Hospital of Udmurtia, Izhevsk, Russia
| | - G Gaidano
- Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - T Pika
- Department of Hematooncology, University Hospital Olomouc, Olomouc, Czech Republic
| | - K Weisel
- Universitätsklinikum Tübingen, Tübingen, Germany
| | - V Goranova-Marinova
- University Multiprofile Hospital for Active Treatment ‘Sv. Georgi' and Medical University, Plovdiv, Bulgaria
| | - H H Gillenwater
- Onyx Pharmaceuticals, Inc., an Amgen subsidiary, South San Francisco, CA, USA
| | - N Mohamed
- Onyx Pharmaceuticals, Inc., an Amgen subsidiary, South San Francisco, CA, USA
| | - S Aggarwal
- Onyx Pharmaceuticals, Inc., an Amgen subsidiary, South San Francisco, CA, USA
| | - S Feng
- Onyx Pharmaceuticals, Inc., an Amgen subsidiary, South San Francisco, CA, USA
| | - M A Dimopoulos
- National and Kapodistrian University of Athens, Athens, Greece
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Joshua D, Suen H, Brown R, Bryant C, Ho PJ, Hart D, Gibson J. The T Cell in Myeloma. Clin Lymphoma Myeloma Leuk 2016; 16:537-542. [PMID: 27601001 DOI: 10.1016/j.clml.2016.08.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 07/15/2016] [Accepted: 08/02/2016] [Indexed: 11/16/2022]
Abstract
An active role for the immune system in controlling the malignant plasma cell clone in myeloma has been postulated for many years. The clinical states of monoclonal gammopathy of undetermined significance, plateau phase disease, and smoldering myeloma all suggest that a significant host-tumor interaction is taking place. The fundamental role of the cytotoxic T cell in tumor elimination and control has been exemplified by the dramatic efficacy of adoptive T-cell therapies in many hemopoietic malignancies. However, tumor-host cross-talk results in suppression of the endogenous cytotoxic T-cell response against the malignant plasma cell. Whereas patients with myeloma do not clinically exhibit a T-cell immunodeficiency state, with, for example, increased mycobacterial infections, a number of abnormalities of T-cell function are evident. The major abnormalities of T cells include clonal expansions and associated immunosenescence, alterations of regulatory T cells/T helper 17 cells (Treg/Th17 ratio) and acquired membrane abnormalities, due to trogocytosis, which result in acquired Treg cells. Dendritic cell dysfunction associated with impaired antigen processing and presentation caused by abnormalities of the bone marrow microenvironment plays an additional role. In this perspective, we examine the T-cell abnormalities in myeloma and postulate that, whereas cytotoxic T cells interacting with the tumor are dysfunctional, residual T cells still function adequately against external pathogens and thus protect patients from the infections normally associated with a generalized T-cell immunodeficiency state. The so-called 3 E's of host-tumor interaction (elimination, equilibrium, and escape) are clearly reflected in the immune landscape and clinical behavior of myeloma.
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Affiliation(s)
- Douglas Joshua
- Institute of Haematology, NSW Pathology, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia.
| | - Hayley Suen
- Institute of Haematology, NSW Pathology, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia
| | - Ross Brown
- Institute of Haematology, NSW Pathology, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia
| | - Christian Bryant
- Institute of Haematology, NSW Pathology, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia; Dendritic Cell Research, ANZAC Research Institute, University of Sydney, Concord, NSW, Australia
| | - P Joy Ho
- Institute of Haematology, NSW Pathology, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia
| | - Derek Hart
- Dendritic Cell Research, ANZAC Research Institute, University of Sydney, Concord, NSW, Australia
| | - John Gibson
- Institute of Haematology, NSW Pathology, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia
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Dimopoulos MA, Sonneveld P, Leung N, Merlini G, Ludwig H, Kastritis E, Goldschmidt H, Joshua D, Orlowski RZ, Powles R, Vesole DH, Garderet L, Einsele H, Palumbo A, Cavo M, Richardson PG, Moreau P, San Miguel J, Rajkumar SV, Durie BG, Terpos E. International Myeloma Working Group Recommendations for the Diagnosis and Management of Myeloma-Related Renal Impairment. J Clin Oncol 2016; 34:1544-57. [DOI: 10.1200/jco.2015.65.0044] [Citation(s) in RCA: 221] [Impact Index Per Article: 27.6] [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
Purpose The aim of the International Myeloma Working Group was to develop practical recommendations for the diagnosis and management of multiple myeloma–related renal impairment (RI). Methods Recommendations were based on published data through December 2015, and were developed using the system developed by the Grading of Recommendation, Assessment, Development, and Evaluation Working Group. Recommendations All patients with myeloma at diagnosis and at disease assessment should have serum creatinine, estimated glomerular filtration rate, and electrolytes measurements as well as free light chain, if available, and urine electrophoresis of a sample from a 24-hour urine collection (grade A). The Chronic Kidney Disease Epidemiology Collaboration, preferably, or the Modification of Diet in Renal Disease formula should be used for the evaluation of estimated glomerular filtration rate in patients with stabilized serum creatinine (grade A). International Myeloma Working Group criteria for renal reversibility should be used (grade B). For the management of RI in patients with multiple myeloma, high fluid intake is indicated along with antimyeloma therapy (grade B). The use of high-cutoff hemodialysis membranes in combination with antimyeloma therapy can be considered (grade B). Bortezomib-based regimens remain the cornerstone of the management of myeloma-related RI (grade A). High-dose dexamethasone should be administered at least for the first month of therapy (grade B). Thalidomide is effective in patients with myeloma with RI, and no dose modifications are needed (grade B). Lenalidomide is effective and safe, mainly in patients with mild to moderate RI (grade B); for patients with severe RI or on dialysis, lenalidomide should be given with close monitoring for hematologic toxicity (grade B) with dose reduction as needed. High-dose therapy with autologous stem cell transplantation (with melphalan 100 mg/m2 to 140 mg/m2) is feasible in patients with RI (grade C). Carfilzomib can be safely administered to patients with creatinine clearance > 15 mL/min, whereas ixazomib in combination with lenalidomide and dexamethasone can be safely administered to patients with creatinine clearance > 30 mL/min (grade A).
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Affiliation(s)
- Meletios A. Dimopoulos
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - Pieter Sonneveld
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - Nelson Leung
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - Giampaolo Merlini
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - Heinz Ludwig
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - Efstathios Kastritis
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - Hartmut Goldschmidt
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - Douglas Joshua
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - Robert Z. Orlowski
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - Raymond Powles
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - David H. Vesole
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - Laurent Garderet
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - Hermann Einsele
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - Antonio Palumbo
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - Michele Cavo
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - Paul G. Richardson
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - Philippe Moreau
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - Jesús San Miguel
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - S. Vincent Rajkumar
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - Brian G.M. Durie
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - Evangelos Terpos
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
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Nath CE, Trotman J, Tiley C, Presgrave P, Joshua D, Kerridge I, Kwan YL, Gurney H, McLachlan AJ, Earl JW, Nivison-Smith I, Zeng L, Shaw PJ. High melphalan exposure is associated with improved overall survival in myeloma patients receiving high dose melphalan and autologous transplantation. Br J Clin Pharmacol 2016; 82:149-59. [PMID: 26879446 DOI: 10.1111/bcp.12906] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [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: 10/08/2015] [Revised: 02/01/2016] [Accepted: 02/09/2016] [Indexed: 11/28/2022] Open
Abstract
AIM High dose melphalan (HDM) and autologous stem cell transplantation (ASCT) retains a central role in the treatment of myeloma. The aim of this study was to determine whether HDM exposure (area under the concentration vs. time curve, AUC), is significantly associated with transplant outcomes. METHODS Melphalan concentrations were measured in six to 11 plasma samples collected after HDM (median 192 mg m(-) (2) ) to determine melphalan AUC for a total of 114 patients. Binary logistic regression was used to assess whether melphalan AUC was associated with severe (≥ grade 3) oral mucositis. Multivariate Cox regression was used to assess whether melphalan AUC was significantly associated with time to progression, progression-free survival and overall survival (OS). RESULTS Melphalan AUC ranged from 4.9 to 24.6 mg l(-1) h, median 12.84 mg l(-1) h. Melphalan AUC above the median was a risk factor for severe mucositis (HR 1.21, 95% CI 1.06, 1.38, P = 0.004) but was also associated with significantly improved overall survival (OS) (HR 0.40, 95% CI 0.20, 0.81, P = 0.001), with an estimated median survival of 8.50 years vs. 5.38 years for high vs. low AUC groups. Multivariate analysis did not identify melphalan AUC as being significantly associated with time to progression or progression-free survival. CONCLUSIONS This large scale pharmacodynamic analysis of HDM demonstrates that high melphalan exposure is associated with improved survival, with an acceptable increase in transplant toxicity. These results suggest studies targeting a higher AUC are warranted in patients undergoing HDM and ASCT for myeloma.
