Serum neurofilament levels correlate with electrodiagnostic evidence of axonal loss in paclitaxel-induced peripheral neurotoxicity

INTRODUCTION

Paclitaxel-induced peripheral neurotoxicity (PIPN) typically manifests as a predominantly sensory axonopathy. Nerve conduction studies (NCS) represent the gold standard method to quantify axonal impairment in PIPN. Serum neurofilament light chain (sNfL) levels are emerging biomarkers for quantifying axonal damage in peripheral neuropathies. To date, the association between NCS abnormalities and sNfL levels during paclitaxel-based chemotherapy has not been specifically addressed.

METHODS

We prospectively conducted longitudinal measurement of sNfL levels in 27 chemotherapy-naïve breast cancer patients and correlated conventional NCS recordings with sNfL in 22 of them, before (T0) and after (T1) 12 cycles of weekly paclitaxel-based therapy.

RESULTS

PIPN was diagnosed in 24/27 patients (88%) after completion of the 12-week paclitaxel-based chemotherapy regimen. Serum NfL levels (pg/mL) were significantly higher at T1 compared to T0 (T0: 18.50 ± 12.88 vs T1: 255.80 ± 194.16; p < 0.001). The increase of sNfL levels at T1 significantly correlated with the decrease or abolishment of amplitudes recorded from the sural nerve (r = 0.620; p = 0.0035), sensory radial (r = 0.613; p = 0.005), sensory ulnar (r = 0.630; p = 0.005), and peroneal motor (r = 0.568; p = 0.024) nerves.

CONCLUSION

sNfL levels proportionally increase during chemotherapy administration and significantly correlate with NCS axonal abnormalities in patients with PIPN. A multimodal testing approach employing both sNfL and NCS might improve the PIPN diagnostic accuracy.

P14.02.A Serum neurofilaments correlate with axonal loss in paclitaxel-induced peripheral neurotoxicity

Background

Paclitaxel-induced peripheral neuropathy (PIPN) is a dose-limiting axonal polyneuropathy. Nerve conduction studies (NCS) are unique for the assessment of axonal impairment in PIPN. Neurofilaments (NFs), constituent of the neuronal cytoskeleton, are emerging as axonal damage biomarker. To date, the association between changes in NCS and NfL quantification across paclitaxel treatment in breast cancer patients has not been specifically addressed.

MATERIAL AND METHODS: Prospective longitudinal measurement of sNfL levels and NCS in 27 chemotherapy-naïve breast cancer patients before (V0) and after completion (V1) of 12 cycles of weekly paclitaxel-based therapy.

Results

Serum NfL levels (in pg/mL) increased over the course of treatment in the whole of patients (T0: 18,509 +/- 12,886 vs T1:255,805 +/- 194,165, p&lt;0.001). The increase in sNfL levels at T1 showed a significant moderate correlation with the percentage of decrease in the amplitude of the sural (ρ = 0.6205 (p=0.0035), radial (r=0.6134, p=0.005)), ulnar (ρ = 0.6298 (p=0.005)) and peroneal motor (ρ = 0.5676, p=0.024)) nerve in NCS across treatment.

Conclusion

sNfL levels increase proportionally to the degree of paclitaxel-induced neuroaxonal damage, revealing being a promising blood biomarker able to detect the severity of large nerve fiber degeneration and, therefore, improving the diagnostic accuracy in PIPN.

[Update on the effectiveness and evidence of antenatal perineal massage]

The impact and morbidity generated by perineal trauma during vaginal delivery justifies the need to find strategies to minimize it. Antenatal perineal massage (APM) is proposed as a technique that increases the elasticity of the perineum and that could reduce damage to the pelvic floor. This review set out to discover the effectiveness and the scientific evidence that supports this procedure. The Medline, Cochrane, Tripdatabase and Cuiden databases for the last six years were consulted, in Spanish and English. Ten studies with different levels of evidence were found. All of them favoured the use of this technique. Although further research is needed, evidence currently available suggests that the use of APM in late pregnancy could be an effective and safe procedure to reduce perineal trauma in childbirth, especially in primiparous women, and postpartum pain in multi-parous women.

Laparoscopic pyelolithotomy in pelvic ectopic kidney: Case report and literature review

INTRODUCTION

Pelvic kidney is a rare congenital anomaly. The ectopic kidney is more susceptible to developing lithiasis. The management of this type of lithiasis is a challenge. The objective of this paper was to conduct a review of available literature on the treatment of stone in ectopic kidney.

