Dysregulation of miRNAs In AL Amyloidosis

Abstract Abstract 4648 Bone marrow plasma cells (BMPC) were purified from aspirates obtained from patients with AL amyloidosis using anti-CD138 immunomagnetic beads, and from controls. Expression levels of micro RNAs (miRNAs) were compared by microarray. The levels of ten miRNAs were found to be increased more than 1.5-fold in BMPC of AL amyloidosis patients. These results were confirmed using stem-loop RT-qPCR for miR-148a, miR-26a, and miR-16, the most highly upregulated miRNAs in the AL samples. miR-16, a micro RNA linked to other hematopoietic diseases, was significantly increased in the AL group at baseline and also in treated patients with persistent monoclonal plasma cells in the bone marrow, but not in patients who achieved a hematologic remission after therapy and normal polyclonal BMPCs. miR-16 can be derived from the miR-16-1/mirR-15a cluster on chromosome 13 or the miR-16-2/miR-15b cluster on chromosome 3. The expression of miR-15b was much higher than miR15a in AL and control BMPC samples; this suggests that miR-16 in plasma cells is mostly derived from chromosome 3. The anti-apoptosis gene BCL-2, a putative target mRNA that can be down-regulated by miR-16, was present in the BMPCs from the AL group despite the elevated levels of miR-16. Our data suggest that miRNAs are dysregulated in clonal plasma cells from AL amyloidosis patients and that abnormal levels of miRNAs may be potential biomarkers for disease. Disclosures: No relevant conflicts of interest to declare.

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Systemic AL amyloidosis with high bone marrow plasma cells (BMPCs) infiltration: a case report and literature review

Journal of Xiangya Medicine ◽

10.21037/jxym.2019.07.01 ◽

2019 ◽

Vol 4 ◽

pp. I 30-30

Author(s):

Hui-Wen Wang ◽

Rong Tang ◽

Xiang-Cheng Xiao ◽

Wei Liu ◽

Morie A. Gertz ◽

...

Keyword(s):

Bone Marrow ◽

Case Report ◽

Literature Review ◽

Plasma Cells ◽

Al Amyloidosis ◽

Bone Marrow Plasma ◽

High Bone

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Human Granulocytic Anaplasmosis: a Case Report and Review of Literature.

Blood ◽

10.1182/blood.v114.22.4518.4518 ◽

2009 ◽

Vol 114 (22) ◽

pp. 4518-4518

Author(s):

Jian Ouyang ◽

Qiguo Zhang ◽

Jingyan Xu ◽

Bing Chen ◽

Rong-Fu Zhou

Keyword(s):

Bone Marrow ◽

Hemophagocytic Syndrome ◽

Plasma Cells ◽

Conflicts Of Interest ◽

Diagnosis And Treatment ◽

Case Presentation ◽

Human Granulocytic Anaplasmosis ◽

Granulocytic Anaplasmosis ◽

Laboratory Features ◽

Bone Marrow Plasma

Abstract Abstract 4518 Purpose To discuss the clinical and laboratory features, diagnosis and treatment of human granulocytic anaplasmosis. Methods We present the clinical and laboratory features, diagnosis and treatment of a patient with human granulocytic anaplasmosis. Case presentation The patient with human granulocytic anaplasmosis presented with fever,cough?Adiarrhea?Amyalgia?Afacies typhosa?Arelative infrequent pulse and swelling of lymph nodes. Laboratory examination showed the patient had leukopenia?Athrombocytopenia?Aproteinuria?Aliver injury?Ablood clotting abnormal?AEBV-DNA positive. We also found the patient's ferritin?Acreatase?Aamylase and lipase increased. In the patient's bone marrow, plasma cells were increased, hemophagocyte and intragranulocytic inclusions were found. The patient did not respond to the treatment of imipenem, cefepime hydrochloride and teicoplanin. But he was treated successfully with moxifloxacin. Conclusion Patient with human granulocytic anaplasmosis can present leukopenia, thrombocytopenia, blood clotting abnormal and plasma cells increased in bone marrow. It's quite necessary to make differential diagnosis with some blood diseases. The patient can be accompanied with EBV infection and hemophagocytic syndrome. The patient can be cured by antibiotics-quinolones. Disclosures: No relevant conflicts of interest to declare.

