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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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2
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Suresh S, Kandasamy M, Karthick Kumar S, Pugazhenthiran N. Investigation of Optical Properties and Photovoltaic Performance of Solid-State Dye-Sensitized Solar Cells Comprised of Photoanodes of Titanium Dioxide Nanoparticles Calcinated at Different Temperatures. Results in Chemistry 2023. [DOI: 10.1016/j.rechem.2023.100898] [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: 03/14/2023] Open
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3
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Pugazhenthiran N, Sathishkumar P, Albormani O, Murugesan S, Kandasamy M, Selvaraj M, Suresh S, Kumar SK, Contreras D, Váldes H, Mangalaraja RV. Silver nanoparticles modified ZnO nanocatalysts for effective degradation of ceftiofur sodium under UV-vis light illumination. Chemosphere 2023; 313:137515. [PMID: 36495978 DOI: 10.1016/j.chemosphere.2022.137515] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 11/14/2022] [Accepted: 12/07/2022] [Indexed: 06/17/2023]
Abstract
Light-induced photocatalytic degradation of ceftiofur sodium (CFS) has been assessed in the presence of plasmonic zinc oxide nanostructures (ZnONSTs), like, ZnO nanoparticles, ZnO nanorods (ZnONRs) and ZnO nanoflowers (ZnONFs). Silver nanoparticles (Ag NPs) loaded ZnO nanostructures (Ag-ZnONSTs) are obtained through seed-assisted chemical reaction followed by chemical reduction of silver. The surface modification of ZnO nanostructures by Ag NPs effectually altered their optical properties. Further, the surface plasmonic effect of Ag NPs facilitates visible light absorption by ZnONSTs and improved the photogenerated electron and hole separation, which makes the ZnONSTs a more active photocatalyst than TiO2 (P25) nanoparticles. Especially, Ag-ZnONRs showed higher CFS oxidation rate constant (k' = 4.6 × 10-4 s-1) when compared to Ag-ZnONFs (k' = 2.8 × 10-4 s-1) and Ag-ZnONPs (k' = 2.5 × 10-4 s-1), owing to their high aspect ratio (60:1). The unidirectional transport of photogenerated charge carriers on the Ag-ZnONRs may be accountable for the observed high photocatalytic oxidation of CFS. The photocatalytic oxidation of CFS mainly proceeds through •OH radicals generated on the Ag-ZnONRs surface under light illumination. In addition, heterogeneous activation of peroxymonosulfate by Ag-ZnONRs accelerates the rate of photocatalytic mineralization of CFS. The quantification of oxidative radicals supports the proposed CFS oxidation mechanism. Stability studies of plasmonic Ag-ZnONSTs strongly suggests that it could be useful to clean large volume of pharmaceutical wastewater under direct solar light irradiation.
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Affiliation(s)
- N Pugazhenthiran
- Laboratorio de Fotoquímica y Fotofísica, Departamento de Química, Universidad Técnica Federico Santa María, Campus Casa Central, Av. España 1680, Valparaíso, Chile.
| | - P Sathishkumar
- Department of Chemistry, School of Advanced Sciences, Vellore Institute of Technology (VIT), Vellore, 632 014, India
| | - Omeer Albormani
- Department of Chemistry, Faculty of Science, King Khalid University, Abha-61413, Saudi Arabia
| | - S Murugesan
- Department of Inorganic Chemistry, School of Chemistry Madurai Kamaraj University, Madurai-625021, Tamil Nadu, India.
| | - M Kandasamy
- Department of Chemistry, K. Ramakrishnan College of Technology, Tiruchirappalli-621 112, Tamil Nadu, India
| | - M Selvaraj
- Department of Chemistry, Faculty of Science, King Khalid University, Abha-61413, Saudi Arabia.
| | - S Suresh
- PG & Research Department of Physics, Sri Vidya Mandir Arts & Science College (Autonomous), Katteri-636 902, Uthangarai, Tamil Nadu, India
| | - S Karthick Kumar
- Department of Physics, Sethu Institute of Technology, Kariapatti-626115, Virudhunagar, Tamil Nadu, India
| | - D Contreras
- Department of Analytical and Inorganic Chemistry, Faculty of Chemical Sciences, University of Concepcion, Concepcion 4070409, Chile
| | - H Váldes
- Laboratorio de Tecnologías Limpias, Facultad de Ingeniería, Universidad Católica de la Santísima Concepción, Concepción, Chile
| | - R V Mangalaraja
- Faculty of Engineering and Science, Universidad Adolfo Ibáñez, Diagonal las Torres 2640, Peñalolén, Santiago, Chile
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4
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Arumugam J, Thambidurai S, Suresh S, Selvapandiyan M, Kandasamy M, Pugazhenthiran N, Karthick Kumar S, Muneeswaran T, Quero F. Green synthesis of zinc oxide nanoparticles using Ficus carica leaf extract and their bactericidal and photocatalytic performance evaluation. Chem Phys Lett 2021. [DOI: 10.1016/j.cplett.2021.139040] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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5
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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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6
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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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Kalaiyan G, Suresh S, Thambidurai S, Prabu K, Kumar SK, Pugazhenthiran N, Kandasamy M. Green synthesis of hierarchical copper oxide microleaf bundles using Hibiscus cannabinus leaf extract for antibacterial application. J Mol Struct 2020. [DOI: 10.1016/j.molstruc.2020.128379] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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9