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Affiliation(s)
- Christa E Nath
- The Children's Hospital at Westmead, Hawkesbury Rd, Westmead, 2145
| | - Judith Trotman
- Concord Hospital, Hospital Road, Concord, NSW, 2139.,University of Sydney, Sydney, NSW, 2006
| | - Campbell Tiley
- Gosford Hospital, Holden St, Gosford, NSW, 2250.,University of Newcastle, University Dr, Callaghan, NSW, 2308
| | - Peter Presgrave
- Wollongong Hospital, Loftus St, Wollongong, NSW, 2500.,University of Wollongong, Northfields Ave, Wollongong, NSW, 2522
| | - Douglas Joshua
- University of Sydney, Sydney, NSW, 2006.,Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW, 2050
| | - Ian Kerridge
- University of Sydney, Sydney, NSW, 2006.,Westmead Hospital, Hawkesbury Rd, Westmead, NSW, 2145
| | - Yiu Lam Kwan
- Concord Hospital, Hospital Road, Concord, NSW, 2139
| | - Howard Gurney
- University of Sydney, Sydney, NSW, 2006.,Westmead Hospital, Hawkesbury Rd, Westmead, NSW, 2145
| | - Andrew J McLachlan
- Concord Hospital, Hospital Road, Concord, NSW, 2139.,University of Sydney, Sydney, NSW, 2006
| | - John W Earl
- The Children's Hospital at Westmead, Hawkesbury Rd, Westmead, 2145.,University of Sydney, Sydney, NSW, 2006
| | - Ian Nivison-Smith
- Australasian Bone Marrow Transplant Recipient Registry, 370 Victoria Street, Darlinghurst, NSW, 2010, Australia
| | - Lihua Zeng
- The Children's Hospital at Westmead, Hawkesbury Rd, Westmead, 2145
| | - Peter J Shaw
- The Children's Hospital at Westmead, Hawkesbury Rd, Westmead, 2145.,University of Sydney, Sydney, NSW, 2006
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16
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Suen H, Brown R, Yang S, Weatherburn C, Ho PJ, Woodland N, Nassif N, Barbaro P, Bryant C, Hart D, Gibson J, Joshua D. Multiple myeloma causes clonal T-cell immunosenescence: identification of potential novel targets for promoting tumour immunity and implications for checkpoint blockade. Leukemia 2016; 30:1716-24. [PMID: 27102208 DOI: 10.1038/leu.2016.84] [Citation(s) in RCA: 137] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 03/09/2016] [Accepted: 03/30/2016] [Indexed: 02/07/2023]
Abstract
Tumour-induced dysfunction of cytotoxic T cells in patients with multiple myeloma (MM) may contribute to immune escape and be responsible for the lack of therapeutic efficacy of immune checkpoint blockade. We therefore investigated dysfunctional clonal T cells in MM and demonstrated immunosenescence but not exhaustion as a predominant feature. T-cell clones were detected in 75% of MM patients and their prognostic significance was revalidated in a new post-immunomodulatory drug cohort. The cells exhibited a senescent secretory effector phenotype: KLRG-1+/CD57+/CD160+/CD28-. Normal-for-age telomere lengths indicate that senescence is telomere independent and potentially reversible. p38-mitogen-activated protein kinase, p16 and p21 signalling pathways known to induce senescence were not elevated. Telomerase activity was found to be elevated and this may explain how normal telomere lengths are maintained in senescent cells. T-cell receptor signalling checkpoints were normal but elevated SMAD levels associated with T-cell inactivation were detected and may provide a potential target for the reversal of clonal T-cell dysfunction in MM. Low programmed death 1 and cytotoxic T-lymphocyte-associated antigen 4 expression detected on T-cell clones infers that these cells are not exhausted but suggests that there would be a suboptimal response to immune checkpoint blockade in MM. Our data suggest that other immunostimulatory strategies are required in MM.
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Affiliation(s)
- H Suen
- Institute of Haematology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,School of Life Sciences, University of Technology Sydney, Sydney, New South Wales, Australia
| | - R Brown
- Institute of Haematology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - S Yang
- Institute of Haematology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - C Weatherburn
- Institute of Haematology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Sydney University Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - P J Ho
- Institute of Haematology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Sydney University Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - N Woodland
- School of Life Sciences, University of Technology Sydney, Sydney, New South Wales, Australia
| | - N Nassif
- School of Life Sciences, University of Technology Sydney, Sydney, New South Wales, Australia
| | - P Barbaro
- Children's Medical Research Institute, Sydney, New South Wales, Australia
| | - C Bryant
- Institute of Haematology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Sydney University Medical School, University of Sydney, Sydney, New South Wales, Australia.,Dendritic Cell Research, ANZAC Research Institute, Sydney, New South Wales, Australia
| | - D Hart
- Sydney University Medical School, University of Sydney, Sydney, New South Wales, Australia.,Dendritic Cell Research, ANZAC Research Institute, Sydney, New South Wales, Australia
| | - J Gibson
- Institute of Haematology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Sydney University Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - D Joshua
- Institute of Haematology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Sydney University Medical School, University of Sydney, Sydney, New South Wales, Australia
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17
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Bryant C, Fromm PD, Kupresanin F, Clark G, Lee K, Clarke C, Silveira PA, Suen H, Brown R, Newman E, Cunningham I, Ho PJ, Gibson J, Bradstock K, Joshua D, Hart DN. A CD2 high-expressing stress-resistant human plasmacytoid dendritic-cell subset. Immunol Cell Biol 2016; 94:447-57. [PMID: 26791160 DOI: 10.1038/icb.2015.116] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 12/15/2015] [Accepted: 12/15/2015] [Indexed: 01/22/2023]
Abstract
Human plasmacytoid dendritic cells (pDCs) were considered to be a phenotypically and functionally homogeneous cell population; however, recent analyses indicate potential heterogeneity. This is of major interest, given their importance in the induction of anti-viral responses and their role in creating immunologically permissive environments for human malignancies. For this reason, we investigated the possible presence of human pDC subsets in blood and bone marrow, using unbiased cell phenotype clustering and functional studies. This defined two major functionally distinct human pDC subsets, distinguished by differential expression of CD2. The CD2(hi) and CD2(lo) pDCs represent discontinuous subsets, each with hallmark pDC functionality, including interferon-alpha production. The rarer CD2(hi) pDC subset demonstrated a significant survival advantage over CD2(lo) pDC during stress and upon exposure to glucocorticoids (GCs), which was associated with higher expression of the anti-apoptotic molecule BCL2. The differential sensitivity of these two human pDC subsets to GCs is demonstrated in vivo by a relative increase in CD2(hi) pDC in multiple myeloma patients treated with GCs. Hence, the selective apoptosis of CD2(lo) pDC during stress represents a novel mechanism for the control of innate responses.
