1
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Jaccard A, Bridoux F, Roeloffzen W, Minnema MC, Bergantim R, Hájek R, João C, Cibeira MT, Palladini G, Schönland S, Merlini G, Milani P, Dimopoulos MA, Ravichandran S, Hegenbart U, Agis H, Gros B, Asra A, Dergarabetian E, Magarotto V, Leonidakis A, Cheliotis G, Sonneveld P, Wechalekar A, Kastritis E. P1714: HEALTHCARE RESOURCE UTILIZATION IN PATIENTS WITH LIGHT CHAIN AMYLOIDOSIS IN EUROPE. Hemasphere 2022. [PMCID: PMC9429565 DOI: 10.1097/01.hs9.0000849712.10352.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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2
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Milani P, Cavenaghi G, Obici L, Mussinelli R, Klersy C, Lodola L, Manfrinato G, Basset M, Sabena A, Nuvolone M, Foli A, Perlini S, Merlini G, Palladini G. Regional cardiac uptake of 99-Tc-DPD is a novel powerful and independent prognostic marker in cardiac ATTR wild type amyloidosis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2116] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Skeletal scintigraphy with bone tracers is a key tool for cardiac ATTR diagnosis. However its prognostic value has not been systematically assessed.
Purpose
We evaluated the prognostic relevance of a quantitative method to assess regional 99mTc-DPD uptake by SPECT in the heart of ATTRwt patients.
Methods
All ATTRwt patients (n=229) undergoing clinical assessment and bone scintigraphy at our center (from 2012 to 2019) were enrolled. Theyreceived approximately 700 MBq of 99mTc-DPD. Planar whole body acquisition 10' after the injection followed by cardiac SPECT after 3 hours were performed. SPECT data were reconstructed into 64x64 matrices with an ordered-subset expectation maximization algorithm. For each wall region and for the apex, a circular region of interest (ROI, 20 pixels) was manually drawn and a value equating to the number of counts contained in the ROI was obtained. Partial correlation of ln-transformed ROI and biomarkers was retrieved from a multivariable regression model, while controlling for each cardiac wall region. Multivariable Cox regression was used to assess the prognostic role of lnROI while adjusting for wall region, NT-proBNP, cTnI and eGFR. Hazard ratios and 95% confidence intervals (HR, 95% CI) were computed. The Harrell's c statistic was reported for model discrimination. The interaction of biomarker and regional wall on survival was assessed; also, to account for intra-subject correlation of measures, within subject robust standard errors were computed.
Results
Median follow-up was 21 months (IQR 11, 40) and 39 (17%) patients died. Median age was 76 years (IQR, 72–80), NT-proBNP 2944 ng/L (IQR, 1815–5319), cTnI 0.095 ng/L (IQR, 0.062–0.144) and eGFR 62 mL/min (IQR, 51–77). ROI did not correlate with any of NT-proBNP, eGFR, age, cTnI or mLVWT (R<1% in all cases). All analyses were adjusted for cardiac wall. At the multivariable Cox regression (Harrell's c=0.75), there was a linear increase in the risk of death associated with lnROI (HR 2.14, P=0.014), which was independent of cardiac wall region, NTproBNP, cTnI and eGFR. Only cTnI maintained a significant prognostic value. The association of lnROI and mortality was not modified by the site of measurement test for interaction with cardiac wall p=0.818). At the predefined subgroup analysis, the risk of death was similar for all walls; we computed the optimal cut-off for 12 months survival at the apex (a region usually lately involved) to 4193 (AUC: 0.68, sensitivity 80%, specificity 68%). At the multivariable Cox regression (Harrell's c 0.76), apex ROI>4193 was an independent predictor of death (HR 3.60, 95% CI 1.45–8.93, p=0.006) and outperformed all the biomarkers tested.
Conclusions
Quantitative assessment of ROI uptake at cardiac SPECT is a powerful predictor of survival in ATTRwt patients, independent of and outperforming the other known prognostic factors. This observation warrants validation with prolonged follow-up and in independent patient series.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- P Milani
- Amyloidosis Research and Treatment Center, Pavia, Italy
| | - G Cavenaghi
- Policlinic Foundation San Matteo IRCCS, Nuclear Medicine, Pavia, Italy
| | - L Obici
- Amyloidosis Research and Treatment Center, Pavia, Italy
| | - R Mussinelli
- Amyloidosis Research and Treatment Center, Pavia, Italy
| | - C Klersy
- Policlinic Foundation San Matteo IRCCS, Scientific Direction, Pavia, Italy
| | - L Lodola
- Policlinic Foundation San Matteo IRCCS, Nuclear Medicine, Pavia, Italy
| | - G Manfrinato
- Policlinic Foundation San Matteo IRCCS, Nuclear Medicine, Pavia, Italy
| | - M Basset
- Amyloidosis Research and Treatment Center, Pavia, Italy
| | - A Sabena
- Amyloidosis Research and Treatment Center, Pavia, Italy
| | - M Nuvolone
- Amyloidosis Research and Treatment Center, Pavia, Italy
| | - A Foli
- Amyloidosis Research and Treatment Center, Pavia, Italy
| | - S Perlini
- Amyloidosis Research and Treatment Center, Pavia, Italy
| | - G Merlini
- Amyloidosis Research and Treatment Center, Pavia, Italy
| | - G Palladini
- Amyloidosis Research and Treatment Center, Pavia, Italy
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3
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Milani P, Obici L, Mussinelli R, Basset M, Manfrinato G, Nuvolone M, De Matteis G, Sabena A, Benigna F, Cavenaghi G, Foli A, Perlini S, Merlini G, Palladini G. Cardiac transthyretin wild-type amyloidosis (ATTRwt): a prospective study of 400 patients followed at the Italian referral center. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2144] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Cardiac wild type transthyretin (ATTRwt) amyloidosis, formerly known as senile systemic amyloidosis, is an increasingly recognized, progressive, and fatal cardiomyopathy. Two biomarkers staging systems were proposed based on NT-proBNP (in both cases) and troponin or estimated glomerular filtration rate, that are able to predict survival in this population. The availability of novel effective treatments requires large studies to describe the natural history of the disease in different populations.
Objective
To describe the natural history of the disease in a large, prospective, national series.
Methods
Starting in 2007, we protocolized data collection in all the patients diagnosed at our center (n=400 up to 7/2019).
Results
The referrals to our center increased over time: 5 cases (1%) between 2007–2009, 33 (9%) in 2010–2012, 90 (22%) in 2013–2015 and 272 (68%) in 2016–2019. Median age was 76 years [interquartile range (IQR): 71–80 years] and 372 patients (93%) were males. One hundred and seventy-three (43%) had atrial fibrillation, 63 (15%) had a history of ischemic cardiomyopathy and 64 (15%) underwent pacemaker or ICD implantation. NYHA class was I in 58 subjects (16%), II in 225 (63%) and III in 74 (21%). Median NT-proBNP was 3064 ng/L (IQR: 1817–5579 ng/L), troponin I 0.096 ng/mL (IQR: 0.063–0.158 ng/mL), eGFR 62 mL/min (IQR: 50–78 mL/min). Median IVS was 17 mm (IQR: 15–19 mm), PW 16 mm (IQR: 14–18 mm) and EF 53% (IQR: 45–57%). One-hundred and forty-eight subjects (37%) had a concomitant monoclonal component in serum and/or urine and/or an abnormal free light chain ratio. In these patients, the diagnosis was confirmed by immunoelectron microscopy or mass spectrometry. In 252 (63%) the diagnosis was based on bone scintigraphy. DNA analysis for amyloidogenic mutations in transthyretin and apolipoprotein A-I genes was negative in all subjects. The median survival of the whole cohort was 59 months. The Mayo Clinic staging based on NT-proBNP (cutoff: 3000 ng/L) and troponin I (cutoff: 0.1 ng/mL) discriminated 3 different groups [stage I: 131 (35%), stage II: 123 (32%) and stage III: 127 (33%)] with different survival between stage I and II (median 86 vs. 81 months, P=0.04) and between stage II and III (median 81 vs. 62 months, P<0.001). The UK staging system (NT-proBNP 3000 ng/L and eGFR 45 mL/min), discriminated three groups [stage I: 170 (45%), stage II: 165 (43%) and stage III: 45 (12%)] with a significant difference in survival: between stage I and stage II (86 vs. 52 months, P<0.001) and between stage II and stage III (median survival 52 vs. 33 months, P=0.045).
