Pretreatment Plasma Cell Proteasome Levels Predict Responses To Treatment With Carfilzomib, Lenalidomide, and Dexamethasone (CRd) Followed By Lenalidomide Extended Dosing (CRd-R) In Newly Diagnosed Multiple Myeloma Patients

Abstract Background Carfilzomib (Cz) is an irreversible proteasome inhibitor with potent anti-myeloma effects resulting in deep clinical responses and durable remissions in the majority of patients. In our two-stage phase II trial of 45 newly diagnosed multiple myeloma (MM) patients using carfilzomib (Cz), lenalidomide (Ln), and dexamethasone (Dx) combination therapy followed by 2 years of Ln maintenance, best responses after a median of 9 completed cycles (range 2-20), included 17-stringent-(s)-complete response-(CR)/1-CR/6-near-(n)-CR (63%), 10-very good partial response (VGPR) (26%), 3-partial response (PR) (8%), and 1-stable disease (SD) (3%) (reported in a separate abstract). In this pre-planned correlative sub-study based on our ongoing clinical CRd trial for newly diagnosed MM patients, we conducted a prospective flow cytometric study designed to characterize pretreatment levels of proteasomes and aggresomes in plasma cells in relation to response to therapy. Methods Bone marrow aspirates were collected at baseline and C1D2 (single agent Cz exposed). Permeabilized CD138 and CD38 positive plasma cells were tested using anti-19S proteasome subunit antibodies (Abcam, Cambridge, UK). In parallel, cells were labeled with ProteoStat Aggresome Detection Reagent (Enzo Life Sciences, Farmingdale, NY). Multicolor flow cytometric acquisition and analysis was performed using BD FACS CANTO and DIVA software. Data was expressed as mean fluorescence intensity (MFI) ratio using isotype-matched controls. Patients’ best responses to therapy after minimum of 4 cycles were correlated to the acquired proteasome and aggresome data. Statistical analysis was performed using DataPrism software. Statistical significance was considered as p-value <0.05. Results Total of 21 patients were assessed: 14 achieved CR (CR group), 4-VGPR, 2-PR and 1-SD (non-CR group). The median plasma cell 19S MFI ratio in the CR group was 20.21 (range 5.21-84.27), and in the non-CR group 6.19 (range 2.88-11.68), p<0.005. The percent of plasma cells in bone marrow aspirates was not statistically significantly different between two groups. 45% of non-CR patients had plasma cell 19S MFI ratio of less than 5, while 65% of CR patients had plasma cell 19S MFI ratio of over 12. After single agent Cz treatment (C1D2) plasma cell 19S proteasome MFI ratio in the CR group decreased in 90% of patients, while aggresome MFI ratio increased compared to baseline. Conversely, in the non-CR group, C1D2 plasma cell 19S MFI ratio increased in 80% of patients, while aggresome MFI ratio remained unchanged or decreased compared to baseline. Conclusions We found the pretreatment florescence intensity (MFI) ratio of 19S proteasome subunit in plasma cells to be significantly higher in MM patients who obtained CR (versus non-CR) when treated with CRd treatment. None of the patients with pretreatment 19S MFI ratio of less than 5 achieved CR; conversely, all patients with pretreatment 19S MFI ratio of over 12 achieved CR. After a single dose of carfilzomib, 90% of CR patients had decreased 19S MFI and increased aggresomes MFI ratio, while 80% of non-CR patients showed opposite changes: increased 19S MFI and unchanged/decreased aggresomes MFI ratio. We conclude that pretreatment plasma cell proteasome levels predict response to the CRd treatment in newly diagnosed MM patients. Disclosures: No relevant conflicts of interest to declare.

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A bottom-up proteomic approach in bone marrow plasma cells of newly diagnosed multiple myeloma patients

Current Proteomics ◽

10.2174/1570164617999201124142232 ◽

2020 ◽

Vol 17 ◽

Author(s):

Beycan Ayhan ◽

Seçil Karahisar Turan ◽

N. Pınar Barkan ◽

Klara Dalva ◽

Meral Beksaç ◽

...

