1
|
Kogure Y, Handa H, Ito Y, Ri M, Horigome Y, Iino M, Harazaki Y, Kobayashi T, Abe M, Ishida T, Ito S, Iwasaki H, Kuroda J, Shibayama H, Sunami K, Takamatsu H, Tamura H, Hayashi T, Akagi K, Shinozaki T, Yoshida T, Mori I, Iida S, Maeda T, Kataoka K. ctDNA improves prognostic prediction in relapsed/refractory MM receiving ixazomib, lenalidomide, and dexamethasone. Blood 2024:blood.2023022540. [PMID: 38427753 DOI: 10.1182/blood.2023022540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 02/22/2024] [Accepted: 02/23/2024] [Indexed: 03/03/2024] Open
Abstract
It remains elusive how driver mutations, including those detected in circulating tumor DNA (ctDNA), affect prognosis in relapsed/refractory multiple myeloma (RRMM). Here we performed targeted-capture sequencing using bone marrow plasma cells (BMPC) and ctDNA of 261 RRMM cases uniformly treated with ixazomib, lenalidomide, and dexamethasone in a multicenter, prospective, observational study. We detected 24 and 47 recurrently mutated genes in BMPC and ctDNA, respectively. In addition to clonal hematopoiesis-associated mutations, varying proportion of driver mutations, particularly TP53 mutations (59.2% of mutated cases), were present in only ctDNA, suggesting their subclonal origin. In univariable analyses, ctDNA mutations of KRAS, TP53, DIS3, BRAF, NRAS, and ATM were associated with worse progression-free survival (PFS). BMPC mutations of TP53 and KRAS were associated with inferior PFS, while KRAS mutations were prognostically relevant only when detected in both BMPC and ctDNA. A total number of ctDNA mutations in the six relevant genes was a strong prognostic predictor (2-year PFS rates: 57.3%, 22.7%, and 0% for 0, 1, and ≥ 2 mutations, respectively) and independent of clinical factors and plasma DNA concentration. Using the number of ctDNA mutations, plasma DNA concentration, and clinical factors, we developed a prognostic index (ctRRMM-PI), classifying patients into three categories with 2-year PFS rates of 57.9%, 28.6%, and 0%. Serial analysis of ctDNA mutations in 94 cases revealed that TP53 and KRAS mutations frequently emerge after therapy. Thus, we clarify the genetic characteristics and clonal architecture of ctDNA mutations and demonstrate their superiority over BMPC mutations for prognostic prediction in RRMM.
Collapse
Affiliation(s)
| | - Hiroshi Handa
- Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yuta Ito
- The Jikei University School of Medicine, Japan
| | - Masaki Ri
- Nagoya City University Graduate School of Medical Sciences, Ngoya, Japan
| | | | - Masaki Iino
- Yamanashi Prefectural Central Hospital, Kofu, Japan
| | | | | | | | | | | | | | - Junya Kuroda
- Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | - Kazutaka Sunami
- National Hospital Organization Okayama Medical Center, Okayama, Japan
| | | | | | | | - Kiwamu Akagi
- Saitama Cancer Center, Ina, kitaadachigun, Saitama, Japan
| | | | | | - Ikuo Mori
- Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Shinsuke Iida
- Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takahiro Maeda
- Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | | |
Collapse
|
2
|
Horigome Y, Iino M, Harazaki Y, Kobayashi T, Handa H, Hiramatsu Y, Kuroi T, Tanimoto K, Matsue K, Abe M, Ishida T, Ito S, Iwasaki H, Kuroda J, Shibayama H, Sunami K, Takamatsu H, Tamura H, Hayashi T, Akagi K, Maeda T, Yoshida T, Mori I, Shinozaki T, Iida S. A prospective, multicenter, observational study of ixazomib plus lenalidomide-dexamethasone in patients with relapsed/refractory multiple myeloma in Japan. Ann Hematol 2024; 103:475-488. [PMID: 37695378 PMCID: PMC10798923 DOI: 10.1007/s00277-023-05428-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/24/2023] [Indexed: 09/12/2023]
Abstract
Real-world studies permit inclusion of a more diverse patient population and provide more information on the effectiveness of treatments used in routine clinical practice. This prospective, multicenter, observational study investigated the effectiveness and safety of ixazomib plus lenalidomide and dexamethasone (IRd) in 295 patients with relapsed/refractory multiple myeloma (RRMM) in routine clinical practice in Japan. Patients had a median age of 74 years, 80.0% were aged ≥ 65 years, 42.0% had received ≥ 3 lines of prior treatment, and 28.5% were "frail" according to the International Myeloma Working Group frailty score. After a median follow-up of 25.0 months, median progression-free survival (PFS) was 15.3 (95% CI 12.4-19.5) months, while median overall survival was not reached. The overall response rate was 53.9%, and 31.5% of patients had a very good partial response or better. In the subgroup analysis, median PFS was better in patients with 1 versus 2 or ≥ 3 lines of prior treatment (29.0 vs 19.2 or 6.9 months) and paraprotein versus clinical relapse (16.0 vs 7.9 months), but median PFS was not notably affected by frailty score or age group. Dose adjustment was more frequent among patients aged > 75 years, especially early after IRd treatment initiation. Treatment-emergent adverse events (TEAEs) of any grade occurred in 84.4% of patients and 24.7% of patients discontinued treatment due to TEAEs; no new safety concerns were found. These findings suggest that oral IRd triplet regimen is an effective and tolerable treatment option for RRMM patients in real-world settings outside of clinical trials.ClinicalTrials.gov identifier: NCT03433001; Date of registration: 14 February 2018.