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High Dose Melphalan with Autologous Stem Cell Transplantation Overcomes Poor Prognosis of Primary Amyloidosis

Blood ◽

10.1182/blood.v116.21.1350.1350 ◽

2010 ◽

Vol 116 (21) ◽

pp. 1350-1350

Author(s):

Simrit Parmar ◽

Mubeen Khan ◽

Gabriela Rondon ◽

Nina Shah ◽

Qaiser Bashir ◽

...

Keyword(s):

Bone Marrow ◽

Stem Cell ◽

Plasma Cells ◽

High Dose ◽

Al Amyloidosis ◽

Hematologic Response ◽

Bone Marrow Plasma ◽

Organ Response ◽

High Dose Melphalan

Abstract Abstract 1350 Background: Systemic Primary AL Amyloidosis is a rare but potentially fatal disease resulting from tissue deposits of amyloid fibrils derived from monoclonal immunoglobulin light chains. High-dose melphalan followed by autologous hematopoietic stem cell transplant (auto HCT) is associated with hematologic and organ responses and improved survival. Methods: In this retrospective analysis we identified 46 patients with primary AL amyloidosis who received auto HCT between 01/1998 to 05/2010 at MDACC. Organ responses were determined using Amyloidosis Consensus Criteria. Results: The median age at auto HSCT was 56 years (34-74) where 61% were males and 35% were older than 60 years of age. 61% had lambda light chain restriction and only 4% had cytogenetic abnormalities. Disease characteristics are summarized in Table 1. The median time from diagnosis to auto HCT was 6.6 months (2.2-29.4 months). 22 pts (47.8%) had one organ, 19 pts (41.3%) had 2 organ and 4 pts (8.7%) had 3 organ involvement. 11 pts (23.9%) had heart and 35 pts (76.1%) had kidney involvement. The median follow up from the time of diagnosis was 22.4 months and from time of auto HCT was 16.7 months. High dose Melphalan dose was 200mg/m2 in 24 pts (52%) and 140mg/m2 in 22 (47.8%). There were 4 early deaths and 4 pts whose follow up was less than 3 months and their response was not assessed. Out of the 38 evaluable patients, the post-transplant organ responses were as follows ≥PR 25(66%), ≥stable disease 35(92%) (Table2). The hematologic responses were: CR=5 (13%), ≥VGPR=10(26%), ≥PR=26 (68%), ≥SD=37(97%). One patient had progressive disease. There was a correlation between organ response and hematologic response (chi square;p<10-3). The day-100 treatment related mortality (TRM) was 8.7% and 1-yr TRM was 13%. The median progression-free (PFS) and overall survival (OS) from auto HCT was 73.8 months and not reached (from transplant). The median PFS and OS from diagnosis were 93 months and 59.8 months respectively. In multivariate analysis, heart involvement (p=0.01), female sex (p=0.011), age ≥60 years (p=0.002), bone marrow plasma cells≥10% (p=0.043) and Beta-2 microglobulin>3.5mg/l (p=0.02) were associated with poor OS. Improved OS correlated with organ response (52.6 vs 11.4 months; p=0.01) and hematologic response (52.6 vs.6.1months; p=0.002). Hemoglobin <10 g/dl (p=0.047), bone marrow plasma cells≥10% (p=0.043) and age≥60 years (p=0.075) were associated with shorter PFS. Hematologc response (p=0.48) and organ response (p=0.12) were not associated with improved PFS. Conclusion: In this analysis the outcome of patients with primary systemic AL amyloidosis was durable with auto HCT with acceptable mortality risk and improved survival. Disclosures: No relevant conflicts of interest to declare.

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Metabolomics Identifies Potential Biomarkers of Multiple Myeloma Development and Progression

Blood ◽

10.1182/blood.v120.21.3985.3985 ◽

2012 ◽

Vol 120 (21) ◽

pp. 3985-3985

Author(s):

Francesca Fontana ◽

Josè Manuel garcia Manteiga ◽

Magda Marcatti ◽

Francesca Lorentino ◽

Giovanni Tonon ◽

...

