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Vaxman I, Kumar SK, Buadi F, Lacy MQ, Dingli D, Hayman S, Kourelis T, Warsame R, Hwa Y, Fonder A, Hobbs M, Muchtar E, Leung N, Kapoor P, Go R, Lin Y, Gonsalves W, Siddiqui M, Kyle RA, Rajkumar SV, Gertz MA, Dispenzieri A. Daratumumab, carfilzomib, and pomalidomide for the treatment of POEMS syndrome: The Mayo Clinic Experience. Blood Cancer J 2023; 13:91. [PMID: 37253713 DOI: 10.1038/s41408-023-00859-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/20/2023] [Accepted: 05/12/2023] [Indexed: 06/01/2023] Open
Affiliation(s)
- I Vaxman
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah- Tikvah, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - S K Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - F Buadi
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - M Q Lacy
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - D Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - S Hayman
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - T Kourelis
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - R Warsame
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Y Hwa
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - A Fonder
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - M Hobbs
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - E Muchtar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - N Leung
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - P Kapoor
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - R Go
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Y Lin
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - W Gonsalves
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - M Siddiqui
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - R A Kyle
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - S V Rajkumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - M A Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - A Dispenzieri
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.
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Abdallah N, Smith A, Geyer S, Binder M, Greipp P, Kapoor P, Dispenzieri A, Gertz M, Baughn L, Lacy M, Hayman S, Buadi F, Dingli D, Hwa Y, Lin Y, Kourelis T, Warsame R, Kyle R, Rajkumar S, Kumar S. 639P Conditional survival in MM and impact of prognostic factors over time. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.765] [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: 11/30/2022] Open
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Dasari S, Chiu A, Theis J, Vrana JA, Kurtin PJ, Rech KL, Dao LN, Howard MT, McPhail ED, Dispenzieri A, Grogan M. Bone marrow involvement by ATTR amyloid is common in cardiac amyloidosis patients and may signal advanced-stage disease. Am J Clin Pathol 2021. [DOI: 10.1093/ajcp/aqab191.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction/Objective
Amyloidosis encompasses a heterogeneous group of disorders characterized by abnormal deposition of misfolded proteins leading to progressive organ failure. Accurate amyloid typing is essential for proper patient management, as treatment regimens vary dramatically across different types. Bone marrow (BM) biopsy, in conjunction with fat pad aspiration/biopsy, is often the first step in patients with suspected amyloidosis. Although BM involvement by AL amyloid has been previously characterized, little is known about the incidence, morphology and clinical phenotype of non-AL amyloid in BM.
Methods/Case Report
We retrospectively identified 1469 BM biopsies by querying our reference laboratory database of 19,298 specimens from myriad anatomic sites typed by mass spectrometry-based proteomics (LC-MS/MS). These were reviewed for frequency of amyloid types (N=1469), distribution of amyloid deposits (N=139), and clinical phenotypes (N=345), with particular emphases on cardiac involvement.
Results (if a Case Study enter NA)
We identified the following amyloid types: AL (N=1172; 79.8%), ATTR (transthyretin) (N=240; 16.3%), AH (immunoglobulin heavy chain) (N=38; 2.6%), AA (serum amyloid A) (N=17; 1.2%), and Aβ2M (β2-microglobulin) (N=2; 0.1%). ATTR deposits showed striking predilection for periosteal soft tissue and/or periosteal vessels, and rarely involved BM stroma and/or interstitial vessels, while AL variably involved these compartments. AA primarily involved interstitial vessels. Both AL and ATTR cases commonly had a monoclonal gammopathy (AL: 92.9%; ATTR: 62.5%) with concomitant cardiac amyloidosis (AL: 91.6%; ATTR: 100%). Compared to AL, ATTR patients had higher stage cardiac amyloidosis and lower overall survival.
Conclusion
ATTR is common in BM, constituting16.3% of cases in our cohort. Rarer amyloid types, such as AA, AH and AB2M can also occur in BM. ATTR was frequently identified in patients with concomitant monoclonal gammopathy, in whom AL may have been suspected. Although ATTR deposits have distinctive morphologic distribution, primarily involving periosteal soft tissue and/or periosteal vessels and rarely involving BM stroma and/or interstitial vessels, there is considerable morphologic overlap with AL. Therefore, it is imperative to type BM amyloidosis, preferably by LC-MS/MS, to ensure proper patient management. Furthermore, BM involvement by ATTR may be a marker for advanced stage of disease.
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Affiliation(s)
- S Dasari
- Qualitative Health Sciences, Mayo Clinic, Rochester, Minnesota, UNITED STATES
| | - A Chiu
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, UNITED STATES
| | - J Theis
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, UNITED STATES
| | - J A Vrana
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, UNITED STATES
| | - P J Kurtin
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, UNITED STATES
| | - K L Rech
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, UNITED STATES
| | - L N Dao
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, UNITED STATES
| | - M T Howard
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, UNITED STATES
| | - E D McPhail
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, UNITED STATES
| | - A Dispenzieri
- Medicine, Mayo Clinic, Rochester, Minnesota, UNITED STATES
| | - M Grogan
- Medicine, Mayo Clinic, Rochester, Minnesota, UNITED STATES
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Tan T, Grogan M, Borgeson D, Pislaru S, Dispenzieri A, Garvan K, Oguz D, Lin G. RV free wall longitudinal strain as an independent predictor of survival in wtATTR-CA patients. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.005] [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
Wild type transthyretin cardiac amyloidosis (wtATTR-CA) is increasingly recognized as a cause of heart failure with preserved ejection fraction (HFpEF) but prognosis is often limited due to late or misdiagnosis.Longitudinal left ventricular strain and biomarkers are established as markers of disease severity, but the role of RV free wall strain, reflecting RV contractility, is less well understood.
Purpose
We sought to determine whether RV free wall strain might add incremental prognostic value in wtATTR-CA.
Methods
Consecutive patients diagnosed with wtATTR-CA with tissue confirmation at Mayo clinic between 2013 and 2015 were included. Patients with TTR gene mutations were excluded. Baseline characteristics and transthoracic echocardiography measurements were obtained from the medical records. Speckle tracking RV free wall longitudinal 2D strain and peak LA longitudinal 2D strain were measured using Tom Tec Imaging System. Survival was determined using Kaplan Meier estimates and using the cox proportional hazard ratio, univariate and multivariable analysis were performed to identify predictors of mortality in patients with wtATTR.
Results
The study group comprised 139 patients (mean age 74.9±8.6, 92.8% male), of which 102 had adequate image quality for RV strain, and 99 for LA strain. Amongst these, 102 (73.3%) had AF and 118 patients (84.8%) had HF. During 3.23±2.0 years of follow up, 66 patients died. Both mean RV and LA strain were impaired at baseline: RV free wall strain was −14.7±4.9, and peak atrial longitudinal strain (PALS) was 13.2±8.8%. Using ROC analysis, RV strain of −16.8% was an independent predictor of all-cause mortality. In univariate modeling, higher levels of NT-proBNP (HR: 1.1 per 1000 pg.ml; 95%, CI 1.05–1.15, p<0.001) and Troponin T (HR: 2.0 per 0.1ng/ml; 95% CI 1.49–2.61, p<0.001) were associated with increased all-cause mortality. In addition, LV GLS (HR: 1.13 per 1%; 95% CI1.04–1.24, p=0.003), RV free wall LS (HR: 2.16 per 5%; 95%, CI 1.57–3.03, p<0.0001), and PALS (HR: 0.91 per1%; 95% CI 0.85–0.96, p<0.0001) were univariate predictors of all-cause mortality. In multivariate analysis using a stepwise regression model, RV free wall longitudinal strain (HR: 1.81; 95% CI 1.29–2.62, p<0.001) and Troponin T (HR: 1.7; 95% CI 1.25–2.26, p=0.001) remained independent predictors. Kaplan-Meier survival analysis demonstrated a higher mortality rate above −16.8 RV strain cut-off (Wilcoxon <0.0001). All stages were divided into two groups by −16.8% RV strain, and survival in individual stages analyzed. Stage 1 and 2 with <−16.8 RV free wall strain value had higher mortality than ≤-16.8% RV strain (Stage 1: Wilcoxon = 0.0041 and Stage 2: Wilcoxon = 0.023). However, there was not a survival difference between two RV strain groups in stage3 (Wilcoxon = 0.34)
Conclusion
RV free wall strain is an independent predictor of survival in wtATTR patients and may add incremental prognostic value to NT-proBNP and Troponin.
Funding Acknowledgement
Type of funding sources: None. Kaplan-Meier curve of all patientsKaplan-Meier curve of stages
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Affiliation(s)
- T.S Tan
- Mayo Clinic, Cardiology Department, Rochester, United States of America
| | - M Grogan
- Mayo Clinic, Cardiology Department, Rochester, United States of America
| | - D Borgeson
- Mayo Clinic, Cardiology Department, Rochester, United States of America
| | - S.V Pislaru
- Mayo Clinic, Cardiology Department, Rochester, United States of America
| | - A Dispenzieri
- Mayo Clinic, Internal Medicine, Rochester, United States of America
| | - K Garvan
- Mayo Clinic, Cardiology Department, Rochester, United States of America
| | - D Oguz
- Mayo Clinic, Cardiology Department, Rochester, United States of America
| | - G Lin
- Mayo Clinic, Cardiology Department, Rochester, United States of America
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Visram A, Soof C, Rajkumar SV, Kumar SK, Bujarski S, Spektor TM, Kyle RA, Berenson JR, Dispenzieri A. Serum BCMA levels predict outcomes in MGUS and smoldering myeloma patients. Blood Cancer J 2021; 11:120. [PMID: 34168119 PMCID: PMC8225625 DOI: 10.1038/s41408-021-00505-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/24/2021] [Accepted: 05/28/2021] [Indexed: 11/09/2022] Open
Abstract
Soluble BCMA (sBCMA) levels are elevated in monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM). However, the association between sBCMA levels and prognosis in MGUS and SMM has not been studied. We retrospectively analyzed sBCMA levels in stored samples from 99 MGUS and 184 SMM patients. Baseline sBCMA levels were significantly higher in MGUS and SMM patients progressing to MM during clinical follow up. When stratified according to the median baseline sBCMA level for each cohort, higher levels were associated with a shorter PFS for MGUS (HR 3.44 comparing sBCMA ≥77 vs <77 ng/mL [95% CI 2.07-5.73, p < 0.001] and SMM (HR 2.0 comparing sBCMA ≥128 vs <128 ng/mL, 95% 1.45-2.76, p < 0.001) patients. The effect of sBCMA on PFS was similar even after adjusting for the baseline MGUS or SMM risk stratification. We evaluated paired serum samples and found that sBCMA increased significantly in MGUS and SMM patients who eventually progressed to MM, whereas among MGUS non-progressors the sBCMA level remained stable. While our results require independent validation, they suggest that sBCMA may be a useful biomarker to identify MGUS and SMM patients at increased risk of progression to MM independent of the established risk models.
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Affiliation(s)
- A Visram
- Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - C Soof
- Institute for Myeloma & Bone Cancer Research, West Hollywood, CA, California, USA
| | - S V Rajkumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - S K Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - S Bujarski
- Institute for Myeloma & Bone Cancer Research, West Hollywood, CA, California, USA
| | - T M Spektor
- OncoTracker, West Hollywood, CA, California, USA
| | - R A Kyle
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - J R Berenson
- Institute for Myeloma & Bone Cancer Research, West Hollywood, CA, California, USA.,OncoTracker, West Hollywood, CA, California, USA.,Oncotherapeutics, West Hollywood, CA, California, USA.,Berenson Cancer Center, West Hollywood, CA, California, USA
| | - A Dispenzieri
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.