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Affiliation(s)
- Christian Bryant
- Dendritic Cell Research, ANZAC Research Institute, Concord Repatriation General Hospital, Sydney, NSW, Australia.,Concord Clinical School, University of Sydney, Sydney, NSW, Australia.,Department of Haematology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Phillip D Fromm
- Dendritic Cell Research, ANZAC Research Institute, Concord Repatriation General Hospital, Sydney, NSW, Australia.,Concord Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Fiona Kupresanin
- Dendritic Cell Research, ANZAC Research Institute, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Georgina Clark
- Dendritic Cell Research, ANZAC Research Institute, Concord Repatriation General Hospital, Sydney, NSW, Australia.,Concord Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Kenneth Lee
- Concord Clinical School, University of Sydney, Sydney, NSW, Australia.,Department of Anatomical Pathology, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Candice Clarke
- Department of Anatomical Pathology, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Pablo A Silveira
- Dendritic Cell Research, ANZAC Research Institute, Concord Repatriation General Hospital, Sydney, NSW, Australia.,Concord Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Hayley Suen
- Department of Haematology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Ross Brown
- Department of Haematology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Elizabeth Newman
- Department of Haematology, Concord Hospital, Sydney, NSW, Australia
| | - Ilona Cunningham
- Department of Haematology, Concord Hospital, Sydney, NSW, Australia
| | - P Joy Ho
- Department of Haematology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - John Gibson
- Department of Haematology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Kenneth Bradstock
- Dendritic Cell Research, ANZAC Research Institute, Concord Repatriation General Hospital, Sydney, NSW, Australia.,Blood and Bone Marrow Transplant Service, Westmead Hospital, Sydney, NSW, Australia
| | - Douglas Joshua
- Department of Haematology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Derek Nj Hart
- Dendritic Cell Research, ANZAC Research Institute, Concord Repatriation General Hospital, Sydney, NSW, Australia.,Concord Clinical School, University of Sydney, Sydney, NSW, Australia.,Department of Haematology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Department of Haematology, Concord Hospital, Sydney, NSW, Australia
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18
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Weber N, Mollee P, Augustson B, Brown R, Catley L, Gibson J, Harrison S, Ho PJ, Horvath N, Jaksic W, Joshua D, Quach H, Roberts AW, Spencer A, Szer J, Talaulikar D, To B, Zannettino A, Prince HM. Management of systemic AL amyloidosis: recommendations of the Myeloma Foundation of Australia Medical and Scientific Advisory Group. Intern Med J 2016; 45:371-82. [PMID: 25169210 DOI: 10.1111/imj.12566] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 06/06/2014] [Accepted: 08/19/2014] [Indexed: 11/30/2022]
Abstract
Systemic AL amyloidosis is a plasma cell dyscrasia with a characteristic clinical phenotype caused by multi-organ deposition of an amyloidogenic monoclonal protein. This condition poses a unique management challenge due to the complexity of the clinical presentation and the narrow therapeutic window of available therapies. Improved appreciation of the need for risk stratification, standardised use of sensitive laboratory testing for monitoring disease response, vigilant supportive care and the availability of newer agents with more favourable toxicity profiles have contributed to the improvement in treatment-related mortality and overall survival seen over the past decade. Nonetheless, with respect to the optimal management approach, there is a paucity of high-level clinical evidence due to the rarity of the disease, and enrollment in clinical trials is still the preferred approach where available. This review will summarise the Clinical Practice Guidelines on the Management of Systemic Light Chain (AL) Amyloidosis recently prepared by the Medical Scientific Advisory Group of the Myeloma Foundation of Australia. It is hoped that these guidelines will assist clinicians in better understanding and optimising the management of this difficult disease.
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Affiliation(s)
- N Weber
- Clinical Haematology and Bone Marrow Transplant Unit, Royal Brisbane and Women's Hospital, Brisbane, Australia
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19
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Dimopoulos MA, Moreau P, Palumbo A, Joshua D, Pour L, Hájek R, Facon T, Ludwig H, Oriol A, Goldschmidt H, Rosiñol L, Straub J, Suvorov A, Araujo C, Rimashevskaya E, Pika T, Gaidano G, Weisel K, Goranova-Marinova V, Schwarer A, Minuk L, Masszi T, Karamanesht I, Offidani M, Hungria V, Spencer A, Orlowski RZ, Gillenwater HH, Mohamed N, Feng S, Chng WJ. Carfilzomib and dexamethasone versus bortezomib and dexamethasone for patients with relapsed or refractory multiple myeloma (ENDEAVOR): a randomised, phase 3, open-label, multicentre study. Lancet Oncol 2016; 17:27-38. [DOI: 10.1016/s1470-2045(15)00464-7] [Citation(s) in RCA: 524] [Impact Index Per Article: 65.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 10/26/2015] [Accepted: 10/27/2015] [Indexed: 01/11/2023]
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20
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Laubach J, Garderet L, Mahindra A, Gahrton G, Caers J, Sezer O, Voorhees P, Leleu X, Johnsen HE, Streetly M, Jurczyszyn A, Ludwig H, Mellqvist UH, Chng WJ, Pilarski L, Einsele H, Hou J, Turesson I, Zamagni E, Chim CS, Mazumder A, Westin J, Lu J, Reiman T, Kristinsson S, Joshua D, Roussel M, O'Gorman P, Terpos E, McCarthy P, Dimopoulos M, Moreau P, Orlowski RZ, Miguel JS, Anderson KC, Palumbo A, Kumar S, Rajkumar V, Durie B, Richardson PG. Management of relapsed multiple myeloma: recommendations of the International Myeloma Working Group. Leukemia 2015; 30:1005-17. [DOI: 10.1038/leu.2015.356] [Citation(s) in RCA: 175] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 09/11/2015] [Accepted: 09/24/2015] [Indexed: 11/09/2022]
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21
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Giralt S, Garderet L, Durie B, Cook G, Gahrton G, Bruno B, Hari P, Lokhorst H, McCarthy P, Krishnan A, Sonneveld P, Goldschmidt H, Jagannath S, Barlogie B, Mateos M, Gimsing P, Sezer O, Mikhael J, Lu J, Dimopoulos M, Mazumder A, Palumbo A, Abonour R, Anderson K, Attal M, Blade J, Bird J, Cavo M, Comenzo R, de la Rubia J, Einsele H, Garcia-Sanz R, Hillengass J, Holstein S, Johnsen HE, Joshua D, Koehne G, Kumar S, Kyle R, Leleu X, Lonial S, Ludwig H, Nahi H, Nooka A, Orlowski R, Rajkumar V, Reiman A, Richardson P, Riva E, San Miguel J, Turreson I, Usmani S, Vesole D, Bensinger W, Qazilbash M, Efebera Y, Mohty M, Gasparreto C, Gajewski J, LeMaistre CF, Bredeson C, Moreau P, Pasquini M, Kroeger N, Stadtmauer E. American Society of Blood and Marrow Transplantation, European Society of Blood and Marrow Transplantation, Blood and Marrow Transplant Clinical Trials Network, and International Myeloma Working Group Consensus Conference on Salvage Hematopoietic Cell Transplantation in Patients with Relapsed Multiple Myeloma. Biol Blood Marrow Transplant 2015; 21:2039-2051. [PMID: 26428082 PMCID: PMC4757494 DOI: 10.1016/j.bbmt.2015.09.016] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 09/21/2015] [Indexed: 12/14/2022]
Abstract
