P-139: The impact of CD56 expression in smoldering Multiple Myeloma

Despite the improvement of patient’s outcome obtained by the current use of immunomodulatory drugs, proteasome inhibitors or anti-CD38 monoclonal antibodies, multiple myeloma (MM) remains an incurable disease. More recently, the testing in clinical trials of novel drugs such as anti-BCMA CAR-T cells, antibody–drug conjugates or bispecific antibodies broadened the possibility of improving patients’ survival. However, thus far, these treatment strategies have not been able to steadily eliminate all malignant cells, and the aim has been to induce a long-term complete response with minimal residual disease (MRD)-negative status. In this sense, approaches that target not only myeloma cells but also the surrounding microenvironment are promising strategies to achieve a sustained MRD negativity with prolonged survival. This review provides an overview of current and future strategies used for immunomodulation of MM focusing on the impact on bone marrow (BM) immunome.

Download Full-text

What Is New in the Treatment of Smoldering Multiple Myeloma?

Journal of Clinical Medicine ◽

10.3390/jcm10030421 ◽

2021 ◽

Vol 10 (3) ◽

pp. 421

Author(s):

Niccolo’ Bolli ◽

Nicola Sgherza ◽

Paola Curci ◽

Rita Rizzi ◽

Vanda Strafella ◽

...

Keyword(s):

Multiple Myeloma ◽

Clinical Trials ◽

High Risk ◽

Early Treatment ◽

Individual Case ◽

Symptomatic Disease ◽

Plasma Cell Neoplasm ◽

Smoldering Multiple Myeloma ◽

Wide Range ◽

Critical Issues

Smoldering multiple myeloma (SMM), an asymptomatic plasma cell neoplasm, is currently diagnosed according to the updated IMWG criteria, which reflect an intermediate tumor mass between monoclonal gammopathy of undetermined significance (MGUS) and active MM. However, SMM is a heterogeneous entity and individual case may go from an “MGUS-like” behavior to “early MM” with rapid transformation into symptomatic disease. This wide range of clinical outcomes poses challenges for prognostication and management of individual patients. However, initial studies showed a benefit in terms of progression or even survival for early treatment of high-risk SMM patients. While outside of clinical trials the conventional approach to SMM generally remains that of close observation, these studies raised the question of whether early treatment should be offered in high-risk patients, prompting evaluation of several different therapeutic approaches with different goals. While delay of progression to MM with a non-toxic treatment is clearly achievable by early treatment, a convincing survival benefit still needs to be proven by independent studies. Furthermore, if SMM is to be considered less biologically complex than MM, early treatment may offer the chance of cure that is currently not within reach of any active MM treatment. In this paper, we present updated results of completed or ongoing clinical trials in SMM treatment, highlighting areas of uncertainty and critical issues that will need to be addressed in the near future before the “watch and wait” paradigm in SMM is abandoned in favor of early treatment.

Download Full-text

Plasma cells in multiple myeloma express a natural killer cell- associated antigen: CD56 (NKH-1; Leu-19)

Blood ◽

10.1182/blood.v76.2.377.377 ◽

1990 ◽

Vol 76 (2) ◽

pp. 377-382 ◽

Cited By ~ 194

Author(s):

B Van Camp ◽

BG Durie ◽

C Spier ◽

M De Waele ◽

I Van Riet ◽

...

Keyword(s):

Multiple Myeloma ◽

Natural Killer Cell ◽

Natural Killer ◽

Plasma Cells ◽

Killer Cell ◽

Neoplastic Tissue ◽

Aggressive Disease ◽

Reactive Plasma ◽

Gut Mucosa ◽

Cd56 Expression

Abstract Bone marrow samples from 55 patients with multiple myeloma (MM) and 23 patients with monoclonal gammopathy of undertermined significance (MGUS) were evaluated with a broad panel of monoclonal antibodies. Plasma cells from 78% (43/55) of patients with MM strongly expressed the natural killer cell antigen CD56 (NKH-1, Leu-19). Of the 23 patients with MGUS, none showed strong CD56 reactivity, although three had weak reactivity in less than 20% of plasma cells. Myeloma cells expressing CD56 did not coexpress the CD57 or CD16 antigens. Patients with CD56-positive plasma cells had both indolent and aggressive disease. However, the 12 CD56-negative patients had predominantly aggressive disease with an unexpected preponderance of kappa Bence Jones only myeloma (5/10[50%] evaluable patients). Polyclonal plasma cells from non-neoplastic tissue sites (normal bone marrows, lymph nodes, tonsillar biopsies, and gut-mucosa biopsies) showed a near absence of CD56. We conclude that isolated, strong CD56 expression is common in MM, but not in MGUS or reactive plasma cells. The potential biologic importance of CD56 positivity in myeloma is reviewed.