Keyword(s):

Multiple Myeloma ◽

Bone Marrow ◽

Plasma Cell ◽

Marginal Zone ◽

Plasma Cells ◽

B Cell Lymphoma ◽

Newly Diagnosed ◽

Cell Content ◽

Peptide Mass ◽

Proteomic Approach

Background: Multiple myeloma (MM) is characterized by infiltration of bone marrow (BM) with clonal malignant plasma cells. The percentage of plasma cells in the BM is required for both diagnosis and prognosis. Objective: Intracellular protein screening and quantitative proteomic analysis was performed in myeloma plasma cells with an aim to compare expressions between low (0-9%), intermediate (10-20%) and high (>20%) plasma cell infiltration groups. Methods: BM aspiration samples were collected from newly diagnosed untreated patients with MM. The samples were pooled into three groups according to the plasma cell content (PCC) in the BM: group 1 (0-9%), group 2 (10-20%) and group 3 (>20%). Protein profiles were obtained and proteins were identified by peptide mass fingerprinting analysis. Results: Differentially expressed proteins were detected between all groups. The identified proteins are Endoplasmin, Calreticulin, Protein Disulfide-isomerase, Marginal zone B and B1 cell specific protein/pERp1, Actin cytoplasmic 1, Myeloblastin, Thioredoxin domain-containing protein 5, Ig kappa chain C region, Apoptosis regulator B-cell lymphoma 2 and Peroxiredoxin- 4. Conclusion: Proteins involved in cell proliferation, apoptosis, redox homeostasis and unfolded protein disposal through endoplasmic reticulum-associated degradation machinery has been found to be correlated to PCC. Our results confirm earlier reports in regards to the potential effects of identified proteins in the major signaling pathways that lead to cancer. Moreover, this study reveals a novel association between PCC levels and MM. It further highlights the roles of Marginal zone B and B1 cell specific proteins in MM, which could be used as candidate biomarkers in future studies.

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Biomarker Proteasome Levels Predict Response to Combination Therapy with Carfilzomib, Lenalidomide, and Dexamethasone in Newly Diagnosed Multiple Myeloma Patients

Blood ◽

10.1182/blood.v124.21.2080.2080 ◽

2014 ◽

Vol 124 (21) ◽

pp. 2080-2080 ◽

Cited By ~ 1

Author(s):

Neha Korde ◽

Talib Dosani ◽

Olga Simakova ◽

Sham Mailankody ◽

Rene Costello ◽

...

Keyword(s):