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Vaxman I, Kumar SK, Buadi F, Lacy MQ, Dingli D, Hwa Y, Fonder A, Hobbs M, Hayman S, Kourelis T, Warsame R, Muchtar E, Leung N, Kapoor P, Grogan M, Go R, Lin Y, Gonsalves W, Siddiqui M, Kyle RA, Rajkumar SV, Gertz MA, Dispenzieri A. Outcomes among newly diagnosed AL amyloidosis patients with a very high NT-proBNP: implications for trial design. Leukemia 2021; 35:3604-3607. [PMID: 34021252 PMCID: PMC8632659 DOI: 10.1038/s41375-021-01297-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/30/2021] [Accepted: 05/10/2021] [Indexed: 12/14/2022]
Affiliation(s)
- I Vaxman
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.,Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - S K Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - F Buadi
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - M Q Lacy
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - D Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Y Hwa
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - A Fonder
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - M Hobbs
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - S Hayman
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - T Kourelis
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - R Warsame
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - E Muchtar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - N Leung
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - P Kapoor
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - M Grogan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - R Go
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Y Lin
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - W Gonsalves
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - M Siddiqui
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - R A Kyle
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - S V Rajkumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - M A Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - A Dispenzieri
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.
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Muchtar E, Dispenzieri A, Magen H, Grogan M, Mauermann M, McPhail ED, Kurtin PJ, Leung N, Buadi FK, Dingli D, Kumar SK, Gertz MA. Systemic amyloidosis from A (AA) to T (ATTR): a review. J Intern Med 2021; 289:268-292. [PMID: 32929754 DOI: 10.1111/joim.13169] [Citation(s) in RCA: 116] [Impact Index Per Article: 38.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/15/2020] [Indexed: 01/09/2023]
Abstract
Systemic amyloidosis is a rare protein misfolding and deposition disorder leading to progressive organ failure. There are over 15 types of systemic amyloidosis, each caused by a different precursor protein which promotes amyloid formation and tissue deposition. Amyloidosis can be acquired or hereditary and can affect various organs, including the heart, kidneys, liver, nerves, gastrointestinal tract, lungs, muscles, skin and soft tissues. Symptoms are usually insidious and nonspecific resulting in diagnostic delay. The field of amyloidosis has seen significant improvements over the past decade in diagnostic accuracy, prognosis prediction and management. The advent of mass spectrometry-based shotgun proteomics has revolutionized amyloid typing and has led to the discovery of new amyloid types. Accurate typing of the precursor protein is of paramount importance as the type dictates a specific management approach. In this article, we review each type of systemic amyloidosis to provide the practitioner with practical tools to improve diagnosis and management of these rare disorders.
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Affiliation(s)
- E Muchtar
- From the, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - A Dispenzieri
- From the, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - H Magen
- Hematology Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - M Grogan
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - M Mauermann
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - E D McPhail
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - P J Kurtin
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - N Leung
- From the, Division of Hematology, Mayo Clinic, Rochester, MN, USA.,Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - F K Buadi
- From the, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - D Dingli
- From the, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - S K Kumar
- From the, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - M A Gertz
- From the, Division of Hematology, Mayo Clinic, Rochester, MN, USA
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8
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Gillmore J, Berk J, Dispenzieri A, Polydefkis M, Gonzalez-Duarte A, Sekijima Y, Sweetser M, Arum S, Wang J, White M, Maurer M. Long-term integrated safety of patisiran in patients with hereditary transthyretin-mediated amyloidosis with polyneuropathy. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2129] [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: 11/12/2022] Open
Abstract
Abstract
Background/Introduction
Hereditary transthyretin-mediated (hATTR) amyloidosis is a progressive, life-threatening disease; the majority of patients develop a mixed phenotype of polyneuropathy and cardiomyopathy. Patisiran halted or reversed polyneuropathy and improved quality of life in the Phase 3 (APOLLO) study. In a prespecified cardiac subpopulation of APOLLO, patisiran also improved cardiac structure and function versus placebo.
Purpose
To describe the long-term comprehensive, integrated safety data from the patisiran clinical development program in patients with hATTR amyloidosis with polyneuropathy.
Methods
Safety data as of October 7, 2019 from the Phase 2 Open-Label Extension (OLE) (NCT01961921), Phase 3 APOLLO (NCT01960348), and ongoing Global OLE (NCT02510261) studies were analysed.
Results
Across the three studies, 224 patients received patisiran for a mean (range) of 43.6 (0.7–71.7) months, with a cumulative 813.9 patient-years of exposure; 105 (46.9%) patients received patisiran for ≥4 years and 35 (15.6%) patients received patisiran for ≥5 years. In this cohort, 149 (66.5%) had medical histories of cardiac disorders per MedDRA System Organ Class (SOC), which may be reflective of a mixed phenotype in some patients. A total of 222 (99.1%) patients experienced at least one adverse event (AE) and 132 (58.9%) patients experienced at least one serious AE. AEs considered to be related to patisiran and occurring in >5% of patients included infusion-related reactions (IRRs) (25.9%) and diarrhoea (6.3%). Cardiac AEs occurring in >5% of patients included atrial fibrillation (10.7%) and cardiac failure (7.6%). Amongst all patients, the exposure-adjusted mortality rate was 4.3 deaths per 100 patient-years.
Conclusions
Patients with hATTR amyloidosis with polyneuropathy in the patisiran clinical development program represent those with the longest treatment with an RNAi therapeutic, including more than 15% of patients receiving patisiran for ≥5 years. Patisiran continues to demonstrate a positive benefit:risk profile in patients with hATTR amyloidosis with polyneuropathy.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Alnylam Pharmaceuticals
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Affiliation(s)
- J Gillmore
- University College London, National Amyloidosis Centre, London, United Kingdom
| | - J Berk
- Boston University, Amyloidosis Center, Boston, United States of America
| | | | - M Polydefkis
- Johns Hopkins, Baltimore, United States of America
| | - A Gonzalez-Duarte
- Instituto Nacional de Ciencias Médicas y Nutriciόn, Salvador Zubirán, Mexico City, Mexico
| | - Y Sekijima
- Shinshu University School of Medicine, Matsumoto, Japan
| | - M.T Sweetser
- Alnylam Pharmaceuticals, Cambridge, United States of America
| | - S Arum
- Alnylam Pharmaceuticals, Cambridge, United States of America
| | - J.J Wang
- Alnylam Pharmaceuticals, Cambridge, United States of America
| | - M.T White
- Alnylam Pharmaceuticals, Cambridge, United States of America
| | - M Maurer
- Columbia University, College of Physicians and Surgeons, New York, United States of America
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Garcia-Pavia P, Grogan M, Dispenzieri A, Mundayat R, Amass L, Rapezzi C. P336A descriptive analysis of patients with wild-type ATTR cardiomyopathy from the transthyretin amyloidosis outcomes survey. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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
Introduction
Transthyretin amyloidosis (ATTR amyloidosis) is a rare, life-threatening disorder caused by the deposition of amyloid fibrils composed of misfolded transthyretin (TTR). ATTR amyloidosis may arise from mutations in TTR or from aggregation of wild-type TTR (ATTRwt). ATTR amyloidosis with predominantly symptoms of cardiomyopathy (ATTR-CM) includes both hereditary and wild-type forms of the disease.
Purpose
To describe clinical history and disease presentation in a large population of patients with wild-type ATTR-CM from the Transthyretin Amyloidosis Outcomes Survey (THAOS). THAOS is an ongoing, global, longitudinal, observational survey of patients with ATTR amyloidosis, including both inherited and wild-type disease, and asymptomatic patients with TTR mutations.
Methods
Data from ATTRwt patients were extracted from THAOS (cut-off date: January 16, 2019) and demographic and clinical characteristics reported using descriptive statistics.
Results
There were 758 ATTRwt patients in THAOS (95% male). The majority of patients (69.3%) were in the United States, with the remainder in Italy (11.1%), Germany (7.3%), Spain (5.3%), and other countries (7.1%). Most patients (86.3%) were Caucasian, with 3.3% being of African Descent and 3.1% being of other races/ethnicities (7.4% missing data). The median (10–90th percentile) age at symptom onset was 69.7 (54.0–81.3) years and the median (10–90th percentile) time from symptom onset to diagnosis was 3.9 (0.1–17.8) years. Median (10–90th percentile) age at enrollment in THAOS was 76.4 (67.2–85.2) years. Nearly all subjects had either a cardiac (59.6%) or mixed cardiac and neurologic (36.5%) phenotype. At enrollment, 97.1% (577 of 594 patients assessed) had an abnormal ECG, with the prevalence of low voltage being 20.8% (115 of 552) and prevalence of left-ventricular hypertrophy being 2.1% (16 of 758). Atrial fibrillation was documented in 55% of patients (208 of 378). The mean (standard deviation [SD]) left-ventricular septum thickness was 17.5 (3.5) mm (n=505; 94.9% with thickness >12 mm) and mean (SD) left-ventricular ejection fraction (LVEF) was 48.3% (13.2) (n=511; 48.0% with LVEF <50.0%). Other signs and symptoms at enrollment were compatible with a sensory neuropathy in 54.2% of patients, autonomic neuropathy in 33.5% of patients, and motor neuropathy in 29.1% of patients. Gastrointestinal symptoms related to ATTR amyloidosis were present in 10.4% of patients.
Conclusions
Although patients with wild-type ATTR-CM tend to be older Caucasian men with a mostly cardiac disease phenotype, the clinical spectrum of ATTRwt is heterogeneous and differs from the classic phenotype. Our findings show that ATTRwt should not be considered an exclusively cardiac disease and there is a need for both cardiologic and neurologic assessment of these patients. Further study is needed to determine if the non-cardiac manifestations are due to amyloidosis or more common causes in this older population.
Acknowledgement/Funding
This study was sponsored by Pfizer.