Collapse
Affiliation(s)
- Yuichi Horigome
- Department of Hematology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Masaki Iino
- Department of Hematology, Yamanashi Prefectural Central Hospital, Kofu, Japan
| | - Yoriko Harazaki
- Department of Hematology, Miyagi Cancer Center, Natori, Japan
| | - Takahiro Kobayashi
- Department of Hematology, Nephrology and Rheumatology, Akita University Graduate School of Medicine, Akita, Japan
| | - Hiroshi Handa
- Department of Hematology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yasushi Hiramatsu
- Department of Hematology and Oncology, Japanese Red Cross Society Himeji Hospital, Himeji, Japan
| | - Taiga Kuroi
- Department of Hematology, Chugoku Central Hospital, Fukuyama, Japan
| | - Kazuki Tanimoto
- Department of Hematology and Oncology, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan
| | - Kosei Matsue
- Division of Hematology/Oncology, Department of Internal Medicine, Kameda Medical Center, Kamogawa, Japan
| | - Masahiro Abe
- Department of Hematology, Endocrinology and Metabolism, Tokushima University Graduate School, Tokushima, Japan
| | - Tadao Ishida
- Department of Hematology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Shigeki Ito
- Department of Hematology and Oncology, Iwate Medical University Hospital, Iwate, Japan
| | - Hiromi Iwasaki
- Department of Hematology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Junya Kuroda
- Division of Hematology and Oncology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hirohiko Shibayama
- Department of Hematology, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Kazutaka Sunami
- Department of Hematology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | | | - Hideto Tamura
- Department of Hematology, Nippon Medical School, Tokyo, Japan
| | - Toshiaki Hayashi
- Department of Hematology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Kiwamu Akagi
- Division of Molecular Diagnosis and Cancer Prevention, Saitama Cancer Center, Ina, Japan
| | - Takahiro Maeda
- Division of Precision Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Takahiro Yoshida
- Medical Affairs, Japan Oncology Business Unit, Takeda Pharmaceutical Co. Ltd, Tokyo, Japan
| | - Ikuo Mori
- Medical Affairs, Japan Oncology Business Unit, Takeda Pharmaceutical Co. Ltd, Tokyo, Japan
| | - Tomohiro Shinozaki
- Department of Information and Computer Technology, Faculty of Engineering, Tokyo University of Science, Tokyo, Japan
| | - Shinsuke Iida
- Department of Hematology and Oncology, Nagoya City University Institute of Medical and Pharmaceutical Sciences, 1, Kawasumi, Mizuho-Cho, Mizuho-Ku, Nagoya, Aichi, 467-8601, Japan.