Multiple Myeloma ◽

Bone Marrow ◽

Plasma Cell ◽

Plasma Cells ◽

Residual Disease ◽

Single Agent ◽

Data Monitoring Committee ◽

Exact Test ◽

Median Plasma ◽

Pre Treatment

Abstract Introduction Carfilzomib is an effective irreversible proteasome inhibitor, exerting strong anti-myeloma effects and deep minimal residual disease negative responses. Updated results of a phase II clinical and correlative study combining carfilzomib, lenalidomide, and dexamethasone (CRd) in newly diagnosed multiple myeloma patients (NCT01402284) demonstrates a best response rate of very good partial response rate or higher (>VGPR) of 89%. As part of the prospective clinical correlative trial, we developed a novel flow cytometric assay for measuring proteasome and aggresome levels in bone marrow plasma cells pre- and post-carfilzomib single drug exposure in patient samples. The measurements were correlated with clinical treatment outcomes after CRd therapy. Methods Bone marrow aspirates were collected at baseline and C1D2 (single agent cfz exposed prior to len/dex administration). Permeabilized CD138 and CD38 positive plasma cells were tested using anti-19S proteasome or B-4 proteasome subunit antibodies subunit antibodies (Abcam, Cambridge, UK). In parallel, cells were labeled with ProteoStat Aggresome Detection Reagent (Enzo Life Sciences, Farmingdale, NY). Multicolor flow cytometric acquisition and analysis was performed using BD FACS CANTO and DIVA software. Data was expressed as mean fluorescence intensity (MFI) ratio using isotype-matched controls. Patients’ best responses to therapy, minimal residual disease status, and progression free survival data were correlated to the acquired proteasome and aggresome data. Statistical analysis was performed using DataPrism software. Statistical significance was considered as p-value <0.05. Results Twenty-six out of 45 patient pre-treatment bone marrow samples were available for analysis of 19S proteasome, B4 proteasome, or aggresome levels in plasma cells: 16 complete response/stringent (CR/sCR) (1 CR, 15 sCR) and 10 non-CR (7 VGPR, and 3 partial response) groups. The total percent of plasma cells was not statistically significantly different between two groups. The median plasma cell 19S MFI ratio was higher in the CR group: 20.7 months (range: 5.21-84.3) compared to the non-CR group: 6.4 months (range: 0.4-12.4) (p<0.01, Mann-Whitney). Median plasma cell B4 or aggresome MFI ratios did not vary significantly prior to treatment between CR and non-CR groups (p=NS, Mann-Whitney). After single agent carfilzomib treatment (C1D2), plasma cell 19S proteasome MFI ratio in the CR group decreased in 8 out of 10 samples compared to baseline (p=0.06, Wilcoxon signed rank test) and the mean percentage decline was 42.3%. A baseline 19S MFI ratio > 10 was associated with obtaining CR/sCR compared to 19S MFI ratio < 10 (p=0.02, Fisher’s exact test), and trended towards achieving MRD negative status (p=0.05, Fisher’s exact test). PFS and duration of response improved significantly in patients with higher baseline 19S MFI ratio > 10 compared to baseline 19S MFI ratio <10, median NR vs. 19 months (p=0.04, two-tailed log-rank) and NR vs. 16.3 months (p=0.04, two-tailed log-rank), respectively. However, median time to reach a CR/sCR did not vary between 19S MFI ratio > 10 vs. ratio <10 (p=NS, two-tailed log-rank). Conclusion In patients receiving combination therapy with CRd, higher pre-treatment 19S proteasome levels correlate with deeper clinical responses to treatment (ie, CR and sCR). Also higher pre-treatment proteasome levels were predictive of improved duration of response and PFS. In further support of these observations, decreased 19S proteasome levels after single drug carfilzomib exposure were associated with a higher likelihood of reaching CR/sCR. Our findings suggest that quantification of 19S proteasome levels in plasma cells, prior to initiation of carfilzomib-based therapy, may be a clinically useful biomarker to predict clinical outcomes in multiple myeloma patients. Disclosures Landgren: Onyx Pharmaceuticals: Consultancy; Medscape: Consultancy; Millennium Pharmaceuticals: Independent Data Monitoring Committee (IDMC), Independent Data Monitoring Committee (IDMC) Other.

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Multiple myeloma: circulating lymphocytes that express plasma cell antigens

Blood ◽

10.1182/blood.v64.2.352.bloodjournal642352 ◽

1984 ◽

Vol 64 (2) ◽

pp. 352-356

Author(s):

GJ Ruiz-Arguelles ◽

JA Katzmann ◽

PR Greipp ◽

NJ Gonchoroff ◽

JP Garton ◽

...

Keyword(s):

Multiple Myeloma ◽

Bone Marrow ◽

Plasma Cell ◽

Peripheral Blood ◽

Plasma Cells ◽

Peripheral Blood Lymphocytes ◽

Tumor Burden ◽

B Cell Differentiation ◽

Blood Lymphocytes ◽

Bone Marrow Plasma

The bone marrow and peripheral blood of 14 patients with multiple myeloma were studied with murine monoclonal antibodies that identify antigens on plasma cells (R1–3 and OKT10). Peripheral blood lymphocytes expressing plasma cell antigens were found in six cases. Five of these cases expressed the same antigens that were present on the plasma cells in the bone marrow. Patients that showed such peripheral blood involvement were found to have a larger tumor burden and higher bone marrow plasma cell proliferative activity. In some patients, antigens normally found at earlier stages of B cell differentiation (B1, B2, and J5) were expressed by peripheral blood lymphocytes and/or bone marrow plasma cells.