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Kurzrock R, Gurski LA, Carlson RW, Ettinger DS, Horwitz SM, Kumar SK, Million L, von Mehren M, Benson AB. Level of evidence used in recommendations by the National Comprehensive Cancer Network (NCCN) guidelines beyond Food and Drug Administration approvals. Ann Oncol 2019; 30:1647-1652. [PMID: 31373348 PMCID: PMC6857604 DOI: 10.1093/annonc/mdz232] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND A previous analysis of 113 National Comprehensive Cancer Network® (NCCN®) recommendations reported that NCCN frequently recommends beyond Food and Drug Administration (FDA)-approved indications (44 off-label recommendations) and claimed that the evidence for these recommendations was weak. METHODS In order to determine the strength of the evidence, we carried out an in-depth re-analysis of the 44 off-label recommendations listed in the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). RESULTS Of the 44 off-label recommendations, 14 were later approved by the FDA and/or are supported by randomized controlled trial (RCT) data. In addition, 13 recommendations were either very minor extrapolations from the FDA label (n = 8) or were actually on-label (n = 5). Of the 17 remaining extrapolations, 8 were for mechanism-based agents applied in rare cancers or subsets with few available treatment options (median response rate = 43%), 7 were based on non-RCT data showing significant efficacy (>50% response rates), and 2 were later removed from the NCCN Guidelines because newer therapies with better activity and/or safety became available. CONCLUSION Off-label drug use is a frequent component of care for patients with cancer in the United States. Our findings indicate that when the NCCN recommends beyond the FDA-approved indications, the strength of the evidence supporting such recommendations is robust, with a significant subset of these drugs later becoming FDA approved or supported by RCT. Recommendations without RCT data are often for mechanism-based drugs with high response rates in rare cancers or subsets without effective therapies.
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Affiliation(s)
- R Kurzrock
- Center for Personalized Cancer Therapy, University of California San Diego, Moores Cancer Center, San Diego, USA.
| | - L A Gurski
- National Comprehensive Cancer Network, Plymouth Meeting, Pennsylvania, USA
| | - R W Carlson
- National Comprehensive Cancer Network, Plymouth Meeting, Pennsylvania, USA; Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA; Stanford Cancer Institute, Stanford, California, USA
| | - D S Ettinger
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland, USA
| | - S M Horwitz
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - S K Kumar
- Mayo Clinic Cancer Center, Rochester, Minnesota, USA
| | - L Million
- Stanford Cancer Institute, Stanford, California, USA
| | - M von Mehren
- Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - A B Benson
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois, USA
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Chim CS, Kumar SK, Orlowski RZ, Cook G, Richardson PG, Gertz MA, Giralt S, Mateos MV, Leleu X, Anderson KC. Correction: Management of relapsed and refractory multiple myeloma: novel agents, antibodies, immunotherapies and beyond. Leukemia 2019; 33:1058-1059. [PMID: 30842604 PMCID: PMC7608453 DOI: 10.1038/s41375-019-0410-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- C S Chim
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Hong Kong.
| | - S K Kumar
- Department of Medicine, Mayo Clinic at Rochester, Rochester, MN, USA
| | - R Z Orlowski
- Department of Lymphoma/Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - G Cook
- Haematology & Myeloma Studies, Section of Experimental Haematology, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - P G Richardson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - M A Gertz
- Department of Medicine, Mayo Clinic at Rochester, Rochester, MN, USA
| | - S Giralt
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - M V Mateos
- Department of Haematology, University Hospital of Salamanca, Salamanca, Spain
| | - X Leleu
- Hopital La Mileterie, part of the Academic Hospital of Poitiers (CHU), Poitiers, France
| | - K C Anderson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
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Chim CS, Kumar SK, Orlowski RZ, Cook G, Richardson PG, Gertz MA, Giralt S, Mateos MV, Leleu X, Anderson KC. Management of relapsed and refractory multiple myeloma: novel agents, antibodies, immunotherapies and beyond. Leukemia 2018; 32:252-262. [PMID: 29257139 PMCID: PMC5808071 DOI: 10.1038/leu.2017.329] [Citation(s) in RCA: 213] [Impact Index Per Article: 35.5] [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: 08/02/2017] [Revised: 10/09/2017] [Accepted: 11/06/2017] [Indexed: 02/06/2023]
Abstract
Despite enormous advances, management of multiple myeloma (MM) remains challenging. Multiple factors impact the decision to treat or which regimen to use at MM relapse/progression. Recent major randomized controlled trials (RCTs) showed widely varying progression-free survivals (PFS), ranging from a median of 4 months (MM-003) to 23.6 months (ASPIRE). Based on these RCTs, next-generation proteasome inhibitors (carfilzomib and ixazomib), next-generation immunomodulatory agent (pomalidomide), and monoclonal antibodies (elotuzumab and daratumumab) were approved for relapsed and refractory MM. Daratumumab, targeting CD38, has multiple mechanisms of action including modulation of the immunosuppressive bone marrow micro-environment. In addition to the remarkable single agent activity in refractory MM, daratumumab produced deep responses and superior PFS in MM when combined with lenalidomide/dexamethasone, or bortezomib/dexamethasone. Other anti-CD38 antibodies, such as isatuximab and MOR202, are undergoing assessment. Elotuzumab, targeting SLAMF7, yielded superior response rates and PFS when combined with lenalidomide/dexamethasone. New combinations of these next generation novel agents and/or antibodies are undergoing clinical trials. Venetoclax, an oral BH3 mimetic inhibiting BCL2, showed single agent activity in MM with t(11;14), and is being studied in combination with bortezomib/dexamethasone. Selinexor, an Exportin-1 inhibitor, yielded promising results in quad- or penta-refractory MM including patients resistant to daratumumab. Pembrolizumab, an anti-PD1 check-point inhibitor, is being tested in combination with lenalidomide/dexamethasone or pomalidomide/dexamethasone. Chimeric antigen receptor-T cells targeting B-cell maturation antigen have yielded deep responses in RRMM. Finally, salvage autologous stem cell transplantation (ASCT) remains an important treatment in MM relapsing/progressing after a first ASCT. Herein, the clinical trial data of these agents are summarized, cautious interpretation of RCTs highlighted, and algorithm for salvage treatment of relapse/refractory MM proposed.