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Affiliation(s)
- P Garcia-Pavia
- University Hospital Puerta de Hierro Majadahonda, Department of Cardiology, Madrid, Spain
| | - M Grogan
- Mayo Clinic, Department of Cardiovascular Diseases, Rochester, United States of America
| | - A Dispenzieri
- Mayo Clinic, Division of Hematology, Rochester, United States of America
| | - R Mundayat
- Pfizer Inc, New York, United States of America
| | - L Amass
- Pfizer Inc, Collegeville, United States of America
| | - C Rapezzi
- University of Bologna, Department of Experimental, Diagnostic and Specialty Medicine, Bologna, Italy
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Polydefkis M, Gillmore J, Dispenzieri A, Chen J, Sweetser M, Vest J, Melanson M, Conceicao I, Kristen A. Risk Factors for Mortality in Patients with Hereditary Transthyretin-Mediated Amyloidosis: An Analysis of APOLLO and Global Open Label Extension Studies. J Card Fail 2019. [DOI: 10.1016/j.cardfail.2019.07.276] [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: 11/30/2022]
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11
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Sidiqi M, Saleh AA, Kumar S, Morie G, Dispenzieri A, Buadi F, Lacy M, Leung N, Muchtar E, Kyle R, Go R, Hobbs M, Gonsalves W, Kourelis T, Warsame R, Dingli D, Lust J, Hayman S, Rajkumar V, Kapoor P. PS1422 VENETOCLAX FOR THE TREATMENT OF MULTIPLE MYELOMA: OUTCOMES OUTSIDE OF CLINICAL TRIALS. Hemasphere 2019. [DOI: 10.1097/01.hs9.0000563964.92802.c3] [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: 11/25/2022] Open
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12
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Grieb B, Abeykoon J, Zanwar S, Rajkumar S, Lacy M, Dispenzieri A, Gertz M, Gonsalves W, Go R, Buadi F, Dingli D, Hayman S, Warsame R, Kourelis T, Muchtar E, Kyle R, Kumar S, Kapoor P. PS1397 OUTCOMES OF LONG-TERM SURVIVORS WITH ACTIVE MULTIPLE MYELOMA. Hemasphere 2019. [DOI: 10.1097/01.hs9.0000563864.43294.ef] [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: 11/25/2022] Open
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13
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El-Am E, Dispenzieri A, Grogan M, Ammash N, Melduni R, White R, Hodge D, Noseworthy P, Lin G, Pislaru S, Nkomo V. P2925Outcomes of direct current cardioversion in adults with cardiac amyloidosis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2925] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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)
- E El-Am
- Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America
| | - A Dispenzieri
- Mayo Clinic, Hematology, Rochester, United States of America
| | - M Grogan
- Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America
| | - N Ammash
- Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America
| | - R Melduni
- Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America
| | - R White
- Mayo Clinic, Anesthesiology and Perioperative Medicine, Rochester, United States of America
| | - D Hodge
- Mayo Clinic, Biomedical Statistics and Informatics, Jacksonville, United States of America
| | - P Noseworthy
- Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America
| | - G Lin
- Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America
| | - S Pislaru
- Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America
| | - V Nkomo
- Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America
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14
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Chakraborty R, Muchtar E, Kumar SK, Buadi FK, Dingli D, Dispenzieri A, Hayman SR, Hogan WJ, Kapoor P, Lacy MQ, Leung N, Gertz MA. Elevated pre-transplant C-reactive protein identifies a high-risk subgroup in multiple myeloma patients undergoing delayed autologous stem cell transplantation. Bone Marrow Transplant 2017; 53:155-161. [PMID: 29131152 DOI: 10.1038/bmt.2017.228] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 09/01/2017] [Accepted: 09/06/2017] [Indexed: 01/12/2023]
Abstract
The significance of elevated C-reactive protein (CRP) prior to autologous stem cell transplantation (ASCT) in multiple myeloma (MM) has not been studied. We analyzed 1111 MM patients who underwent ASCT at Mayo Clinic from 2007 to 2015. A total of 840 patients (76%) received early ASCT (⩽12 months from diagnosis) and 271 patients (24%) received delayed ASCT (>12 months from diagnosis). Elevated CRP (> upper normal limit (8 mg/L)) was seen in 14% and 22% of patients undergoing early and delayed ASCT, respectively (P=0.003). There was no correlation of CRP with pre-transplant response, bone marrow plasma cell percentage or labeling index. Patients with an elevated CRP had a higher likelihood of having circulating plasma cells prior to ASCT (33 vs 19%; P<0.001). In the early ASCT cohort, the median overall survival (OS) in patients with normal and elevated CRP was not reached and 91 months respectively (P=0.011). In the delayed ASCT cohort, the median OS in respective groups were 73 and 30 months respectively (P<0.001), with elevated CRP being an independent prognostic marker on multivariate analysis (hazard ratio 2.0; 95% confidence interval, 1.0-3.8; P=0.045). Elevated pre-transplant CRP identifies a high-risk population especially in patients undergoing delayed ASCT and should be incorporated in the pre-transplant evaluation.
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Affiliation(s)
- R Chakraborty
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - E Muchtar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - S K Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - F K Buadi
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - D Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - A Dispenzieri
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - S R Hayman
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - W J Hogan
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - P Kapoor
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - M Q Lacy
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - N Leung
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - M A Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
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15
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Landgren O, Graubard BI, Kumar S, Kyle RA, Katzmann JA, Murata K, Costello R, Dispenzieri A, Caporaso N, Mailankody S, Korde N, Hultcrantz M, Therneau TM, Larson DR, Cerhan JR, Rajkumar SV. Prevalence of myeloma precursor state monoclonal gammopathy of undetermined significance in 12372 individuals 10-49 years old: a population-based study from the National Health and Nutrition Examination Survey. Blood Cancer J 2017; 7:e618. [PMID: 29053158 PMCID: PMC5678222 DOI: 10.1038/bcj.2017.97] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 08/03/2017] [Indexed: 01/20/2023] Open
Abstract
We studied the prevalence of monoclonal gammopathy of undetermined significance (MGUS) in younger individuals, age 10–49 years, using samples from the National Health and Nutritional Examination Survey (NHANES) III. NHANES prevalence rates were standardized to the 2000 US total population. Among 12 372 individuals (4073 blacks, 4146 Mexican-Americans, 3595 whites, and 558 others), MGUS was identified in 63 persons (0.34%, 95% CI 0.23–0.50). The prevalence of MGUS was significantly higher in blacks (0.88%, 95% CI 0.62–1.26) compared with whites (0.22%, 95% CI 0.11–0.45), P=0.001. The prevalence of MGUS in Mexican-Americans was at an intermediate level (0.41%, 95% CI 0.23–0.73). The disparity in prevalence of MGUS between blacks and whites was most striking in the 40–49 age-group; 3.26% (95% CI 2.04–5.18) versus 0.53% (95% CI 0.20–1.37), P=0.0013. There was a trend to earlier age of onset of MGUS in blacks compared with whites. MGUS was seen in only two persons in the 10–19 age-group (both Mexican-American), and in three persons in the 20–29-year age-group (all of whom were black). In persons less than 50 years of age, MGUS is significantly more prevalent, with up to 10 years earlier age of onset, in blacks compared with whites.
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Affiliation(s)
- O Landgren
- Myeloma Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - B I Graubard
- Divsion of Cancer Epidemiology and Genetics, Biostatistics Branch, National Cancer Institute, Rockville, MD, USA
| | - S Kumar
- Division of Hematology, Department of Medicine, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - R A Kyle
- Division of Hematology, Department of Medicine, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - J A Katzmann
- Department of Laboratory Medicine and Pathology, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - K Murata
- Myeloma Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - R Costello
- Multiple Myeloma Section, Center for Cancer Research, Lymphoid Malignancies Branch, National Cancer Institute, Rockville, MD, USA
| | - A Dispenzieri
- Division of Hematology, Department of Medicine, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - N Caporaso
- Divsion of Cancer Epidemiology and Genetics, Biostatistics Branch, National Cancer Institute, Rockville, MD, USA
| | - S Mailankody
- Myeloma Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - N Korde
- Myeloma Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - M Hultcrantz
- Myeloma Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - T M Therneau
- Division of Biostatistics, Department of Medicine, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - D R Larson
- Division of Biostatistics, Department of Medicine, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - J R Cerhan
- Division of Epidemiology, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - S V Rajkumar
- Division of Hematology, Department of Medicine, College of Medicine, Mayo Clinic, Rochester, MN, USA
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16
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Ailawadhi S, Mikhael JR, LaPlant BR, Laumann KM, Kumar S, Roy V, Dingli D, Bergsagel PL, Buadi FK, Rajkumar SV, Fonseca R, Gertz MA, Kapoor P, Sher T, Hayman SR, Stewart AK, Dispenzieri A, Kyle RA, Gonsalves WI, Reeder CB, Lin Y, Go RS, Leung N, Kourelis T, Lust JA, Russell SJ, Chanan-Khan AA, Lacy MQ. Pomalidomide-dexamethasone in refractory multiple myeloma: long-term follow-up of a multi-cohort phase II clinical trial. Leukemia 2017; 32:719-728. [PMID: 28860655 DOI: 10.1038/leu.2017.258] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 06/07/2017] [Accepted: 07/05/2017] [Indexed: 11/09/2022]
Abstract
Despite therapeutic advances, multiple myeloma remains incurable, with limited options for patients with refractory disease. We conducted a large, multi-cohort clinical trial testing various doses and treatment schedules of pomalidomide and dexamethasone (Pom/dex) in patients with refractory multiple myeloma. Overall, 345 patients were enrolled to six cohorts based on number and type of prior lines of therapy, pomalidomide dose and schedule. Median prior lines of therapy were three with near universal prior exposure to proteasome inhibitors and/or immunomodulatory drugs. A confirmed response rate of 35% was noted for all cohorts (range 23-65%) with higher responses in cohorts with fewer prior lines of therapy. Median time to confirmed response was ⩽2 months and the longest progression-free survival and overall survival seen in any cohort were 13.1 and 47.9 months, respectively. Observed adverse reactions were as expected, with myelosuppression and fatigue being the most common hematologic and non-hematologic adverse events (AEs), respectively. Longer durations of treatment and response, higher response rates and fewer AEs were noted with the 2 mg pomalidomide dose. This is the longest follow-up data for Pom/dex in refractory multiple myeloma and will help shape the real-world utilization of this regimen.
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Affiliation(s)
- S Ailawadhi
- Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - J R Mikhael
- Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - B R LaPlant
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - K M Laumann
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - S Kumar
- Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - V Roy
- Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - D Dingli
- Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - P L Bergsagel
- Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - F K Buadi
- Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - S V Rajkumar
- Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - R Fonseca
- Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - M A Gertz
- Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - P Kapoor
- Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - T Sher
- Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - S R Hayman
- Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - A K Stewart
- Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - A Dispenzieri
- Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - R A Kyle
- Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - W I Gonsalves
- Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - C B Reeder
- Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Y Lin
- Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - R S Go
- Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - N Leung
- Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - T Kourelis
- Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - J A Lust
- Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - S J Russell
- Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - A A Chanan-Khan
- Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - M Q Lacy
- Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic, Phoenix, AZ, USA
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17
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Mills JR, Barnidge DR, Dispenzieri A, Murray DL. High sensitivity blood-based M-protein detection in sCR patients with multiple myeloma. Blood Cancer J 2017; 7:e590. [PMID: 28841203 PMCID: PMC5596386 DOI: 10.1038/bcj.2017.75] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 06/29/2017] [Accepted: 07/05/2017] [Indexed: 01/23/2023] Open
Abstract
We assessed the ability of a mass spectrometry-based technique, called monoclonal immunoglobulin rapid accurate mass measurement (miRAMM), to extend the analytical range of M-protein detection in serum samples obtained from myeloma patients in stringent complete response (sCR) post-autologous stem cell transplant (ASCT). To aid the M-protein detection post ASCT, the accurate molecular mass of the M-protein light chain at diagnosis was determined in all patients (N=30) and used to positively identify clones in the sCR serum. Day 100 post-ASCT, sCR samples had miRAMM identifiable M-proteins in 81% of patients. Patients who had achieved only a partial remission (PR) pre-ASCT and those with IgG isotypes serum samples had the highest rate of M-protein detection by miRAMM. miRAMM positivity at single time points (day 100, 6 months or 12 months) did not correlate with progression-free survival (PFS). In contrast, sCR patients who did not decrease their miRAMM M-protein intensities in serial measurements had shorter PFS than those whose miRAMM intensities decreased (median 17.9 months vs 51.6 months; P<0.0017). miRAMM M-protein is a more sensitive blood-based test than traditional M-protein tests and could cost effectively aid in serially monitoring complete remission for continue response or biochemical relapse.