In contrast to the upfront setting in which the role of high-dose therapy with autologous hematopoietic cell transplantation (HCT) as consolidation of a first remission in patients with multiple myeloma (MM) is well established, the role of high-dose therapy with autologous or allogeneic HCT has not been extensively studied in MM patients relapsing after primary therapy. The International Myeloma Working Group together with the Blood and Marrow Transplant Clinical Trials Network, the American Society of Blood and Marrow Transplantation, and the European Society of Blood and Marrow Transplantation convened a meeting of MM experts to: (1) summarize current knowledge regarding the role of autologous or allogeneic HCT in MM patients progressing after primary therapy, (2) propose guidelines for the use of salvage HCT in MM, (3) identify knowledge gaps, (4) propose a research agenda, and (5) develop a collaborative initiative to move the research agenda forward. After reviewing the available data, the expert committee came to the following consensus statement for salvage autologous HCT: (1) In transplantation-eligible patients relapsing after primary therapy that did NOT include an autologous HCT, high-dose therapy with HCT as part of salvage therapy should be considered standard; (2) High-dose therapy and autologous HCT should be considered appropriate therapy for any patients relapsing after primary therapy that includes an autologous HCT with initial remission duration of more than 18 months; (3) High-dose therapy and autologous HCT can be used as a bridging strategy to allogeneic HCT; (4) The role of postsalvage HCT maintenance needs to be explored in the context of well-designed prospective trials that should include new agents, such as monoclonal antibodies, immune-modulating agents, and oral proteasome inhibitors; (5) Autologous HCT consolidation should be explored as a strategy to develop novel conditioning regimens or post-HCT strategies in patients with short (less than 18 months remissions) after primary therapy; and (6) Prospective randomized trials need to be performed to define the role of salvage autologous HCT in patients with MM relapsing after primary therapy comparing it to "best non-HCT" therapy. The expert committee also underscored the importance of collecting enough hematopoietic stem cells to perform 2 transplantations early in the course of the disease. Regarding allogeneic HCT, the expert committee agreed on the following consensus statements: (1) Allogeneic HCT should be considered appropriate therapy for any eligible patient with early relapse (less than 24 months) after primary therapy that included an autologous HCT and/or high-risk features (ie, cytogenetics, extramedullary disease, plasma cell leukemia, or high lactate dehydrogenase); (2) Allogeneic HCT should be performed in the context of a clinical trial if possible; (3) The role of postallogeneic HCT maintenance therapy needs to be explored in the context of well-designed prospective trials; and (4) Prospective randomized trials need to be performed to define the role salvage allogeneic HCT in patients with MM relapsing after primary therapy.
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Affiliation(s)
- Sergio Giralt
- Weill Cornell Medical College, Memorial Sloan Kettering Cancer Center, New York, New York.
| | | | - Brian Durie
- International Myeloma Foundation, Los Angeles, California
| | - Gordon Cook
- St. James University Hospital, Leed, United Kingdom
| | | | | | | | | | | | | | | | | | | | | | - Maria Mateos
- Hospital Universitario de Salamanca, Salamanca, Spain
| | | | | | | | - Jin Lu
- Peking University Institute of Hematology, People's Hospital, Beijing, Peoples Republic of China
| | - Meletios Dimopoulos
- National and Kapodistrian University of Athens Alexandra Hospital, Athens, Greece
| | | | | | - Rafat Abonour
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana
| | - Kenneth Anderson
- Dana Farber Cancer Institute, Harvard University, Boston, Massachusetts
| | | | - Joan Blade
- Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - Jenny Bird
- University Hospital Bristol, Bristol, United Kingdom
| | - Michele Cavo
- Seragnoli Institut of Hematology, Bologna University School of Medicine, Bologna, Italy
| | | | | | | | | | | | | | | | - Douglas Joshua
- Royal Prince Alfred Hospital, Sydney University Medical School, Sydney, Australia
| | - Guenther Koehne
- Weill Cornell Medical College, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | | | - Sagar Lonial
- Emory University School of Medicine, Winship Cancer Institute, Atlanta, Georgia
| | - Heinz Ludwig
- Wilhelminenkrebsforschungsinstituts, Vienna, Austria
| | | | - Anil Nooka
- Emory University School of Medicine, Winship Cancer Institute, Atlanta, Georgia
| | - Robert Orlowski
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Anthony Reiman
- Dalhousie University Medical School, Dalhousie, Nova Scotia, Canada
| | - Paul Richardson
- Dana Farber Cancer Institute, Harvard University, Boston, Massachusetts
| | | | | | | | - Saad Usmani
- Levine Cancer Institute, Charlotte, North Carolina
| | - David Vesole
- John Theurer Cancer Center, Hackensack, New Jersey
| | | | | | | | - Mohamed Mohty
- University Marie and Pierre Curie, Hospital St Antoine, Paris, France
| | | | | | | | - Chris Bredeson
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | | | | | - Edward Stadtmauer
- University of Pennsylvania Abramson Cancer Center, Philadelphia, Pennsylvania
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22
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Suen H, Brown R, Yang S, Ho PJ, Gibson J, Joshua D. The failure of immune checkpoint blockade in multiple myeloma with PD-1 inhibitors in a phase 1 study. Leukemia 2015; 29:1621-2. [DOI: 10.1038/leu.2015.104] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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23
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Quach H, Joshua D, Ho J, Szer J, Spencer A, Harrison S, Mollee P, Roberts A, Horvath N, Talaulikar D, To B, Zannettino A, Brown R, Catley L, Augustson B, Jaksic W, Gibson J, Prince HM. Treatment of patients with multiple myeloma who are not eligible for stem cell transplantation: position statement of the myeloma foundation of Australia Medical and Scientific Advisory Group. Intern Med J 2015; 45:335-43. [DOI: 10.1111/imj.12688] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Accepted: 12/20/2014] [Indexed: 11/29/2022]
Affiliation(s)
- H. Quach
- Department of Haematology; St Vincent's Hospital; Melbourne Victoria Australia
- Faculty of Medicine; Dentistry and Health Sciences; The University of Melbourne; Melbourne Victoria Australia
| | - D. Joshua
- Faculty of Medicine; University of Sydney; Sydney New South Wales Australia
- Department of Haematology; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - J. Ho
- Faculty of Medicine; University of Sydney; Sydney New South Wales Australia
- Department of Haematology; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - J. Szer
- Department of Clinical Haematology and BMT; Royal Melbourne Hospital; Melbourne Victoria Australia
| | - A. Spencer
- Department of Haematology; The Alfred Hospital; Melbourne Victoria Australia
| | - S. Harrison
- Faculty of Medicine; Dentistry and Health Sciences; The University of Melbourne; Melbourne Victoria Australia
- Department of Haematology; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - P. Mollee
- Amyloidosis Centre and Department of Haematology; Princess Alexandra Hospital; Brisbane Queensland Australia
- School of Medicine; University of Queensland; Brisbane Queensland Australia
| | - A. Roberts
- Faculty of Medicine; Dentistry and Health Sciences; The University of Melbourne; Melbourne Victoria Australia
- Department of Clinical Haematology and BMT; Royal Melbourne Hospital; Melbourne Victoria Australia
| | - N. Horvath
- Department of Haematology; South Australia Pathology; Adelaide South Australia Australia
| | - D. Talaulikar
- Department of Haematology; Canberra Hospital; Canberra Australian Capital Territory Australia
- Australian National University; Canberra Australian Capital Territory Australia
| | - B. To
- Department of Haematology; South Australia Pathology; Adelaide South Australia Australia
| | - A. Zannettino
- Department of Haematology; South Australia Pathology; Adelaide South Australia Australia
| | - R. Brown
- Department of Haematology; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - L. Catley
- School of Medicine; University of Queensland; Brisbane Queensland Australia