Conclusions
This is one of the largest series of patients with cardiac ATTRwt reported so far. Referrals and diagnoses increased exponentially in recent years, One-third of patients has a concomitant monoclonal gammopathy and needed tissue typing. Both the current staging systems offered good discrimination of staging and were validated in our independent cohort.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- P Milani
- Amyloidosis Research and Treatment Center, Pavia, Italy
| | - L Obici
- Amyloidosis Research and Treatment Center, Pavia, Italy
| | - R Mussinelli
- Amyloidosis Research and Treatment Center, Pavia, Italy
| | - M Basset
- Amyloidosis Research and Treatment Center, Pavia, Italy
| | - G Manfrinato
- Policlinic Foundation San Matteo IRCCS, Nuclear Medicine, Pavia, Italy
| | - M Nuvolone
- Amyloidosis Research and Treatment Center, Pavia, Italy
| | - G De Matteis
- Policlinic Foundation San Matteo IRCCS, Nuclear Medicine, Pavia, Italy
| | - A Sabena
- Amyloidosis Research and Treatment Center, Pavia, Italy
| | - F Benigna
- Amyloidosis Research and Treatment Center, Pavia, Italy
| | - G Cavenaghi
- Policlinic Foundation San Matteo IRCCS, Nuclear Medicine, Pavia, Italy
| | - A Foli
- Amyloidosis Research and Treatment Center, Pavia, Italy
| | - S Perlini
- Amyloidosis Research and Treatment Center, Pavia, Italy
| | - G Merlini
- Amyloidosis Research and Treatment Center, Pavia, Italy
| | - G Palladini
- Amyloidosis Research and Treatment Center, Pavia, Italy
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4
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Brannagan TH, Wang AK, Coelho T, Waddington Cruz M, Polydefkis MJ, Dyck PJ, Plante-Bordeneuve V, Berk JL, Barroso F, Merlini G, Conceição I, Hughes SG, Kwoh J, Jung SW, Guthrie S, Pollock M, Benson MD, Gertz M. Early data on long-term efficacy and safety of inotersen in patients with hereditary transthyretin amyloidosis: a 2-year update from the open-label extension of the NEURO-TTR trial. Eur J Neurol 2020; 27:1374-1381. [PMID: 32343462 PMCID: PMC7496583 DOI: 10.1111/ene.14285] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 03/26/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND PURPOSE Hereditary transthyretin (hATTR) amyloidosis causes progressive polyneuropathy resulting from transthyretin (TTR) amyloid deposition throughout the body, including the peripheral nerves. The efficacy and safety of inotersen, an antisense oligonucleotide inhibitor of TTR protein production, were demonstrated in the pivotal NEURO-TTR study in patients with hATTR polyneuropathy. Here, the long-term efficacy and safety of inotersen are assessed in an ongoing open-label extension (OLE) study. METHODS Patients who completed NEURO-TTR were eligible to enroll in the OLE (NCT02175004). Efficacy assessments included the modified Neuropathy Impairment Score plus seven neurophysiological tests composite score (mNIS + 7), the Norfolk Quality of Life - Diabetic Neuropathy (Norfolk QOL-DN) questionnaire total score and the Short-Form 36 Health Survey (SF-36) Physical Component Summary (PCS) score. Safety and tolerability were also assessed. RESULTS Overall, 97% (135/139) of patients who completed NEURO-TTR enrolled in the OLE. Patients who received inotersen for 39 cumulative months in NEURO-TTR and the OLE continued to show benefit; patients who switched from placebo to inotersen in the OLE demonstrated improvement or stabilization of neurological disease progression by mNIS + 7, Norfolk QOL-DN and SF-36 PCS. No new safety concerns were identified. There was no evidence of increased risk for grade 4 thrombocytopenia or severe renal events with increased duration of inotersen exposure. CONCLUSION Inotersen slowed disease progression and reduced deterioration of quality of life in patients with hATTR polyneuropathy. Early treatment with inotersen resulted in greater long-term disease stabilization than delayed initiation. Routine platelet and renal safety monitoring were effective; no new safety signals were observed.
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Affiliation(s)
- T H Brannagan
- Columbia University Medical Center, New York, NY, USA
| | - A K Wang
- University of California, Irvine, Orange, CA, USA
| | - T Coelho
- Centro Hospitalar do Porto, Porto, Portugal
| | - M Waddington Cruz
- CEPARM, Amyloidosis Referral Center, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | | | - J L Berk
- Boston University, Boston, MA, USA
| | | | - G Merlini
- Amyloidosis Center, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - I Conceição
- CHULN, Hospital Santa Maria and Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - S G Hughes
- Ionis Pharmaceuticals, Inc., Carlsbad, CA, USA
| | - J Kwoh
- Ionis Pharmaceuticals, Inc., Carlsbad, CA, USA
| | - S W Jung
- Ionis Pharmaceuticals, Inc., Carlsbad, CA, USA
| | | | - M Pollock
- Akcea Therapeutics, Inc., Boston, MA, USA
| | - M D Benson
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - M Gertz
- Mayo Clinic, Rochester, MN, USA
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5
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Pica S, Piatti F, Milani P, Mussinelli R, Foli A, Basset M, Camporeale A, Geppert C, Giese D, Chow K, Perlini S, Merlini G, Palladini G, Lombardi M. 5234D flow CMR for diastolic function assessment in cardiac amyloidosis. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez124.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S Pica
- IRCCS Polyclinic San Donato, Multimodality Cardiac Imaging, Milan, Italy
| | - F Piatti
- IRCCS, Policlinico San Donato, 3D and Computer Simulation Laboratory, San Donato Milanese, Italy
| | - P Milani
- Amyloidosis Research and Treatment Center, Department of Molecular Medicine University of Pavia, Pavia, Italy
| | - R Mussinelli
- Amyloidosis Research and Treatment Center, Department of Molecular Medicine University of Pavia, Pavia, Italy
| | - A Foli
- Amyloidosis Research and Treatment Center, Department of Molecular Medicine University of Pavia, Pavia, Italy
| | - M Basset
- Amyloidosis Research and Treatment Center, Department of Molecular Medicine University of Pavia, Pavia, Italy
| | - A Camporeale
- IRCCS Polyclinic San Donato, Multimodality Cardiac Imaging, Milan, Italy
| | - C Geppert
- Siemens Healthcare GmbH, Erlangen, Germany
| | - D Giese
- Siemens Healthcare GmbH, Erlangen, Germany
| | - K Chow
- Siemens Healthcare GmbH, Erlangen, Germany
| | - S Perlini
- Amyloidosis Research and Treatment Center, Department of Molecular Medicine University of Pavia, Pavia, Italy
| | - G Merlini
- Amyloidosis Research and Treatment Center, Department of Molecular Medicine University of Pavia, Pavia, Italy
| | - G Palladini
- Amyloidosis Research and Treatment Center, Department of Molecular Medicine University of Pavia, Pavia, Italy
| | - M Lombardi
- IRCCS Polyclinic San Donato, Multimodality Cardiac Imaging, Milan, Italy
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6
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Gavriatopoulou M, Kastritis E, Morel P, Duhamel A, Kyrtsonis M, Durot E, Symeonidis A, Laribi K, Hatjiharisi E, Ysebaert L, Vassou A, Giannakoulas N, Merlini G, Repousis P, Varettoni M, Michalis E, Hivert B, Michalis M, Leblond V, Dimopoulos M. A revised international prognostic score system for Waldenström’s macroglobulinemia. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy286.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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7
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Ucci G, Riccardi A, Luoni R, Spriano P, Merlini G, Danova M, Cassano E, Molinari E, Ascari E. Serum Thymidine Kinase and Beta-2 Microglobulin in Monoclonal Gammopathies. Tumori 2018; 73:445-9. [PMID: 3318049 DOI: 10.1177/030089168707300503] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 11/16/2022]
Abstract
We evaluated the serum thymidine kinase (TK) and β-2 microglobulin (β-2) levels of 22 patients with monoclonal gammopathy of undetermined significance (MGUS) and of 29 patients with multiple myeloma (MM). Both parameters were significantly lower in MGUS than in MM patients and in early (stage I+II) than in advanced (stage III) MM. TK was also lower in MGUS than in stage I MM (p < 0.025). A seven-fold increase of TK level was documented in one patient who developed a full blown picture of MM 6 years after a diagnosis of MGUS. In 3 patients with stage III MM, a sharp decrease in TK (40–77%) and in β-2 (29–53%) levels at remission was evident with respect to the levels measured at diagnosis. Patients with high levels of TK or [3-2 had a shorter survival than those with low levels; however, this was statistically significant only for β-2 levels (p < 0.02). Serum TK as well as β-2 levels appear to be of clinical value in monoclonal gammopathies and related to the course of the disease.