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Affiliation(s)
- J R Mills
- Protein Immunology Laboratory, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - D R Barnidge
- Protein Immunology Laboratory, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - A Dispenzieri
- Protein Immunology Laboratory, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.,Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - D L Murray
- Protein Immunology Laboratory, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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18
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Chakraborty R, Muchtar E, Kumar SK, Buadi FK, Dingli D, Dispenzieri A, Hayman SR, Hogan WJ, Kapoor P, Lacy MQ, Leung N, Warsame R, Kourelis T, Gonsalves W, Gertz MA. Outcomes of maintenance therapy with lenalidomide or bortezomib in multiple myeloma in the setting of early autologous stem cell transplantation. Leukemia 2017; 32:712-718. [PMID: 28848227 DOI: 10.1038/leu.2017.256] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 07/20/2017] [Accepted: 08/02/2017] [Indexed: 01/04/2023]
Abstract
Post-transplant maintenance is widely used in multiple myeloma (MM); however, there is a lack of data on real-world outcomes. We have analyzed 577 patients with newly diagnosed MM undergoing early auto-transplantation between 2010 and 2015. A total of 341, 132 and 104 patients received no, lenalidomide (Len) or bortezomib (Bort) maintenance, respectively. Patients receiving Len or Bort maintenance had a higher incidence of high-risk cytogenetics by fluorescence in situ hybridization (31% (Len) vs 58% (Bort) vs 8% (No); P<0.001). Len maintenance led to a superior progression-free survival (PFS) compared with no maintenance (median, 37 vs 28 months, respectively; P=0.002; adjusted hazard ratio 0.48 (95% CI, 0.35-0.66)), including in subgroups with ISS stage III disease (median, 40 vs 24 months; P=0.008) and high-risk cytogenetics (median, 27 vs 16 months; P=0.032). Bort maintenance did not confer PFS benefit for the entire cohort, but improved PFS in the high-risk cytogenetic subgroup (median, 28 vs 16 months; P=0.035). Discontinuation due to toxicity was seen in 17 and 7% of patients receiving Len or Bort maintenance, respectively. Our results indicate that post-transplant maintenance with Len or Bort is well tolerated in clinical practice and improves PFS in high-risk subgroups of MM patients.
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Affiliation(s)
- R Chakraborty
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - E Muchtar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - S K Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - F K Buadi
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - D Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - A Dispenzieri
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - S R Hayman
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - W J Hogan
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - P Kapoor
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - M Q Lacy
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - N Leung
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - R Warsame
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - T Kourelis
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - W Gonsalves
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - M A Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
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19
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Lakshman A, Alhaj Moustafa M, Rajkumar SV, Dispenzieri A, Gertz MA, Buadi FK, Lacy MQ, Dingli D, Fonder AL, Hayman SR, Hobbs MA, Gonsalves WI, Hwa YL, Kapoor P, Leung N, Go RS, Lin Y, Kourelis TV, Lust JA, Russell SJ, Zeldenrust SR, Kyle RA, Kumar SK. Natural history of t(11;14) multiple myeloma. Leukemia 2017; 32:131-138. [DOI: 10.1038/leu.2017.204] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 06/07/2017] [Accepted: 06/19/2017] [Indexed: 12/19/2022]
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20
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Ravi P, Kumar S, Gonsalves W, Buadi F, Lacy MQ, Go RS, Dispenzieri A, Kapoor P, Lust JA, Dingli D, Lin Y, Russell SJ, Leung N, Gertz MA, Kyle RA, Bergsagel PL, Rajkumar SV. Changes in uninvolved immunoglobulins during induction therapy for newly diagnosed multiple myeloma. Blood Cancer J 2017. [PMID: 28622306 PMCID: PMC5584483 DOI: 10.1038/bcj.2017.46] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Little is known about the impact of multiple myeloma (MM) treatment on uninvolved immunoglobulins (Ig). We identified 448 patients who received high-dose dexamethasone (HD-DEX), lenalidomide and dexamethasone (RD), bortezomib and dexamethasone (VD), bortezomib, cyclophosphamide and dexamethasone (VCD) or bortezomib, lenalidomide and dexamethasone (VRD) for newly diagnosed MM at our institution between 2000 and 2013, and who had available data on absolute lymphocyte count (ALC) and quantitative uninvolved Ig at baseline and at the end of four cycles of therapy. Changes in ALC and uninvolved Ig were significantly different across treatments, with VCD and HD-DEX producing reductions in uninvolved Ig, and RD, VD and VRD leading to increases in uninvolved Ig. In addition, treatment with RD, VD and VRD was independently associated with higher odds of achieving a ⩾25% increase in or normalization of the primary uninvolved Ig on multivariate analysis. Although achievement of a humoral response in the primary uninvolved Ig was associated with a higher odds of achieving VGPR or better after four cycles of therapy, it was not associated with improved overall survival. These data highlight the different mechanisms of action of MM drugs and point toward a possible role for the use of VCD in treating antibody-mediated autoimmune disease.
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Affiliation(s)
- P Ravi
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - S Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - W Gonsalves
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - F Buadi
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - M Q Lacy
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - R S Go
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - A Dispenzieri
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - P Kapoor
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - J A Lust
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - D Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Y Lin
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - S J Russell
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - N Leung
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - M A Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - R A Kyle
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - P L Bergsagel
- Division of Hematology and Oncology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - S V Rajkumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
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21
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Muchtar E, Dean DS, Dispenzieri A, Dingli D, Buadi FK, Lacy MQ, Hayman SR, Kapoor P, Leung N, Russell S, Lust JA, Lin Y, Warsame R, Gonsalves W, Kourelis TV, Go RS, Chakraborty R, Zeldenrust S, Kyle RA, Rajkumar SV, Kumar SK, Gertz MA. Prevalence and predictors of thyroid functional abnormalities in newly diagnosed AL amyloidosis. J Intern Med 2017; 281:611-619. [PMID: 28439924 DOI: 10.1111/joim.12617] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Data on the effect of systemic immunoglobulin light chain amyloidosis (AL amyloidosis) on thyroid function are limited. OBJECTIVE To assess the prevalence of hypothyroidism in AL amyloidosis patients and determine its predictors. METHODS 1142 newly diagnosed AL amyloidosis patients were grouped based on the thyroid-stimulating hormone (TSH) measurement at diagnosis: hypothyroid group (TSH above upper normal reference; >5 mIU L-1 ; n = 217, 19% of study participants) and euthyroid group (n = 925, 81%). Predictors for hypothyroidism were assessed in a binary multivariate model. Survival between groups was compared using the log-rank test and a multivariate analysis. RESULTS Patients with hypothyroidism were older, more likely to present with renal and hepatic involvement and had a higher light chain burden compared to patients in the euthyroid group. Higher proteinuria in patients with renal involvement and lower albumin in patients with hepatic involvement were associated with hypothyroidism. In a binary logistic regression model, age ≥65 years, female sex, renal involvement, hepatic involvement, kappa light chain restriction and amiodarone use were independently associated with hypothyroidism. Ninety-three per cent of patients in the hypothyroid group with free thyroxine measurement had normal values, consistent with subclinical hypothyroidism. Patients in the hypothyroid group had a shorter survival compared to patients in the euthyroid group (4-year survival 36% vs 43%; P = 0.008), a difference that was maintained in a multivariate analysis. CONCLUSION A significant proportion of patients with AL amyloidosis present with hypothyroidism, predominantly subclinical, which carries a survival disadvantage. Routine assessment of TSH in these patients is warranted.
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Affiliation(s)
- E Muchtar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - D S Dean
- Division of Diabetes, Endocrinology, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - A Dispenzieri
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - D Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - F K Buadi
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - M Q Lacy
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - S R Hayman
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - P Kapoor
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - N Leung
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.,Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - S Russell
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - J A Lust
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - R Warsame
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - W Gonsalves
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - T V Kourelis
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - R S Go
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - R Chakraborty
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.,Hospitalist Services, Essentia Health St. Joseph's Hospital, Brainerd, MN, USA
| | - S Zeldenrust
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - R A Kyle
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - S K Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - M A Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
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Tandon N, Muchtar E, Sidana S, Dispenzieri A, Lacy MQ, Dingli D, Buadi FK, Hayman SR, Chakraborty R, Hogan WJ, Gonsalves W, Warsame R, Kourelis TV, Leung N, Kapoor P, Kumar SK, Gertz MA. Revisiting conditioning dose in newly diagnosed light chain amyloidosis undergoing frontline autologous stem cell transplant: impact on response and survival. Bone Marrow Transplant 2017; 52:1126-1132. [DOI: 10.1038/bmt.2017.68] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 02/17/2017] [Accepted: 03/01/2017] [Indexed: 11/09/2022]
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23
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Chakraborty R, Muchtar E, Kumar SK, Jevremovic D, Buadi FK, Dingli D, Dispenzieri A, Hayman SR, Hogan WJ, Kapoor P, Lacy MQ, Leung N, Gertz MA. Risk stratification in myeloma by detection of circulating plasma cells prior to autologous stem cell transplantation in the novel agent era. Blood Cancer J 2016; 6:e512. [PMID: 27983726 PMCID: PMC5223152 DOI: 10.1038/bcj.2016.117] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 10/28/2016] [Indexed: 11/09/2022] Open
Abstract
The impact of circulating plasma cells (CPCs) prior to autologous stem cell transplantation (ASCT) for multiple myeloma has not been defined in the novel agent era. We evaluated the impact of pre-transplant CPCs, detected by six-color flow cytometry in patients undergoing early ASCT on post-transplant response, progression-free survival (PFS) and overall survival (OS). CPCs were detected in 162 out of 840 (19.3%) patients, with the median number of CPCs being 58 per 150 000 events. Ninety-nine percent of patients had received proteasome inhibitor and/or immunomodulator-based induction. The incidence of post-transplant stringent complete response (sCR) in the subgroups with and without CPCs was 15% and 38%, respectively, (P<0.001). The median PFS in the subgroups with and without CPCs was 15.1 (95% confidence interval (CI), 12.5-17.8) and 29.6 months (95% CI, 26.2-32.8), respectively, and the median OS was 41.0 months (95% CI, 32.6-58.2) and not reached (NR) (95% CI, 99.1-NR), respectively, (P<0.001 for both). On multivariate analysis for OS, factors independently predictive of mortality were the presence of CPCs (hazard ratio (HR) 2.5; 95% CI, 1.8-3.6; P<0.001) and sCR post transplant (HR 0.4; 95% CI, 0.2-0.6; P<0.001). Presence of CPCs prior to transplant has a high prognostic impact and should be prospectively validated in clinical trials.