| |
Collapse
|
3
|
Takamatsu H, Matsuda T, Mizuno S, Takahashi T, Fuchida SI, Hanamura I, Kataoka K, Tsukada N, Matsumoto M, Hangaishi A, Doki N, Uchida N, Sawa M, Maruyama Y, Kurahashi S, Nagafuji K, Harazaki Y, Kako S, Iida S, Ichinohe T, Kanda Y, Atsuta Y, Sunami K. Changing trends in the risk factors for second primary malignancies after autologous stem cell transplantation for multiple myeloma before and after the introduction of proteasome inhibitors and immunomodulatory drugs. Haematologica 2023; 108:3399-3408. [PMID: 37470160 PMCID: PMC10690906 DOI: 10.3324/haematol.2023.283202] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/10/2023] [Indexed: 07/21/2023] Open
Abstract
The incidence of second primary malignancies (SPM) in long-term survivors of multiple myeloma (MM) is increasing because of increased life expectancy. We retrospectively analyzed the risk factors for SPM in patients with MM after autologous stem cell transplantation (ASCT) before and after the introduction of proteasome inhibitors and immunomodulatory drugs (IMiDs). In total, 2,340 patients newly diagnosed with MM who underwent ASCT between 1995 and 2016 were enrolled in this study. Forty-three patients developed SPM (29 solid, 12 hematological, and 2 unknown tumors), with cumulative incidence rates of 0.8% and 2.5% at 24 and 60 months, respectively. The cumulative incidence rates of hematological and solid SPM at 60 months were 0.8% and 1.8%, respectively. The overall survival (OS) rate at 60 months after ASCT was 62.9% and the OS rates after the diagnosis of SPM at 24 months were 72.2% for hematological SPM and 70.9% for solid SPM. Multivariate analysis revealed that the use of IMiDs (P=0.024) and radiation (P=0.002) were significant independent risk factors for SPM. The probabilities of developing SPM and death due to other causes (mainly MM) at 60 months were 2.5% and 36.5%, respectively, indicating that the risk of SPM was lower than that of death from MM. Furthermore, SPM between the pre-novel and novel agent eras (ASCT between 2007 and 2016) groups significantly increased (1.9% vs. 4.3% at 60 months; P=0.022). The early occurrence of SPM after ASCT should be monitored cautiously.
Collapse
Affiliation(s)
| | - Tomohiro Matsuda
- Division of International Health Policy Research, National Cancer Center Institute for Cancer Control, Tokyo
| | - Shohei Mizuno
- Division of Hematology, Department of Internal Medicine, Aichi Medical University, Nagakute
| | | | - Shin-Ichi Fuchida
- Department of Hematology, Japan Community Health care Organization Kyoto Kuramaguchi Medical Center, Kyoto
| | - Ichiro Hanamura
- Division of Hematology, Department of Internal Medicine, Aichi Medical University, Nagakute
| | - Keisuke Kataoka
- Division of Molecular Oncology, National Cancer Center Research Institute, Tokyo, Japan; Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo
| | - Nobuhiro Tsukada
- Division of Hematology, Japanese Red Cross Medical Center, Tokyo
| | - Morio Matsumoto
- Department of Hematology, National Hospital Organization Shibukawa Medical Center, Shibukawa
| | - Akira Hangaishi
- Department of Hematology, National Center for Global Health and Medicine, Tokyo
| | - Noriko Doki
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo
| | - Naoyuki Uchida
- Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations TORANOMON HOSPITAL, Tokyo
| | - Masashi Sawa
- Department of Hematology and Oncology, Anjo Kosei Hospital, Anjo
| | - Yumiko Maruyama
- Department of Hematology, University of Tsukuba Hospital, Tsukuba
| | - Shingo Kurahashi
- Division of Hematology and Oncology, Toyohashi Municipal Hospital, Toyohashi
| | - Koji Nagafuji
- Division of Hematology and Oncology, Department of Medicine, Kurume University Hospital, Kurume