MATERIAL AND METHODS

Description of a case of transperitoneal laparoscopic pyelolithotomy for the treatment of inferior calyceal lithiasis in a right pelvic kidney. A literature review was performed by using Pubmed. The following terms and combination terms were searched: «pelvic ectopic kidney», «ureterorenoscopy», «extracorporeal lithotripsy», «PCNL», «pyelolithotomy». We included original articles, meta-analysis, review and case reports.

RESULTS

130 articles were excluded by title or duplication. 62 abstracts articles and them 50 full text articles were evaluated. Stone free rate were 75% (SLW), 85% (URSf), 85-90% (PCNL) and 100% (laparoscopic pyelolithotomy). The literature on treatment on pelvic kidney is poor.

CONCLUSION

Factors such stone size, density and location, and upper urinary tract abnormalities, influence the choice of therapeutic approach (retrograde, percutaneous and/or laparoscopic/robotic). Laparoscopic pyelolithotomy is a safe and minimally invasive treatment option for large kidney stones with unfavorable anatomy for the endoscopic approach.

Clinical assessment of acid-base balance in Netherland Dwarf rabbit

Pet rabbits have increased their popularity in a lot of countries. However, most of the laboratory profiles in rabbit medicine come from the observations made in rabbit as biomodels or meat production. So that further researches are necessary to obtain reference values for hematology and biochemical profiles in pet rabbits and the different breeds, especially, in relation to acid-base balance. The aim of this report was to offer the mean values of the main parameters connected with acid-base profile in Netherland Dwarf breed. Thirty-five healthy rabbits (15 males and 20 females) were studied. Venous blood sample from lateral saphenous vein was analyzed to measure: haematocrit, haemoglobin, blood urea nitrogen, glucose, blood pH, partial pressure of CO2 (pCO2), total CO2, ions bicarbonate, chloride, sodium, potassium, base excess and anion Gap. Results showed a shorter range that those reported by different researchers. Moreover, differences between genders were showed in pCO2, its values were higher in males. It may be associated with a greater cellular metabolism. Values obtained in this research should be taken into account by veterinary clinicians for this breed in their clinical assessments. Besides, these values provide new results in parameters with few reference values.

Undetectable PSA after radical prostatectomy is more likely in low burden N+ prostate cancer patients when an extended lymph node dissection is performed

OBJECTIVES

To analyze the likelihood of undetectable PSA (< 0.01 ng/mL) after extended (ePLND) versus standard pelvic lymph-nodes dissection (sPLND) in pN+ patients.

MATERIALS AND METHODS

The institutional prospectively maintained Prostate Cancer Database was queried for patients who underwent radical prostatectomy with PLND and were found with 3or less lymph-nodal metastases between 2007 and 2017. The extension of the PLND was defined according to the number of lymph-nodes (LN) removed. Patients in the 75th or higher percentile of lymph-nodes removed were considered as the ePLND group; patients in the 25th or lower percentile in the sPLND group. Groups were compared in clinical and pathological variables. Student T-test was used for comparing continuous variables; chi-square test was used for categorical variables. Multivariable logistic regression assessed the probability of undetectable PSA at 3^rd month postoperatively. Kaplan-Meier method estimated the probability of biochemical recurrence. Differences between the groups were compared by Log-rank test.

RESULTS

1478 patients were treated within the time span considered. 95 with 1 to 3 lymph-nodal metastases were extracted. After accounting for inclusion criteria, 23 patients with a median of 11 LN removed were included in the sPLND group (25th percentile); 23 patients with > 27 LN were included in ePLND group (75th percentile). Surgical time was longer for ePLND. Sixteen patients (69.6%) who underwent ePLND had undetectable PSA postoperatively. At multivariable analysis, the probability of undetectable PSA at 3^rd month was higher in patients who received an ePLND (HR=5.18; IC 95%=1.16-23.11; P=.03).

CONCLUSIONS

ePLND is more likely to predict undetectable PSA at third month after radical prostatectomy, irrespective of disease characteristics.

Trained dogs can identify malignant solitary pulmonary nodules in exhaled gas

OBJECTIVES

To investigate the capacity of a trained dog to identify LC in patients with malignant SPN.