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Affiliation(s)
- R Chakraborty
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA.,Department of Internal Medicine, Hospitalist Services, Essentia Health-St Joseph's Medical Center, Brainerd, MN, USA
| | - E Muchtar
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - S K Kumar
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - D Jevremovic
- Department of Laboratory Medicine and Pathology, Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - F K Buadi
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - D Dingli
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - A Dispenzieri
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - S R Hayman
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - W J Hogan
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - P Kapoor
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - M Q Lacy
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - N Leung
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - M A Gertz
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
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24
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McDonald RJ, McDonald JS, Kallmes DF, Lehman VT, Diehn FE, Wald JT, Thielen KR, Dispenzieri A, Luetmer PH. Effect of Systemic Therapies on Outcomes following Vertebroplasty among Patients with Multiple Myeloma. AJNR Am J Neuroradiol 2016; 37:2400-2406. [PMID: 27758772 DOI: 10.3174/ajnr.a4925] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 07/08/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The role of vertebroplasty in patients with myeloma remains relatively undefined. Accordingly, we sought to better define the efficacy of vertebroplasty for myeloma-associated fractures and determine the effect of procedure timing relative to the initiation of systemic therapy on outcomes and complication rates. MATERIALS AND METHODS Clinical, laboratory, and medication data were retrieved for 172 patients with multiple myeloma treated with vertebroplasty since October 2000. Quantitative outcome data (Roland-Morris Disability Questionnaire [scale, 0-24] and the Numeric Rating Scale [0-10] for pain at rest and with activity) were collected immediately pre- and postoperatively and at 1 week, 1 month, 6 months, and 1 year following vertebroplasty. Patients with ≥50% improvement on the Numeric Rating Scale and ≥40% improvement on the Roland-Morris Disability Questionnaire were classified as "responders." Peri- and postoperative complications were also collected. RESULTS Significant median improvement in the Roland-Morris Disability and rest and activity Numeric Rating Scale scores (15, 2, and 6 points, respectively; P < .0001) persisted at 1 year without significant change from the immediate postoperative scores (P > .36). Patients on systemic therapy at the time of vertebroplasty were more likely to achieve "responder status," compared with patients not on systemic therapy, for the Numeric Rating Scale pain at rest score (P < .01) and the Roland-Morris Disability Questionnaire score (P < .003), with no difference in complication rates (χ2 = 0.17, P = .68). CONCLUSIONS Vertebroplasty is an effective therapy for patients with myeloma with symptomatic compression fractures. Favorable outcomes are more likely to be achieved when spinal augmentation is performed after systemic therapy is initiated. Complication rates were not affected by the timing of systemic therapy.
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Affiliation(s)
- R J McDonald
- From the Departments of Radiology (R.J.M., J.S.M, D.F.K., V.T.L., F.E.D., J.T.W., K.R.T., P.H.L.)
| | - J S McDonald
- From the Departments of Radiology (R.J.M., J.S.M, D.F.K., V.T.L., F.E.D., J.T.W., K.R.T., P.H.L.)
| | - D F Kallmes
- From the Departments of Radiology (R.J.M., J.S.M, D.F.K., V.T.L., F.E.D., J.T.W., K.R.T., P.H.L.).,Neurosurgery (D.F.K.)
| | - V T Lehman
- From the Departments of Radiology (R.J.M., J.S.M, D.F.K., V.T.L., F.E.D., J.T.W., K.R.T., P.H.L.)
| | - F E Diehn
- From the Departments of Radiology (R.J.M., J.S.M, D.F.K., V.T.L., F.E.D., J.T.W., K.R.T., P.H.L.)
| | - J T Wald
- From the Departments of Radiology (R.J.M., J.S.M, D.F.K., V.T.L., F.E.D., J.T.W., K.R.T., P.H.L.)
| | - K R Thielen
- From the Departments of Radiology (R.J.M., J.S.M, D.F.K., V.T.L., F.E.D., J.T.W., K.R.T., P.H.L.)
| | - A Dispenzieri
- Hematology (A.D.), College of Medicine, Mayo Clinic, Rochester, Minnesota
| | - P H Luetmer
- From the Departments of Radiology (R.J.M., J.S.M, D.F.K., V.T.L., F.E.D., J.T.W., K.R.T., P.H.L.)
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25
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Chakraborty R, Muchtar E, Kumar S, Buadi FK, Dingli D, Dispenzieri A, Hayman SR, Hogan WJ, Kapoor P, Lacy MQ, Leung N, Gertz MA. The impact of induction regimen on transplant outcome in newly diagnosed multiple myeloma in the era of novel agents. Bone Marrow Transplant 2016; 52:34-40. [PMID: 27548464 DOI: 10.1038/bmt.2016.214] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 06/14/2016] [Accepted: 07/08/2016] [Indexed: 12/22/2022]
Abstract
We compared overall survival (OS) of 1017 patients with newly diagnosed multiple myeloma (MM) who were treated with different novel agent-based induction regimens and who underwent early autologous stem cell transplant (ASCT). Subgroups were defined by type of induction therapy: cyclophosphamide-bortezomib-dexamethasone (CyBorD; n=193), bortezomib-dexamethasone (Vd; n=64), lenalidomide-dexamethasone (Rd; n=251), bortezomib-lenalidomide-dexamethasone (VRd; n=126), thalidomide-dexamethasone (Td; n=155) and vincristine-doxorubicin-dexamethasone or dexamethasone alone (VAD/Dex; n=228). The median follow-up of the surviving patients was 66.7 months. The 5-year OS rates with CyBorD, Vd, Rd, VRd, Td and VAD/Dex were 79.2%, 72.3%, 79.2%, 79.0%, 57.4% and 63.4%, respectively (log-rank, P<0.001). In a multivariate analysis, after controlling for important patient and disease variables, VRd had a superior OS compared with CyBorD (hazard ratio (HR), 0.32; 95% confidence interval (CI), 0.10-0.88; P=0.03) and Vd (HR, 0.16; 95% CI, 0.04-0.52; P=0.002). In conclusion, our study demonstrates that among patients completing induction therapy and continuing to early transplant, VRd induction leads to improved OS compared with CyBorD and Vd regimens.
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Affiliation(s)
- R Chakraborty
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.,Hospitalist Services, Essentia Health-St. Joseph's Medical Center, Brainerd, MN, USA
| | - E Muchtar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - S Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - F K Buadi
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - D Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - A Dispenzieri
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - S R Hayman
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - W J Hogan
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - P Kapoor
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - M Q Lacy
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - N Leung
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - M A Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
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26
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Ravi P, Kumar S, Larsen JT, Gonsalves W, Buadi F, Lacy MQ, Go R, Dispenzieri A, Kapoor P, Lust JA, Dingli D, Lin Y, Russell SJ, Leung N, Gertz MA, Kyle RA, Bergsagel PL, Rajkumar SV. Evolving changes in disease biomarkers and risk of early progression in smoldering multiple myeloma. Blood Cancer J 2016; 6:e454. [PMID: 27471870 PMCID: PMC5030386 DOI: 10.1038/bcj.2016.65] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 06/23/2016] [Indexed: 01/07/2023] Open
Abstract
We studied 190 patients with smoldering multiple myeloma (SMM) at our institution between 1973 and 2014. Evolving change in monoclonal protein level (eMP) was defined as ⩾10% increase in serum monoclonal protein (M) and/or immunoglobulin (Ig) (M/Ig) within the first 6 months of diagnosis (only if M-protein ⩾3 g/dl) and/or ⩾25% increase in M/Ig within the first 12 months, with a minimum required increase of 0.5 g/dl in M-protein and/or 500 mg/dl in Ig. Evolving change in hemoglobin (eHb) was defined as ⩾0.5 g/dl decrease within 12 months of diagnosis. A total of 134 patients (70.5%) progressed to MM over a median follow-up of 10.4 years. On multivariable analysis adjusting for factors known to predict for progression to MM, bone marrow plasma cells ⩾20% (odds ratio (OR)=3.37 (1.30-8.77), P=0.013), eMP (OR=8.20 (3.19-21.05), P<0.001) and eHb (OR=5.86 (2.12-16.21), P=0.001) were independent predictors of progression within 2 years of SMM diagnosis. A risk model comprising these variables was constructed, with median time to progression of 12.3, 5.1, 2.0 and 1.0 years among patients with 0-3 risk factors respectively. The 2-year progression risk was 81.5% in individuals who demonstrated both eMP and eHb, and 90.5% in those with all three risk factors.
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Affiliation(s)
- P Ravi
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - S Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - J T Larsen
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - W Gonsalves
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - F Buadi
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - M Q Lacy
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - R Go
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - A Dispenzieri
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - P Kapoor
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - J A Lust
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - D Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Y Lin
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - S J Russell
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - N Leung
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - M A Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - R A Kyle
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - P L Bergsagel
- Division of Hematology and Oncology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - S V Rajkumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
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27
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Gonsalves WI, Rajkumar SV, Dispenzieri A, Dingli D, Timm MM, Morice WG, Lacy MQ, Buadi FK, Go RS, Leung N, Kapoor P, Hayman SR, Lust JA, Russell SJ, Zeldenrust SR, Hwa L, Kourelis TV, Kyle RA, Gertz MA, Kumar SK. Quantification of circulating clonal plasma cells via multiparametric flow cytometry identifies patients with smoldering multiple myeloma at high risk of progression. Leukemia 2016; 31:130-135. [PMID: 27457702 DOI: 10.1038/leu.2016.205] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 05/24/2016] [Accepted: 06/06/2016] [Indexed: 12/11/2022]
Abstract
The presence of high numbers of circulating clonal plasma cells (cPCs) in patients with smoldering multiple myeloma (SMM), detected by a slide-based immunofluorescence assay, has been associated with a shorter time to progression (TTP) to MM. The significance of quantifying cPCs via multiparameter flow cytometry, a much more readily available diagnostic modality, in patients with SMM has not been evaluated. This study evaluated 100 patients with a known or new diagnosis of SMM who were seen at the Mayo Clinic, Rochester from January 2008 until December 2013. Patients with ⩾150 cPCs (N=9) were considered to have high number of cPCs based on the 97% specificity and 78% PPV of progression to MM within 2 years of cPC assessment. The median TTP of patients with ⩾150 cPCs was 9 months compared with not reached for patients with <150 cPCs (P<0.001). Thus, quantification of cPCs via multiparametric flow cytometry identifies patients with SMM at very high risk of progression to MM within 2 years and warrants confirmation in larger studies. In the future, this may allow reclassification of such patients as having MM requiring therapy prior to them enduring end-organ damage.
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Affiliation(s)
- W I Gonsalves
- The Divisions of Hematology and Blood and Marrow Transplantation, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - S V Rajkumar
- The Divisions of Hematology and Blood and Marrow Transplantation, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - A Dispenzieri
- The Divisions of Hematology and Blood and Marrow Transplantation, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - D Dingli
- The Divisions of Hematology and Blood and Marrow Transplantation, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - M M Timm
- The Divisions of Hematology and Blood and Marrow Transplantation, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - W G Morice
- The Divisions of Hematology and Blood and Marrow Transplantation, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - M Q Lacy
- The Divisions of Hematology and Blood and Marrow Transplantation, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - F K Buadi
- The Divisions of Hematology and Blood and Marrow Transplantation, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - R S Go
- The Divisions of Hematology and Blood and Marrow Transplantation, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - N Leung
- The Divisions of Hematology and Blood and Marrow Transplantation, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - P Kapoor
- The Divisions of Hematology and Blood and Marrow Transplantation, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - S R Hayman
- The Divisions of Hematology and Blood and Marrow Transplantation, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - J A Lust
- The Divisions of Hematology and Blood and Marrow Transplantation, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - S J Russell
- The Divisions of Hematology and Blood and Marrow Transplantation, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - S R Zeldenrust
- The Divisions of Hematology and Blood and Marrow Transplantation, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - L Hwa
- The Divisions of Hematology and Blood and Marrow Transplantation, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - T V Kourelis
- The Divisions of Hematology and Blood and Marrow Transplantation, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - R A Kyle
- The Divisions of Hematology and Blood and Marrow Transplantation, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - M A Gertz
- The Divisions of Hematology and Blood and Marrow Transplantation, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - S K Kumar
- The Divisions of Hematology and Blood and Marrow Transplantation, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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28
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Majithia N, Rajkumar SV, Lacy MQ, Buadi FK, Dispenzieri A, Gertz MA, Hayman SR, Dingli D, Kapoor P, Hwa L, Lust JA, Russell SJ, Go RS, Kyle RA, Kumar SK. Early relapse following initial therapy for multiple myeloma predicts poor outcomes in the era of novel agents. Leukemia 2016; 30:2208-2213. [PMID: 27211270 DOI: 10.1038/leu.2016.147] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 05/01/2016] [Accepted: 05/09/2016] [Indexed: 11/09/2022]
Abstract
Outcomes for patients with multiple myeloma (MM) have improved in recent years owing to use of novel agents and high-dose therapy followed by autologous stem cell transplant (ASCT). We analyzed the outcomes of 511 consecutive patients treated with novel therapies at our institution between 2006 and 2014 to determine the impact of relapse within 12 months of initiating treatment. A total of 82 patients (16.0%) experienced early relapse, with median time to relapse of 8.0 months (95% confidence interval (CI); 6.3, 8.9). Median overall survival (OS) was significantly worse for this group at 21.0 months (95% CI; 16.3, 27.2) vs not reached (NR) (95% CI; 96.3, NR) for those with late relapse (P<0.001). Survival outcomes remained poor among early relapse patients irrespective of depth of response to initial therapy. In multivariate analysis, low albumin and high-risk cytogenetics predicted early relapse. Outcomes of early relapse from early ASCT were also considered; median OS from ASCT for those relapsing within 12 months was 23.1 months (95% CI; 15.7, 32.4) vs 122.2 months (95% CI; 111.5, 122.2) for the remaining patients (P<0.001). Early relapse remains a marker of poor prognosis in the current era, and such patients should be targeted for clinical trials.