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Affiliation(s)
- C S Chim
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Hong Kong
| | - S K Kumar
- Department of Medicine, Mayo Clinic at Rochester, Rochester, MN, USA
| | - R Z Orlowski
- Department of Lymphoma/Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - G Cook
- Haematology & Myeloma Studies, Section of Experimental Haematology, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - P G Richardson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - M A Gertz
- Department of Medicine, Mayo Clinic at Rochester, Rochester, MN, USA
| | - S Giralt
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - M V Mateos
- Department of Haematology, University Hospital of Salamanca, Salamanca, Spain
| | - X Leleu
- Hopital La Mileterie, part of the Academic Hospital of Poitiers (CHU), France
| | - K C Anderson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
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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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13
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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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14
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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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15
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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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16
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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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17
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Kumar SK, Trujillo PB, Ucros GR. Positron emission mammography is a useful adjunct in assessment of dense breasts. Med J Malaysia 2017; 72:138-140. [PMID: 28473683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Worldwide breast cancer remains as the most common malignancy in women and the numbers who form a subgroup with dense breast parenchyma are substantial. In addition to mammography, the adjuncts used for further evaluation of dense breasts have been anatomically based modalities such as ultrasound and magnetic resonance imaging. The practice of functionally based imaging of breasts is relatively new but has undergone rapid progress over the past few years with promising results. The value of positron emission mammography is demonstrated in patients with dense breasts and mammographically occult disease.
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Affiliation(s)
- S K Kumar
- National Cancer Centre, Department of Oncologic Imaging, Singapore.
| | - P B Trujillo
- Nuclear Medicine & PET, Department of Nuclear Medicine Santa Fe de Bogotá, Bogotá, Colombia
| | - G R Ucros
- Hospital Universitario Fundacion Santa Fe de Bogotá, Bogotá, Cundinamarca, Columbia
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18
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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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19
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Singh P, Saha T, Mishra P, Parai MK, Ireddy S, Lavanya Kumar M S, Krishna S, Kumar SK, Chaturvedi V, Sinha S, Siddiqi MI, Panda G. Additional synthesis on thiophene-containing trisubstituted methanes (TRSMs) as inhibitors of M. tuberculosis and 3D-QSAR studies. SAR QSAR Environ Res 2016; 27:911-937. [PMID: 27885861 DOI: 10.1080/1062936x.2016.1243575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 09/28/2016] [Indexed: 05/28/2023]
Abstract
We earlier reported thiophene-containing trisubstituted methanes (TRSMs) as novel cores carrying anti-tubercular activity, and identified S006-830 as the phenotypic lead with potent bactericidal activity against single- and multi-drug resistant clinical isolates of Mycobacterium tuberculosis (M. tb). In this work, we carried out additional synthesis of several TRSMs. The reaction scheme essentially followed the Grignard reaction and Friedel-Crafts alkylation, followed by insertion of a dialkylaminoethyl chain. We also performed microbiological evaluations including in vitro screening against the virulent strain M. tb H37Rv, cytotoxicity assessment in the Vero C-1008 cell line, and 3D-QSAR studies with comparative molecular field analysis (CoMFA) and comparative molecular similarity index analysis (CoMSIA). CoMFA and CoMSIA models yielded good statistical results in terms of q2 and r2 values, suggesting the validity of the models. It was concluded that a para-substituted benzene ring with bulkier electron-donating groups and aminoalkyl chains are required for higher inhibitory capacity against M. tuberculosis. We believe that these insights will rationally guide the design of newer, optimal, TRSMs.