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Affiliation(s)
- G Ucci
- Istituto di Clinica Medica II, Università di Pavia, Italia
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8
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Merlini G, Riccardi A, Riccardi PG, Montecucco CM, Pavesi F, Ascari E. Peptichemio, Vincristine, Prednisone Induction Treatment in Multiple Myeloma. Tumori 2018; 71:581-8. [PMID: 4082291 DOI: 10.1177/030089168507100611] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Twenty-nine patients with multiple myeloma, 16 untreated and 13 relapsing after treatment with melphalan and/or cyclophosphamide, were treated with Peptichemio (PTC), vincristine (VCR) and prednisone (PRD). The treatment was well tolerated and produced rapid resolution of bone pain and improved performance status in symptomatic patients. Rapid and marked monoclonal component reduction (greater than 50 per cent) was noted in 50% of previously untreated and 31% of previously treated patients. The median survival of previously untreated patients was 27 months, 19 months for stage III patients. Four patients resistant to common alkylating agents responded to PTC-VCR-PRD treatment and achieved long remissions (from 18 to 38 months). The therapeutic results suggest that the present combination regimen may be indicated for induction treatment of multiple myeloma patients in an advanced stage of the disease, and for treatment of myeloma patients refractory or resistant to melphalan and/or cyclophosphamide.
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9
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Caers J, Paiva B, Zamagni E, Leleu X, Bladé J, Kristinsson SY, Touzeau C, Abildgaard N, Terpos E, Heusschen R, Ocio E, Delforge M, Sezer O, Beksac M, Ludwig H, Merlini G, Moreau P, Zweegman S, Engelhardt M, Rosiñol L. Diagnosis, treatment, and response assessment in solitary plasmacytoma: updated recommendations from a European Expert Panel. J Hematol Oncol 2018; 11:10. [PMID: 29338789 PMCID: PMC5771205 DOI: 10.1186/s13045-017-0549-1] [Citation(s) in RCA: 146] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 12/26/2017] [Indexed: 02/07/2023] Open
Abstract
Solitary plasmacytoma is an infrequent form of plasma cell dyscrasia that presents as a single mass of monoclonal plasma cells, located either extramedullary or intraosseous. In some patients, a bone marrow aspiration can detect a low monoclonal plasma cell infiltration which indicates a high risk of early progression to an overt myeloma disease. Before treatment initiation, whole body positron emission tomography-computed tomography or magnetic resonance imaging should be performed to exclude the presence of additional malignant lesions. For decades, treatment has been based on high-dose radiation, but studies exploring the potential benefit of systemic therapies for high-risk patients are urgently needed. In this review, a panel of expert European hematologists updates the recommendations on the diagnosis and management of patients with solitary plasmacytoma.
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Affiliation(s)
- J. Caers
- Department of Hematology, CHU de Liège, Liège, Belgium
| | - B. Paiva
- Clinica Universidad de Navarra, Centro de Investigacion Medica Aplicadas (CIMA); Instituto de Investigación Sanitaria de Navarra (IDISNA), CIBERONC, Pamplona, Spain
| | - E. Zamagni
- Seràgnoli Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
| | - X. Leleu
- Hopital La Miletrie, University Hospital of Poitiers, Poitiers, France
| | - J. Bladé
- Department of Hematology, Hospital Clínic de Barcelona, IDIBAPS, Barcelona, Spain
| | - S. Y. Kristinsson
- Department of Hematology, Landspitali National University Hospital, Reykjavik, Iceland
| | - C. Touzeau
- Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France
| | - N. Abildgaard
- Department of Hematology, Odense University Hospital, Odense, Denmark
| | - E. Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - R. Heusschen
- Department of Hematology, CHU de Liège, Liège, Belgium
| | - E. Ocio
- Instituto de Investigacion Biomedica de Salamanca, Centro de Investigación del Cancer, Hospital Universitario de Salamanca, Salamanca, Spain
| | - M. Delforge
- Department of Hematology, University Hospital Leuven, Leuven, Belgium
| | - O. Sezer
- Department of Haematology, Oncology, and Bone Marrow Transplantation, Universitaetsklinikum Eppendorf, Hamburg, Germany
| | - M. Beksac
- Department of Hematology, University of Ankara, Ankara, Turkey
| | - H. Ludwig
- Department of Medicine I, Wilhelminen Hospital, Vienna, Austria
| | - G. Merlini
- Department of Molecular Medicine, Amyloidosis Research and Treatment Center, Foundation ‘Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo’, University of Pavia, Pavia, Italy
| | - P. Moreau
- Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France
| | - S. Zweegman
- Department of Hematology, VU University Medical Center, Amsterdam, the Netherlands
| | - M. Engelhardt
- Department of Hematology and Oncology, University of Freiburg Medical Center, Freiburg, Germany
| | - L. Rosiñol
- Department of Hematology, Hospital Clínic de Barcelona, IDIBAPS, Barcelona, Spain
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10
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da Silva Filho MI, Försti A, Weinhold N, Meziane I, Campo C, Huhn S, Nickel J, Hoffmann P, Nöthen MM, Jöckel KH, Landi S, Mitchell JS, Johnson D, Morgan GJ, Houlston R, Goldschmidt H, Jauch A, Milani P, Merlini G, Rowcieno D, Hawkins P, Hegenbart U, Palladini G, Wechalekar A, Schönland SO, Hemminki K. Genome-wide association study of immunoglobulin light chain amyloidosis in three patient cohorts: comparison with myeloma. Leukemia 2016; 31:1735-1742. [PMID: 28025584 DOI: 10.1038/leu.2016.387] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 10/28/2016] [Accepted: 11/30/2016] [Indexed: 01/27/2023]
Abstract
Immunoglobulin light chain (AL) amyloidosis is characterized by tissue deposition of amyloid fibers derived from immunoglobulin light chain. AL amyloidosis and multiple myeloma (MM) originate from monoclonal gammopathy of undetermined significance. We wanted to characterize germline susceptibility to AL amyloidosis using a genome-wide association study (GWAS) on 1229 AL amyloidosis patients from Germany, UK and Italy, and 7526 healthy local controls. For comparison with MM, recent GWAS data on 3790 cases were used. For AL amyloidosis, single nucleotide polymorphisms (SNPs) at 10 loci showed evidence of an association at P<10-5 with homogeneity of results from the 3 sample sets; some of these were previously documented to influence MM risk, including the SNP at the IRF4 binding site. In AL amyloidosis, rs9344 at the splice site of cyclin D1, promoting translocation (11;14), reached the highest significance, P=7.80 × 10-11; the SNP was only marginally significant in MM. SNP rs79419269 close to gene SMARCD3 involved in chromatin remodeling was also significant (P=5.2 × 10-8). These data provide evidence for common genetic susceptibility to AL amyloidosis and MM. Cyclin D1 is a more prominent driver in AL amyloidosis than in MM, but the links to aggregation of light chains need to be demonstrated.