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Affiliation(s)
- N Majithia
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - S V Rajkumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - M Q Lacy
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - F K Buadi
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - A Dispenzieri
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - M A Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - S R Hayman
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - D Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - P Kapoor
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - L Hwa
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - J A Lust
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - S J Russell
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - R S Go
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - R A Kyle
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - S K Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
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Gonsalves WI, Rajkumar SV, Gertz MA, Dispenzieri A, Lacy MQ, Buadi FK, Dingli D, Go RS, Leung N, Kapoor P, Hayman SR, Lust JA, Russell SJ, Zeldenrust SR, Hwa YL, Kourelis TV, Kyle RA, Kumar SK. Clinical course and outcomes of patients with multiple myeloma who relapse after autologous stem cell therapy. Bone Marrow Transplant 2016; 51:1156-8. [DOI: 10.1038/bmt.2016.91] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Kourelis TV, Buadi FK, Gertz MA, Lacy MQ, Kumar SK, Kapoor P, Go RS, Lust JA, Hayman SR, Rajkumar V, Zeldenrust SR, Russell SJ, Dingli D, Lin Y, Leung N, Hwa YL, Gonsalves W, Kyle RA, Dispenzieri A. Risk factors for and outcomes of patients with POEMS syndrome who experience progression after first-line treatment. Leukemia 2015; 30:1079-85. [DOI: 10.1038/leu.2015.344] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 11/16/2015] [Accepted: 12/02/2015] [Indexed: 11/09/2022]
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Mihalcea D, Bergler-Klein J, Grogan M, Pagourelias E, Faber L, Ciampi Q, Debonnaire P, Saberniak J, Florescu M, Vladareanu AM, Mihaila S, Vinereanu D, Spannbauer A, Zlabinger K, Macejovska D, Maurer G, Gyongyosi M, Scott C, Lin G, Klarich K, Miller W, Dispenzieri A, Mirea OC, Duchenne J, Vovas G, Van Aelst L, Claus P, Van Cleemput J, Delforge M, Bogaert J, Voigt JU, Burghardt A, Seggewiss H, Van Buuren F, Horstkotte D, Olivotto I, Gardini C, Monserrat L, Peteiro J, Lopes L, Cotrim C, Losi MA, Lazzeroni DE, Picano E, Joyce E, Van Den Brink OVW, Bax JJ, Delgado V, Ajmone Marsan N, Leren IS, Haland TF, Hopp E, Edvardsen T, Haugaa KH. Rapid Fire Abstract session: new insights in cardiomyopthies434The role of 4D echocardiography and cardiac biomarkers for early detection of chemotherapy induced cardiotoxicity in nonHodgkin lymphoma patients435Identification of proto-oncogenes and genes responsible for myocardial fibrosis and diastolic dysfunction after anticancer treatment under experimental conditions436Wild type transthyretin cardiac amyloidosis: clinical characteristics, echocardiographic findings, and predictors of outcome437A novel echocardiographic index for detection of cardiac amyloidosis.438Left ventricular outflow obstruction is a treatable feature rather than a risk marker in patients with hypertrophic cardiomyopathy439The international stress echo registry in hypertrophic cardiomyopathy440Value of left atrial size and function to risk stratify for new onset atrial fibrillation in hypertrophic cardiomyopathy441Right ventricle ejection fraction by cardiac resonance imaging is superior in discrimination between early phase ARVC and right ventricular outflow tract ventricular tachycardia. Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Vu T, Gonsalves W, Kumar S, Dispenzieri A, Lacy MQ, Buadi F, Gertz MA, Rajkumar SV. Characteristics of exceptional responders to lenalidomide-based therapy in multiple myeloma. Blood Cancer J 2015; 5:e363. [PMID: 26495860 PMCID: PMC4635199 DOI: 10.1038/bcj.2015.91] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 09/18/2015] [Indexed: 01/03/2023] Open
Abstract
We studied all patients at our institution with a diagnosis of multiple myeloma (MM), from 1 January 2004 to 1 July 2009, who received lenalidomide-dexamethasone (Rd) as initial therapy and had a time to progression of 72 months or longer. Of 240 patients, we identified 33 exceptional responders. Twenty-five patients received primary therapy with Rd and eight patients received Rd induction followed by early stem cell transplantation (SCT). Seven of the eight patients who received SCT did not receive maintenance therapy; one patient received 9 months of lenalidomide post transplant. Fifteen (45%) patients had known clonal plasma cell disorder before the diagnosis of MM. The dominant mode of clinical presentation was with lytic lesions in 28 patients. Of those with informative cytogenetics (n=24), trisomies were present in 19 (79%), including one patient with concurrent trisomies and t(11;14). Overall, 21 of 24 patients (88%) had either trisomies or t(11;14). None of these exceptional responders had high-risk cytogenetic features at baseline. Twenty-five patients (76%) had a complete response (CR), whereas eight patients (24%) achieved the exceptional response state without ever achieving a CR. We identify a cohort of exceptional responders to Rd-based therapy, representing ~10-15% newly diagnosed MM patients with normal renal function.
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Affiliation(s)
- T Vu
- Mayo Medical School, Mayo Clinic, Rochester, MN, USA
| | - W Gonsalves
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - S Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - A Dispenzieri
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - M Q Lacy
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - F Buadi
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - M A Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - S V Rajkumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
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Gonsalves WI, Leung N, Rajkumar SV, Dispenzieri A, Lacy MQ, Hayman SR, Buadi FK, Dingli D, Kapoor P, Go RS, Lin Y, Russell SJ, Lust JA, Zeldenrust S, Kyle RA, Gertz MA, Kumar SK. Improvement in renal function and its impact on survival in patients with newly diagnosed multiple myeloma. Blood Cancer J 2015; 5:e296. [PMID: 25794132 PMCID: PMC4382661 DOI: 10.1038/bcj.2015.20] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 02/02/2015] [Indexed: 11/09/2022] Open
Abstract
Renal impairment (RI) is seen in over a quarter of patients with newly diagnosed multiple myeloma (NDMM). It is not clear if reversal of RI improves the outcome to that expected for NDMM patients without RI. We evaluated 1135 consecutive patients with NDMM seen at the Mayo Clinic between January 2003 and December 2012. RI was defined as having a creatinine clearance (CrCl) <40ml/min. The median overall survival (OS) for patients with RI at diagnosis receiving and not receiving novel agent induction therapy was not reached vs 46 months (P<0.001). The median OS for patients with CrCl ⩾40 ml/min at diagnosis, CrCl <40 ml/min at diagnosis but improved to ⩾40 ml/min and CrCl <40 ml/min at diagnosis and remained <40 ml/min, were 112, 56 and 33 months, respectively (P<0.001). The complete renal response rate for patients with RI at diagnosis receiving novel agent induction therapy compared to the rest was 40 vs 16% (P<0.001). In conclusion, patients with reversal of RI have improved outcomes, but it remains inferior to patients with normal renal function at diagnosis. These results have implications for identifying early treatment strategies for patients at risk of developing renal insufficiency.
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Affiliation(s)
- W I Gonsalves
- Divisions of Hematology and Nephrology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - N Leung
- Divisions of Hematology and Nephrology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - S V Rajkumar
- Divisions of Hematology and Nephrology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - A Dispenzieri
- Divisions of Hematology and Nephrology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - M Q Lacy
- Divisions of Hematology and Nephrology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - S R Hayman
- Divisions of Hematology and Nephrology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - F K Buadi
- Divisions of Hematology and Nephrology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - D Dingli
- Divisions of Hematology and Nephrology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - P Kapoor
- Divisions of Hematology and Nephrology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - R S Go
- Divisions of Hematology and Nephrology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Y Lin
- Divisions of Hematology and Nephrology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - S J Russell
- Divisions of Hematology and Nephrology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - J A Lust
- Divisions of Hematology and Nephrology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - S Zeldenrust
- Divisions of Hematology and Nephrology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - R A Kyle
- Divisions of Hematology and Nephrology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - M A Gertz
- Divisions of Hematology and Nephrology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - S K Kumar
- Divisions of Hematology and Nephrology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
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Zhen D, Swiecicki P, Zeldenrust S, Dispenzieri A, Mauermann M, Gertz M. Frequencies and geographic distributions of genetic mutations in transthyretin- and non-transthyretin-related familial amyloidosis. Clin Genet 2014; 88:396-400. [DOI: 10.1111/cge.12500] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 09/08/2014] [Accepted: 09/09/2014] [Indexed: 11/29/2022]
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Kumar SK, Dispenzieri A, Lacy MQ, Gertz MA, Buadi FK, Pandey S, Kapoor P, Dingli D, Hayman SR, Leung N, Lust J, McCurdy A, Russell SJ, Zeldenrust SR, Kyle RA, Rajkumar SV. Continued improvement in survival in multiple myeloma: changes in early mortality and outcomes in older patients. Leukemia 2014; 28:1122-8. [PMID: 24157580 PMCID: PMC4000285 DOI: 10.1038/leu.2013.313] [Citation(s) in RCA: 988] [Impact Index Per Article: 98.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 10/15/2013] [Indexed: 12/23/2022]
Abstract
Therapy for multiple myeloma (MM) has markedly changed in the past decade with the introduction of new drugs, but it is not clear whether the improvements have been sustained. We studied 1038 patients diagnosed between 2001 and 2010, grouping patients into two 5-year periods by diagnosis, 2001-2005 and 2006-2010. The median estimated follow-up for the cohort was 5.9 years with 47% alive at the last follow-up. The median overall survival (OS) for the entire cohort was 5.2 years: 4.6 years for patients in the 2001-2005 group compared with 6.1 years for the 2006-2010 cohort (P=0.002). The improvement was primarily seen among patients over 65 years, the 6-year OS improving from 31 to 56%, P<0.001. Only 10% of patients died during the first year in the latter group, compared with 16% in the earlier cohort (P<0.01), suggesting improvement in early mortality. The improved outcomes were linked closely to the use of one or more new agents in initial therapy. The current results confirm continued survival improvement in MM and highlight the impact of initial therapy with novel agents. Most importantly, we demonstrate that the improved survival is benefitting older patients and that early mortality in this disease has reduced considerably.