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Affiliation(s)
- P Singh
- a Institut des Biomolécules Max Mousseron , Montpellier , France
- b Medicinal and Process Chemistry Division , CSIR-Central Drug Research Institute , Lucknow , India
| | - T Saha
- b Medicinal and Process Chemistry Division , CSIR-Central Drug Research Institute , Lucknow , India
| | - P Mishra
- b Medicinal and Process Chemistry Division , CSIR-Central Drug Research Institute , Lucknow , India
| | - M K Parai
- b Medicinal and Process Chemistry Division , CSIR-Central Drug Research Institute , Lucknow , India
| | - S Ireddy
- b Medicinal and Process Chemistry Division , CSIR-Central Drug Research Institute , Lucknow , India
| | - S Lavanya Kumar M
- b Medicinal and Process Chemistry Division , CSIR-Central Drug Research Institute , Lucknow , India
| | - S Krishna
- c Molecular and Structural Biology Division , CSIR-Central Drug Research Institute , Lucknow , India
| | - S K Kumar
- d Biochemistry Division , CSIR-Central Drug Research Institute , Lucknow , India
| | - V Chaturvedi
- d Biochemistry Division , CSIR-Central Drug Research Institute , Lucknow , India
| | - S Sinha
- d Biochemistry Division , CSIR-Central Drug Research Institute , Lucknow , India
| | - M I Siddiqi
- c Molecular and Structural Biology Division , CSIR-Central Drug Research Institute , Lucknow , India
| | - G Panda
- b Medicinal and Process Chemistry Division , CSIR-Central Drug Research Institute , Lucknow , India
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20
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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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21
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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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22
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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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23
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Choi BR, Kumar SK, Zhao C, Zhang LT, Kim CY, Lee SW, Jeon JH, So I, Kim SH, Park NC, Kum HK, Park JK. Additive effects of Artemisia capillaris extract and scopoletin on the relaxation of penile corpus cavernosum smooth muscle. Int J Impot Res 2016; 28:80. [PMID: 26965159 DOI: 10.1038/ijir.2016.1] [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: 11/09/2022]
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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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25
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Choi BR, Kumar SK, Zhao C, Zhang LT, Kim CY, Lee SW, Jeon JH, Soní KK, So I, Kim SH, Park NC, Kim HK, Park JK. Additive effects of Artemisia capillaris extract and scopoletin on the relaxation of penile corpus cavernosum smooth muscle. Int J Impot Res 2015; 27:225-32. [PMID: 26447600 DOI: 10.1038/ijir.2015.23] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Revised: 06/07/2015] [Accepted: 07/30/2015] [Indexed: 11/09/2022]
Abstract
The objective was to investigate the cellular effect and action mechanism of Artemisia capillaris extract (ACE) and its component, scopoletin, on penile corpus cavernosum smooth muscle (PCCSM). In vitro study with PCCSM, the precontracted PCCSM with phenylephrine was treated with ACE or scopoletin. Cyclic nucleotides in the perfusate were measured by radioimmunoassay and expression of protein and mRNA of endothelial nitric oxide synthase (eNOS) and neuronal nitric oxide synthase in the perfused PCCSM were measured by western blot and real-time PCR, respectively. The interaction of ACE or scopoletin with udenafil was also evaluated. ACE and scopoletin exerted a significant and concentration-dependent relaxation in PCCSM. The perfusion with ACE or scopoletin significantly increased cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP) and the perfusion with ACE or scopoletin increased the expression of eNOS mRNA and protein. Furthermore, ACE or scopoletin enhanced udenafil-inducing relaxation in PCCSM. ACE and scopoletin relaxed the PCCSM mainly by activating nitric oxide-cGMP system and cAMP pathway and they may be additive therapeutic candidates for ED patients who do not completely respond to udenafil.
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Affiliation(s)
- B R Choi
- Department of Urology, Chonbuk National University and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute and Clinical Trial Center of Medical Device of Chonbuk National University, Jeonju, Republic of Korea
| | - S K Kumar
- Department of Urology, Chonbuk National University and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute and Clinical Trial Center of Medical Device of Chonbuk National University, Jeonju, Republic of Korea
| | - C Zhao
- Department of Urology, Renji Hospital, Jiao Tong University School of Medicine, and Shanghai Institute of Andrology, Shanghai, China
| | - L T Zhang
- Department of Urology, Chonbuk National University and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute and Clinical Trial Center of Medical Device of Chonbuk National University, Jeonju, Republic of Korea
| | - C Y Kim
- Department of Pharmacognosy, Hangyang University, Ansan, Republic of Korea
| | - S W Lee
- Department of Urology, Sungkyunkwan University Medical School, Seoul, Republic of Korea
| | - J-H Jeon
- Department of Physiology, Seoul National University Medical School, Seoul, Republic of Korea
| | | | - I So
- Department of Physiology, Seoul National University Medical School, Seoul, Republic of Korea
| | - S H Kim
- Department of Physiology, Diabetic Research Center, Chonbuk National University Medical School, Jeonju, Republic of Korea
| | - N C Park
- Department of Urology, Pusan National University Hospital, Busan, Republic of Korea
| | - H K Kim
- Department of Urology, Chonbuk National University and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute and Clinical Trial Center of Medical Device of Chonbuk National University, Jeonju, Republic of Korea
| | - J K Park
- Department of Urology, Chonbuk National University and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute and Clinical Trial Center of Medical Device of Chonbuk National University, Jeonju, Republic of Korea
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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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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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28
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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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30
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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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31
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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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32
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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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Crawford MK, Smalley RJ, Cohen G, Hogan B, Wood B, Kumar SK, Melnichenko YB, He L, Guise W, Hammouda B. Chain conformation in polymer nanocomposites with uniformly dispersed nanoparticles. Phys Rev Lett 2013; 110:196001. [PMID: 23705720 DOI: 10.1103/physrevlett.110.196001] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Indexed: 05/28/2023]
Abstract
The effect of nanoparticles (NP) on chain dimensions in polymer melts has been the source of considerable theoretical and experimental controversy. We exploit our ability to ensure a spatially uniform dispersion of 13 nm silica NPs miscible in polystyrene melts, together with neutron scattering, x-ray scattering, and transmission electron microscopy, to show that there is no measurable change in the polymer size in miscible mixtures, regardless of the relative sizes of the chains and the nanoparticles, and for NP loadings as high as 32.7 vol%. Our results provide a firm basis from which to understand the properties of polymer nanocomposites.