- Department of Haematology; Mater Public Hospital; Brisbane Queensland Australia
- Mater Medical Research Institute; Brisbane Queensland Australia
| | - B. Augustson
- Department of Haematology; Sir Charles Gairdner Hospital; Perth Western Australia Australia
| | - W. Jaksic
- Department of Haematology; Queen Elizabeth Hospital; Adelaide South Australia Australia
| | - J. Gibson
- Faculty of Medicine; University of Sydney; Sydney New South Wales Australia
- Department of Haematology; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - H. M. Prince
- Faculty of Medicine; Dentistry and Health Sciences; The University of Melbourne; Melbourne Victoria Australia
- Department of Haematology; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
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24
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McAuliffe S, Brown R, Catalano A, Ho PJ, Nassif N, Woodland N, Hart D, Weatherburn C, Yang S, Suen H, Paul C, Joshua D, Gibson J. Using digital polymerase chain reaction to detect minimal residual disease in myeloma by identifying FGFR3 up-regulation. Leuk Lymphoma 2015; 56:2714-6. [PMID: 25651422 DOI: 10.3109/10428194.2014.1003061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Simon McAuliffe
- a Institute of Haematology, Royal Prince Alfred Hospital , Sydney , Australia.,b School of Medical and Molecular Biosciences, University of Technology , Sydney , Australia
| | - Ross Brown
- a Institute of Haematology, Royal Prince Alfred Hospital , Sydney , Australia
| | - Alberto Catalano
- a Institute of Haematology, Royal Prince Alfred Hospital , Sydney , Australia
| | - P Joy Ho
- a Institute of Haematology, Royal Prince Alfred Hospital , Sydney , Australia
| | - Najah Nassif
- b School of Medical and Molecular Biosciences, University of Technology , Sydney , Australia
| | - Narelle Woodland
- b School of Medical and Molecular Biosciences, University of Technology , Sydney , Australia
| | - Derek Hart
- c Dendritic Cell Biology and Therapeutics Group, ANZAC Research Institute, Concord Hospital , Sydney , Australia
| | - Claire Weatherburn
- a Institute of Haematology, Royal Prince Alfred Hospital , Sydney , Australia
| | - Shihong Yang
- a Institute of Haematology, Royal Prince Alfred Hospital , Sydney , Australia
| | - Hayley Suen
- a Institute of Haematology, Royal Prince Alfred Hospital , Sydney , Australia.,b School of Medical and Molecular Biosciences, University of Technology , Sydney , Australia
| | - Cheryl Paul
- a Institute of Haematology, Royal Prince Alfred Hospital , Sydney , Australia
| | - Douglas Joshua
- a Institute of Haematology, Royal Prince Alfred Hospital , Sydney , Australia
| | - John Gibson
- a Institute of Haematology, Royal Prince Alfred Hospital , Sydney , Australia
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Quach H, Joshua D, Ho J, Szer J, Spencer A, Harrison SJ, Mollee P, Roberts AW, Horvath N, Talulikar D, To B, Zannettino A, Brown R, Catley L, Augustson B, Jaksic W, Gibson J, Prince HM. Treatment of patients with multiple myeloma who are eligible for stem cell transplantation: position statement of the Myeloma Foundation of Australia Medical and Scientific Advisory Group. Intern Med J 2015; 45:94-105. [DOI: 10.1111/imj.12640] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Accepted: 09/29/2014] [Indexed: 11/28/2022]
Affiliation(s)
- H. Quach
- Department of Haematology; St Vincent's Hospital; Melbourne Victoria Australia
- Faculty of Medicine, Dentistry and Health Sciences; University of Melbourne; Melbourne Victoria Australia
| | - D. Joshua
- Department of Haematology; Royal Prince Alfred Hospital; Sydney New South Wales Australia
- Faculty of Medicine; University of Sydney; Sydney New South Wales Australia
| | - J. Ho
- Department of Haematology; Royal Prince Alfred Hospital; Sydney New South Wales Australia
- Faculty of Medicine; University of Sydney; Sydney New South Wales Australia
| | - J. Szer
- Department of Clinical Haematology and BMT; Royal Melbourne Hospital; Melbourne Victoria Australia
| | - A. Spencer
- Department of Haematology; The Alfred Hospital; Melbourne Victoria Australia
| | - S. J. Harrison
- Faculty of Medicine, Dentistry and Health Sciences; University of Melbourne; Melbourne Victoria Australia
- Department of Haematology; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - P. Mollee
- Amyloidosis Centre and Department of Haematology; Princess Alexandra Hospital; Brisbane Queensland Australia
- School of Medicine; University of Queensland; Brisbane Queensland Australia
| | - A. W. Roberts
- Department of Clinical Haematology and BMT; Royal Melbourne Hospital; Melbourne Victoria Australia
| | - N. Horvath
- Department of Haematology; South Australia Pathology; Adelaide South Australia Australia
| | - D. Talulikar
- Department of Haematology; Canberra Hospital; Canberra ACT Australia
- Australian National University; Canberra ACT Australia
| | - B. To
- Department of Haematology; South Australia Pathology; Adelaide South Australia Australia
| | - A. Zannettino
- Department of Haematology; South Australia Pathology; Adelaide South Australia Australia
| | - R. Brown
- Department of Haematology; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - L. Catley
- School of Medicine; University of Queensland; Brisbane Queensland Australia
- Department of Haematology; Mater Public Hospital; Brisbane Queensland Australia
- Mater Medical Research Institute; Brisbane Queensland Australia
| | - B. Augustson
- Department of Haematology; Sir Charles Gairdner Hospital; Perth Western Australia Australia
| | - W. Jaksic
- Department of Haematology; Queen Elizabeth Hospital; Adelaide South Australia Australia
| | - J. Gibson
- Department of Haematology; Royal Prince Alfred Hospital; Sydney New South Wales Australia
- Faculty of Medicine; University of Sydney; Sydney New South Wales Australia
| | - H. M. Prince
- Faculty of Medicine, Dentistry and Health Sciences; University of Melbourne; Melbourne Victoria Australia
- Department of Haematology; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
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Brown R, Yang S, Weatherburn C, Gibson J, Ho PJ, Suen H, Hart D, Joshua D. Phospho-flow detection of constitutive and cytokine-induced pSTAT3/5, pAKT and pERK expression highlights novel prognostic biomarkers for patients with multiple myeloma. Leukemia 2014; 29:483-90. [DOI: 10.1038/leu.2014.204] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 06/11/2014] [Accepted: 06/30/2014] [Indexed: 12/28/2022]
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Favaloro J, Liyadipitiya T, Brown R, Yang S, Suen H, Woodland N, Nassif N, Hart D, Fromm P, Weatherburn C, Gibson J, Ho PJ, Joshua D. Myeloid derived suppressor cells are numerically, functionally and phenotypically different in patients with multiple myeloma. Leuk Lymphoma 2014; 55:2893-900. [PMID: 24625328 DOI: 10.3109/10428194.2014.904511] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Myeloid derived suppressor cells (MDSCs) are a heterogeneous population of cells that have been implicated as inhibitors of lymphopoiesis in patients with malignancies. They have a consensus phenotype of CD33+/CD11b+/HLA-DRlo/- and can be further divided into CD15 + granulocytic (G-MDSC) and CD14 + monocytic (M-MDSC) subsets. We characterized MDSCs in patients with multiple myeloma (MM) and found a significant increase in G-MDSCs in the blood of patients with progressive MM. Flow-sorted MDSCs from patients with MM induced the generation of regulatory T cells (Treg). MDSCs from both patients with MM and aged-matched controls demonstrated a dose-dependent inhibition of lymphocyte proliferation in carboxyfluorescein succinimidyl ester (CFSE)-tracking experiments. Granulocyte colony stimulating factor (G-CSF) administered to induce stem cell mobilization caused an increase in the number of MDSCs in the peripheral blood of patients with MM and a concentration of these immune-suppressive cells in peripheral blood stem cell collections. MDSCs are likely to cause immune dysfunction in patients with MM.