Download Full-text

Telomere Architecture Correlates with Aggressiveness in Multiple Myeloma

Cancers ◽

10.3390/cancers13081969 ◽

2021 ◽

Vol 13 (8) ◽

pp. 1969

Author(s):

Aline Rangel-Pozzo ◽

Pak Yu ◽

Sadhana LaL ◽

Yasmin Asbaghi ◽

Luiza Sisdelli ◽

...

Keyword(s):

Multiple Myeloma ◽

Disease Progression ◽

Genomic Instability ◽

Clinical Decision Making ◽

Three Dimensional ◽

Clinical Decision ◽

Response To Treatment ◽

Average Intensity ◽

Patient Response ◽

Smoldering Multiple Myeloma

The prognosis of multiple myeloma (MM), an incurable B-cell malignancy, has significantly improved through the introduction of novel therapeutic modalities. Myeloma prognosis is essentially determined by cytogenetics, both at diagnosis and at disease progression. However, for a large cohort of patients, cytogenetic analysis is not always available. In addition, myeloma patients with favorable cytogenetics can display an aggressive clinical course. Therefore, it is necessary to develop additional prognostic and predictive markers for this disease to allow for patient risk stratification and personalized clinical decision-making. Genomic instability is a prominent characteristic in MM, and we have previously shown that the three-dimensional (3D) nuclear organization of telomeres is a marker of both genomic instability and genetic heterogeneity in myeloma. In this study, we compared in a longitudinal prospective study blindly the 3D telomeric profiles from bone marrow samples of 214 initially treatment-naïve patients with either monoclonal gammopathy of undetermined significance (MGUS), smoldering multiple myeloma (SMM), or MM, with a minimum follow-up of 5 years. Here, we report distinctive 3D telomeric profiles correlating with disease aggressiveness and patient response to treatment in MM patients, and also distinctive 3D telomeric profiles for disease progression in smoldering multiple myeloma patients. In particular, lower average intensity (telomere length, below 13,500 arbitrary units) and increased number of telomere aggregates are associated with shorter survival and could be used as a prognostic factor to identify high-risk SMM and MM patients.

Download Full-text

High prevalence of peripheral neuropathy in multiple myeloma patients and the impact of vitamin D levels, a cross-sectional study

Supportive Care in Cancer ◽

10.1007/s00520-021-06414-3 ◽

2021 ◽

Author(s):

B. E. Oortgiesen ◽

J. A. Kroes ◽

P. Scholtens ◽

J. Hoogland ◽

P. Dannenberg - de Keijzer ◽

...

Keyword(s):

Multiple Myeloma ◽

Vitamin D ◽

Peripheral Neuropathy ◽

Hypovitaminosis D ◽

Cross Sectional Study ◽

Clinical Trial Registration ◽

Cross Sectional ◽

Validated Questionnaire ◽

Vitamin D Levels ◽

The Impact

Abstract Purpose Peripheral neuropathy (PN) is common in patients with multiple myeloma (MM). We hypothesized that the relationship between hypovitaminosis D and PN described in diabetes mellitus patients may also be present in MM patients. Methods To study this potential association, we assessed the incidence of hypovitaminosis D (vitamin D < 75 nmol/L [= 30 ng/mL]) in smouldering and active MM patients in two Dutch hospitals. Furthermore, a validated questionnaire was used to distinguish different PN grades. Results Of the 120 patients included between January 2017 and August 2018, 84% had an inadequate vitamin D level (median vitamin D level 49.5 nmol/L [IQR 34–65 nmol/L]; mean age: 68 years [SD ± 7.7]; males: 58%). PN was reported by 69% of patients (n = 83); however, of these 83 patients, PN was not documented in the medical records of 52%. An association was found between lower vitamin D levels and higher incidence of PN in the total population (P = 0.035), and in the active MM patients (P = 0.016). Conclusion This multi-centre cohort study showed that PN and hypovitaminosis D are common in MM patients, and addressing low vitamin D levels in the treatment of MM patients might be beneficial in reducing the risk of PN. More attention for PN is warranted, as PN is underreported by clinicians. Further research is needed to fully understand the implications of vitamin D in the development of PN in patients with MM. Clinical trial registration Netherland Trial Register NL5835, date of registration July 28, 2016

Download Full-text