Keyword(s):

Multiple Myeloma ◽

Bone Marrow ◽

Plasma Cells ◽

Conflicts Of Interest ◽

In Vitro Tests ◽

Incurable Cancer ◽

Disease Evolution ◽

Cell Counts ◽

Bone Marrow Plasma ◽

Active Disease

Abstract Abstract 3985 Multiple myeloma is a malignancy of plasma cells, which grows at multiple foci in the bone marrow, secretes monoclonal immunoglobulins, and typically induces skeletal destruction, hypercalcemia, anemia, and renal failure. Although it remains an incurable cancer, novel therapeutic regimens have improved overall survival in the last decade. Multiple myeloma originates from post germinal center, terminally differentiated B lymphocytes through a multi-step process involving early and late genetic changes. Multiple myeloma is preceded by monoclonal gammopathy of undetermined significance (MGUS), a frequent age-progressive premalignant expansion of bone marrow plasma cells that behave benignly despite the presence of most myeloma-specific genetic abnormalities. Indeed, development and progression of multiple myeloma are believed to rely on vicious interactions with the bone marrow environment, offering a paradigm to investigate the bone-cancer relationship. In particular, bone and stromal cells are known to be diverted by cancer cells through altered cytokine circuitry. The resulting enhanced osteoclastogenesis and neoangiogenesis, and reduced osteoblast differentiation and activity sustain cancer cell survival, proliferation, migration and chemoresistance. Such crucial interactions, however, have only partially been elucidated in their complexity, dynamics and exact role in disease evolution. A better knowledge of this interplay, still elusive, could help identify prognostic markers, pathomechanisms, and therapeutic targets for future validation. Aiming to achieve an unbiased, comprehensive assessment of the extracellular milieu during multiple myeloma genesis and progression, we performed a metabolomic analysis of patient-derived peripheral and bone marrow plasma by ultra high performance liquid and gas chromatography followed by mass spectrometry. By feature transformation-based multivariate analyses, metabolic profiling of both peripheral and bone marrow plasma successfully discriminated active disease from control conditions (health, MGUS or remission). Moreover, both central and peripheral metabolic scores significantly correlated with bone marrow plasma cell counts. Significant changes in the peripheral metabolome were found to be associated with abnormal renal function in the subset of myeloma patients. Noteworthy, however, renal dysfunction-associated features failed to independently predict disease load, while non-overlapping disease vs. control analyses consistently identified a number of metabolites associated with disease. Among these, increased levels of the C3f-derived peptide, HWESASLL, and loss of circulating lysophosphocholines emerged as hallmarks of active disease. In vitro tests on myeloma cell lines and primary patient-derived cells revealed a previously unsuspected direct trophic role exerted by lysophosphocholines on malignant plasma cells. Altogether, our data demonstrate that metabolomics is a powerful approach suitable for studying the complex interactions of multiple myeloma with the bone marrow environment and general metabolism. This novel strategy holds potential to identify unanticipated markers and pathways involved in development and progression of multiple myeloma. Disclosures: No relevant conflicts of interest to declare.

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Clinical presentation and outcome of patients with AL amyloidosis requiring salvage therapy.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e20043 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e20043-e20043

Author(s):

Chen Wang ◽

Yumeng Zhang ◽

Lauren Duncanson ◽

Jason B. Brayer ◽

Doris K. Hansen ◽

...

Keyword(s):