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Affiliation(s)
- James Favaloro
- Institute of Haematology, Royal Prince Alfred Hospital , Sydney, NSW , Australia
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Zarkos K, Favaloro J, Liyadipitiya T, Brown R, Yang S, Suen H, Weatherburn C, Gibson J, Ho P, Joshua D. Myeloid derived suppressor cells are expanded in patients with multiple myeloma, induce Treg cells and delay T-cell recovery post transplantation. Cytotherapy 2014. [DOI: 10.1016/j.jcyt.2014.01.239] [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: 11/24/2022]
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Hocking J, Schwarer AP, Gasiorowski R, Patil S, Avery S, Gibson J, Iland H, Ho PJ, Joshua D, Muirhead J, Lai H, Irving I. Excellent outcomes for adolescents and adults with acute lymphoblastic leukemia and lymphoma without allogeneic stem cell transplant: the FRALLE-93 pediatric protocol. Leuk Lymphoma 2014; 55:2801-7. [PMID: 24528220 DOI: 10.3109/10428194.2014.894191] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Adolescents and adults with acute lymphoblastic leukemia/lymphoma (ALL) have better outcomes when treated using pediatric protocols compared with treatment using adult protocols. We reviewed the progress and outcomes of 40 adolescents and adults up to 45 years of age, from three Australian centers, treated on the intensive French group for childhood ALL (FRALLE)-93 pediatric protocol. All except one patient achieved a morphologic complete remission following induction chemotherapy. Three-year overall survival for all-risk and standard-risk disease was 70% and 75%, respectively. The treatment protocol was generally well tolerated with no treatment related mortality. The FRALLE-93 pediatric protocol showed excellent overall survival for patients with standard-risk disease, without the need for allogeneic hematopoietic stem cell transplant in first remission.
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Ludwig H, Miguel JS, Dimopoulos MA, Palumbo A, Garcia Sanz R, Powles R, Lentzsch S, Ming Chen W, Hou J, Jurczyszyn A, Romeril K, Hajek R, Terpos E, Shimizu K, Joshua D, Hungria V, Rodriguez Morales A, Ben-Yehuda D, Sondergeld P, Zamagni E, Durie B. International Myeloma Working Group recommendations for global myeloma care. Leukemia 2013; 28:981-92. [DOI: 10.1038/leu.2013.293] [Citation(s) in RCA: 139] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 09/17/2013] [Accepted: 09/23/2013] [Indexed: 12/31/2022]
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Favaloro J, Brown R, Aklilu E, Yang S, Suen H, Hart D, Fromm P, Gibson J, Khoo L, Ho PJ, Joshua D. Myeloma skews regulatory T and pro-inflammatory T helper 17 cell balance in favor of a suppressive state. Leuk Lymphoma 2013; 55:1090-8. [PMID: 23865833 DOI: 10.3109/10428194.2013.825905] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract Discrepancies in the literature between regulatory T cell (Treg) and pro-inflammatory T helper 17 (Th17) numbers in multiple myeloma (MM) can be largely explained by technical differences in methodology and patient selection. In this study, Treg cells were defined as CD3(+)CD4(+)CD25(++)CD127(lo) cells. Patients with MM (n = 20) had a significant imbalance in Treg/Th17 ratio when compared with either aged-matched controls (n = 28) or other monoclonal gammopathies, and this was associated with a significantly worse survival. The percent Treg in bone marrow of patients with MM was higher than that in matched peripheral blood samples (p = 0.02), although FOXP3 expression within bone marrow T cells was lower (p = 0.02). We observed increased Treg function, both in vivo and in vitro, due at least partially to an increase in CTLA-4 expression by concurrent treatment with dexamethasone and immune modulatory compounds (iMiDs). We suggest that immunoregulatory balance is important during active chemotherapy and that conclusions related to the immunostimulatory effect of iMiDs based on in vitro testing must be considered with caution.
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Affiliation(s)
- James Favaloro
- Institute of Haematology, Royal Prince Alfred Hospital , Sydney, NSW , Australia
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Barrow L, Brown RD, Murray A, Sze DM, Pope B, Gibson J, Hart D, Joshua D. CMRF44+ Dendritic Cells from Peripheral Blood Stem Cell Harvests of Patients with Myeloma as Potential Cellular Vectors for Idiotype Vaccination. Leuk Lymphoma 2011; 44:2117-22. [PMID: 14959857 DOI: 10.1080/1042819031000123401] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The optimal conditions required to harvest dendritic cells (DC) for immunotherapy were investigated in a series of preliminary investigations using peripheral blood stem cell (PBSC) harvests and blood from patients with myeloma. There was no difference in the number of DC (CMRF44+, CD19-, CD14-) in PBSC mobilized with G-CSF (mean 0.28%, n = 7) compared with GM-CSF (mean 0.24%, n = 6) and apheresis itself did not concentrate DC. In longitudinal studies (n = 10), the peak DC count (day 12 post PBSC harvest) did not correlate with the peak CD34+ cell count or white cell count. A simple affinity purification of DC resulted in a mean 63-fold purification. Affinity enriched suspensions from normal blood contained more DC (mean = 18.8%; n = 5) than those from patients with myeloma (mean = 9.9%; n = 13). The percentage of DC with a lymphoid phenotype (CD11c-, CDw123hi+) was significantly higher in G-CSF mobilized PBSC harvests (22.7%; n = 6) than in peripheral blood samples from patients with myeloma (7.0%; n = 13; p = 0.01). DC endocytosis was normal and did not change throughout the course of the disease. Neither DC numbers nor subsets changed significantly between days 1 and 3 of culture. Current mobilization procedures, optimized for PBSC, need to be altered when harvesting DC.
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Affiliation(s)
- L Barrow
- Institute of Hematology, Royal Prince Alfred Hospital, Sydney, Australia
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Khoo TL, Vangsted AJ, Joshua D, Gibson J. Interferon-alpha in the treatment of multiple myeloma. Curr Drug Targets 2011; 12:437-46. [PMID: 21143148 DOI: 10.2174/138945011794815329] [Citation(s) in RCA: 14] [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: 06/14/2010] [Accepted: 09/05/2010] [Indexed: 11/22/2022]
Abstract
Interferons are soluble proteins produced naturally by cells in response to viruses. It has both anti-proliferative and immunomodulating properties and is one of the first examples of a biological response modifier use to treat the haematological malignancy multiple myeloma. Interferon has been used in this clinical practice for over thirty years. However, despite considerable efforts, numerous clinical trials and two large meta-analysis, its exact role in the management of multiple myeloma still remains unclear. Its role in the treatment of multiple myeloma has been as a single induction agent, a co-induction agent with other chemotherapy regimens, and as maintenance therapy after conventional chemotherapy or complete remission after autologous or allogeneic transplantation. Interferon as a single induction agent or co-induction agent with other chemotherapy agents appears only to have minimal benefit in myeloma. Its role as maintenance therapy in the plateau phase of myeloma also remains uncertain. More recently, the use of interferon must now compete with the "new drugs"--thalidomide, lenalidomide and bortezomib in myeloma treatment. Will there be a future role of interferon in the treatment of multiple myeloma or will interferon be resigned to the history books remains to be seen.