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Affiliation(s)
- M I da Silva Filho
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - A Försti
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Center for Primary Health Care Research, Lund University, Malmo, Sweden
| | - N Weinhold
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany.,Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - I Meziane
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - C Campo
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - S Huhn
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - J Nickel
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - P Hoffmann
- Institute of Human Genetics, University of Bonn, Bonn, Germany.,Department of Biomedicine, University of Basel, Basel, Switzerland
| | - M M Nöthen
- Institute of Human Genetics, University of Bonn, Bonn, Germany.,Department of Genomics, Life and Brain Research Center, University of Bonn, Bonn, Germany
| | - K-H Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University of Duisburg-Essen, Germany
| | - S Landi
- Department of Biology, University of Pisa, Pisa, Italy
| | - J S Mitchell
- Division of Genetics and Epidemiology, The Institute of Cancer Research, Surrey, UK
| | - D Johnson
- Division of Molecular Pathology, The Institute of Cancer Research, Surrey, UK
| | - G J Morgan
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - R Houlston
- Division of Genetics and Epidemiology, The Institute of Cancer Research, Surrey, UK.,Division of Molecular Pathology, The Institute of Cancer Research, Surrey, UK
| | - H Goldschmidt
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany.,National Centre of Tumor Diseases, Heidelberg, Germany
| | - A Jauch
- Institute of Human Genetics, University of Heidelberg, Heidelberg, Germany
| | - P Milani
- Department of Molecular Medicine, Amyloidosis Research and Treatment Center, Foundation 'Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo', University of Pavia, Pavia, Italy
| | - G Merlini
- Department of Molecular Medicine, Amyloidosis Research and Treatment Center, Foundation 'Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo', University of Pavia, Pavia, Italy
| | - D Rowcieno
- National Amyloidosis Centre, University College London Medical School, London UK
| | - P Hawkins
- National Amyloidosis Centre, University College London Medical School, London UK
| | - U Hegenbart
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - G Palladini
- Department of Molecular Medicine, Amyloidosis Research and Treatment Center, Foundation 'Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo', University of Pavia, Pavia, Italy
| | - A Wechalekar
- National Amyloidosis Centre, University College London Medical School, London UK
| | - S O Schönland
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - K Hemminki
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Center for Primary Health Care Research, Lund University, Malmo, Sweden
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11
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Kastritis E, Leleu X, Arnulf B, Zamagni E, Cibeira M, Kwok F, Mollee P, Hájek R, Moreau P, Jaccard A, Schönland S, Filshie R, Nicolas-Virelizier E, Augustson B, Mateos MV, Wechalekar A, Hachulla E, Milani P, Dimopoulos M, Fermand JP, Foli A, Gavriatopoulou M, Palumbo A, Sonneveld P, Johnsen H, Merlini G, Palladini G. A Randomized Phase III Trial of Melphalan and Dexamethasone (MDex) versus Bortezomib, Melphalan and Dexamethasone (BMDex) for Untreated Patients with AL Amyloidosis. Clinical Lymphoma Myeloma and Leukemia 2015. [DOI: 10.1016/j.clml.2015.07.200] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Palladini G, Milani P, Foli A, Vidus Rosin M, Basset M, Lavatelli F, Nuvolone M, Obici L, Perlini S, Merlini G. Melphalan and dexamethasone with or without bortezomib in newly diagnosed AL amyloidosis: a matched case–control study on 174 patients. Leukemia 2014; 28:2311-6. [DOI: 10.1038/leu.2014.227] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 07/04/2014] [Accepted: 07/15/2014] [Indexed: 01/01/2023]
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13
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Ocio EM, Richardson PG, Rajkumar SV, Palumbo A, Mateos MV, Orlowski R, Kumar S, Usmani S, Roodman D, Niesvizky R, Einsele H, Anderson KC, Dimopoulos MA, Avet-Loiseau H, Mellqvist UH, Turesson I, Merlini G, Schots R, McCarthy P, Bergsagel L, Chim CS, Lahuerta JJ, Shah J, Reiman A, Mikhael J, Zweegman S, Lonial S, Comenzo R, Chng WJ, Moreau P, Sonneveld P, Ludwig H, Durie BGM, Miguel JFS. New drugs and novel mechanisms of action in multiple myeloma in 2013: a report from the International Myeloma Working Group (IMWG). Leukemia 2014; 28:525-42. [PMID: 24253022 PMCID: PMC4143389 DOI: 10.1038/leu.2013.350] [Citation(s) in RCA: 182] [Impact Index Per Article: 18.2] [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: 08/27/2013] [Revised: 10/23/2013] [Accepted: 11/07/2013] [Indexed: 01/08/2023]
Abstract
Treatment in medical oncology is gradually shifting from the use of nonspecific chemotherapeutic agents toward an era of novel targeted therapy in which drugs and their combinations target specific aspects of the biology of tumor cells. Multiple myeloma (MM) has become one of the best examples in this regard, reflected in the identification of new pathogenic mechanisms, together with the development of novel drugs that are being explored from the preclinical setting to the early phases of clinical development. We review the biological rationale for the use of the most important new agents for treating MM and summarize their clinical activity in an increasingly busy field. First, we discuss data from already approved and active agents (including second- and third-generation proteasome inhibitors (PIs), immunomodulatory agents and alkylators). Next, we focus on agents with novel mechanisms of action, such as monoclonal antibodies (MoAbs), cell cycle-specific drugs, deacetylase inhibitors, agents acting on the unfolded protein response, signaling transduction pathway inhibitors and kinase inhibitors. Among this plethora of new agents or mechanisms, some are specially promising: anti-CD38 MoAb, such as daratumumab, are the first antibodies with clinical activity as single agents in MM. Moreover, the kinesin spindle protein inhibitor Arry-520 is effective in monotherapy as well as in combination with dexamethasone in heavily pretreated patients. Immunotherapy against MM is also being explored, and probably the most attractive example of this approach is the combination of the anti-CS1 MoAb elotuzumab with lenalidomide and dexamethasone, which has produced exciting results in the relapsed/refractory setting.
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Affiliation(s)
- E M Ocio
- Department of Hematology, University Hospital and Cancer Research Center, University of Salamanca-IBSAL, IBMCC (USAL-CSIC), Salamanca, Spain
| | - P G Richardson
- Department of Medicine, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - S V Rajkumar
- Department of Hematology, Mayo Clinic, Rochester, MN, USA
| | - A Palumbo
- Department of Hematology, University of Torino, Torino, Italy
| | - M V Mateos
- Department of Hematology, University Hospital and Cancer Research Center, University of Salamanca-IBSAL, IBMCC (USAL-CSIC), Salamanca, Spain
| | - R Orlowski
- Department of Lymphoma/Myeloma, MD Anderson Cancer Center, Houston, TX, USA
| | - S Kumar
- Department of Hematology, Mayo Clinic, Rochester, MN, USA
| | - S Usmani
- M.I.R.T. UAMS, Little Rock, AR, USA
| | - D Roodman
- Director of Hematology/Oncology, Indiana University, Indianapolis, IN, USA
| | - R Niesvizky
- Department of Hematology, Weill Cornell Medical College, New York, NY, USA
| | - H Einsele
- Department of Internal Medicine, University of Wurzburg, Wurzburg, Germany
| | - K C Anderson
- Department of Medicine, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - M A Dimopoulos
- School of Medicine, University of Athens, Athens, Greece
| | - H Avet-Loiseau
- Department of Hematology, University of Toulouse, Toulouse, France
| | - U-H Mellqvist
- Department of Medicine, Section of Hematology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - I Turesson
- Department of Medicine, Section of Hematology, Skane University Hospital, Malmo, Sweden
| | - G Merlini
- Department of Molecular Medicine, Univeristy of Pavia, Pavia, Italy
| | - R Schots
- Department of Clinical Hematology and Stem Cell Laboratory, University Ziekenhuis, Brussels, Belgium
| | - P McCarthy
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - L Bergsagel
- Division of Hematology and Oncology, Mayo Clinic, Scottsdale, AZ, USA
| | - C S Chim
- Department of Hematology, Queen Mary Hospital, Hong Kong
| | - J J Lahuerta
- Department of Hematology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - J Shah
- Department of Lymphoma/Myeloma, MD Anderson Cancer Center, Houston, TX, USA
| | - A Reiman
- Department of Oncology, University of New Brunswick, Saint John Regional Hospital, St John, NB, Canada
| | - J Mikhael
- Division of Hematology and Oncology, Mayo Clinic, Scottsdale, AZ, USA
| | - S Zweegman
- Department of Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - S Lonial