Bone Marrow ◽

Overall Survival ◽

Light Chain ◽

Salvage Therapy ◽

Plasma Cells ◽

Al Amyloidosis ◽

Comparison Results ◽

Bone Marrow Plasma ◽

Organ Response ◽

Upfront Therapy

e20043 Background: The diagnosis and upfront management of immunoglobulin light chain (AL) amyloidosis have greatly improved in recent years. However, little is known about the presentation, treatment, and outcome of these patients at first relapse/progression (R/P). Methods: All patients with AL amyloidosis who received salvage therapy for first R/P disease at Moffitt Cancer Center between 2008 and 2020 were included in this retrospective review. Definitions of hematologic and organ R/P were based on 2012 consensus. Overall survival was measured from the time of salvage to last follow up/death. Survival was assessed by Kaplan-Meier with log-rank comparison. Results: Sixty-nine patients were included. The median age at diagnosis was 62 years and 61% were male. Upfront therapy included high dose melphalan with autologous transplant in 36% and bortezomib in 52%. At salvage, 19% had disease refractory to upfront therapy and 40% had not achieved an organ response. The median time from upfront to salvage therapy was 22 months. Salvage regimens included proteasome inhibitors, daratumumab and immunomodulatory drugs in 55%, 13% and 22%, respectively. At least a very good partial response and organ response were achieved in 35% (22/62) and 39% (21/54) with measurable disease. The median overall survival was 60 months. Based on salvage indication, patients were classified into hematologic (n = 29) and organ R/P (n = 40), and the latter showed more frequent lambda-light chain disease (59% vs. 83%, p = 0.028) and low difference of involved-uninvolved free light chain at diagnosis (< 50 mg/L, 8% vs. 44%, p = 0.002). Negative prognostic markers for survival included bone marrow plasma cells ≥20% at diagnosis (median 17 months vs. not reached; p < 0.001) and organ, particularly cardiac R/P (median, 31 months vs. not reached; p = 0.003). Salvage ( p = 0.48) or prior regimens ( p = 0.11) did not impact post-salvage survival. Conclusions: Our study highlights the unmet need of salvage in R/P AL amyloidosis in a real-world setting, given the low rate of deep responses regardless of current salvage options. Patients with bone marrow plasma cells ≥20% at diagnosis and organ R/P at salvage had inferior survival, supporting use of intensive upfront regimens for the former and adjustment of therapy if deep response is not achieved.[Table: see text]

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Comparison Of Hevylite™ Assay and Plasma Cell Immunophenotyping For Response Evaluation and Residual Disease Characterisation In IgA Myeloma

Blood ◽

10.1182/blood.v122.21.5319.5319 ◽

2013 ◽

Vol 122 (21) ◽

pp. 5319-5319

Author(s):

Daniela Lakomy ◽

Stephanie Lemaire-Ewing ◽

Cedric Rossi ◽

Jessica Borgeot ◽

Jean-Noël Bastie ◽

...

Keyword(s):

Bone Marrow ◽

Binding Site ◽

Plasma Cell ◽

Light Chain ◽

Plasma Cells ◽

Conflicts Of Interest ◽

Residual Disease ◽

Response To Treatment ◽

Response Evaluation ◽

Bone Marrow Plasma

Abstract Introduction The evaluation of multiple myeloma response to treatment as defined by international guidelines is currently based on morphologic examination of bone marrow plasma cells, serum protein electrophoresis (SPEP), immunofixation electrophoresis (IFE) and serum free light chain assay. For several years new tools are available as bone marrow plasma cell immunophenotyping and the HevyliteTM assay. HevyliteTM IgA assay provides an automated evaluation of serum heavy/light chain ratio (HLC) of the involved and uninvolved immunoglobulin (Ig) (i.e. IgAΚ/IgAλ). This is particularly interesting in IgA myeloma where the use of SPEP is limited due to a frequent comigration of monoclonal IgA with other proteins. We therefore compared the IgA quantification by Hevylite™ assay and the bone marrow plasma cell immunophenotyping for response evaluation and residual disease characterisation in IgA myeloma. Methods Hevylite™ assay, SPEP, IFE were performed in eleven IgA myeloma patients at different times: after induction chemotherapy, after the consolidation phase and after autologous stem-cell transplantation (ASCT). In the same time, minimal residual disease (MRD) assessment was performed on bone marrrow by multiparameter flow cytometry (MFC). Hevylite™ assay was performed on a Binding Site SPAplus analyser (Hevylite, Binding Site, Birmingham, UK) following the manufacturer recommendations. SPE and IFE were realized on Sebia Hydrasys analyser (Sebia, Evry, France) and results were read by two experienced biologists. Results 1. We found a perfect agreement between the IFE and immunophenotyping results at each time of evaluation, for positive results as for negative results. 2. The SPEP was contributive only in two patients and in these cases it was less sensitive than IFE. In the other patients, the monoclonal IgA migrated in beta region and/or as multiple bands, making the quantitative estimation difficult. 3. In all patients, when MRD by MFC was undetectable and IFE was negative, the HLC ratio was normal. 4. In 3 patients, HLC ratio was consistent with the IFE and MRD by MFC at each time of evaluation. Nevertheless, in 8 patients out of 11, while HLC ratio became normal, MRD by MFC and IFE were still positive. In all cases, the normalization of HLC ratio was followed, at the next step of evaluation, by the normalization of MFC and IFE. 5. In 5 patients, the normalization of HLC ratio occurred before ASCT, while IFE and MRD by MFC were still positive. Nevertheless, after ASCT, IFE and MRD by MFC became also negative, in accordance with the HLC ratio (Table 1). Conclusions During the evaluation of response to treatment of IgA myeloma, we observed a normalization of HLC ratio (Hevylite™ IgA assay) preceding the normalization of MRD by MFC and IFE. This could be explained by the fact that IFE and immunophenotyping provide very sensitive information but only on the monoclonal component. HLC ratio reflects the balance between the monoclonal and polyclonal Igs of involved and uninvolved isotype. A normalization of HLC ratio can be interpreted as an increasing polyclonal Ig proportion parallel with a decreasing monoclonal Ig proportion and may reflect the reconstitution of polyclonal plasma cells. If confirmed by other studies and long term follow-up, HLC ratio could be a non-invasive predictive marker of a good response in IgA myeloma. Disclosures: No relevant conflicts of interest to declare.