METHODS

We collected 90 exhaled gas samples from 30 patients with SPN (3 samples/patient). As controls we used 61 healthy volunteers and 18 COPD patients without SNP or LC, in each of whom we collected 5 exhaled gas samples (n = 395). The dog (Blat, a 4-year-old crossbreed between a Labrador Retriever and a Pitbull) and the methodology used were the same as previously reported by our group (see: https://drive.google.com/open?id=1R4mOtOtuZkTeb5iOEEv0K9r2kHKlPhWd).

RESULTS

Of 30 patients with SPN, Blat recognized 27 of them as positive for LC and 3 as negative for LC. These results fully matched post-surgical pathological results. Sensibility was 0.97, Specificity 0.99, Positive Predictive value 0.97 and negative predictive value 0.99. The AUC of the ROC curve was 0.985.

CONCLUSIONS

Trained dogs can identify accurately the malignant origin of SPN. It is now time to develop technology that can match canine olfaction and facilitate the implementation of this diagnostic approach in the clinic.

Electrocardiographic reference values for healthy Netherland Dwarf rabbits and the influence of body position, age and gender

<p>The aim of this study was to provide reference values for a single, popular breed of pet rabbit. Moreover, additional objectives were to determine whether sex, body position or age alter Netherland Dwarf rabbit electrocardiographic variables and whether the use of electrocardiographic filters affects those variables. Forty Netherland Dwarf rabbits were examined clinically and standard six-lead electrocardiograms (ECGs) were recorded in sternal and then dorsal recumbency. At first power-line and anti-drift filters were used and then they were disabled. The following variables were measured in lead II: heart rate; P wave duration and amplitude; P-R interval; QRS duration; R wave amplitude (with and without filters); Q-T interval; T wave duration and amplitude; S-T segment; J-T duration; and mean electrical axis (MEA) (with and without filters). MEA was determined by 3 different methods. After statistical processing of the data, our results showed that there were no significant differences between both recumbencies, with the exception of the J-T duration, which was higher in dorsal recumbency. The R wave amplitude using electrocardiographic filters showed significant differences between males (0.083 mV) and females (0.115 mV; P&lt;0.05); and between younger rabbits (0.108 mV) and older rabbits (0.097 mV; P&lt;0.05). These differences were not shown between R waves with filters disabled. Moreover, the strongest correlation was between 2 MEA methods without filters. MEA was more leftward in the pet rabbit than in other species (dog or cats). In conclusion, electrocardiography recording without electrocardiographic filters should be assessed when it is possible, and the specific ECGs characteristics for Netherland Dwarf rabbit should be taken into account.</p>

Identifying the limitations of conventional biofiltration of diffuse methane emissions at long-term operation

There is growing international concern about the increasing levels of greenhouse gases in the atmosphere, particularly CO2 and methane. The emissions of methane derived from human activities are associated with large flows and very low concentrations, such as those emitted from landfills and wastewater treatment plants, among others. The present work was focused on the biological methane degradation at diffuse concentrations (0.2% vv(-1)) in a conventional biofilter using a mixture of compost, perlite and bark chips as carrier. An extensive characterization of the process was carried out at long-term operation (250 days) in a fully monitored pilot plant, achieving stable conditions during the entire period. Operational parameters such as waterings, nitrogen addition and inlet loads and contact time influences were evaluated. Obtained results indicate that empty bed residence times within 4-8 min are crucial to maximize elimination rates. Waterings and the type of nitrogen supplied in the nutrient solution (ammonia or nitrate) have a strong impact on the biofilter performance. The better results compatible with a stable operation were achieved using nitrate, with elimination capacities up to 7.6 ± 1.1 g CH4 m(-3 )h(-1). The operation at low inlet concentrations (IC) implied that removal rates obtained were quite limited (ranging 3-8 g CH4 m(-3 )h(-1)); however, these results could be significantly increased (up to 20.6 g CH4 m(-3) h(-1)) at higher IC, which indicates that the mass transfer from the gas to the liquid layer surrounding the biofilm is a key limitation of the process.

Orbital ossifying fibroma: A case report

CLINICAL CASE

The case concerns a 34 year-old man, who presented with pain in the medial canthus in his left eye, with proptosis and diplopia. The examination showed exophthalmus and a palpable mass at the inner canthus. The computed tomography revealed a lesion, which was confirmed by biopsy to be a ossifying fibroma.

DISCUSSION

Ossifying fibroma is a benign fibro-osseous lesion that mostly affects the jaw. Clinical presentation and complications vary according to its location. Clinical examination, imaging, and histopathology are essential for definitive diagnosis. Surgical treatment is multidisciplinary and long-term follow up is needed.

