Circulating Angiogenic Cytokines Are Elevated in Patients with Smoldering Myeloma; Implications Into Disease Biology

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 5059-5059
Author(s):  
Maria Gkotzamanidou ◽  
Evangelos Terpos ◽  
Athanasios Papatheodorou ◽  
Evangelos Eleutherakis-Papaiakovou ◽  
Meletios Athanasios Dimopoulos ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Conflicts Of Interest ◽  
Hematologic Malignancy ◽  
Prognostic Significance ◽  
Serum Levels ◽  
Bone Marrow Infiltration ◽  
Early Event ◽  
Healthy Controls ◽  
Angiogenic Switch ◽  
Angiogenic Cytokines

Abstract Abstract 5059 Angiogenesis is a critical step in the evolution of carcinogenesis in solid tumors and hematologic malignancies and is considered to be an early event in tumorigenesis. Multiple myeloma (MM) is a hematologic malignancy in which a preceding monoclonal gammopathy (MGUS) is considered a precursor. Asymptomatic/smoldering MM (SMM) is associated with a substantial risk of progression to MM and according to current recommendations these patients should be followed without therapy. Thus evolution from MGUS to SMM and to symptomatic myeloma is now considered as the model describing the natural history of the disease. In order to study the role and evolution of circulating angiogenesis related cytokines, we studied their levels in patients with MGUS, asymptomatic MM and symptomatic MM, before the initiation of first line therapy. We also studied possible associations of these cytokines with features of the disease in patients with SMM that could help identify possible markers of early evolution. We measured serum levels of vascular endothelial growth factor (VEGF), angiogenin, angiopoietin (angp)-1 and -2, using standard ELISA methodology (R&D Systems, Minneapolis, MN, USA). The definition of MGUS, SMM and symptomatic MM was based on the published IMWG criteria. All above cytokines were also measured in 21 individuals with MGUS, in 174 newly diagnosed, untreated MM patients (31 with SMM) and in 44 age- and gender-matched healthy controls. We focused our analysis on patients with SMM. The median age was 63.5 years (range 40–83 years) and 55% were males. The median bone marrow infiltration in trephine biopsy was 20% (range: 12%-75%). Sixty-one per cent had IgG, 29% had IgA isotype while 3% had light chain only myeloma and 6% had biclonal myeloma. The median (range) serum levels for VEGF were 406.5 pg/ml (186.3–797.6 pg/ml), for angp-1 were 31064 pg/ml (18220–50856 pg/ml), for angp-2 were 1434 pg/ml (486.1–4004.5 pg/ml), for angp-1 to angp-2 ratio were 20.8 (6.5–78.1), for angiogenin were 262732.6 pg/ml (138670–1003040 pg/ml) and for bFGF were 12.082 pg/ml (non-detected to 123.37 pg/ml). There were no significant correlations of the levels of angiogenesis related cytokines with serum beta-2 microglobulin levels, the levels of the monoclonal protein, IgA versus IgG isotype, serum LDH levels or age. Patients with extensive bone marrow infiltration (≥60%) had significantly higher levels of ang-2 (p=0.017) and significantly lower angp-1/angp-2 ratio (p=0.004) compared to all others. Compared to healthy controls, patients with SMM had higher levels of angp-1 (p=0.05) and angp-2 (p=0.03) but their respective ratio was not significantly different (p=0.272). Serum levels of VEGF were significantly higher in SMM patients than in controls (mean 429 pg/ml vs. 196 pg/ml, p<0.001). Similarly serum levels of angiogenin were significantly higher in SMM (mean 304028 pg/ml vs 190245 pg/ml, p<0.001). When patients with SMM compared to MGUS patients, there were no significant differences for any of the studied angiogenesis related cytokines. Compared to patients with symptomatic MM, patients with SMM had higher levels of angp-1 (p<0.001) and lower level of angp-2 (p<0.001) resulting in a significantly lower angp-1/angp-2 ratio, indicating a switch to increased vessel-formation activity, while the levels of VEGF were similar. The above results indicate that early in the evolution of the disease (MGUS to SMM to Symptomatic MM) there is an angiogenic switch which is manifested by an increase in the levels of angiogenic cytokines that promote neovasculogenesis (such as VEGF, angp-2 and angiogenin) and a gradual suppression of cytokines that balance their effects (such as angp-1). A possible prognostic significance of the circulating levels of angiogenic cytokines in patients with SMM that could help identify patients at higher risk for progression to symptomatic MM needs further study. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Clinical Characteristics, Immunophenotype and Outcomes of Blastic Plasmacytoid Dendritic Cell Neoplasms in a Peruvian Cohort