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Excessive fibrinolysis in AL-amyloidosis is induced by urokinae-type plasminogen activator from bone marrow plasma cells

Amyloid ◽

10.1080/13506120902879269 ◽

2009 ◽

Vol 16 (2) ◽

pp. 89-93 ◽

Cited By ~ 9

Author(s):

Mitsuhiro Uchiba ◽

Takahisa Imamura ◽

Hiroyuki Hata ◽

Hiro Tatetsu ◽

Yuji Yonemura ◽

...

Keyword(s):

Bone Marrow ◽

Plasminogen Activator ◽

Plasma Cells ◽

Al Amyloidosis ◽

Type Plasminogen Activator ◽

Bone Marrow Plasma

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Correction: Bone marrow plasma cells 20% or greater discriminate presentation, response, and survival in AL amyloidosis

Leukemia ◽

10.1038/s41375-020-0993-8 ◽

2020 ◽

Vol 34 (10) ◽

pp. 2819-2819

Author(s):

Eli Muchtar ◽

Morie A. Gertz ◽

Taxiarchis V. Kourelis ◽

Surbhi Sidana ◽

Ronald S. Go ◽

...

Keyword(s):

Bone Marrow ◽

Plasma Cells ◽

Al Amyloidosis ◽

Bone Marrow Plasma

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An Epigenomic Map of Multiple Myeloma Reveals the Importance of Polycomb Gene Silencing for the Malignancy

Blood ◽

10.1182/blood.v124.21.2192.2192 ◽

2014 ◽

Vol 124 (21) ◽

pp. 2192-2192

Author(s):

Prasoon Agarwal ◽

Antonia Kalushkova ◽

Stefan Enroth ◽

Mohammad Alzrigat ◽

Anders Österborg ◽

...

Keyword(s):

Multiple Myeloma ◽

Bone Marrow ◽

Gene Silencing ◽

Transcriptional Activation ◽

Drug Targeting ◽

Plasma Cells ◽

Conflicts Of Interest ◽

Underlying Mechanism ◽

Proliferation Capacity ◽

Bone Marrow Plasma

Abstract Multiple myeloma (MM) is characterized by accumulation of post-germinal center, isotype-switched, long-living plasma cells with retained proliferation capacity within the bone marrow. MM is highly heterogeneous and remains fatal. This heterogeneity has hampered identification of a common underlying mechanism for disease establishment and the development of targeted therapy. We recently provided proof-of-principle that gene silencing associated with H3K27me3 contributes to the malignancy of MM. Here we present the first epigenomic map of MM for H3K27me3 and H3K4me3 derived by ChIP- and RNA-sequencing from freshly-isolated bone marrow plasma cells from four patients. We compile lists of targets common among the patients as well as unique to MM when compared with PBMCs. Indicating the clinical relevance of our findings, we find increased silencing of H3K27me3 targets with disease progression and in patients presenting with a poor prognosis. Bivalent genes further significantly correlated to under-expressed genes in MM and were unique to MM when compared to PBMCs. Furthermore, bivalent genes, unlike H3K27me3 targets, significantly associated with transcriptional activation upon Polycomb inhibition indicating a potential for drug targeting. Thus, we suggest that gene silencing by Polycomb plays an important role in the development of the malignant phenotype of the MM cell during tumor progression. Disclosures No relevant conflicts of interest to declare.

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