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Affiliation(s)
- S K Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - A Dispenzieri
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - M Q Lacy
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - M A Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - F K Buadi
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - S Pandey
- Division of Nephrology, Mayo Clinic, Rochester, MN, USA
| | - P Kapoor
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - D Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - S R Hayman
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - N Leung
- 1] Division of Hematology, Mayo Clinic, Rochester, MN, USA [2] Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - J Lust
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - A McCurdy
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - S J Russell
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - R A Kyle
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - S V Rajkumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
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Ehlers SL, Bronars CA, Patten CA, Brockman T, Hughes C, Decker PA, Cerhan JR, Hogan W, Dispenzieri A, Ansell S, Ebbert J, Gastineau D. Accuracy of self-reported tobacco use status among hematopoietic SCT patients. Bone Marrow Transplant 2014; 49:961-5. [PMID: 24732958 PMCID: PMC4162628 DOI: 10.1038/bmt.2014.70] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 02/20/2014] [Accepted: 02/26/2014] [Indexed: 11/21/2022]
Abstract
Tobacco use is a risk factor for adverse outcomes among Hematopoietic Stem Cell Transplant (HSCT) patients. Accurate identification of tobacco use offers a vital opportunity to treat this risk factor. The current study compared self-reported tobacco use status to serum cotinine levels among HSCT patients at time of pre-transplant evaluation. A total of 444 participants completed both assessments; 44 participants (9.9%) were classified as tobacco users with serum cotinine concentrations > 2ng/Ml versus 29 with self-report. Sensitivity and specificity of self-report were 65.9% and 100%. Positive predictive and negative predictive values were 100% and 96.4%. Comparing tobacco use documented in the medical record with cotinine, sensitivity and specificity were 51.2% and 99.2%. Factors associated with tobacco use were male gender, single relationship status, less education, and younger age. In summary, utilization of serum cotinine assays increased detection of tobacco use cases more than 50% over self-report. Results are discussed in context of translation to care, including clinical and ethical implications, and current tobacco use treatment guidelines. When cotinine assays are not available, self-report of any tobacco use in the year prior to HSCT should trigger brief advice and cessation or relapse prevention counseling.
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Affiliation(s)
- S L Ehlers
- 1] Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, USA [2] Behavioral Health Research Program, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - C A Bronars
- 1] Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, USA [2] Behavioral Health Research Program, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - C A Patten
- 1] Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, USA [2] Behavioral Health Research Program, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - T Brockman
- Behavioral Health Research Program, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - C Hughes
- Behavioral Health Research Program, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - P A Decker
- Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - J R Cerhan
- Division of Epidemiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - W Hogan
- Division of Hematology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - A Dispenzieri
- Division of Hematology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - S Ansell
- Division of Hematology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - J Ebbert
- 1] Nicotine Dependence Center Research Program, Mayo Clinic College of Medicine, Rochester, MN, USA [2] Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - D Gastineau
- 1] Division of Hematology, Mayo Clinic College of Medicine, Rochester, MN, USA [2] Human Cellular Therapy Laboratory, Mayo Clinic College of Medicine, Rochester, MN, USA
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Gonsalves WI, Rajkumar SV, Gupta V, Morice WG, Timm MM, Singh PP, Dispenzieri A, Buadi FK, Lacy MQ, Kapoor P, Gertz MA, Kumar SK. Quantification of clonal circulating plasma cells in newly diagnosed multiple myeloma: implications for redefining high-risk myeloma. Leukemia 2014; 28:2060-5. [PMID: 24618735 DOI: 10.1038/leu.2014.98] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 02/21/2014] [Indexed: 12/22/2022]
Abstract
The presence of clonal circulating plasma cells (cPCs) is a marker of high-risk disease in all stages of monoclonal gammopathies. However, the prognostic utility of quantitating cPCs using multiparametric flow cytometry in multiple myeloma (MM) patients with current treatments is unknown. There were 157 consecutive patients with newly diagnosed MM seen at the Mayo Clinic, Rochester from 2009 to 2011 that had their peripheral blood evaluated for cPCs by multiparameter flow cytometry. Survival analysis was performed by the Kaplan-Meier method and differences assessed using the log-rank test. Using a receiver operating characteristics (ROC) analysis, ⩾400 cPCs were considered as the optimal cutoff for defining high-risk disease. The presence of ⩾400 cPCs was associated with higher plasma cell (PC) proliferation and adverse cytogenetics. The median time-to-next-treatment and overall survival (OS) in patients with ⩾400 cPCs (N=37, 24%) was 14 months and 32 months compared with 26 months and not reached for the rest (P<0.001). In a multivariable model, the presence of ⩾400 cPCs and older age adversely affected OS. Flow cytometry to quantify cPCs is a valuable test for risk stratifying newly diagnosed MM patients in the era of novel agents. Future studies are needed to determine its role in developing a risk-adapted treatment approach.
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Affiliation(s)
- W I Gonsalves
- 1] Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA [2] Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - S V Rajkumar
- 1] Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA [2] Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - V Gupta
- 1] Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA [2] Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - W G Morice
- 1] Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA [2] Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - M M Timm
- 1] Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA [2] Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - P P Singh
- 1] Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA [2] Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - A Dispenzieri
- 1] Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA [2] Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - F K Buadi
- 1] Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA [2] Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - M Q Lacy
- 1] Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA [2] Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - P Kapoor
- 1] Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA [2] Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - M A Gertz
- 1] Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA [2] Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - S K Kumar
- 1] Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA [2] Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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Dispenzieri A, Gertz MA, Kumar SK, Lacy MQ, Kyle RA, Saenger AK, Grogan M, Zeldenrust SR, Hayman SR, Buadi F, Greipp PR, Leung N, Russell SR, Dingli D, Lust JA, Rajkumar SV, Jaffe AS. High sensitivity cardiac troponin T in patients with immunoglobulin light chain amyloidosis. Heart 2014; 100:383-8. [PMID: 24402772 DOI: 10.1136/heartjnl-2013-304957] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To define whether the high sensitivity cardiac troponin T (hs-cTnT) assay in patients with immunoglobulin light chain amyloidosis (AL) improves risk prediction. BACKGROUND Cardiac involvement is the major cause of death in patients with AL amyloidosis. Risk stratification is facilitated by cardiac biomarkers such as cardiac troponin T (cTnT) and N-terminal pro B-type natriuretic peptide (NT-proBNP). METHODS Stored serum from patients with newly diagnosed AL was used to measure hs-cTnT, cTnT, and NT-proBNP. Survival modelling was performed. RESULTS The direct numeric result from hs-cTnT measurement cannot merely be substituted for a cTnT measurement in the Mayo AL staging system. The performance of the receiver operator curve derived an hs-cTnT cut-point of 54 ng/L which improves on the value of 35 ng/L validated with the prior iteration of the assay. An alternate staging option using hs-cTnT alone-using the two thresholds 14 ng/L and 54 ng/L-performs as well as either the original Mayo AL staging system or other systems incorporating hs-cTnT. On multivariate analysis, an hs-cTnT alone staging system was independent of period of diagnosis, type of therapy, and NT-proBNP value, the last of which dropped out of the model. Alternate models were explored, but none performed better than the original system or the new hs-cTnT system. Thus, hs-cTnT can be used alone for the staging of disease prognosis. CONCLUSIONS A survival model based on hs-cTnT improves the prognostic staging of patients with AL amyloidosis, relegating NT-proBNP to a measure of cardiac response.
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Affiliation(s)
- A Dispenzieri
- Division of Hematology and Internal Medicine, Mayo Clinic, , Rochester, Minnesota, USA
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Freytes CO, Vesole DH, LeRademacher J, Zhong X, Gale RP, Kyle RA, Reece DE, Gibson J, Schouten HC, McCarthy PL, Lonial S, Krishnan AY, Dispenzieri A, Hari PN. Second transplants for multiple myeloma relapsing after a previous autotransplant-reduced-intensity allogeneic vs autologous transplantation. Bone Marrow Transplant 2013; 49:416-21. [PMID: 24270389 PMCID: PMC3947725 DOI: 10.1038/bmt.2013.187] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 10/03/2013] [Accepted: 10/10/2013] [Indexed: 11/09/2022]
Abstract
There is no standard therapy for multiple myeloma relapsing after an autotransplant. We compared the outcomes of a second autotransplant (N=137) with those of an allotransplant (N=152) after non-myeloablative or reduced-intensity conditioning (NST/RIC) in 289 subjects reported to the CIBMTR from 1995 to 2008. NST/RIC recipients were younger (median age 53 vs 56 years; P<0.001) and had a shorter time to progression after their first autotransplant. Non-relapse mortality at 1-year post transplant was higher in the NST/RIC cohort, 13% (95% confidence interval (CI), 8-19) vs 2% (95% CI, 1-5, P0.001). Three-year PFS and OS for the NST/RIC cohort were 6% (95% CI, 3-10%) and 20% (95% CI, 14-27%). Similar outcomes for the autotransplant cohort were 12% (95% CI, 7-19%, P=0.038) and 46% (95% CI, 37-55%, P=0.001). In multivariate analyses, risk of death was higher in NST/RIC recipients (hazard ratio (HR) 2.38 (95% CI, 1.79-3.16), P<0.001), those with Karnofsky performance score<90 (HR 1.96 (95% CI, 1.47-2.62), P<0.001) and transplant before 2004 (HR 1.77 (95% CI, 1.34-2.35) P0.001). In conclusion, NST/RIC was associated with higher TRM and lower survival than an autotransplant. As disease status was not available for most allotransplant recipients, it is not possible to determine which type of transplant is superior after autotransplant failure.
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Affiliation(s)
- C O Freytes
- South Veterans Health Care System and University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - D H Vesole
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA
| | - J LeRademacher
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - X Zhong
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - R P Gale
- Section of Hematology, Division of Experimental Medicine, Department of Medicine, Imperial College, London, UK
| | - R A Kyle
- Mayo Clinic Rochester, Rochester, MN, USA
| | - D E Reece
- Princess Margaret Hospital, University of Toronto, Toronto, Canada
| | - J Gibson
- Royal Prince Alfred Hospital Institute of Haematology, Camperdown, Australia
| | - H C Schouten
- Interne Geneeskunde, Academische Ziekenhuis Maastricht, Maastricht, Netherlands
| | | | - S Lonial
- Emory University Hospital, Atlanta, GA, USA
| | - A Y Krishnan
- City of Hope National Medical Center, Duarte, CA, USA
| | | | - P N Hari
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI, USA
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Kourelis TV, Kumar SK, Srivastava G, Gertz MA, Lacy MQ, Buadi FK, Kyle RA, Dispenzieri A. Long-term response to lenalidomide in patients with newly diagnosed multiple myeloma. Leukemia 2013; 28:455-7. [PMID: 24150218 DOI: 10.1038/leu.2013.300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- T V Kourelis
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - S K Kumar
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - G Srivastava
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - M A Gertz
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - M Q Lacy
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - F K Buadi
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - R A Kyle
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - A Dispenzieri
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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42
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Chanan-Khan AA, Swaika A, Paulus A, Kumar SK, Mikhael JR, Rajkumar SV, Dispenzieri A, Lacy MQ. Pomalidomide: the new immunomodulatory agent for the treatment of multiple myeloma. Blood Cancer J 2013; 3:e143. [PMID: 24013664 PMCID: PMC3789204 DOI: 10.1038/bcj.2013.38] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 07/17/2013] [Indexed: 01/09/2023] Open
Abstract
In this report, we provide a comprehensive review on the preclinical and clinical investigations conducted in development of the next-generation immunomodulatory drug (IMiD) pomalidomide for the treatment of relapsed/refractory multiple myeloma (MM). We consulted PubMed, MEDLINE, ASH, ASCO annual symposium abstracts and http://clinicaltrials.gov/ for the purpose of this literature review. Twenty-six preclinical and 11 clinical studies were examined. These studies delineate the mechanisms of action of pomalidomide and attest to the robust clinical activity in relapsed/refractory MM. MM is the second most common hematological malignancy in the US. Despite availability of several therapeutic agents, MM remains incurable. Thus, the development of new therapies remains a priority. Pomalidomide is the newest member of the IMiDs class of drugs, and in preclinical and clinical investigations, it has demonstrated an improved efficacy and toxicity profile in comparison to its sister compounds, lenalidomide and thalidomide. Importantly, recent clinical studies have demonstrated its activity in relapsed or refractory myeloma, particularly in lenalidomide and bortezomib-refractory patients. Thus, the addition of pomalidomide to the anti-myeloma armamentarium is widely anticipated to have a significant impact on the overall clinical outcome of advanced stage relapsed and refractory MM patients.