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 42-43
Author(s):  
Daniela Dueñas ◽  
Elizabeth Cervantes ◽  
Daniel J Enriquez ◽  
Claudio Flores ◽  
Carlos Barrionuevo ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Dendritic Cell ◽  
Clinical Characteristics ◽  
Conflicts Of Interest ◽  
Plasmacytoid Dendritic Cell ◽  
Age At Diagnosis ◽  
Bone Marrow Infiltration ◽  
Maturation Stage ◽  
Female Predominance ◽  
The Impact

Background:Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare and fatal myeloid malignancy characterized by clonal proliferation of immature plasmacytoid dendritic cells. BDCN has been frequently described in men and age above 60 years, and usually involves the skin and bone marrow. Immunophenotyping is based on CD123+, CD4+ and CD56+ expression and is necessary rule out other myeloid malignancies. Objective: We aimed to describe the clinical characteristics and immunophenotype of BPDCN cases diagnosed at two tertiary Peruvian cancer institutions between 2018-2019. Methods: We retrospectively reviewed medical records of patients diagnosed of BPDCN at two tertiary Peruvian cancer centers (Instituto Nacional de Enfermedades Neoplasicas and Oncosalud-AUNA, Lima-Peru) between 2008 and 2019. Clinical characteristics, treatments, outcomes and immunophenotype by pathology or flow cytometry review, were collected. Patients were classified according to their maturation stage using CD34 and CD117 expression into three subgroups: Immature-Intermediate blastic (IIB-BPDCN; partial expression of CD117 and absence or minimal expression of CD34), mature (M-BPDCN; absence of CD34 and CD117) and unknown(U-BPDCN). Overall survival (OS) and event-free survival (EFS) curves were estimated using the Kaplan-Meier method and compared with the Log-rank test to determine the impact of immunophenotype. Results: Thirty-eight cases were included during the study period. The median age at diagnosis was 38 years (7-82), only six (16%) were older than 65 years, and a notorious female predominance (F/M ratio: 1.7:1) was observed. Twenty-four cases had CD34/117 expression available and were classified according to the maturation stage in IIB-BPDCN (13) and M-BPDCN(11), additionally 14 cases had unknown stage (U-BPDCN). Table 1 summarizes clinical characteristics, treatment and outcomes according to their immunophenotype. Bone marrow infiltration was more frequent in immature phenotypes (92% IIB-BPDCN vs 73% M-BPDCN, p=0.001), as well as skin infiltration was more common in mature phenotype (72% vs 31%, p=0.008). CNS infiltration at diagnosis was 15% and 55% in IIB-BPDCN and M-BPDCN, respectively. Sixteen patients received treatment based on ALL-like protocols, 8 AML-like, 5 CHOP-like and 9 patients only palliative care. At 5 years median follow-up, median EFS and OS was 12 and 16 months, respectively. IIB-BPDCN had the lowest survival (4 months EFS and 6 months OS). Conclusions: We describe a Peruvian cohort of BPDCN patients with younger age at diagnosis and female predominance than reported previously by other series, however further studies in Latino population are required to confirm these results. Immature phenotypes based on CD34 and CD117 expression were associated with high rate of bone marrow infiltration and fatal outcomes. New successful target therapies must be warranted for this rare and fatal condition. Disclosures No relevant conflicts of interest to declare.

Erythropoietin for the treatment of anemia of malignancy associated with neoplastic bone marrow infiltration.

1990 ◽  
Vol 8 (6) ◽  
pp. 956-962 ◽  
Author(s):  
W Oster ◽  
F Herrmann ◽  
H Gamm ◽  
G Zeile ◽  
A Lindemann ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bolus Injection ◽  
Bone Marrow Involvement ◽  
Serum Levels ◽  
Underlying Disease ◽  
Bone Marrow Infiltration ◽  
Low Grade ◽  
History Of ◽  
Neoplastic Lymphocytes ◽  
Rbc Count