- Department of Hematology and Medical Oncology, Shanghai Chang Zheng Hospital, Atlanta, GA, USA
| | - R Comenzo
- Department of Hematology, Tufts Medical School, Boston, MA, USA
| | - W J Chng
- Department of Hematology Oncology, National University Cancer Institute, Singapore
| | - P Moreau
- Department of Hematology, University Hospital, Nantes, France
| | - P Sonneveld
- Department of Hematology, Erasmus MC, Rotterdam, The Netherlands
| | - H Ludwig
- Department of Medicine, Center for Oncology, Hematology and Palliative Care, Wilhelminenspital, Vienna, Austria
| | | | - J F S Miguel
- 1] Department of Hematology, University Hospital and Cancer Research Center, University of Salamanca-IBSAL, IBMCC (USAL-CSIC), Salamanca, Spain [2] Department of Clinical and Translational Medicine, University of Navarra, Pamplona, Spain
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Lucherini OM, Ferracin M, Fulci V, McDermott M, Merlini G, Muscari I, Magnotti F, Dickie LJ, Galeazzi M, Negrini M, Baldari CT, Obici L, Cimaz R, Cantarini L. PReS-FINAL-1010: circulating micrornas in traps. Pediatr Rheumatol Online J 2013. [PMCID: PMC4043651 DOI: 10.1186/1546-0096-11-s2-p8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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15
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Obici L, Lachmann HJ, Touitou I, Palladini G, Donadei S, Pasotti M, Cantarini L, Gerhold K, Meini A, Toplak N, Woo P, Martini A, Merlini G, Gattorno M. PW02-021 - SAA1 is the strongest predictor of AA in TRAPS. Pediatr Rheumatol Online J 2013. [PMCID: PMC3953181 DOI: 10.1186/1546-0096-11-s1-a161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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16
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Lucherini OM, Obici L, Ferracin M, Fulci V, McDermott MF, Merlini G, Muscari I, Magnotti F, Dickie LJ, Galeazzi M, Negrini M, Baldari CT, Cimaz R, Cantarini L. OR10-004 - Circulating micrornas in TRAPS. Pediatr Rheumatol Online J 2013. [PMCID: PMC3952357 DOI: 10.1186/1546-0096-11-s1-a187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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17
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Musca F, Salinaro F, Mussinelli R, Boldrini M, Raimondi A, Cappelli F, Perfetto F, Palladini G, Merlini G, Perlini S. Is a restrictive LV filling pattern invariably present in restrictive cardiomyopathy? The case of cardiac AL amyloidosis. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p2442] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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18
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Malpasso G, Rognoni P, Lavatelli F, Cervio E, Pellegrini C, Viarengo GL, Merlini G, Gnecchi M. Amyloidogenic light chains induce human cardiac fibroblast toxicity through alteration of mitochondrial functionality. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p4239] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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19
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Boldrini M, Salinaro F, Musca F, Mussinelli R, Raimondi A, Cappelli F, Palladini G, Merlini G, Rapezzi C, Perlini S. An ECG/ECHO comparison between AL and ATTR cardiac amyloidosis at diagnosis. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p2991] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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20
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Quarta C, Longhi S, Cappelli F, Perfetti F, Ferlini A, Perlini S, Cinelli MM, Gentile N, Merlini G, Rapezzi C. Late onset cardiomyopathy due to transthyretin Ile68Leu mutation: a cardiogenic variant of familial amyloidosis potentially mimicking sarcomeric hypertrophic cardiomyopathy. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p2958] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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21
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Raimondi A, Salinaro F, Mussinelli R, Boldrini M, Cappelli F, Perfetto F, Palladini G, Merlini G, Rapezzi C, Perlini S. The role of gender and age in cardiac AL amyloidosis. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p2996] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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22
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Galeazzi M, Obici L, Ferracin M, Fulci V, McDermott MF, Lucherini OM, Merlini G, Dickie L, Muscari I, Frediani B, Negrini M, Cimaz R, Cantarini L. OP0074 First Report of Circulating Micrornas in Tumour Necrosis Factor Receptor-Associated Periodic Syndrome (TRAPS). Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Cantarini L, Obici L, Simonini G, Cimaz R, Bacarelli M, Merlini G, Vitale A, Lucherini O, Brizi M, Galeazzi M, Fioravanti A. THU0376 Serum leptin, resistin, visfatin and adiponectin levels in tumor necrosis factor receptor-associated periodic syndrome (TRAPS). Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2341] [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: 11/04/2022]
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Castellano G, Cafiero C, Divella C, Sallustio F, Gigante M, Gesualdo L, Kirsch AH, Smaczny N, Riegelbauer V, Sedej S, Hofmeister A, Stojakovic T, Brodmann M, Pilger E, Rosenkranz A, Eller K, Eller P, Meier P, Lucisano S, Arena A, Donato V, Fazio MR, Santoro D, Buemi M, Wornle M, Ribeiro A, Koppel S, Pircher J, Czermak T, Merkle M, Rupanagudi K, Kulkarni OP, Lichtnekert J, Darisipudi MN, Mulay SR, Schott B, Hartmann G, Anders HJ, Pletinck A, Glorieux G, Schepers E, Van Landschoot M, Eloot S, Van Biesen W, Vanholder R, Castoldi A, Oliveira V, Amano M, Aguiar C, Caricilli A, Vieira P, Burgos M, Hiyane M, Festuccia W, Camara N, Djudjaj S, Rong S, Lue H, Bajpai A, Klinkhammer B, Moeller M, Floege J, Bernhagen J, Ostendorf T, Boor P, Wornle M, Ribeiro A, Koppel S, Merkle M, Ito S, Aoki R, Hamada K, Edamatsu T, Itoh Y, Osaka M, Yoshida M, Oliva E, Maritati F, Palmisano A, Alberici F, Buzio C, Vaglio A, Grabulosa C, Cruz E, Carvalho J, Manfredi S, Canziani M, Cuppari L, Quinto B, Batista M, Cendoroglo M, Dalboni M, Wornle M, Ribeiro A, Merkle M, Niemir Z, Swierzko A, Polcyn-Adamczak M, Cedzynski M, Sokolowska A, Szala A, Baudoux T, Hougardy JM, Pozdzik A, Antoine MH, Husson C, De Prez E, Nortier J, Ni HF, Chen JF, Zhang MH, Pan MM, Liu BC, Machcinska M, Bocian K, Korczak-Kowalska G, Tami Amano M, Castoldi A, Andrade-Oliveira V, da Silva M, Miyagi MYS, Olsen Camara N, Xu L, Jin Y, Zhong F, Liu J, Dai Q, Wang W, Chen N, Grosjean F, Tribioli C, Esposito V, Catucci D, Azar G, Torreggiani M, Merlini G, Esposito C, Fell LH, Zawada AM, Rogacev KS, Seiler S, Fliser D, Heine GH, Neprintseva N, Tchebotareva N, Bobkova I, Kozlovskaya L, Virzi GM, Brocca A, de Cal M, Bolin C, Vescovo G, Ronco C, Fuchs A, Eidenschink K, Steege A, Fellner C, Bollheimer C, Gronwald W, Schroeder J, Banas B, Banas MC, Zawada AM, Luthe A, Seiler SS, Rogacev K, Fliser D, Heine GH, Trimboli D, Graziani G, Haroche J, Lupica R, Fazio MR, Lucisano S, Donato V, Cernaro V, Montalto G, Pettinato G, Buemi M, Cho E, Lee JW, Kim MG, Jo SK, Cho WY, kim HK. Immune and inflammatory mechanisms. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Fernández de Larrea C, Kyle RA, Durie BGM, Ludwig H, Usmani S, Vesole DH, Hajek R, San Miguel JF, Sezer O, Sonneveld P, Kumar SK, Mahindra A, Comenzo R, Palumbo A, Mazumber A, Anderson KC, Richardson PG, Badros AZ, Caers J, Cavo M, LeLeu X, Dimopoulos MA, Chim CS, Schots R, Noeul A, Fantl D, Mellqvist UH, Landgren O, Chanan-Khan A, Moreau P, Fonseca R, Merlini G, Lahuerta JJ, Bladé J, Orlowski RZ, Shah JJ. Plasma cell leukemia: consensus statement on diagnostic requirements, response criteria and treatment recommendations by the International Myeloma Working Group. Leukemia 2012; 27:780-91. [PMID: 23288300 DOI: 10.1038/leu.2012.336] [Citation(s) in RCA: 229] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Plasma cell leukemia (PCL) is a rare and aggressive variant of myeloma characterized by the presence of circulating plasma cells. It is classified as either primary PCL occurring at diagnosis or as secondary PCL in patients with relapsed/refractory myeloma. Primary PCL is a distinct clinic-pathological entity with different cytogenetic and molecular findings. The clinical course is aggressive with short remissions and survival duration. The diagnosis is based upon the percentage (≥ 20%) and absolute number (≥ 2 × 10(9)/l) of plasma cells in the peripheral blood. It is proposed that the thresholds for diagnosis be re-examined and consensus recommendations are made for diagnosis, as well as, response and progression criteria. Induction therapy needs to begin promptly and have high clinical activity leading to rapid disease control in an effort to minimize the risk of early death. Intensive chemotherapy regimens and bortezomib-based regimens are recommended followed by high-dose therapy with autologous stem cell transplantation if feasible. Allogeneic transplantation can be considered in younger patients. Prospective multicenter studies are required to provide revised definitions and better understanding of the pathogenesis of PCL.