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Myeloma Cell Associated Therapeutic Protein Discovery Using Single Cell RNA-Seq Data

Blood ◽

10.1182/blood-2020-142205 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 4-5

Author(s):

Lijun Yao ◽

Reyka G Jayasinghe ◽

Tianjiao Wang ◽

Julie O'Neal ◽

Ruiyang Liu ◽

...

Keyword(s):

Multiple Myeloma ◽

Bone Marrow ◽

Cell Surface ◽

B Cell ◽

Tumor Cells ◽

Plasma Cell ◽

Tissue Specificity ◽

Plasma Cells ◽

Expression Data ◽

Intracellular Proteins

Multiple myeloma (MM) is a hematological cancer of the antibody-secreting plasma cells. Despite therapeutic advancements, MM remains incurable due to high incidence of drug-resistant relapse. In recent years, targeted immunotherapies, which take advantage of the immune system's cytotoxic defenses to specifically eliminate tumor cells expressing certain cell surface and intracellular proteins have shown promise in combating this and other B cell hematologic malignancies. A major limitation in the development of these therapies lies in the discovery of optimal candidate targets, which require both high expression in tumor cells as well as stringent tissue specificity. In an effort to identify potential myeloma-specific target antigens, we performed an unbiased search for genes with specific expression in plasma and/or B cells using single-cell RNA-sequencing (scRNAseq) of 53 bone marrow samples taken from 42 patients. By comparing >40K plasma cells to >97K immune cells across our cohort, we were able to identify a total of 181 plasma cell-associated genes, including 65 that encode cell-surface proteins and 116 encoding intracellular proteins. Of particular interest is that the plasma cells from each patient were shown to be transcriptionally distinct with unique sets of genes expressed defining each patient's malignant plasma cells. Using pathway enrichment analysis, we found significant overrepresentation of cellular processes related to B-Cell receptor (BCR) signaling, protein transport, and endoplasmic reticulum (ER) stress, involving genes such as DERL3, HERPUD1, PDIA4, PDIA6, RRBP1, SSR3, SSR4, TXNDC5, and UBE2J1. To note, our strategy successfully captured several of the most promising MM therapeutic targets currently under pre-clinical and clinical trials, including TNFRSF17(BCMA), SLAMF7, and SDC1 (CD138). Among these, TNFRSF17 showed very high plasma cell expression, with concomitant sharp exclusion of other immune cell types. To ascertain tissue specificity of candidate genes outside of the bone marrow, we analyzed gene and protein expression data from the Genotype-Tissue Expression (GTEx) portal and Human Protein Atlas (HPA). We found further support for several candidates (incl. TNFRSF17,SLAMF7, TNFRSF13B (TACI), and TNFRSF13C) as being both exclusively and highly expressed in lymphoid tissues. While several surface candidates were not found to be lymphocyte-restricted at the protein level, they remain relevant considerations as secondary targets for bi-specific immunotherapy approaches currently under development. To further investigate potential combinatorial targeting, we examine sample-level patterns of candidate co-expression and mutually-exclusive expression using correlation analysis. As the majority of our detected plasma cell-specific genes encode intracellular proteins, we investigated the potential utility of these epitopes as therapeutic targets via MHC presentation. Highly expressed candidates include MZB1, SEC11C, HLA-DOB, POU2AF1, and EAF2. We analyzed protein sequences using NetMHC and NETMHCII to predict high-affinity peptides for common class-I and class-II HLA alleles. To correlate MHC allelic preference with candidate expression in our cohort, we performed HLA-typing for 29 samples using Optitype. To support our scRNAseq-driven findings, we cross-referenced gene expression data with 907 bulk RNA-sequencing samples, including 15 from internal studies and 892 from the Multiple Myeloma Research Foundation (MMRF), as well as bulk global proteomics data from 4 MM cell lines (TIB.U266, RPMI8226, OPM2, MM1ST) and 4 patients. We see consistent trends across both cohorts, with high positive correlation (Pearson R ranging between 0.60 and 0.99) for a majority of genes when comparing scRNA and bulk RNA expression in the same samples. Our experimental design and analysis strategies enabled the efficient discovery of myeloma-associated therapeutic target candidates. In conclusion, this study identified a set of promising myeloma CAR-T targets, providing novel treatment options for myeloma patients. Disclosures Goldsmith: Wugen Inc.: Consultancy. DiPersio:Magenta Therapeutics: Membership on an entity's Board of Directors or advisory committees.