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Affiliation(s)
- A A Chanan-Khan
- Department of Hematology and Oncology, Mayo Clinic, Jacksonville, FL, USA
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43
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Greenberg AJ, Rajkumar SV, Therneau TM, Singh PP, Dispenzieri A, Kumar SK. Relationship between initial clinical presentation and the molecular cytogenetic classification of myeloma. Leukemia 2013; 28:398-403. [PMID: 24005246 PMCID: PMC3924716 DOI: 10.1038/leu.2013.258] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 07/19/2013] [Accepted: 08/02/2013] [Indexed: 11/09/2022]
Abstract
Multiple myeloma (MM) consists of several distinct cytogenetic subtypes, and we hypothesized that each subtype may have a unique mode of initial presentation and end-organ damage. We studied 484 patients with newly diagnosed MM to determine the relationship between specific myeloma-defining event (MDE) and the cytogenetic subtype. Patients were divided into four non-overlapping groups based on the MDE at diagnosis: isolated renal failure, isolated anemia, isolated lytic bone disease or a combination (mixed). MM with translocations without trisomies accounted for 30% of all patients, but accounted for 50% of patients with renal failure. Specifically, the t(14;16) translocation accounted for only 5% of all MM patients, but was present in 13.5% of patients with renal failure as MDE. Among patients with t(14;16), 25% presented with renal failure only as MDE. Patients with isolated renal failure as MDE had significantly poorer survival compared with all other groups, whereas patients with bone disease as MDE had the best outcome (P<0.001). Our findings support the hypothesis that in addition to prognostic differences, there is significant heterogeneity in clinical presentation associated with the cytogenetic subtype, suggesting that MM encompasses a group of cytogenetically and phenotypically distinct disorders rather than a single entity.
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Affiliation(s)
- A J Greenberg
- 1] Center for Translational Science Activities, Rochester, MN, USA [2] Division of Epidemiology, Department of Health Sciences Research, Rochester, MN, USA
| | - S V Rajkumar
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - T M Therneau
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Rochester, MN, USA
| | - P P Singh
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - A Dispenzieri
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - S K Kumar
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
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44
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Xu YL, Dispenzieri A, Pellikka PA, Olson M, Cha S, Villarraga HR. Can longitudinal strain by 2 dimensional speckle tracking echocardiography provide diagnostic and prognostic value in immunoglobulin light chain and hereditary transthyretin cardiac amyloidosis? Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p1192] [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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45
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Srivastava G, Rana V, Lacy MQ, Buadi FK, Hayman SR, Dispenzieri A, Gertz MA, Dingli D, Zeldenrust S, Russell S, McCurdy A, Kapoor P, Kyle R, Rajkumar SV, Kumar S. Long-term outcome with lenalidomide and dexamethasone therapy for newly diagnosed multiple myeloma. Leukemia 2013; 27:2062-6. [PMID: 23648667 DOI: 10.1038/leu.2013.143] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 05/01/2013] [Indexed: 01/25/2023]
Abstract
The combination of lenalidomide and dexamethasone (Len-Dex) is a commonly used initial therapy for newly diagnosed multiple myeloma (MM). Although the initial response rates and toxicity are well known, long-term outcome is not well described. We studied 286 consecutive patients with newly diagnosed MM initially treated with Len-Dex. The median (range) age at diagnosis was 63 (28-92) years, 166 (58%) patients ≤ 65 years and 175 (61%) male. The median estimated duration on Len-Dex was 5.3 months with overall response (≥ partial response) of 72%, including 26% with very good partial response or better. The median overall survival (OS) from the diagnosis was not reached (NR) and the estimated 5-year survival was 71%. The median time to first disease progression, irrespective of transplant status, was 30.2 months. Overall, 143 (50%) patients underwent stem cell transplant. The median OS was NR for patients ≤ 70 years and 5.8 years for the older patients (P=0.01). The 5-year OS estimate for patients in International Staging System stage 1, 2 and 3 were 82, 65, and 44% respectively. There were 21 new second malignancies after MM diagnosis (6.6%). The median survival exceeding 7 years reflects the efficacy of novel agents. The risk of second malignancies doesn't appear to be excessive in this population.
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Affiliation(s)
- G Srivastava
- Division of Hematology and Blood and Marrow Transplant, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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46
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Dispenzieri A, Seenithamby K, Lacy MQ, Kumar SK, Buadi FK, Hayman SR, Dingli D, Litzow MR, Gastineau DA, Inwards DJ, Micallef IN, Ansell SM, Johnston PB, Porrata LF, Patnaik MM, Hogan WJ, Gertz MAA. Patients with immunoglobulin light chain amyloidosis undergoing autologous stem cell transplantation have superior outcomes compared with patients with multiple myeloma: a retrospective review from a tertiary referral center. Bone Marrow Transplant 2013; 48:1302-7. [DOI: 10.1038/bmt.2013.53] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Revised: 03/05/2013] [Accepted: 03/06/2013] [Indexed: 11/09/2022]
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47
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Tschumper RC, Dispenzieri A, Abraham RS, Henderson KJ, Jelinek DF. Molecular analysis of immunoglobulin genes reveals frequent clonal relatedness in double monoclonal gammopathies. Blood Cancer J 2013; 3:e112. [PMID: 23599024 PMCID: PMC3641320 DOI: 10.1038/bcj.2013.12] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Monoclonal gammopathies (MGs) are hematological diseases characterized by high levels of a monoclonal immunoglobulin (Ig) or M-protein. Within this group are patients with more than one M-protein, referred to as double MGs (DMGs). The M-proteins in DMG patients may have different heavy chain (HC) isotypes that are associated with different light chains (LCs), or different HCs that are LC matched. In this study, we examined the clonal relatedness of the M-proteins in the latter type in a cohort of 14 DMG patients. By using PCR, we identified 7/14 DMG patients that expressed two Ig HC isotypes with identical Ig HC variable (IGHV), diversity (IGHD), joining (IGHJ), and complementarity determining region (HCDR3) sequences. Two additional DMG patients had two Ig transcripts using the same IGHV, IGHD and IGHJ genes but with slight differences in variable region or HCDR3 mutations. LC analysis confirmed that a single LC was expressed in 3/7 DMG patients with identical HC transcripts and in the two DMGs with highly similar transcripts. The PCR findings were confirmed by immunofluorescence for HC and LC expression. Clonally related HC-dissimilar/LC-matched DMGs may occur often and defines a new subtype of MG that may serve as a tool for studies of disease pathogenesis.
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Affiliation(s)
- R C Tschumper
- Department of Immunology, Mayo Clinic, Rochester, MN, USA
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Msaouel P, Iankov ID, Dispenzieri A, Galanis E. Attenuated oncolytic measles virus strains as cancer therapeutics. Curr Pharm Biotechnol 2013; 13:1732-41. [PMID: 21740361 DOI: 10.2174/138920112800958896] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Accepted: 09/18/2010] [Indexed: 12/18/2022]
Abstract
Attenuated measles virus vaccine strains have emerged as a promising oncolytic vector platform, having shown significant anti-tumor activity against a broad range of malignant neoplasms. Measles virus strains derived from the attenuated Edmonston-B (MV-Edm) vaccine lineage have been shown to selectively infect, replicate in and lyse cancer cells while causing minimal cytopathic effect on normal tissues. This review summarizes the preclinical data that led to the rapid clinical translation of oncolytic measles vaccine strains and provides an overview of early clinical data using this oncolytic platform. Furthermore, novel approaches currently under development to further enhance the oncolytic efficacy of MV-Edm strains, including strategies to circumvent immunity or modulate immune system responses, combinatorial approaches with standard treatment modalities, virus retargeting as well as strategies for in vivo monitoring of viral replication are discussed.
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Affiliation(s)
- P Msaouel
- Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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49
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Roeker LE, Larson DR, Kyle RA, Kumar S, Dispenzieri A, Rajkumar SV. Risk of acute leukemia and myelodysplastic syndromes in patients with monoclonal gammopathy of undetermined significance (MGUS): a population-based study of 17 315 patients. Leukemia 2013; 27:1391-3. [PMID: 23380709 DOI: 10.1038/leu.2013.34] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The purpose of this study was to determine if there is an increased risk of acute leukemia and myelodysplastic syndromes (MDS) in persons with monoclonal gammopathy of undetermined significance (MGUS). We used a large population-based cohort of individuals systematically screened for the presence or absence of MGUS. MGUS status was then linked to the diagnosis of acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL) and MDS. A total of 17 315 patients age 50 and older (605 MGUS and 16 710 controls) with a cumulative 435 021 person-years of follow-up were studied. MGUS patients had a significantly higher risk of developing MDS compared with controls, hazard ratio 2.4 (95% CI 1.08, 5.32), P=0.031. There was no statistically significant increase in the risk of AML (RR 1.36 P=0.675), and no increased risk of developing ALL.
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Affiliation(s)
- L E Roeker
- Mayo Medical School, Mayo Clinic, Rochester, MN, USA
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50
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Bianchi G, Kyle RA, Larson DR, Witzig TE, Kumar S, Dispenzieri A, Morice WG, Rajkumar SV. High levels of peripheral blood circulating plasma cells as a specific risk factor for progression of smoldering multiple myeloma. Leukemia 2012; 27:680-5. [PMID: 22902364 PMCID: PMC3597230 DOI: 10.1038/leu.2012.237] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Smoldering multiple myeloma (SMM) carries a 50% risk of progression to multiple myeloma (MM) or related malignancy within the first 5 years following diagnosis. The goal of this study was to determine if high levels of circulating plasma cells (PCs) are predictive of SMM transformation within the first 2–3 years from diagnosis. Ninety-one patients diagnosed with SMM at Mayo Clinic from January 1994 through January 2007 who had testing for circulating PCs using an immunofluorescent assay and adequate follow up to ascertain disease progression, were studied. High level of circulating PCs was defined as absolute peripheral blood PCs >5000 ×106/L and/or > 5% cytoplasmic immunoglobulin (Ig) positive PCs per 100 peripheral blood mononuclear cells. Patients with high circulating PCs (14 of 91 patients, 15%) were significantly more likely to progress to active disease within 2 years compared with patients without high circulating PCs, 71% versus 25%, respectively, P=0.001. Corresponding rates for progression within 3 years were 86% versus 35%, respectively, P<0.001. Overall survival (OS) after both SMM diagnosis and MM diagnosis was also significantly different. High levels of circulating PCs identify SMM patients with an elevated risk of progression within the first 2 to 3 years following diagnosis.
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Affiliation(s)
- G Bianchi
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
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