Role of major resection in pulmonary metastasectomy for colorectal cancer in the Spanish prospective multicenter study (GECMP-CCR)

BACKGROUND

Patients with pulmonary metastases from colorectal cancer (CRC) may benefit from aggressive surgical therapy. The objective of this study was to determine the role of major anatomic resection for pulmonary metastasectomy to improve survival when compared with limited pulmonary resection.

PATIENTS AND METHODS

Data of 522 patients (64.2% men, mean age 64.5 years) who underwent pulmonary resections with curative intent for CRC metastases over a 2-year period were reviewed. All patients were followed for a minimum of 3 years. Disease-specific survival (DSS) and disease-free survival (DFS) were assessed with the Kaplan-Meier method. Factors associated with DSS and DFS were analyzed using a Cox proportional hazards regression model.

RESULTS

A total of 394 (75.6%) patients underwent wedge resection, 19 (3.6%) anatomic segmentectomy, 5 (0.9%) lesser resections not described, 100 (19.3%) lobectomy, and 4 (0.8%) pneumonectomy. Accordingly, 104 (19.9%) patients were treated with major anatomic resection and 418 (80.1%) with lesser resection. Operations were carried out with video-assisted thoracoscopic surgery (VATS) in 93 patients. The overall DSS and DFS were 55 and 28.3 months, respectively. Significant differences in DSS and DFS in favor of major resection versus lesser resection (DSS median not reached versus 52.2 months, P = 0.03; DFS median not reached versus 23.9 months, P < 0.001) were found. In the multivariate analysis, major resection appeared to be a protective factor in DSS [hazard ratio (HR) 0.6, 95% confidence interval (CI) 0.41-0.96, P = 0.031] and DFS (HR 0.5, 95% CI 0.36-0.75, P < 0.001). The surgical approach (VATS versus open surgical resection) had no effect on outcome.

CONCLUSION

Major anatomic resection with lymphadenectomy for pulmonary metastasectomy can be considered in selected CRC patient with sufficient functional reserve to improve the DSS and DFS. Further prospective randomized studies are needed to confirm the present results.

Association of oxidative status and insulin sensitivity in periparturient dairy cattle: an observational study

Post-parturient insulin resistance (IR) is a common feature in all mammalian animals. However, in dairy cows, it can be exacerbated because of high milk yield, leading to excessive negative energy balance, which is related with increased disease incidence, reduced milk production and worsened reproductive performance. IR has been extensively investigated in humans suffering from diabetes mellitus. In these subjects, it is known that oxidative stress (OS) plays a causative role in the onset of IR. Although OS occurs in transitional dairy cattle, there are yet no studies that investigated the association between IR and OS in dairy cattle. Therefore, the aim of this study was to investigate whether there is a relationship between OS and IR in dairy cattle. Serum samples were taken repeatedly from 22 dairy cows from 2 months prior to the expected calving date to 2 months after calving and were analysed for markers of metabolic and redox balance. Surrogate indices of insulin sensitivity were also calculated. Generalised linear mixed models revealed an effect of the oxidative status on peripheral insulin concentration and on indices of insulin sensitivity. Hence, field trials should investigate the effectiveness of antioxidant therapy on insulin sensitivity in peripheral tissues during the transition period of dairy cattle.

A Pilot Study to Compare Oxidative Status between Organically and Conventionally Managed Dairy Cattle During the Transition Period

The aim of this study was to assess the redox balance of organically managed dairy cattle (OMC; n = 40) during the transition period and to compare this with conventionally managed cattle (CMC; n = 22). Serum samples of dairy cows from two organic and one conventional farm were taken. Markers of oxidants production [reactive oxygen species] and total serum antioxidant capacity were measured in four different production stages: (i) far-off dry (2 to 1 months before calving; 44 samples in CMC and 48 in OMC); (ii) close-up dry (1 month until 3 days before calving; 44 CMC; 54 OMC); (iii) fresh (3 days to +1 month after calving; 44 CMC; 49 OMC); and (iv) peak of lactation (+1 to +3 months; 71 CMC; 78 OMC). Values were compared between production stages and against a metabolic baseline status (4th-5th month of pregnancy; 40 CMC; 30 OMC). Our results indicated that throughout the periparturient period, OMC had lower concentrations of reactive oxygen species, but also a lower antioxidant capacity than CMC. Indeed, when the two components of the redox balance were assessed together through the Oxidative Stress index, the values of this parameter were higher for OMC than for CMC, thereby implying a higher risk of oxidative stress. Therefore, further larger studies are needed to confirm the current observations, as organically reared animals might be exposed to a lack of antioxidants supply.