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Affiliation(s)
- M K Crawford
- DuPont Central Research and Development, E400/5424, Wilmington, Delaware 19880-0400, USA
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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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35
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Fernández de Larrea C, Kyle RA, Durie BGM, Ludwig H, Usmani S, Vesole DH, Hajek R, San Miguel JF, Sezer O, Sonneveld P, Kumar SK, Mahindra A, Comenzo R, Palumbo A, Mazumber A, Anderson KC, Richardson PG, Badros AZ, Caers J, Cavo M, LeLeu X, Dimopoulos MA, Chim CS, Schots R, Noeul A, Fantl D, Mellqvist UH, Landgren O, Chanan-Khan A, Moreau P, Fonseca R, Merlini G, Lahuerta JJ, Bladé J, Orlowski RZ, Shah JJ. Plasma cell leukemia: consensus statement on diagnostic requirements, response criteria and treatment recommendations by the International Myeloma Working Group. Leukemia 2012; 27:780-91. [PMID: 23288300 DOI: 10.1038/leu.2012.336] [Citation(s) in RCA: 229] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Plasma cell leukemia (PCL) is a rare and aggressive variant of myeloma characterized by the presence of circulating plasma cells. It is classified as either primary PCL occurring at diagnosis or as secondary PCL in patients with relapsed/refractory myeloma. Primary PCL is a distinct clinic-pathological entity with different cytogenetic and molecular findings. The clinical course is aggressive with short remissions and survival duration. The diagnosis is based upon the percentage (≥ 20%) and absolute number (≥ 2 × 10(9)/l) of plasma cells in the peripheral blood. It is proposed that the thresholds for diagnosis be re-examined and consensus recommendations are made for diagnosis, as well as, response and progression criteria. Induction therapy needs to begin promptly and have high clinical activity leading to rapid disease control in an effort to minimize the risk of early death. Intensive chemotherapy regimens and bortezomib-based regimens are recommended followed by high-dose therapy with autologous stem cell transplantation if feasible. Allogeneic transplantation can be considered in younger patients. Prospective multicenter studies are required to provide revised definitions and better understanding of the pathogenesis of PCL.
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Affiliation(s)
- C Fernández de Larrea
- Amyloidosis and Myeloma Unit, Department of Hematology, IDIBAPS, Hospital Clinic de Barcelona, Barcelona, Spain.
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Sinha S, Lacy M, Mikhael J, Hayman S, Buadi F, Detweiler-Short K, Dispenzieri A, Gertz M, Dingli D, Rajkumar SV, Kumar SK. Response to salvage therapies and outcome in patients with multiple myeloma relapsing after pomalidomide therapy. Leukemia 2011; 26:839-41. [PMID: 21986842 DOI: 10.1038/leu.2011.279] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Kumar SK, Lee JH, Lahuerta JJ, Morgan G, Richardson PG, Crowley J, Haessler J, Feather J, Hoering A, Moreau P, LeLeu X, Hulin C, Klein SK, Sonneveld P, Siegel D, Bladé J, Goldschmidt H, Jagannath S, Miguel JS, Orlowski R, Palumbo A, Sezer O, Rajkumar SV, Durie BGM. Risk of progression and survival in multiple myeloma relapsing after therapy with IMiDs and bortezomib: a multicenter international myeloma working group study. Leukemia 2011; 26:149-57. [PMID: 21799510 DOI: 10.1038/leu.2011.196] [Citation(s) in RCA: 593] [Impact Index Per Article: 45.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Promising new drugs are being evaluated for treatment of multiple myeloma (MM), but their impact should be measured against the expected outcome in patients failing current therapies. However, the natural history of relapsed disease in the current era remains unclear. We studied 286 patients with relapsed MM, who were refractory to bortezomib and were relapsed following, refractory to or ineligible to receive, an IMiD (immunomodulatory drug), had measurable disease, and ECOG PS of 0, 1 or 2. The date patients satisfied the entry criteria was defined as time zero (T(0)). The median age at diagnosis was 58 years, and time from diagnosis to T(0) was 3.3 years. Following T(0), 213 (74%) patients had a treatment recorded with one or more regimens (median=1; range 0-8). The first regimen contained bortezomib in 55 (26%) patients and an IMiD in 70 (33%). A minor response or better was seen to at least one therapy after T(0) in 94 patients (44%) including ≥ partial response in 69 (32%). The median overall survival and event-free survival from T(0) were 9 and 5 months, respectively. This study confirms the poor outcome, once patients become refractory to current treatments. The results provide context for interpreting ongoing trials of new drugs.
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Affiliation(s)
- S K Kumar
- Divison of Hematology, Mayo Clinic, Rochester, MN 55905, USA.