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Affiliation(s)
- C Fernández de Larrea
- Amyloidosis and Myeloma Unit, Department of Hematology, IDIBAPS, Hospital Clinic de Barcelona, Barcelona, Spain.
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Davenport A, Merlini G. Myeloma kidney: advances in molecular mechanisms of acute kidney injury open novel therapeutic opportunities. Nephrol Dial Transplant 2012; 27:3713-8. [DOI: 10.1093/ndt/gfs449] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Riccardi A, Ucci G, Brugnatelli S, Mora O, Merlini G, Piva N, Depaoli A, Barbarano L, Distasi M, Alberio F, Nicoletti G, Morandi S, Rinaldi E, Piccinini L, Ascari E. A prospective, controlled, nonrandomized study on prophylactic parenteral dichloromethylene bisphosphonate (clodronate) in multiple-myeloma. Int J Oncol 2012; 5:833-9. [PMID: 21559649 DOI: 10.3892/ijo.5.4.833] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Bone resorption by osteoclasts causes neoplastic bone disease, which is a significant cause of death in multiple myeloma (MM). Counteracting bone resorption with prophylactic bisphosphonates has delayed bane disease, and this is expected to improve survival. Between January, 1987 and March, 1990, 341 evaluable previously untreated, consecutive patients with MM entered a prospective, multicenter study in which cytostatic therapy was randomized. The first 148 patients recruited were not planned for prophylaxis and the following 193 were scheduled to receive parenteral, prophylactic clodronate. Clodronate was administered at a dose of 600-1000 mg/4-6 weeks and was started at diagnosis and continued throughout survival time. Data on clodronate prophylaxis were evaluated on both an intention-to-treat and a compliance analysis basis. The rate of response and the duration of response were independent of clodronate prophylaxis. Progression of skeletal disease occurred less often in patients who received the drug than in those who were not given prophylaxis (50.5 vs 34.8%; p<.02 by compliance analysis). Survival was longer for patients on clodronate prophylaxis than for those who were not planned for (p<.02 by intention to-treat-analysis) or for those who did not receive clodronate prophylaxis (p<.009 by compliance analysis). Local pain associated with i.m. administration was the only significant side effect of clodronate. Parenteral clodronate prophylaxis prolongs survival in MM, probably because it allows better control of bone disease and reduces deaths related to it.
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Affiliation(s)
- A Riccardi
- Policlin San Matteo, Ist Ricovera & Cura Carattere Sci, I-27100 Pavia, Italy
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Ricci F, Bordoni V, Pugliese F, Borrini F, Merlini G, Forcione A, Mingazzini P, Izzo L, Bolognese A. Clinical significance of circulating tumor cells in colon and breast solid neoplasms. Eur J Surg Oncol 2012. [DOI: 10.1016/j.ejso.2012.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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29
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Cantarini L, Obici L, Simonini G, Cimaz R, Bacarelli MR, Merlini G, Vitale A, Lucherini OM, Brizi MG, Galeazzi M, Fioravanti A. Serum leptin, resistin, visfatin and adiponectin levels in tumor necrosis factor receptor-associated periodic syndrome (TRAPS). Clin Exp Rheumatol 2012; 30:S108-S114. [PMID: 22935190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Accepted: 03/16/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES The aims of our study were to evaluate serum leptin, resistin, visfatin and adiponectin levels in patients with tumour necrosis factor receptor-associated periodic syndrome (TRAPS), in comparison to healthy controls, and to correlate their levels to parameters of disease activity and/or severity. METHODS Serum leptin, resistin, visfatin and adiponectin levels were obtained from 14 TRAPS patients carrying mutations involving cysteine residues, from 16 TRAPS patients carrying other mutations, and from 16 healthy controls. Demographic, clinical and laboratory parameters, including amyloidosis were entered for each patient. Comparisons between groups as well as reciprocal comparisons have been evaluated. RESULTS Serum leptin, resistin, visfatin and adiponectin did not significantly differ among the 3 groups. Patients carrying cysteine residues mutations showed lower visfatin serum levels than patients carrying other mutations (p<0.02). Serum leptin significantly correlated with the number of attacks/year (multiple R=0.32, multiple adjusted R2= 0.19, p <0.03). Serum adiponectin levels significantly correlated with the presence of amyloidosis (multiple R=0.79, multiple adjusted R2=0.57, p<0.03). Adiponectin values were a significant predictor for amyloidosis (AUC 0.75, 95 CI: 0.56-0.94, p<0.03), with a predicting cut-off value set at 23.16 pg/ml, the predictive positive value was 53.8%. Visfatin serum levels resulted respectively related to leptin (rs=0.42, r2=0.18, p<0.02) and to resistin (rs=0.57, r2=0.32, p<0.01) serum levels; whilst leptin and resistin serum levels did not reciprocally correlate. CONCLUSIONS Although a prospective design study and larger cohort are mandatory, adipokines serum levels and their correlations with parameters of disease activity and/or severity seem to show a baseline pattern in TRAPS patients.
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Affiliation(s)
- L Cantarini
- Interdepartmental Research Center of Systemic Autoimmune and Autoinflammatory Diseases, Rheumatology Unit, Policlinico Le Scotte, University of Siena, 53100 Siena, Italy.
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Izzo L, Gabriele R, Conte M, Di Cello P, Pugliese F, Merlini G, Izzo S, De Toma G, Izzo P, Impara L, Forcione AR, Bolognese A. Severity in biliary peritonitis. G Chir 2012; 33:168-171. [PMID: 22709452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To analyze clinical and laboratory findings in order to find variables predictive of severity of Biliary Peritonitis (BP). Patients and methods. Physical findings, course of illness, imaging and laboratory data were evaluated in 42 patients with BP, and statistically analysed to assess their prognostic significance. RESULTS Serious illness and worse outcome were associated with: age ≥ 60 years (P=0.034), long time between onset of symptoms and treatment (P=0.025), fever > 38°C (P=0.009), WBC count > 17,000 cell/mm³ (P=0.043), diffuse abdominal pain (P=0.034), and infected bile (P=0.048). CONCLUSIONS Most patients become severely ill due to supervening infection, while early bile drainage avoids serious complications. In addition, abdominal pain, fever and WBC count are also predictive of severity of BP.