Gradation of the stress response in rainbow trout exposed to stressors of different severity: the role of brain serotonergic and dopaminergic systems

After an intense acute stressor, fish develop a metabolic and behavioural response that usually lasts for several hours. Brain monoaminergic systems, particularly the serotonergic system, appear to play a key role in the central regulation of the stress response. However, the influence of stressor severity on brain monoaminergic systems and on the induced stress responses is yet poorly understood. We hypothesise that serotonergic system could have a direct role in the integration of sensory information during stressor exposure and in the organisation of the subsequent integrated stress response. According to our hypothesis, a low stressor intensity would induce a low response of brain serotonergic system and therefore stress responses of low magnitude and duration. To test this hypothesis, we exposed fish to handling disturbance for 5 s, 15 s or 3 min. We sampled fish at 0 (controls), 3, 15, 45 and 240 min after the start of the stress protocol. Brain levels of serotonin, dopamine and their respective main oxidative metabolites were quantified, along with plasma levels of stress markers (catecholamines, cortisol, glucose and lactate). Regarding stress markers, the 5-s and 15-s stress protocols induced similar and relatively low elevations in all parameters assessed. As expected, the 3-min protocol induced responses of a higher intensity and duration in all plasma parameters. Interestingly, the alterations of brain monoaminergic systems did not follow the same trend. The three stress protocols induced increases in the serotonergic activity in all brain regions analysed (hypothalamus, telencephalon and medulla oblongata), independently of the duration of the handling disturbance, whereas the effects on the dopaminergic system were minor and brain region-dependent. These data suggest that the brain serotonergic system, although likely involved in the recognition of the stressor stimuli, is not the only actor determining the magnitude and duration of the acute stress response in trout.

Dietary conjugated linoleic acid and its effect on immune response in pigs infected with the porcine reproductive and respiratory syndrome virus

The aim of this study was to evaluate the effects of dietary conjugated linoleic acid (CLA) on immune response in pigs infected with porcine reproductive and respiratory syndrome virus (PRRSV). A total of 18 pigs 4 weeks of age were allocated to 3 treatments, 6 per treatment: 0% CLA, 1% CLA, and 2% CLA. Serum IL-1β, IL-6 and TNF-α; lymphocyte proliferation; and IL-2, IFN-γ, IL-10, IL-4 and IL-12 in PBMCs were evaluated. NF-κB, COX2, iNOS and PPAR-γ mRNA were also evaluated. No differences were observed among treatment groups in most of the in vivo cytokine profiles; only TNF-α production was increased in infected pigs in the CLA-supplemented groups. The cytokine profile in vitro was not affected by CLA supplementation. CLA decreased the proliferation of PBMCs stimulated with PRRSVs. Inflammation mediators and PPAR-γ were not affected by CLA in infected pigs. CLA did not improve the immune response of PRRSV infected pigs.

Sulfasalazine-induced linear immunoglobulin A bullous dermatosis with DRESS

Linear immunoglobulin (Ig) A dermatosis is an immune-mediated bullous disease characterized by linear deposits of IgA along the basal membrane. While usually idiopathic, it can occasionally be induced by drug exposure. We report the case of a 60-year-old woman with rheumatoid arthritis being treated with sulfasalazine who developed linear IgA dermatosis and drug rash with eosinophilia and systemic symptoms (DRESS). The dermatosis and associated symptoms resolved following withdrawal of the drug and treatment with systemic corticosteroids for 2 months. This is the first report of sulfasalazine-induced linear IgA dermatosis in association with DRESS and we believe that sulfasalazine should be added to the list of drugs that can cause linear IgA dermatosis.