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Affiliation(s)
- Teh Liane Khoo
- Department of Hematology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
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Mitsiades CS, Davies FE, Laubach JP, Joshua D, San Miguel J, Anderson KC, Richardson PG. Future directions of next-generation novel therapies, combination approaches, and the development of personalized medicine in myeloma. J Clin Oncol 2011; 29:1916-23. [PMID: 21482978 DOI: 10.1200/jco.2010.34.0760] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [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: 12/22/2022] Open
Abstract
Despite tangible progress in recent years, substantial therapeutic challenges remain in multiple myeloma (MM), particularly for patients at high risk for early relapse or death and for those with advanced multi-drug resistant disease and refractoriness to currently available combination regimens. Addressing these challenges requires identification of novel classes of anti-MM agents, their incorporation into safe and more effective combination regimens, and development of efficient algorithms to select the most appropriate therapeutic options for the clinical and molecular features of individual patients at a given time during their disease. Ideally, these goals can be facilitated by preclinical identification of the "driver" molecular lesions on which different myeloma subtypes exquisitely depend, and by informative preclinical models simulating the clinical setting(s) in which trials will be conducted. Large prospective studies of patients treated uniformly with contemporary clinical regimens are essential, but there is also a major need for flexibility in studying new regimens in the future. Long-term patient follow-up and integrated annotation of clinical (safety and efficacy) and correlative (molecular, biochemical, etc) data are also critical. Novel molecular profiling techniques will likely identify more clinically and biologically discrete subsets of patients with recurrent, even if infrequent, lesions. This molecular heterogeneity, combined with the increasing numbers of candidate therapeutic targets and respective investigational agents, may pose formidable challenges for the development and implementation of personalized medicine in MM. This review discusses these challenges, as well as potential strategies to address them, with the aim of making significant improvement in the clinical outcome of patients with MM.
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Affiliation(s)
- Constantine S Mitsiades
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, 44 Binney St, Boston, MA 02115, USA.
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Berenson JR, Anderson KC, Audell RA, Boccia RV, Coleman M, Dimopoulos MA, Drake MT, Fonseca R, Harousseau JL, Joshua D, Lonial S, Niesvizky R, Palumbo A, Roodman GD, San-Miguel JF, Singhal S, Weber DM, Zangari M, Wirtschafter E, Yellin O, Kyle RA. Monoclonal gammopathy of undetermined significance: a consensus statement. Br J Haematol 2010; 150:28-38. [PMID: 20507313 DOI: 10.1111/j.1365-2141.2010.08207.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
On February 25, 2009, a panel of international experts on plasma cell dyscrasia and skeletal disease met to discuss monoclonal gammopathy of undetermined significance (MGUS). This non-malignant B-cell disorder is the most common plasma cell dyscrasia and is associated with an increased risk of developing serious B-cell disorders. Individuals with MGUS also have an increased risk of osteoporosis and osteopenia associated with an increased likelihood of developing fractures especially in the vertebral column, peripheral neuropathy and thromboembolic events. The goal of the meeting was to develop a consensus statement regarding the appropriate tests to screen, evaluate and follow-up patients with MGUS. The panel also addressed the identification and treatment of MGUS-related skeletal problems, thromboembolic events and neurological complications. The following consensus statement outlines the conclusions and marks the first time that a consensus statement for the screening and treatment of MGUS has been clearly stated.
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Affiliation(s)
- James R Berenson
- Institute for Myeloma & Bone Cancer Research, West Hollywood, CA 90069, USA.
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Nath CE, Shaw PJ, Trotman J, Zeng L, Duffull SB, Hegarty G, McLachlan AJ, Gurney H, Kerridge I, Kwan YL, Presgrave P, Tiley C, Joshua D, Earl J. Population pharmacokinetics of melphalan in patients with multiple myeloma undergoing high dose therapy. Br J Clin Pharmacol 2010; 69:484-97. [PMID: 20573084 PMCID: PMC2856049 DOI: 10.1111/j.1365-2125.2010.03638.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Accepted: 01/08/2010] [Indexed: 12/22/2022] Open
Abstract
AIMS To i) investigate the pharmacokinetics of total and unbound plasma melphalan using a population approach, ii) identify clinical factors that affect melphalan disposition and iii) evaluate the role of melphalan exposure in melphalan-related toxicity and disease response. METHODS Population pharmacokinetic modelling (using NONMEM) was performed with total and unbound concentration-time data from 100 patients (36-73 years) who had received a median 192 mg m(-2) melphalan dose. Model derived estimates of total and unbound melphalan exposure (AUC) in patients with serious melphalan toxicity and those who had a good disease response (>or=90% decrease in paraprotein concentrations) were compared using the Mann-Whitney test. RESULTS A two compartment model generated population mean estimates for total and unbound melphalan clearance (CL) of 27.8 and 128 l h(-1), respectively. Estimated creatinine clearance, fat free mass and haematocrit were important determinants of total and unbound CL, reducing the inter-individual variability in total CL from 34% to 27% and in unbound CL from 42% to 30%. Total AUC (range 4.9-24.4 mg l(-1) h) and unbound AUC (range 1.0-6.5 mg l(-1) h) were significantly higher in patients who had oral mucositis (>or=grade 3) and long hospital admissions (P < 0.01). Patients who responded well had significantly higher unbound AUC (median 3.2 vs. 2.8 mg l(-1) h, P < 0.05) when assessed from diagnosis to post-melphalan and higher total AUC (median 21.3 vs. 13.4 mg l(-1) h, P= 0.06), when assessed from pre- to post-melphalan. CONCLUSIONS Creatinine clearance, fat free mass and haematocrit influence total and unbound melphalan plasma clearance. Melphalan exposure is related to melphalan toxicity while the association with efficacy shows promising trends that will be studied further.
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Affiliation(s)
- Christa E Nath
- The Children's Hospital at Westmead, Sydney, NSW, Australia.
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Brown RD, Gorenc B, Gibson J, Warburton P, Joshua D. Interleukin 4 and 6 Receptor Expression on B Cell Lines and the Lymphocytes of Patients with B Cell Malignancies. Leuk Lymphoma 2009. [DOI: 10.3109/10428199209053570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- R. D. Brown
- Haematology Department, Royal Prince Alfred Hospital, Sydney, Australia
| | - B. Gorenc
- Haematology Department, Royal Prince Alfred Hospital, Sydney, Australia
| | - J. Gibson
- Haematology Department, Royal Prince Alfred Hospital, Sydney, Australia
| | - P. Warburton
- Haematology Department, Royal Prince Alfred Hospital, Sydney, Australia
| | - D. Joshua
- Haematology Department, Royal Prince Alfred Hospital, Sydney, Australia
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Brown R, Joshua D, Uhr E, Snowdon L, Gibson J. The Use of a Commercially Available Immunoassay to Determine the Level of Interleukin-6 in the Serum of Patients with Myeloma. Leuk Lymphoma 2009; 5:151-5. [DOI: 10.3109/10428199109068119] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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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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Brown R, Spencer A, Ho PJ, Kennedy N, Kabani K, Yang S, Sze D, Aklilu E, Gibson J, Joshua D. Prognostically significant cytotoxic T cell clones are stimulated after thalidomide therapy in patients with multiple myeloma. Leuk Lymphoma 2009. [DOI: 10.1080/10428190903216804] [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: 10/20/2022]
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Abstract
Progress in the understanding of multiple myeloma (MM) cell biology has led to the identification of new relevant prognostic factors and subsequently different risk groups. This concept, together with the recent discovery of new drugs with novel mechanisms of action, will probably lead to individualized treatment according to the different patients' characteristics. In this review, we focus on current available agents already approved for MM, and discuss individualized treatment approaches for both transplantation candidates (subdivided into standard and high-risk patients) and elderly patients. Future progress in MM will be based on using science to inform the design of the optimal combined treatments, and high throughput assays that can assess the ability of combination therapies to induce death of MM cells, both alone and in the bone marrow microenvironment.