| | | | - Shinichi Kako
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama
| | - Shinsuke Iida
- Division of Hematology and Oncology, Nagoya City University Hospital, Nagoya
| | - Tatsuo Ichinohe
- Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University
| | - Yoshinobu Kanda
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan; Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke
| | - Yoshiko Atsuta
- Aichi Medical University School of Medicine / Department of Registry Science for Transplant and Cellular Therapy, Nagakute
| | - Kazutaka Sunami
- Department of Hematology, National Hospital Organization Okayama Medical Center, Okayama
| |
Collapse
|
4
|
Nagano A, Kato H, Harazaki Y, Tezuka F, Saijo Y. Rapid progression of left ventricular hypertrophy caused by leukaemic infiltration of myocardium. Eur Heart J Cardiovasc Imaging 2023; 24:e60. [PMID: 36637875 DOI: 10.1093/ehjci/jeac275] [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: 01/14/2023] Open
Affiliation(s)
- Azusa Nagano
- Department of Clinical Examination, Miyagi Cancer Center, 47-1 Nodayama, Medeshima-shiote, Natori, Miyagi 981-1293, Japan
| | - Hiroshi Kato
- Division of Onco-Cardiology, Miyagi Cancer Center, 47-1 Nodayama, Medeshima-shiote, Natori, Miyagi 981-1293, Japan
| | - Yoriko Harazaki
- Division of Hematology, Miyagi Cancer Center, 47-1 Nodayama, Medeshima-shiote, Natori, Miyagi 981-1293, Japan
| | - Fumiaki Tezuka
- Department of Pathology, Sendai Red Cross Hospital, 2-43-3, Yagiyama hon-cho, Taihaku-ku, Sendai, 982-8501, Japan
| | - Yoshifumi Saijo
- Biomedical Imaging Laboratory, Graduate School of Biomedical Engineering, Tohoku University, 6-6-05 Aramaki Aza Aoba, Aobaku, Sendai 980-8579, Japan
| |
Collapse
|
5
|
Miyamoto‐Nagai Y, Mimura N, Tsukada N, Aotsuka N, Ri M, Katsuoka Y, Wakayama T, Suzuki R, Harazaki Y, Matsumoto M, Kumagai K, Miyake T, Ozaki S, Shono K, Tanaka H, Shimura A, Kuroda Y, Sunami K, Suzuki K, Yamashita T, Shimizu K, Murakami H, Abe M, Nakaseko C, Sakaida E. Outcomes of poor peripheral blood stem cell mobilizers with multiple myeloma at the first mobilization: A multicenter retrospective study in Japan. eJHaem 2022; 3:838-848. [PMID: 36051061 PMCID: PMC9422024 DOI: 10.1002/jha2.534] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 07/06/2022] [Accepted: 07/07/2022] [Indexed: 11/26/2022]
Abstract
Autologous stem cell transplantation (ASCT) remains an important therapeutic strategy for multiple myeloma; however, a proportion of patients fail to mobilize a sufficient number of peripheral blood stem cells (PBSCs) to proceed to ASCT. In the present study, we aimed to clarify the characteristics and outcomes of poor mobilizers. Clinical data on poorly mobilized patients who underwent PBSC harvest for almost 10 years were retrospectively collected from 44 institutions in the Japanese Society of Myeloma (JSM). Poor mobilizers were defined as patients with less than 2 × 106/kg of CD34+ cells harvested at the first mobilization. The proportion of poor mobilization was 15.1%. A sufficient dataset including overall survival (OS) was evaluable in 258 poor mobilizers. Overall, 92 out of 258 (35.7%) poor mobilizers did not subsequently undergo ASCT, mainly due to an insufficient number of PBSCs. Median OS from apheresis was longer for poor mobilizers who underwent ASCT than for those who did not (86.0 vs. 61.9 mon., p = 0.02). OS from the diagnosis of poor mobilizers who underwent ASCT in our cohort was similar to those who underwent ASCT in the JSM database (3y OS rate, 86.8% vs. 85.9%). In this cohort, one‐third of poor mobilizers who did not undergo ASCT had relatively poor survival. In contrast, the OS improved in poor mobilizers who underwent ASCT. However, the OS of extremely poor mobilizers was short irrespective of ASCT.