This clinical trial was performed to study the effects of intravenously (IV) administered recombinant human (rh) erythropoietin (EPO) at escalating doses (150, 300, and 450 U/kg, administered as an IV bolus injection, twice weekly, for 6, 4, and 4 weeks, respectively) in five patients with low-grade non-Hodgkin's lymphoma (Ig NHL) and bone marrow involvement and one patient with multiple myeloma (MM). All patients were anemic due to underlying disease. None of the patients had a history of bleeding, hemolysis, renal insufficiency, or other disorders causing anemia in addition to bone marrow infiltrating malignancy. Endogenous EPO serum levels were significantly increased in all patients (74 to 202 mU/mL). Five patients (one MM, four small-cell lymphocytic [SCLC] NHL) showed a dramatic increase of hemoglobin (Hb), hematocrit (Hk) and RBC count becoming obvious on the second EPO dose level. Initial ferritin serum values, which were high mostly due to polytransfusion, were significantly reduced in responding patients. Erythropoiesis of one patient with extensive follicular mixed (fm) NHL did not respond to EPO treatment. Platelet (PLT) count increase (greater than 75% above starting levels) during and following EPO therapy was observed in one patient with MM. Adverse events due to EPO therapy have not been recorded. These findings point out a previously unrecognized capacity of EPO given at pharmacologic doses to stimulate erythropoiesis in patients with anemia due to bone marrow infiltration by neoplastic lymphocytes in spite of enhanced endogenous EPO expression.

Multiplex Analysis of Serum Cytokine Levels in Waldenström Macroglobulinemia Patients.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 2616-2616
Author(s):  
Sherine F. Elsawa ◽  
Anne J. Novak ◽  
Steven C. Ziesmer ◽  
Thomas E. Witzig ◽  
Vincent Rajkumar ◽  
...  
Keyword(s):  
Bone Marrow ◽  
B Cell ◽  
Elevated Serum ◽  
Fold Increase ◽  
Serum Levels ◽  
Healthy Controls ◽  
Β2 Microglobulin ◽  
Healthy Donors ◽  
Cytokine Levels

Abstract Waldenström macroglobulinemia (WM) is a monoclonal B cell disorder characterized by a circulating monoclonal IgM protein that may lead to serum hyperviscosity in association with an infiltration of lymphoplasmacytic cells into the bone marrow. Although proinflammatory and chemotactic cytokines can profoundly affect tumor cells and the tumor microenvironment, and many cytokines have been shown to have potent therapeutic efficacy in preclinical cancer models, the role of cytokine networks in WM is not fully understood. In this study, we used a high-throughput xMAP multiplex immunobead assay technology (Luminex Corp., Austin, TX) to simultaneously test 30 cytokines, chemokines, angiogenic factors as well as growth factors and soluble receptors in the sera of WM patients and compared them with other B cell malignancies including IgM monoclonal gammopathy of undetermined significance (MGUS), follicular lymphoma, chronic lymphocytic leukemia (CLL) as well as healthy controls. Using a Mann-Whitney U test to analyze the differences between the groups, 15 of the 30 cytokines tested had significantly different levels in WM compared to healthy controls. Of those 15 cytokines, 11 were elevated in WM patients and 4 were decreased. Cytokines were grouped into 3 groups; those with &lt; 2-fold difference, 2–8 fold difference and those having &gt; 8-fold difference in their cytokine levels compared to healthy donors. There was a greater than 8-fold increase in the serum levels of Rantes, G-CSF and IL-2R (p&lt;0.0001) in WM patients. Furthermore, 3 cytokines had between 2–8-fold increase in WM patients including IL-4 (p&lt;0.0001), IL-6 (p&lt;0.0019) and IP-10 (p&lt;0.0006). Five cytokines had statistically elevated levels in WM patients compared to healthy controls, however the fold increase was &lt; 2 including HGF (p&lt;0.0185), IL-10 (p&lt;0.0002), MIP-1α (P&lt;0.0484), IL-2 (P&lt;0.0130) and IL-12 (P&lt;0.0155). Of the cytokines that had significantly lower levels in the sera of WM patients, IL-8 (p&lt;0.0001) and EGF (p&lt;0.0001) were &gt; 8-fold decreased, MCP-1 (p&lt;0.0001) was 2–8 fold lower and Eotaxin (p&lt;0.0004) was &lt; 2-fold lower in WM patients. All of the cytokines that had the greatest fold difference (&gt; 8-fold) in WM patients compared to healthy donors also differed significantly from the MGUS patients. Rantes, G-CSF, IL-2R and EGF had significantly different levels compared to other B cell malignancies. We tested for a correlation between the cytokines that had &gt; 2-fold difference between the WM group and control group with clinical features of the disease and found the cytokines IL-6 and IL-2R had a significant correlation with β2-microglobulin levels (p&lt;0.01). We analyzed cytokine levels in the bone marrow plasma of the same patients and found that high levels of IL-2R in the bone marrow microenvironment significantly correlated with anemia and elevated serum β2-microglobulin (p&lt;0.01). In conclusion, we have simultaneously analyzed sera from WM patients for 30 cytokines and found the most significantly elevated cytokines are Rantes, G-CSF and IL-2R and the most significantly downregulated cytokines are IL-8 and EGF. Furthermore, we found that elevated serum levels of IL-6 and IL-2R correlated with β2-microglobulin levels, a measure of disease activity. Further analysis of the biological role of these cytokines in WM may offer insight into disease pathogenesis and provide a basis for novel targeted therapies.