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38
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Gertz MA, Gastineau DA, Lacy MQ, Dispenzieri A, Hayman SR, Kumar SK, Dingli D, Leung N, Wolf RC, Hogan WJ, Buadi FK. SCT without growth factor in multiple myeloma: engraftment kinetics, bacteremia and hospitalization. Bone Marrow Transplant 2010; 46:956-61. [PMID: 20972466 DOI: 10.1038/bmt.2010.233] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
SCT is important in the management of multiple myeloma. In the United States, the standard of care is administration of growth factors to accelerate neutrophil recovery after SCT. The need for growth factors after transplant has not been investigated recently. We analyzed a cohort of 166 patients at our institution who underwent autologous transplant for multiple myeloma without receiving growth factors after transplant and compared them with 498 patients who received standard filgrastim beginning on posttransplant day 5. A neutrophil count of 500/μL was achieved in a median of 12.5 days in patients receiving growth factor, compared with 13.5 days in those not receiving growth factor (P<0.001). Platelet engraftment was identical (median, 14.5 days; P=0.12) in both groups, despite a lower median number of CD34+ cells infused in patients who did not receive growth factors. Incidence of nonstaphylococcal bacteremia was identical in both groups. The median hospital stay was 3.5 days shorter in the group not receiving growth factor. It is feasible and reasonable to perform autologous SCT for multiple myeloma without administering growth factors.
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Affiliation(s)
- M A Gertz
- Division of Hematology, Rochester, MN 55905, USA.
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39
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Kumar SK, Flinn I, Noga SJ, Hari P, Rifkin R, Callander N, Bhandari M, Wolf JL, Gasparetto C, Krishnan A, Grosman D, Glass J, Sahovic EA, Shi H, Webb IJ, Richardson PG, Rajkumar SV. Bortezomib, dexamethasone, cyclophosphamide and lenalidomide combination for newly diagnosed multiple myeloma: phase 1 results from the multicenter EVOLUTION study. Leukemia 2010; 24:1350-6. [PMID: 20508619 DOI: 10.1038/leu.2010.116] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This phase 1 study (Clinicaltrials.gov: NCT00507442) was conducted to determine the maximum tolerated dose (MTD) of cyclophosphamide in combination with bortezomib, dexamethasone and lenalidomide (VDCR) and to assess the safety and efficacy of this combination in untreated multiple myeloma patients. Cohorts of three to six patients received a cyclophosphamide dosage of 100, 200, 300, 400 or 500 mg/m(2) (on days 1 and 8) plus bortezomib 1.3 mg/m(2) (on days 1, 4, 8 and 11), dexamethasone 40 mg (on days 1, 8 and 15) and lenalidomide 15 mg (on days 1-14), for eight 21-day induction cycles, followed by four 42-day maintenance cycles (bortezomib 1.3 mg/m(2), on days 1, 8, 15 and 22). The MTD was the cyclophosphamide dose below which more than one of six patients experienced a dose-limiting toxicity (DLT). Twenty-five patients were treated. Two DLTs were seen, of grade 4 febrile neutropenia (cyclophosphamide 400 mg/m(2)) and grade 4 herpes zoster despite anti-viral prophylaxis (cyclophosphamide 500 mg/m(2)). No cumulative hematological toxicity or thromboembolic episodes were reported. The overall response rate was 96%, including 20% stringent complete response (CR), 40% CR/near-complete response and 68% >or=very good partial response. VDCR is well tolerated and highly active in this population. No MTD was reached; the recommended phase 2 cyclophosphamide dose in VDCR is 500 mg/m(2), which was the highest dose tested.
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Affiliation(s)
- S K Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN 55905, USA.
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40
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Dingli D, Tan TS, Kumar SK, Buadi FK, Dispenzieri A, Hayman SR, Lacy MQ, Gastineau DA, Hogan WJ, Gertz MA. Stem cell transplantation in patients with autonomic neuropathy due to primary (AL) amyloidosis. Neurology 2010; 74:913-8. [PMID: 20231668 DOI: 10.1212/wnl.0b013e3181d55f4d] [Citation(s) in RCA: 27] [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] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Patients with AL amyloidosis can benefit from high-dose chemotherapy and autologous stem cell transplantation (ASCT). Transplantation can be challenging due to fluid shifts, sepsis, and cardiac dysrhythmias. Amyloidosis may present with autonomic neuropathy (AN) that renders peritransplant care problematic. The purpose of this study was to determine the outcome of patients with AN during and after ASCT. METHODS We performed a case-control study of patients with AL amyloidosis with associated AN and compared them to a large matched cohort without AN who also underwent ASCT. RESULTS We identified 13 patients with AN who underwent ASCT and a matched control group of 95 patients without AN. Patients with AN had more organs involved (median 2.5 vs 1, p < 0.001) and the conditioning dose of melphalan was often reduced by 30% compared to controls without AN (p = 0.0015). Median duration of hospitalization was similar for both cohorts, as were engraftment kinetics. Atrial fibrillation occurred in all patients with AN but in only 1 control patient (p < 0.0001). Median overall survival (OS) for patients with AN was 29 months but >60 months for controls (p < 0.0001). On univariate analysis, cardiac involvement (p = 0.0132), AN (p = 0.0011), glomerular filtration rate (p = 0.038), number of organs involved (p = 0.0064), and NT-pro-BNP (p = 0.039) all had an impact on OS. On multivariate analysis, AN retained an independent adverse impact on OS. CONCLUSIONS Patients with autonomic neuropathy secondary to AL amyloidosis can undergo autologous stem cell transplantation with relative safety. Autonomic neuropathy is an independent, adverse determinant of survival in these patients.
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Affiliation(s)
- D Dingli
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA.