Collapse
Affiliation(s)
| | - Naoya Mimura
- Department of Hematology Chiba University Hospital Chiba Japan
- Department of Transfusion Medicine and Cell Therapy Chiba University Hospital Chiba Japan
| | - Nobuhiro Tsukada
- Division of Hematology Japanese Red Cross Medical Center Tokyo Japan
| | - Nobuyuki Aotsuka
- Department of Hematology and Oncology Japanese Red Cross Narita Hospital Narita Japan
| | - Masaki Ri
- Department of Hematology and Oncology Nagoya City University Graduate School of Medical Sciences Nagoya Japan
| | - Yuna Katsuoka
- Department of Hematology National Hospital Organization Sendai Medical Center Sendai Japan
| | - Toshio Wakayama
- Department of Hematology and Oncology Shimane Prefectural Central Hospital Izumo Japan
| | - Rikio Suzuki
- Department of Hematology and Oncology, Department of Medicine Tokai University School of Medicine Isehara Japan
| | | | - Morio Matsumoto
- Department of Hematology National Hospital Organization Shibukawa Medical Center Shibukawa Japan
| | - Kyoya Kumagai
- Division of Hematology‐Oncology Chiba Cancer Center Chiba Japan
| | - Takaaki Miyake
- Department of Oncology and Hematology Shimane University Hospital Izumo Japan
| | - Shuji Ozaki
- Department of Hematology Tokushima Prefectural Central Hospital Tokushima Japan
| | - Katsuhiro Shono
- Department of Hematology Chiba Aoba Municipal Hospital Chiba Japan
| | - Hiroaki Tanaka
- Department of Hematology Asahi General Hospital Asahi Japan
| | - Arika Shimura
- Department of Hematology and Oncology, Graduate School of Medicine The University of Tokyo Tokyo Japan
| | - Yoshiaki Kuroda
- Department of Hematology National Hospital Organization Hiroshimanishi Medical Center Otake Japan
| | - Kazutaka Sunami
- Department of Hematology National Hospital Organization Okayama Medical Center Okayama Japan
| | - Kazuhito Suzuki
- Department Clinical Oncology and Hematology The Jikei University Kashiwa Hospital Kashiwa Japan
| | - Takeshi Yamashita
- Department of Internal Medicine Keiju Kanazawa Hospital Ishikawa Japan
| | - Kazuyuki Shimizu
- Department of Hematology/Oncology Higashi Nagoya National Hospital Nagoya Japan
| | - Hirokazu Murakami
- Faculty of Medical Technology and Clinical Engineering Gunma University of Health and Welfare Maebashi Japan
| | - Masahiro Abe
- Department of Hematology, Endocrinology and Metabolism Tokushima University Graduate School Tokushima Japan
| | - Chiaki Nakaseko
- Department of Hematology International University of Health and Welfare School of Medicine Narita Japan
| | - Emiko Sakaida
- Department of Hematology Chiba University Hospital Chiba Japan
- Department of Transfusion Medicine and Cell Therapy Chiba University Hospital Chiba Japan
| |
Collapse
|
6
|
Suzuki J, Harazaki Y, Morita S, Kaga Y, Nomura K, Sugawara M, Katori Y. Myeloid Sarcoma of the Paranasal Sinuses in a Patient with Acute Myeloid Leukemia. TOHOKU J EXP MED 2018; 246:141-146. [PMID: 30369515 DOI: 10.1620/tjem.246.141] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Myeloid sarcoma (MS) is an uncommon extramedullary malignant tumor, and often represents a subgroup of acute myeloid leukemia (AML). MS of paranasal sinus origin is extremely rare. We report an uncommon case of sinonasal MS associated with AML, who was successfully treated with hematopoietic stem-cell transplantation. A 39-year-old male was admitted with complaints of left nasal obstruction and proptosis. Computed tomography and magnetic resonance imaging identified a left ethmoidal mass involving the maxillary sinus, the orbit, and the skull base. Nasal endoscopic examination detected a whitish homogeneous mass occupying the left nasal cavity. Although accumulation of atypical lymphocytes was suspected based on initial pathological inspection, immunohistochemical analysis showed myeloperoxidase-positive myeloid cells. Together with concomitant leukocytosis (149,000/µL) composed of myeloid blast cells and excess of myeloblasts in the bone marrow, the patient was diagnosed as sinonasal MS with AML with maturation (French-American-British Classification M2). The patient was treated by chemotherapy (remission induction therapy with daunorubicin and cytarabine; salvage chemotherapy with high-dose cytarabine), radiotherapy (30 Gy in 10 fractions) and allogeneic hematopoietic stem-cell transplantation, and followed up for 12 months with no recurrence. Early diagnosis is critical for the best improvement of MS. MS of the paranasal sinuses may easily be misdiagnosed as malignant lymphoma or poorly differentiated carcinoma. Prompt hematological and immunohistological investigations with suspicion of MS are essential for correct diagnosis. Furthermore, we concisely review nine previously reported patients with MS and indicate the importance of hematopoietic stem-cell transplantation for good prognosis.
Collapse
Affiliation(s)
- Jun Suzuki
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University School of Medicine.,Department of Otolaryngology, Tohoku Kosai Hospital
| | | | | | - Yoshiko Kaga
- Department of Clinical Lavoratory, Miyagi Cancer Center
| | | | | | - Yukio Katori
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University School of Medicine
| |
Collapse
|