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Affiliation(s)
- Jesús San-Miguel
- Servicio de Hematología, Hospital Universitario de Salamanca, Paseo de San Vicente, 58, 37007 Salamanca, Spain.
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Sanders J, Crawford B, Gibson J, Joy Ho P, Iland H, Joshua D. Is there a case for the early use of bisphosphonates in smouldering myeloma and MGUS? (Bisphosphonates in SMM & MGUS). Int J Lab Hematol 2007; 29:395-7. [PMID: 17824924 DOI: 10.1111/j.1365-2257.2006.00860.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Durie BGM, Harousseau JL, Miguel JS, Bladé J, Barlogie B, Anderson K, Gertz M, Dimopoulos M, Westin J, Sonneveld P, Ludwig H, Gahrton G, Beksac M, Crowley J, Belch A, Boccadaro M, Turesson I, Joshua D, Vesole D, Kyle R, Alexanian R, Tricot G, Attal M, Merlini G, Powles R, Richardson P, Shimizu K, Tosi P, Morgan G, Rajkumar SV. Erratum: International uniform response criteria for multiple myeloma. Leukemia 2007. [DOI: 10.1038/sj.leu.2404582] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Alhaliq AR, Joshua D, Kershaw G, Dunkley S. The Diamed assay has a poor positive predictive value for HIT in a tertiary hospital referral setting. ACTA ACUST UNITED AC 2007; 29:69-70. [PMID: 17224011 DOI: 10.1111/j.1365-2257.2006.00849.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Durie BGM, Harousseau JL, Miguel JS, Bladé J, Barlogie B, Anderson K, Gertz M, Dimopoulos M, Westin J, Sonneveld P, Ludwig H, Gahrton G, Beksac M, Crowley J, Belch A, Boccadaro M, Turesson I, Joshua D, Vesole D, Kyle R, Alexanian R, Tricot G, Attal M, Merlini G, Powles R, Richardson P, Shimizu K, Tosi P, Morgan G. Erratum: International uniform response criteria for multiple myeloma. Leukemia 2006. [DOI: 10.1038/sj.leu.2404428] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Durie BGM, Harousseau JL, Miguel JS, Bladé J, Barlogie B, Anderson K, Gertz M, Dimopoulos M, Westin J, Sonneveld P, Ludwig H, Gahrton G, Beksac M, Crowley J, Belch A, Boccadaro M, Cavo M, Turesson I, Joshua D, Vesole D, Kyle R, Alexanian R, Tricot G, Attal M, Merlini G, Powles R, Richardson P, Shimizu K, Tosi P, Morgan G, Rajkumar SV. International uniform response criteria for multiple myeloma. Leukemia 2006; 20:1467-73. [PMID: 16855634 DOI: 10.1038/sj.leu.2404284] [Citation(s) in RCA: 2017] [Impact Index Per Article: 112.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
New uniform response criteria are required to adequately assess clinical outcomes in myeloma. The European Group for Blood and Bone Marrow Transplant/International Bone Marrow Transplant Registry criteria have been expanded, clarified and updated to provide a new comprehensive evaluation system. Categories for stringent complete response and very good partial response are added. The serum free light-chain assay is included to allow evaluation of patients with oligo-secretory disease. Inconsistencies in prior criteria are clarified making confirmation of response and disease progression easier to perform. Emphasis is placed upon time to event and duration of response as critical end points. The requirements necessary to use overall survival duration as the ultimate end point are discussed. It is anticipated that the International Response Criteria for multiple myeloma will be widely used in future clinical trials of myeloma.
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Affiliation(s)
- B G M Durie
- Aptium Oncology, Inc., Cedars-Sinai Outpatient Cancer Center, Los Angeles, CA 90048, USA.
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Abstract
Thalidomide and its immunomodulatory derivatives have provided the most significant advance in the therapy of myeloma since the introduction of high dose chemotherapy followed by stem cell transplantation nearly 20 years ago. The mechanism of action of thalidomide is complex and involves many aspects of malignant plasma cell growth and bone marrow stromal cell microenvironment interaction. Thalidomide was first used because of its anti-angiogenic properties, however it is the immunomodulatory actions that involve increasing host tumour-specific immunosurveillance by both T cell and natural killer cells which may be the most important mode of action.
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Affiliation(s)
- Daniel M-Y Sze
- Institute of Haematology, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia.
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Lynch WJ, Sughondhabirom A, Pittman B, Gueorguieva R, Kalayasiri R, Joshua D, Morgan P, Coric V, Malison RT. A paradigm to investigate the regulation of cocaine self-administration in human cocaine users: a randomized trial. Psychopharmacology (Berl) 2006; 185:306-14. [PMID: 16521032 DOI: 10.1007/s00213-006-0323-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2005] [Accepted: 01/05/2006] [Indexed: 11/24/2022]
Abstract
RATIONALE We recently conducted a pilot study supporting the feasibility, safety, and validity of a human laboratory model of ad libitum cocaine administration in which subjects self-selected the timing of infusions. The current study extends this work to include a randomized design with a test-retest component in a larger sample. OBJECTIVES To investigate the regulation of cocaine intake by humans and its effects on subjective and cardiovascular responses. MATERIALS AND METHODS Subjects were 14 non-treatment seeking volunteers (10 M, 4 F) with cocaine abuse/dependence. Subjects self-administered cocaine infusions (0, 8, 16, and 32 mg/70 kg) over a 2-h period under a fixed ratio 1, 5-min time-out schedule on 4 consecutive days. A fifth session was conducted at 16-mg dose to assess the paradigm's test-retest reliability. RESULTS Subjects regulated their cocaine intake in a dose-dependent fashion. Self-reports of cocaine-related subjective effects (e.g., "high" and "stimulated") also varied in a dose-dependent way. Test-retest data and the randomized design support the conclusion that such effects are not due to tolerance or other experimental artifacts. CONCLUSION The current study replicates prior work demonstrating the feasibility, safety, and validity of our human laboratory paradigm of cocaine administration in a larger sample using a randomized design. The current study also shows the test-retest reliability of these methods, establishing its utility for comparisons of experimental interventions (e.g., pharmacological treatments). Finally, the current study suggests that factors other than drug-induced euphoria (i.e., "high") contribute to the regulation of cocaine-taking behaviors in humans.
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Affiliation(s)
- W J Lynch
- Health Services, Department of Psychiatric Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
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Abstract
The use of all-trans retinoic acid (ATRA) is now standard therapy for the treatment of acute promyelocytic leukaemia (APML). There have been increasing reports of ATRA-induced myositis, with its frequent association with retinoic acid syndrome and Sweet's syndrome. We report a case of a young man with APML who developed ATRA-induced myositis characterized by unexplained fevers, bilateral leg swelling and a non-painful purpuric, petechial rash, with prompt resolution of symptoms and signs with high-dose steroids and cessation of ATRA. Rapid recognition of this adverse reaction and prompt institution of steroids is of prime importance given its potentially fatal course.
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Affiliation(s)
- K H Chan
- Division of Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
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Affiliation(s)
- Douglas Joshua
- Institute of Haematology, Royal Prince Alfred Hospital, Sydney, Australia
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