Prognostic Value of Angiogenesis Assessment in Chronic Lymphocytic Leukemia: More Data Needed.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4396-4396
Author(s):  
Darko Antic ◽  
Vladan Cokic ◽  
Marija Dencic Fekete ◽  
Maja Perunicic ◽  
Biljana Mihaljevic ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Chronic Lymphocytic Leukemia ◽  
Disease Progression ◽  
Clinical Course ◽  
Serum Levels ◽  
Lymphocytic Leukemia ◽  
Angiogenic Factor ◽  
Healthy Controls ◽  
Biological Features ◽  
Risk Of Disease

Abstract Abstract 4396 Introduction The association between angiogenesis and cancer progression in solid tumors has been documented, but its significance in chronic lymphocytic leukemia (CLL) has not been completely evaluated. Vascular endothelial growth factor /VEGF/ is the major pro-angiogenic factor in humans and his transduction pathway may be very active in CLL cells contributes to their enhanced survival. In this context VEGF can be additional tool for predicting the clinical course in early CLL. Patients and Methods To predict the risk of disease progression, we analyzed serum levels VEGF (sVEGF) using ELISA tehnique in 33 Binet stage A de novo CLL patients. In addition, We analyzed microvessel density (MVD) of the same patients using immunohistochemical staining with CD34 and vWf. Finally, we explored wheather changes of circulating VEGF concentrations and MVD reflected clinico-biological features of CLL (peripheral blood lymphocytosis (PBL), bone marrow (BM) histology, beta-2 microglobulin (β2m) level, lactat dehidrogenase (LDH) level) and kariotype abnormalities. Results The VEGF serum levels (sVEGF) was not significantly elevated (p=0.31) in CLL patients (mean: 70.9 pg/mL; range: 16–483) compared with and age- and sex-matched healthy controls (mean: 44.7 pg/mL; range: 22–69.2). sVEGF level positively correlated with elevated LDH level (p=0.008), but no correlation with other clinico-biological features was found. Bone marrow MVD was significantly higher (p<0.0001) in CLL patients (mean: 35.91 vessels/field ± 15.71) compared to controls (mean:8.27 vessels/field ±6.19). Also, there was a significant difference between MVD counts according to the antibody used. MVD was higher using CD34 vs vWF (CD34, 35.91 vessels/field ±15.7, vs vWF, 8.15 vessels/field ±4.65, p<0.0001). Bone marrow MVD detected by CD34 was significantlyhigher in patinents with CD38 expression more than 30% (p=0.006). However, no significant MVD differences were detected between CLL subgroups with regard to clinical course, pattern of marrow infiltration, Rai stage and FISH abnormalities. In univariate analysis sVEGF (p=0.018), Rai substages (p=0.027), PBL (p=0,030), β2m level (p=0.008) and diffuse bone marrow infiltration (p=0.006) were significantly associated with increased risk of disease progression. But, in multivariate analysis only sVEGF (p=0.002) and β2m level (p=0.008) retained their prognostic significance. Conclusions Serum VEGF level although not increased in comparasion with healthy controls, may improve the assessment of individual prognosis of patients with early CLL. Assessment of real clinical significance of bone marrow angiogenesis in CLL is required. Disclosures: No relevant conflicts of interest to declare.

Establishment of a Novel CNS Infiltrated Xenograft Model through Engraftment of Patient-Derived Acute Lymphoblastic Leukemic Cells Into NOD/SCID/γc Null Mouse

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3248-3248
Author(s):  
Itaru Kato ◽  
Akira Niwa ◽  
Megumu Saito ◽  
Hisanori Fujino ◽  
Satoshi Saida ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Conflicts Of Interest ◽  
Hematologic Malignancy ◽  
Lymphoblastic Leukemia ◽  
Xenograft Model ◽  
Leukemic Cells ◽  
Null Mouse ◽  
Immunodeficient Mice ◽  
Mouse Xenograft Model ◽  
Nog Mice