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Affiliation(s)
- L Izzo
- University of Rome, Rome, Italy
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Izzo L, Meggiorini ML, Nofroni I, Pala A, De Felice C, Meloni P, Simari T, Izzo S, Pugliese F, Impara L, Merlini G, Di Cello P, Cipolla V, Forcione AR, Paliotta A, Domenici L, Bolognese A. Insulin-like growth factor-I (IGF-1), IGF-binding protein-3 (IGFBP-3) and mammographic features. G Chir 2012; 33:153-162. [PMID: 22709450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION The IGF system has recently been shown to play an important role in the regulation of breast tumor cell proliferation. However, also breast density is currently considered as the strongest breast cancer risk factor. It is not yet clear whether these factors are interrelated and if and how they are influenced by menopausal status. The purpose of this study was to examine the possible effects of IGF-1 and IGFBP-3 and IGF-1/IGFBP-3 molar ratio on mammographic density stratified by menopausal status. PATIENTS AND METHODS A group of 341 Italian women were interviewed to collect the following data: family history of breast cancer, reproductive and menstrual factors, breast biopsies, previous administration of hormonal contraceptive therapy, hormone replacement therapy (HRT) in menopause and lifestyle information. A blood sample was drawn for determination of IGF-1, IGFBP-3 levels. IGF-1/ IGFBP-3 molar ratio was then calculated. On the basis of recent mammograms the women were divided into two groups: dense breast (DB) and non-dense breast (NDB). Student's t-test was employed to assess the association between breast density and plasma level of IGF-1, IGFBP-3 and molar ratio. To assess if this relationship was similar in subgroups of pre- and postmenopausal women, the study population was stratified by menopausal status and Student's t-test was performed. Finally, multivariate analysis was employed to evaluate if there were confounding factors that might influence the relationship between growth factors and breast density. RESULTS The analysis of the relationship between mammographic density and plasma level of IGF-1, IGFBP-3 and IGF-1/ IGFBP-3 molar ratio showed that IGF-1 levels and molar ratio varied in the two groups resulting in higher mean values in the DB group (IGF-1: 109.6 versus 96.6 ng/ml; p= 0.001 and molar ratio 29.4 versus 25.5 ng/ml; p= 0.001) whereas IGFBP-3 showed similar values in both groups (DB and NDB). Analysis of plasma level of IGF-1, IGFBP-3 and IGF-1/IGFBP-3 molar ratio compared to breast density after stratification of the study population by menopausal status (premenopausal and postmenopausal) showed that there was no association between the plasma of growth factors and breast density, neither in premenopausal nor in postmenopausal patients. Multivariate analysis showed that only nulliparity, premenopausal status and body mass index (BMI) are determinants of breast density. CONCLUSIONS Our study provides a strong evidence of a crude association between breast density and plasma levels of IGF-1 and molar ratio. On the basis of our results, it is reasonable to assume that the role of IGF-1 and molar ratio in the pathogenesis of breast cancer might be mediated through mammographic density. IGF-1 and molar ratio might thus increase the risk of cancer by increasing mammographic density.
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Affiliation(s)
- L Izzo
- University of Rome, Italy
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Comenzo RL, Reece D, Palladini G, Seldin D, Sanchorawala V, Landau H, Falk R, Wells K, Solomon A, Wechalekar A, Zonder J, Dispenzieri A, Gertz M, Streicher H, Skinner M, Kyle RA, Merlini G. Consensus guidelines for the conduct and reporting of clinical trials in systemic light-chain amyloidosis. Leukemia 2012; 26:2317-25. [PMID: 22475872 DOI: 10.1038/leu.2012.100] [Citation(s) in RCA: 276] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This manuscript summarizes the recommendations that emerged from the first Roundtable on Clinical Research in Immunoglobulin Light-chain Amyloidosis (AL), a meeting sponsored by the Amyloidosis Foundation (Clarkston, MI, USA) to develop a consensus of experts on a modern framework for clinical trial design and drug development in AL. Recent diagnostic and technical advances in AL, and updated consensus guidelines for assessing hematologic and organ responses, enable us to define study populations, appropriate end points, and other criteria for all phases of clinical research. This manuscript provides a framework for the design and conduct of systematic collaborative clinical research in AL to encourage more rapid testing of therapies and to expedite new drug development and approval.
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Affiliation(s)
- R L Comenzo
- Division of Hematology/Oncology, Tufts Medical Center, Boston, MA 02111, USA.
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Richardson PG, Delforge M, Beksac M, Wen P, Jongen JL, Sezer O, Terpos E, Munshi N, Palumbo A, Rajkumar SV, Harousseau JL, Moreau P, Avet-Loiseau H, Lee JH, Cavo M, Merlini G, Voorhees P, Chng WJ, Mazumder A, Usmani S, Einsele H, Comenzo R, Orlowski R, Vesole D, Lahuerta JJ, Niesvizky R, Siegel D, Mateos MV, Dimopoulos M, Lonial S, Jagannath S, Bladé J, Miguel JS, Morgan G, Anderson KC, Durie BGM, Sonneveld P, Sonneveld P. Management of treatment-emergent peripheral neuropathy in multiple myeloma. Leukemia 2012; 26:595-608. [PMID: 22193964 DOI: 10.1038/leu.2011.346] [Citation(s) in RCA: 189] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Peripheral neuropathy (PN) is one of the most important complications of multiple myeloma (MM) treatment. PN can be caused by MM itself, either by the effects of the monoclonal protein or in the form of radiculopathy from direct compression, and particularly by certain therapies, including bortezomib, thalidomide, vinca alkaloids and cisplatin. Clinical evaluation has shown that up to 20% of MM patients have PN at diagnosis and as many as 75% may experience treatment-emergent PN during therapy. The incidence, symptoms, reversibility, predisposing factors and etiology of treatment-emergent PN vary among MM therapies, with PN incidence also affected by the dose, schedule and combinations of potentially neurotoxic agents. Effective management of treatment-emergent PN is critical to minimize the incidence and severity of this complication, while maintaining therapeutic efficacy. Herein, the state of knowledge regarding treatment-emergent PN in MM patients and current management practices are outlined, and recommendations regarding optimal strategies for PN management during MM treatment are provided. These strategies include early and regular monitoring with neurological evaluation, with dose modification and treatment discontinuation as indicated. Areas requiring further research include the development of MM-specific, patient-focused assessment tools, pharmacogenomic analysis of patient DNA, and trials to assess the efficacy of pharmacological interventions.
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Dubrey SW, Reece DE, Sanchorawala V, Hegenbart U, Merlini G, Palladini G, Fermand JP, Vescio RA, Bladé J, Heffner LT, Hassoun H, Liu X, Enny C, Ramaswami P, Elsayed Y, Van De Velde H, Mortimer S, Cakana A, Comenzo RL. Bortezomib in a phase 1 trial for patients with relapsed AL amyloidosis: cardiac responses and overall effects. QJM 2011; 104:957-70. [PMID: 21752867 DOI: 10.1093/qjmed/hcr105] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Bortezomib is approved for the treatment of multiple myeloma and a role has been suggested in the treatment of systemic AL amyloidosis (AL). METHODS In this phase 1 dose-escalation portion of the first prospective study of single-agent bortezomib in AL, 31 patients with relapsed disease, including 14 (45%) with cardiac involvement, received bortezomib in seven dose cohorts on once-weekly (0.7, 1.0, 1.3, 1.6 mg/m(2)) and twice-weekly (0.7, 1.0, 1.3 mg/m(2)) schedules. Electrocardiographic, Holter and echocardiographic studies were evaluated in all patients to determine safety and response. RESULTS During therapy (median treatment period 210 days), no patient developed significant ventricular or supraventricular rhythm disturbance on 24-h Holter monitoring; however, no patient satisfied study criteria for cardiac response using echocardiographic assessment or New York Heart Association classification. Seven patients (23%) had a ≥ 10% fall in left ventricular ejection fraction, but only one met criteria for cardiac deterioration. The predominant cardiac adverse events were peripheral edema (23%), orthostatic hypotension (13%) and hypotension (10%). Two patients developed grade 3 congestive heart failure, which resolved following treatment interruption. In this Phase 1 portion, the maximum tolerated dose of bortezomib on either schedule was not reached. Hematologic responses occurred in 14 patients (45%), including seven (23%) complete responses. In non-responders mean left ventricular wall thickness increased during the course of treatment. CONCLUSION AL is frequently rapidly progressive; in these patients who had relapsed or progressed following previous conventional therapies, these results suggest that bortezomib may slow the progression of cardiac amyloid with limited toxicity.
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Affiliation(s)
- S W Dubrey
- Department of Cardiology, Hillingdon Hospital, Pield Heath Road, Uxbridge, Middlesex, UB8 3NN, UK.
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35
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Russo P, Palladini G, Foli A, Zenone Bragotti L, Milani P, Nuvolone M, Obici L, Perfetti V, Brugnatelli S, Invernizzi R, Merlini G. Liver involvement as the hallmark of aggressive disease in light chain amyloidosis: distinctive clinical features and role of light chain type in 225 patients. Amyloid 2011; 18 Suppl 1:92-3. [PMID: 21838445 DOI: 10.3109/13506129.2011.574354033] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- P Russo
- Amyloidosis Research and Treatment Center and Department of Biochemistry, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
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36
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Perlini S, Musca F, Salinaro F, Fracchioni I, Palladini G, Obici L, Albertini R, Moratti R, Lavatelli F, Palladini G, Rapezzi C, Merlini G. Functional correlates of N-terminal natriuretic peptide type B (NT-proBNP) response to therapy in cardiac light chain (AL) amyloidosis. Amyloid 2011; 18 Suppl 1:96-7. [PMID: 21838447 DOI: 10.3109/13506129.2011.574354035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- S Perlini
- Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Italy.