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41
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Gertz MA, Kumar SK, Lacy MQ, Dispenzieri A, Hayman SR, Buadi FK, Dingli D, Gastineau DA, Winters JL, Litzow MR. Comparison of high-dose CY and growth factor with growth factor alone for mobilization of stem cells for transplantation in patients with multiple myeloma. Bone Marrow Transplant 2008; 43:619-25. [PMID: 18997825 DOI: 10.1038/bmt.2008.369] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
We retrospectively analyzed outcomes of 716 patients with multiple myeloma who were mobilized using CY and growth factor (n=370) or growth factor alone (n=346) before SCT. Patients receiving CY had higher stem cell yields than the growth factor only group (median number of apheresis sessions needed to achieve stem cell collection goals, two vs four sessions, respectively (P=0.001)). However, patients treated with CY required more time for engraftment of platelets and neutrophils (P<0.001 for both). For patients receiving CY, 75% achieved engraftment (defined as a platelet count of 50 x 10(9)/l) by day 39, whereas 75% of patients not receiving CY achieved engraftment by day 18. Similar results were observed for neutrophil engraftment. These differences did not affect the duration of hospitalization, but patients treated with CY had a higher incidence of post transplant nonstaphylococcal bacteremia. For CY-mobilized patients, considerably faster platelet engraftment (5 fewer days) resulted if stem cell reinfusion occurred more than 30 days after the first apheresis session. Our data suggested that CY damaged the microenvironment and slowed engraftment. By lengthening the period between the completion of apheresis and stem cell reinfusion, the microenvironment may recover and result in faster engraftment.
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Affiliation(s)
- M A Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN 55905, USA.
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42
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Gertz MA, Lacy MQ, Dispenzieri A, Hayman SR, Kumar SK, Leung N, Gastineau DA. Transplantation without growth factor: engraftment kinetics after stem cell transplantation for primary systemic amyloidosis (AL). Bone Marrow Transplant 2007; 40:989-93. [PMID: 17846598 DOI: 10.1038/sj.bmt.1705848] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Stem cell transplantation is increasingly used in the management of immunoglobulin light-chain amyloidosis (AL). It is considered the standard of care to administer growth factors to accelerate neutrophil recovery after transplantation. However, unique toxicities occur with growth factor use in patients with AL who receive a stem cell transplant. We report a cohort of patients who underwent transplantation without receiving posttransplantation growth factors. In total, 282 patients received a stem cell transplant. A neutrophil count of 500/mul was achieved in 50, 75 and 90% of patients at 14, 16 and 22 days, respectively. A platelet count of 20 000/mul was achieved in 50, 75 and 90% of patients at 14, 20 and 31 days, respectively. Non-staphylococcal bacteremia was detected in 16% of patients. The median hospital stay was 9 days. It is feasible and reasonable to withhold growth factor therapy after autologous stem cell transplantation in patients with AL.
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Affiliation(s)
- M A Gertz
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN 55905, USA.
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Abstract
Multiple myeloma (MM) is a disease of the elderly with a median age at diagnosis of 67 years in a referral population. High-dose chemotherapy (HDT) and autologous stem cell transplantation has been shown to improve survival in patients with MM in randomized trials and remains the preferred option for eligible patients. However, the randomized clinical trials demonstrating an advantage for HDT included only patients younger than 65 years and evidence supporting its role for the elderly patients has been based on retrospective reviews. The introduction of thalidomide, lenalidomide and bortezomib has changed the paradigm for treatment of myeloma and improved the outcome for these patients. Several ongoing clinical trials are evaluating the role of these novel agents in this population, specifically comparing these to HDT-based approaches. Other trials are examining the role of maintenance therapy post-HDT with these novel drugs with or without steroids. The role of HDT will be further redefined in the coming years with improvements in other therapies.
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Affiliation(s)
- S K Kumar
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
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Peng XH, Alizadeh A, Bhate N, Varanasi KK, Kumar SK, Nayak SK. First-principles investigation of strain effects on the energy gaps in silicon nanoclusters. J Phys Condens Matter 2007; 19:266212. [PMID: 21694089 DOI: 10.1088/0953-8984/19/26/266212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
First-principles density functional calculations were performed to study strain effects on the energy gaps in silicon nanoclusters with diameter ranging from 0.6 to 2 nm. Hydrostatic and non-hydrostatic strains have been found to affect the energy gaps differently. For the same strain energy density, non-hydrostatic strain leads to a significantly larger change in the energy gap of silicon clusters compared to that of the hydrostatic strain case. In contrast, hydrostatic and non-hydrostatic strain effects on the energy gaps of bulk Si or larger size Si quantum dots are comparable. Non-hydrostatic strains break the tetrahedral bonding symmetry in silicon, resulting in significant variation in the energy gaps due to the splitting of the degenerate orbitals in the clusters. Our results suggest that the combination of energy gaps and strains permits the engineering of photoluminescence in silicon nanoclusters and offers the possibility of designing novel optical devices and chemical sensors.