Abstract Abstract 3248 Background and Purpose: Acute lymphoblastic leukemia (ALL) is the most common type of childhood hematologic malignancy. Although improvements in treatment regimen have raised the 5-year survival rate as high as 80% for pediatric ALL patients, a minority of patients with various risk factors, including central nervous system (CNS) infiltration continue to have poor prognosis. Recently, bone marrow (BM) microenvironments which support leukemic stem cells have become noticed as an important element which can influence treatment response and relapse of the disease. Although leukemic cells appear to be completely eradicated through treatment, they are thought to survive within bone marrow and/or extramedullary microenvironments, such as CNS, causing disease recurrence. However, little is known about the CNS microenvironment for leukemic cells because of the lack of appropriate animal model. Even though several investigators have tried to establish a CNS infiltrated model of leukemia, major limitation with these studies are the use of leukemic cell lines and the preconditioning of recipient mice, which did not represent CNS leukemia observed in patients. Here we report the establishment of a novel xenograft model for primary human ALL using NOD/SCID/γc null (NOG) mouse. Without irradiation, this model recapitulates CNS as well as extramedullary leukemic infiltration (hereby referred to as the h-leukemic NOG model). Result: Primary bone marrow samples were collected from 9 children with ALL at the time of diagnosis with informed consent. The leukemic cells (1×106cells) were injected into the tail veins of non-irradiated 8- to 10-week old NOG mice. Primary samples from 8 out of 9 patients were successfully engrafted. Engrafted leukemic cells could be serially transplanted into secondary, tertiary and quaternary recipients. Morphological and FACS analyses revealed as high as 95% BM chimerism and showed that blast phenotypes were conserved through serial transplantations. Of note, extramedullary organs including the CNS, liver, spleen, and kidneys showed the leukemic invasion consistent with those of the donor ALL patients. Liver pathology in the h-leukemic NOG model is identical to that seen in the ALL patients. We also showed the existence of a functional niche in the liver mediated by SDF-1/CXCR4 axis. In terms of the CNS involvement, we observed the progressive infiltration of leukemic cells into the Virchow-Robin space that is consistent with the pathology of human ALL patients. Using this model, we examined the mechanism of dissemination and harboring of leukemic cells in the CNS niche. Discussion: NOG mice model for engraftment of human leukemic cells provides useful insights into the biology of ALL and allows us to answer various questions concerning the mechanism of extramedullary invasion and expansion. We have reported that NOG mice have significantly better human hematopoietic cell engraftment in the BM and extramedullary organs than other immunodeficient mice (Hiramatsu H. Blood. 2003), and is capable of supporting the growth of human neoplastic cells (Kato M. Nature. 2009). Here we report that this non-preconditioned mouse xenograft model reproduces leukemic extramedullary involvement, including the CNS, in sustaining leukemic cells. This approach provides a more sophisticated and physiological model suitable for the evaluation of molecular interactions between patient leukemic cells and host niche. Our h-leukemic NOG model will provide a powerful tool to analyze the CNS niche that harbors leukemia initiating cells. Moreover, this model would be a useful platform for developing novel anti-leukemic therapies that target CNS extramedullary niche. Disclosures: No relevant conflicts of interest to declare.

Neutropenia Does Not Delay Lymphopoietic Regeneration in NODSCIDcγ−/− Mice

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4831-4831
Author(s):  
Stefanie Bugl ◽  
Stefan Wirths ◽  
R Müller Martin ◽  
Märklin Melanie ◽  
Tina Wiesner ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Peripheral Blood ◽  
Nk Cell ◽  
Conflicts Of Interest ◽  
Control Group ◽  
Early Event ◽  
Wild Type ◽  
Hematopoietic Stem ◽  
Lymphoid Progenitors ◽  
Fate Decision