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37
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Foli A, Palladini G, Caporali R, Verga L, Morbini P, Obici L, Russo P, Sarais G, Donadei S, Montecucco C, Merlini G. The role of minor salivary gland biopsy in the diagnosis of systemic amyloidosis: results of a prospective study in 62 patients. Amyloid 2011; 18 Suppl 1:80-2. [PMID: 21838441 DOI: 10.3109/13506129.2011.574354029] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- A Foli
- Amyloidosis Research and Treatment Center and Department of Biochemistry, Pavia, Italy
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38
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Ferrari R, Caffi E, Quaglini S, Stefanelli M, Russo P, Palladini G, Lavatelli F, Merlini G. AMICA: an electronic patient record specifically designed for an amyloidosis network. Amyloid 2011; 18 Suppl 1:236-8. [PMID: 21838501 DOI: 10.3109/13506129.2011.574354089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- R Ferrari
- IRCCS Policlinico San Matteo Pavia, Italy
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39
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Valentini V, Lavatelli F, Obici L, Donadei S, Perlini S, Palladini G, Merlini G. Proteomic characterization of amyloid deposits in transthyretin amyloidosis associated with various mutations. Amyloid 2011; 18 Suppl 1:61-3. [PMID: 21838434 DOI: 10.3109/13506129.2011.574354022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- V Valentini
- Amyloidosis Research and Treatment Center Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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40
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Berk JL, Dyck PJ, Obici L, Zeldenrust SR, Sekijima Y, Yamashita T, Ando Y, Ikeda SI, Gorevic P, Merlini G, Kelly JW, Skinner M, Bisbee AB, Suhr OB. The diflunisal trial: update on study drug tolerance and disease progression. Amyloid 2011; 18 Suppl 1:196-7. [PMID: 21838485 DOI: 10.3109/13506129.2011.574354073] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- J L Berk
- Amyloid Treatment & Research Program, Boston Medical Center, Boston, MA, USA
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41
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Lavatelli F, Valentini V, Palladini G, Verga L, Russo P, Foli A, Obici L, Sarais G, Perfetti V, Casarini S, Merlini G. Mass spectrometry-based proteomics as a diagnostic tool when immunoelectron microscopy fails in typing amyloid deposits. Amyloid 2011; 18 Suppl 1:64-6. [PMID: 21838435 DOI: 10.3109/13506129.2011.574354023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- F Lavatelli
- Amyloidosis Research and Treatment Center Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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43
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Obici L, Meini A, Cattalini M, Chicca S, Galliani M, Donadei S, Plebani A, Merlini G. Favourable and sustained response to anakinra in tumour necrosis factor receptor-associated periodic syndrome (TRAPS) with or without AA amyloidosis. Ann Rheum Dis 2010; 70:1511-2. [DOI: 10.1136/ard.2010.143438] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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44
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Perlini S, Salinaro F, Musca F, Fracchioni I, Milan A, Quarta CC, Longhi S, Palladini G, Obici L, Rapezzi C, Veglio F, Merlini G. THE CONTRIBUTION OF THE EKG / ECHOCARDIOGRAPHIC MASS RATIO TO THE DIAGNOSIS OF CARDIAC AL AMYLOIDOSIS IN UNEXPLAINED LV HYPERTROPHY: 4C.05. J Hypertens 2010. [DOI: 10.1097/01.hjh.0000378857.91998.b9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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45
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Reece DE, Hegenbart U, Sanchorawala V, Merlini G, Blade J, Liu K, Enny C, Van De Velde H, Cakana A, Comenzo R. Weekly and twice-weekly bortezomib in AL amyloidosis: Results of a phase II study. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Caccialanza R, Palladini G, Klersy C, Bonardi C, Cameletti B, Cereda E, Russo P, Lavatelli F, Merlini G. OP038 NUTRITIONAL STATUS AND QUALITY OF LIFE IN OUTPATIENTS WITH SYSTEMIC IMMUNOGLOBULIN LIGHT-CHAIN AMYLOIDOSIS (AL) AT DIAGNOSIS. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/s1744-1161(10)70064-8] [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: 10/19/2022]
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47
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D'Arezzo M, Balestra E, Fanciulli E, Freddi P, Sagripanti S, Mazzucchelli R, Montironi R, Cangiotti A, Merlini G, Frasca' GM. [Nephrotic proteinuria with type 2 diabetes mellitus and autoimmune thyroiditis]. G Ital Nefrol 2009; 26:621-624. [PMID: 19802808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This study reports on a 67-year-old man, suffering from type 2 diabetes mellitus for 11 years along with arterial hypertension and autoimmune thyroiditis, in whom nephrotic proteinuria was detected together with a mild reduction in GFR. No autoantibodies or monoclonal proteins were detected in blood and urine. Renal biopsy material examined by light microscopy, immunofluorescence and electron microscopy showed AL amyloidosis. This case underlines the role of renal biopsy in patients with type 2 diabetes mellitus, in whom renal diseases other than diabetic nephropathy may occur frequently.
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Affiliation(s)
- M D'Arezzo
- Nefrologia, Ospedali Riuniti, Ancona, Italy.
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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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Abstract
At present, none of the routinely used staging systems is entirely satisfactory, since all of them require some reconsideration to account for the most recent prognostic factors. Among these, serum beta-2 microglobulin (S-beta-2M) has proved to be a powerful prognostic test assessable in most centers. In order to improve the Merlini, Waldenström, Jayakar (MWJ) staging system, we have determined the prognostic significance of several factors in an independent population of 345 retrospective myeloma patients seen at our institution from 1973 to 1988. The Cox regression hazards method showed that S-Creatinine, S-Albumin levels and percentage of bone marrow plasma cells accounted for 94% of total chi 2 achieved with all eight variables (including also: paraprotein index, S-Calcium, S-M-component, bone lesions and hemoglobin). The same analysis, applied to patients in whom S-beta-2M was available at presentation, selected S-beta-2M, S-Creatinine and percentage of bone marrow plasma cells (accounting for 92% of total chi 2), followed by platelet count, S-Albumin and S-M-component. The best discriminatory level of S-beta-2M was found to be 4 mg/l. However, the prognostic power of S-beta-2M when used with binary values was remarkably reduced with respect to its application as a continuous variable. In patients with MWJ stage 1 and 2 disease, S-beta-2M had an independent prognostic significance. Grouping stage I and II patients with S-beta-2M less than or more than 4 mg/l presented a median survival of 70 and 40 months, respectively. In stage 3 patients S-beta-2M did not contribute additional prognostic information.(ABSTRACT TRUNCATED AT 250 WORDS)
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Abstract
The control of myeloma bone disease has been an important therapeutic problem. Bisphosphonates are potentially active for the control of myeloma bone resorption. Although several studies proved the efficacy of short-term bisphosphonate treatment in inhibiting myeloma bone destruction, data on the long-term efficacy are scanty. We present the results of a prospective pilot study for the evaluation of long-term parenteral administration of dichloromethylene bisphosphonate (Clodronate) in 30 patients with active myeloma bone disease. Patients were treated with a mean of 4 courses (range 2-8) of Clodronate: 300 mg/d i.v. for 7 days followed by 100 mg/d i.m. for 10 d, administered at a mean interval of 4 months. The median follow-up was 24 months (range 8-36). Clodronate reduced bone pain rapidly and significantly, and reduced the mean values of the biochemical indices of bone resorption to within normal limits. The occurrence of skeletal morbidity in patients treated with Clodronate was compared with that observed in the control group of myeloma patients treated with chemotherapy only: Clodronate provided a significant (p less than 0.001) reduction in severe bone pain as well as in the incidence of new osteolytic lesions and pathological fractures. The results of this prospective pilot trial indicate that supportive long-term treatment with parenteral Clodronate can contribute significantly to controlling the progression of myeloma bone disease.
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