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Affiliation(s)
- X-H Peng
- General Electric Global Research Center, Niskayuna, NY 12309, USA. Department of Physics, Applied Physics and Astronomy, Rensselaer Polytechnic Institute, Troy, NY 12180, USA
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Timm MM, Kimlinger TK, Haug JL, Kline MP, Greipp PR, Rajkumar SV, Kumar SK. Thymoglobulin targets multiple plasma cell antigens and has in vitro and in vivo activity in multiple myeloma. Leukemia 2006; 20:1863-9. [PMID: 16932343 DOI: 10.1038/sj.leu.2404359] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Multiple myeloma is characterized by the proliferation of clonal plasma cells that have a heterogeneous expression of various cell surface markers, precluding successful use of monoclonal antibodies for therapeutic targeting of the tumor cell. Thymoglobulin (rabbit-derived polyclonal anti-thymocyte globulin), by virtue of its method of preparation, contains antibodies against several B-cell and plasma cell antigens and offers an attractive option for immunotherapy of myeloma. Here, we demonstrate potent anti-myeloma activity of the rabbit anti-thymocyte globulin preparation Thymoglobulin in vitro and in vivo in an animal model of myeloma. Thymoglobulin was able to induce dose- and time-dependent apoptosis of several myeloma cell lines, including those resistant to conventional anti-myeloma agents. Importantly, the anti-myeloma activity was preserved even when myeloma cells were grown with different cytokines demonstrating the ability to overcome microenvironment-mediated resistance. Thymoglobulin induced apoptosis of freshly isolated primary myeloma cells from patients. Using a competitive flow cytometric analysis, we were able to identify the potential antigen targets for Thymoglobulin preparation. Finally, in a plasmacytoma mouse model of myeloma, Thymoglobulin delayed the tumor growth in a dose-dependent manner providing convincing evidence for continued evaluation of this agent in the clinic in patients with myeloma, either alone or in combination with other agents.
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Affiliation(s)
- M M Timm
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN 55905, USA
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46
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Prasad S, Mathur A, Jaggi M, Sharma R, Gupta N, Reddy VR, Sudhakar G, Kumar SU, Kumar SK, Kunwar AC, Chakraborty TK. Furanoid sugar amino acids as dipeptide mimics in design of analogs of vasoactive intestinal peptide receptor binding inhibitor. ACTA ACUST UNITED AC 2005; 66:75-84. [PMID: 16000121 DOI: 10.1111/j.1399-3011.2005.00275.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
In this study we describe the development of peptidomimetic analogs of the potent vasoactive intestinal peptide receptor binding inhibitor, Leu(1) -Met(2) -Tyr(3) -Pro(4) -Thr(5) -Tyr(6) -Leu(7) -Lys(8) -OH 1, by incorporating furanoid sugar amino acids (SAAs) 2-4 into the molecule. The furanoid SAAs 2-4 were used as dipeptide isosteres to replace Tyr(3) -Pro(4) or Pro(4) -Thr(5) in sequence 1. The resulting analogs 5-9 were tested for their anti-cancer activities in vitro, following the standard MTT assay on a panel of human cancer cell lines. One of the potent analogs, 6a was tested in vivo for tumor regression on primary colon tumor xenografted nude mice. Our experimental results suggest that many of these analogs show either retention or enhancement of biological activity.
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Affiliation(s)
- S Prasad
- Dabur Research Foundation, Sahibabad, Ghaziabad, India.
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Affiliation(s)
- A A Riaz
- Department of Surgery, Hemel Hempstead General Hospital, Herts, UK.
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Madhavan GR, Chakrabarti R, Kumar SK, Misra P, Mamidi RN, Balraju V, Kasiram K, Babu RK, Suresh J, Lohray BB, Lohrayb VB, Iqbal J, Rajagopalan R. Novel phthalazinone and benzoxazinone containing thiazolidinediones as antidiabetic and hypolipidemic agents. Eur J Med Chem 2001; 36:627-37. [PMID: 11600232 DOI: 10.1016/s0223-5234(01)01257-0] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We report here the synthesis of a series of 5-[4-[2-[substituted phthalazinones-2(or 4)yl]ethoxy]phenylmethyl]thiazolidine-2,4-diones and 5-[4-[2-[2,3-benzoxazine-4-one-2-yl]ethoxy]phenylmethyl]thiazolidine-2,4-diones and their plasma glucose and plasma triglyceride lowering activity in db/db mice. In vitro PPARgamma transactivation assay was performed in HEK 293T cells. In vitro and in vivo pharmacological studies showed that the phthalazinone analogue has better activity. PHT46 (compound 5a), the best compound in this series, showed better in vitro PPARgamma transactivation potential than troglitazone and pioglitazone. In insulin resistant db/db mice, PHT46 showed better plasma glucose and triglyceride lowering activity than the standard drugs. Pharmacokinetic study in Wistar rats showed good systemic exposure of PHT46. Subchronic toxicity study in Wistar rats did not show any treatment-related adverse effect.
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Affiliation(s)
- G R Madhavan
- Discovery Chemistry, Dr. Reddy's Research Foundation, Bollaram Road, Miyapur, 500 050, Hyderabad, India
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Abstract
Colon cancer remains the third most common cancer, and cause of cancer-related death in the United States. Greater public awareness and acceptance of screening programs have contributed significantly to increasingly earlier detection of colon cancer and decreased mortality. Advances made in the understanding of this disease, both in terms of its clinical behavior and molecular pathogenesis, have translated into major improvements in its therapy. Several large randomized trials during the last two decades have helped the oncology community forge a successful multi-modality treatment strategy against colon cancer. These studies have defined the role of adjuvant therapy for colon cancer after curative surgery. Despite all the advances, a large number of patients continue to succumb to this disease, and the search for better therapies is still necessary. In this article, we discuss the evolution and the current state of adjuvant chemotherapy in colon cancer and briefly review new developments.
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Affiliation(s)
- S K Kumar
- Division of Medical Oncology, Mayo Clinic Cancer Center, 200 First Street SW, Rochester, MN 55905, USA.
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