Abstract Abstract 4831 Introduction: Previously it was demonstrated that lymphopoiesis is rapidly established after transplantation of wild type stem cells into lymphopenic NODSCIDcγ−/− mice. These data were interpreted as evidence for an “empty” preformed lymphopoietic niche being replenished by lymphoid progenitors. We hypothesized that antibody-induced neutropenia might influence early post transplant fate decision to myeloid rather than lymphoid differentiation resulting in delayed lymphoid reconstitution. Materials and Methods: 25,000 flow sorted CD45.2-expressing wild type Lin-/Sca1+/c-Kit+ (LSK) cells from C57BL/6 mice were transplanted into sublethally irradiated B-/T-/NK-cell deficient NODSCIDcγ−/− mice (CD45.1). Three groups of n = 7 mice received anti-Gr1 or anti-1A8 i.p. every 48 h to induce continuous antibody-mediated neutropenia vs. PBS as control. Blood was harvested at regular intervals to monitor the engraftment. After 16, 22, and 34 days, animals were sacrificed and underwent blood and bone marrow analysis. Results: Hematopoietic regeneration started with the emergence of donor-derived monocytes in all groups as well as neutrophils in the control group as early as 9 days after transplantation. On day 14, B cells were to be detected for the first time, followed by T lymphocytes approximately 20 days after transplantation. Besides the fact that neutrophils were undetectable in the antibody treated groups, the peripheral blood revealed no significant changes between the neutropenic mice and the control group at any point of time. At the bone marrow level, an increase of LSK and granulocyte-macrophage progenitors (GMPs) at the expense of megakaryocyte erythrocyte progenitor cells (MEPs) was found in neutropenic mice. Common lymphoid progenitors (CLPs), however, were not significantly different. Conclusions: The engraftment of wild type donor cells after hematopoietic stem cell transplantation into NODSCIDcγ−/− mice started with the production of monocytes and neutrophils. B-lymphocytes were detectable by day 14 after transplantation. The production of T-cells started around day 20. Continuous antibody-mediated neutropenia did not significantly delay lymphoid regeneration. Although the marrow of neutropenic mice displayed increased proliferation of granulocyte progenitors, CLPs were unchanged. We conclude that the detection of donor-derived lymphocytes in the host peripheral blood is a relatively early event after LSK transplantation. Moreover, antibody induced neutropenia is not sufficient to induce sustainable changes in early hematopoietic fate decisions on the bone marrow level. Disclosures: No relevant conflicts of interest to declare.

The Role of Angiopoietins System in Waldenstrom's Macroglobulinemia: Correlations with Marrow Microvessel Density and Survival

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3901-3901
Author(s):  
Efstathios Kastritis ◽  
Evangelos Eleutherakis-Papaiakovou ◽  
Maria Gavriatopoulou ◽  
Dimitrios Christoulas ◽  
Athanasios Papatheodorou ◽  
...  
Keyword(s):  
Microvessel Density ◽  
Prognostic Significance ◽  
Serum Levels ◽  
Waldenström’S Macroglobulinemia ◽  
Vessel Formation ◽  
Waldenstrom's Macroglobulinemia ◽  
Waldenstrom’S Macroglobulinemia ◽  
Waldenström's Macroglobulinemia ◽  
Angiogenic Cytokines