Startup and long-term performance of biotrickling filters packed with polyurethane foam and poplar wood chips treating a mixture of ethylmercaptan, H2S, and NH3

Treatment of a mixture of NH3, H2S, and ethylmercaptan (EM) was investigated for more than 15 months in two biotrickling filters packed with poplar wood chips and polyurethane foam. Inlet loads ranging from 5 to 10 g N-NH3 m-3 hr-1, from 5 to 16 g S-H2S m-3 hr-1, and from 0 to 5 g EM m-3 hr-1 were applied. During startup, the biotrickling filter packed with polyurethane foam was re-inoculated due to reduced biomass retention as well as a stronger effect of nitrogen compounds inhibition compared with the biotrickling filter packed with poplar wood. Accurate pH control between 7 and 7.5 favored pollutants abatement. In the long run, complete NH3 removal in the gas phase was achieved in both reactors, while H2S removal efficiencies exceeded 90%. EM abatement was significantly different in both reactors. A systematically lower elimination capacity was found in the polyurethane foam bioreactor. N fractions in the liquid phase proved that high nitrification rates were reached throughout steady-state operation in both bioreactors. CO2 production showed the extent of the organic packing material degradation, which allowed estimating its service lifetime in around 2 years. In the long run, the bioreactor packed with the organic packing material had a lower stability. However, an economic analysis indicated that poplar wood chips are a competitive alternative to inorganic packing materials in biotrickling filters.

IMPLICATIONS

We provide new insights in the use of organic packing materials in biotrickling filters for the treatment of H2S, NH3, and mercaptans and compare them with polyurethane foam, a packing commonly used in biotrickling filters. We found interesting features related with the startup of the reactors and parameterized both the performance under steady-state conditions and the influence of the gas contact time. We provide relevant conclusions in the profitability of organic packing materials under a biotrickling filter configuration, which is infrequent but proven reliable from our research results. The report is useful to designers and users of this technology.

[Home parenteral nutrition (HPN): feasibility of its implementation from a public hospital]

INTRODUCTION

The intensive care of patients at home had probed important beneficialness for the patient and the Health System. There are very few experiences of this kind of care from the Public Hospitals.

OBJECTIVE

To develop a social-sanitary analysis of the feasibility of the implementation of HPN on patients with short bowel syndrome (SBS) from a Public Hospital.

MATERIAL AND METHODS

Patients hospitalized between 1985-2009 were included. We analyzed: age, residual intestine length (RIL), time between de indication and the beginning of HPN, HPN duration, treatment modality and clinical outcome. Social determinants: home place, habitat conditions, employment conditions, educational level, social security and Low Socioeconomic Status (LSS). The group were divided in two: 1- patients with feasibility of HPN when it was prescribed; 2- patients without feasibility of HPN.

RESULTS

61 patients were included, RIL x: 21.7 ± 11.6 cm. The HPN was feasible (G1) in 32 patients (52.4%) and no feasible (G2) in 29 (47.6%). The home treatment modality was in self-caring 25 (81%) and with nurses support 7 (19 %). The social determinants associated with the HPN feasibility were: more than one takecare (p 0.03), educational level (p 0.01), adequate habitat conditions (p 0.02) and Low Socioeconomis Status (LSS) (p 0.07). 17 patients reached intestinal adaptation (28%), 6 (10%) were transplanted, 19 (31%) died and 19 (31%) are actually on HPN.

CONCLUSION

The HPN realized from the Public Hospital is feasible. Different social determinants were observed. The care of this group of patients must be done by an interdisciplinary group including general aspects of the child and the family.

SNP-based mapping arrays reveal high genomic complexity in monoclonal gammopathies, from MGUS to myeloma status

Genetic events mediating transformation from premalignant monoclonal gammopathies (MG) to multiple myeloma (MM) are unknown. To obtain a comprehensive genomic profile of MG from the early to late stages, we performed high-resolution analysis of purified plasma cells from 20 MGUS, 20 smoldering MM (SMM) and 34 MM by high-density 6.0 SNP array. A progressive increase in the incidence of copy number abnormalities (CNA) from MGUS to SMM and to MM (median 5, 7.5 and 12 per case, respectively) was observed (P=0.006). Gains on 1q, 3p, 6p, 9p, 11q, 19p, 19q and 21q along with 1p, 16q and 22q deletions were significantly less frequent in MGUS than in MM. Although 11q and 21q gains together with 16q and 22q deletions were apparently exclusive of MM status, we observed that these abnormalities were also present in minor subclones in MGUS. Overall, a total of 65 copy number-neutral LOH (CNN-LOH) were detected. Their frequency was higher in active MM than in the asymptomatic entities (P=0.047). A strong association between genetic lesions and fragile sites was also detected. In summary, our study shows an increasing genomic complexity from MGUS to MM and identifies new chromosomal regions involved in CNA and CNN-LOH.