Abstract Abstract 3901 Angiogenesis is elevated in many hematological malignancies, but there is limited information for angiogenesis in Waldenstrom's macroglobulinemia (WM). Several cytokines including VEGF (and its major angiogenic component VEGF-A), bFGF, angiogenin and angiopoietin-1 (Ang-1) and 2 (Ang-2) participate in the neoangiogenesis process. We have previously shown that circulating angiogenic cytokines correlate with disease severity in WM (Anagnostopoulos et al, Br J Haematol 2007;137:560–8), while it has been reported that the bone marrow (BM) microvessel density (MVD) is increased in 30%-40% of patients with WM (Rajkumar et al, Semin Oncol 2003;30:265–9). The ratio of Ang-1/Ang-2 correlates with survival in multiple myeloma, but there is no information for the prognostic value of the angiopoietins and other angiogenic cytokines in WM. To address this issue, we studied the serum levels of VEGF, VEGF-A, bFGF, angiogenin, Ang-1 and Ang-2 in the serum of 55 patients with symptomatic WM before the administration of any kind of therapy, in 5 patients with asymptomatic WM (AWM), in 12 patients with IgM MGUS and in 30 healthy controls, of similar age and gender. Circulating VEGF, VEGF-A, bFGF, angiogenin, Ang-1 and Ang-2 were measured using ELISA method (R&D Systems, Minneapolis, MN, USA for VEGF, bFGF, angiogenin, Ang-1 and, Ang-2; Diaclone SAS, Besancon, France for VEGF-A). MVD was also evaluated in the BM biopsies of all patients, according to standard methodology. Table 1 depicts the levels of the studied angiogenic cytokines. The serum levels of VEGF, VEGFA, bFGF, angiogenin and Ang-2 were markedly elevated in WM patients compared to controls (p<0.001 for all comparisons); Ang-1 levels (p<0.01) were lower in WM patients than in controls, and the corresponding Ang-1 to Ang-2 ratio was significantly lower in WM patients than in controls, further indicating an angiogenic shift in WM patients. Circulating angiogenin (p<0.001) and Ang-2 (p=0.001) levels were also increased in WM patients compared to patients with IgM MGUS but Ang-1 levels were lower (p=0.003) resulting in Ang 1/2 ratio significantly higher in IgM MGUS than WM patients (p=0.004). In symptomatic WM patients, Ang-2 levels and the corresponding Ang-1/2 ratio correlated with serum beta2-microglobulin (r=0.454, p=0.002 and r=0.459, p=0.003, respectively). Ang-2 levels correlated with ISSWM stage (1914 ± 1175 pg/ml vs. 4461 ± 2628 pg/ml vs. 3926 ± 2172 pg/ml, for ISSWM-low, intermediate and high risk, respectively, p=0.007). A strong inverse correlation of MVD to Ang-1 was found in patients with WM (r=-0.600, p=0.011), indicative of the regulatory function of Ang-1 as an antagonist of vessel sprouting and new vessel formation. The median follow-up of symptomatic WM patients was 35 months. The median overall survival (OS) has not been reached yet, while the probability for 3-year OS was 76%. The median progression-free survival (PFS) was 57 months and the 3-year probability of PFS was 56%. Patients with Ang-2 levels above the median value had significantly shorter PFS (3-year PFS rate 82% vs. 50%, p=0.032; Figure). We conclude that in patients with WM, serum levels of several angiogenic cytokines (Ang-2, angiogenin, VEGF, VEGF-A, and bFGF) are markedly elevated and for some of these cytokines there is a correlation with disease features. The levels of pro-angiogenic cytokines, such as Ang-2 increase as disease evolves for IgM MGUS to symptomatic WM, while the Ang-1 decreases. We show that the MVD in the BM strongly correlates to decreasing Ang-1 levels, probably due to the decreasing inhibitory effect of Ang-1 to vessel formation in the BM microenvironment as disease evolves. For the first time we found that Ang-2, may also have a prognostic significance, associated with significantly shorter PFS. Further follow up is needed in order to evaluate the prognostic significance of Ang-2 for the OS of patients with WM Table: Levels of the studied circulating angiogenic cytokines (mean ± SD) Controls IgM MGUS aWM WM VEGF (pg/ml) 106 ± 76 323 ± 217 116 ± 83 399 ± 248 VEGF-A (pg/ml) 6.7 ± 13.6 97.5 ± 94 28.4 ± 49.3 113 ± 113 bFGF (pg/ml) 1.3 ± 3.2 12 ± 14 9.5 ± 16 17 ± 21.6 Angiogenin (pg/ml) 2.4×105 ± 0.5×105 2.7×105 ± 0.8×105 2.8×105 ± 0.7×105 4.5×105 ± 2.1×105 Ang-1 (pg/ml) 4.8×105 ± 1.1×105 4.8×105 ± 1.9×105 2.6×105 ± 1.5×105 2.5×105 ± 2.3×105 Ang-2 (pg/ml) 1747 ± 1023 1783 ± 684 3775 ± 1296 3424 ± 2570 Ang-1/2 ratio 28.1 ± 11.6 31 ± 14 6.5 ± 1.6 14.5 ± 17.7 Disclosures: No relevant conflicts of interest to declare.

Multiple Copies of MLL Is The Most Commonly Detected Cytogenetic Abnormality In Newly Diagnosed Multiple Myeloma and May Modify Disease Risk

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 1910-1910 ◽  
Author(s):  
Chrystal Landry ◽  
Dory Londono ◽  
Sean M. Devlin ◽  
Alex Lesokhin ◽  
Nikoletta Lendvai ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Bone Marrow ◽  
Overall Survival ◽  
Disease Risk ◽  
Conflicts Of Interest ◽  
Prognostic Significance ◽  
Protein Translation ◽  
Response To Therapy ◽  
Cytogenetic Abnormality ◽  
Newly Diagnosed

Abstract Background Multiple myeloma (MM) is a heterogeneous condition with variable disease course, response to therapy, and survival outcome. Cytogenetics and fluorescent in-situ hybridization (FISH) have identified several recurrent chromosomal aberrations in MM and play important and independent roles in risk stratification (Munshi et al. Blood 2011). However, the pathogenesis of the disorder remains poorly understood. Next-generation sequencing has recently identified that MM involves mutations of genes with roles in protein translation, histone methylation, and blood coagulation (Chapman et al. Nature 2011). Based on the observation that extra copies of MLL, a histone methyltransferase known to regulate the homeotic transcription factor HOXA9 that is highly expressed in MM, is frequently detected in MM, we sought to define the incidence and prognostic significance of excess MLL in MM patients. Methods We identified 188 patients with newly diagnosed MM who had cytogenetics and/or FISH performed on initial, pre-treatment bone marrow specimens at Memorial Sloan-Kettering Cancer Center between January 2009 and December 2012. Standard karyotype and FISH were performed as previously described (Cigudosa et al. Blood 1998, Gerritsen et al. Blood 1992). Probes included LSI IgH/FGF3, LSI IgH/CCND1, LSI IgH/MAF, LSI MLL, LSI p53/cep17, LSI13q14.3/13q34, LSI ETV6, LSI CBFB, LSI 1p36/1q25, and LSI 5,9,15 from Abbott Molecular. Fisher's exact test evaluated the association between MLL and selected abnormalities. Kaplan-Meier methodology estimated overall survival from the date of BM evaluation, and survival was compared using a logrank test. Results In unselected bone marrow specimens, abnormalities were detected by karyotype in 17% (27/156) and FISH in 47% (87/186) of patients tested. Hyperdiploidy, which has been associated with longer survival, was identified in 23% (43/187) of patients, while the unfavorable risk abnormalities, including loss of p53, deletion 13q (by karyotype), translocation (4;14) and excess 1q were seen in 8% (15/179), 8% (12/156), 4% (7/176) and 16% (29/178) of patients, respectively. Translocation (11;14) was seen in 4 patients; translocation (14;16) was not identified in any patient. 28% (51/183) of patients had extra copies of MLL, which was the most frequent genetic abnormality identified. Unexpectedly, this abnormality was significantly associated with both favorable (hyperdiploidy, P = <0.001) and unfavorable (deletion 13q, P = 0.043; excess 1q P = 0.001) risk genetics. While having excess MLL had no impact on the overall survival of standard-risk patients, defined as neither hyperdiploid nor with unfavorable genetics (N = 100), patients with poor-risk genetics (N = 46) and extra copies of MLL had a trend toward better survival, P = 0.06 (Figure 1). Conclusions Karyotype and FISH studies identified excess MLL as the most frequent cytogenetic abnormality in a large cohort of newly diagnosed MM patients. In patients with MM and unfavorable cytogenetics, the presence of excess MLL may ameliorate some of the adverse impact of associated with these abnormalities. Understanding the functional significance of excess MLL, perhaps as it relates to frequently dysregulated HOXA9 in MM, may provide insight into disease pathogenesis and/or identify drugable targets. Disclosures: No relevant conflicts of interest to declare.

Morphological Distinction Unravels Mechanisms Of Platelet Biogenesis From Bone Marrow Megakaryocytes

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2428-2428
Author(s):  
Satoshi Nishimura ◽  
Koji Eto ◽  
Ryozo Nagai
Keyword(s):  
Bone Marrow ◽  
Fluorescent Protein ◽  
Conflicts Of Interest ◽  
Human Subjects ◽  
Blood Platelets ◽  
Serum Levels ◽  
Cytokine Balance ◽  
Green Fluorescent

Abstract Blood platelets are generated in the bone marrow (BM) from their precursors, megakaryocytes (MK). Although we know that MKs produce platelets throughout life, precisely how platelets are produced in vivo remains uncertain, largely because of the rarity of MKs in the BM and the lack an adequate visualization technique. In the present study, we were able to visualize MK dynamics leading to platelet release in living animals at high resolution. To clearly understand the nature of thrombopoiesis in BM MKs, we optimized an in vivo imaging technique based on two-photon microscopy that enabled us to visualize living BM in CAG- enhanced green fluorescent protein (eGFP) mice. By visualizing living bone marrow in vivo, we observed that two modes (fragmentation and proplatelet formation) can be ongoing simultaneously in the same mouse. We observed that these two modes detectable by different morphological behavior can be ongoing simultaneously in the same BM of mouse, and are regulated by specific cytokines. Short proplatelets from megakaryocytes predominated at steady state, and more elongated proplatelets were accelerated by thrombopoietin (TPO) with responding to chronic platelet needs including recovery form BM transplantations. In contrast, acute platelet needs by blood loss, 5-FU administration or pritoneal acute inflammation increased cytoplasmic fragmentation following rapid ‘rupture’. Observed two modes are both dependent on tubulin reorganization on platelet biogenesis. In addition, platelet increase at acute phase is independent of proliferation by MK progenitors and this factor might exert apoptosis machinery on already reserved mature type of MKs. This humoral factor was identified by combination of in vitro screening systems and in vivo MK visualization analysis. Factor serum levels were reduced independently of the thrombopoietin level in human subjects with low platelet counts. It thus appears the cytokine balance dynamically regulates the mode of thrombopoiesis and the cellular programming of MKs. Thus, these novel factor may be a novel therapeutic target in thrombocytopenic situations, especially when associated with acute loss of platelets or when platelet transfusion is limited or unsuccessful. Disclosures: No relevant conflicts of interest to declare.

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