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THE BONE MARROW ON STERNAL ASPIRATION IN MULTIPLE MYELOMA

Blood ◽

10.1182/blood.v3.9.987.987 ◽

1948 ◽

Vol 3 (9) ◽

pp. 987-1018 ◽

Cited By ~ 52

Author(s):

EDWIN D. BAYRD

Keyword(s):

Multiple Myeloma ◽

Bone Marrow ◽

Plasma Cell ◽

Plasma Cells ◽

Myeloma Cell ◽

Multinucleated Cells ◽

Cytoplasmic Bodies ◽

Plasma Cell Type ◽

Well Differentiated ◽

Diagnostic Pitfalls

Abstract Generalizing, it can be said that the pathologic cells seen in smears of the bone marrow in multiple myeloma resemble the plasma cell and vary from the very anaplastic and immature cell to the well-differentiated and almost characteristic plasma cell. The feature which the "myeloma" cell shares with the plasma cell is the abundant, granular, basophilic cytoplasm which tends to be fragile and undergo the same degenerative changes in each; namely, the formation of Russell bodies and vacuolization. Fairly frequently a perinuclear clear area or Hof is present and the nucleus tends to be eccentrically placed. Cytoplasmic extensions or pseudopodia may also be seen in either case, but they occur more often and more dramatically in instances of multiple myeloma. Multinucleated cells are commonly seen. In addition, myeloma-plasma cells will often have a large clear nucleolus and a leptochromatic nucleus and will exhibit a tendency to the formation of isolated areas of condensed chromatin. Cytoplasmic extrusions, free cytoplasmic bodies, occasionally complete with Russell bodies and vacuoles are almost universally present. All cases were of the plasma cell type; there was no exception. In these cases, the myeloma-plasma cell constituted from 2.5 to 96 per cent of the leukocytic elements present. The opinion was expressed that all so-called types of multiple myeloma are merely variations in differentiation of this same cell. It was noted that anaplasia, hypernucleation and lack of plasma cell predominance in certain cases were diagnostic pitfalls. Additional evidence was adduced to confirm the reticulo-endothelial origin of the myeloma-plasma cell. It was further observed that certain prognostically valuable information could be gleaned from a careful review of the cytologic characteristics in these cases.

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Peripheral blood monoclonal plasma cells as a predictor of survival in patients with multiple myeloma [see comments]

Blood ◽

10.1182/blood.v88.5.1780.1780 ◽

1996 ◽

Vol 88 (5) ◽

pp. 1780-1787 ◽

Cited By ~ 85

Author(s):

TE Witzig ◽

MA Gertz ◽

JA Lust ◽

RA Kyle ◽

WM O'Fallon ◽

...

Keyword(s):

Multiple Myeloma ◽

Prognostic Factors ◽

High Risk ◽

Plasma Cell ◽

Plasma Cells ◽

Cell Labelling ◽

Newly Diagnosed ◽

C Reactive Protein ◽

Reactive Protein ◽

Beta 2 Microglobulin

Abstract The purpose of this study was to quantitate the number and labeling index of monoclonal plasma cells in the blood of patients with newly diagnosed multiple myeloma (MM) to learn if these values were independent prognostic factors for survival. Patients were candidates for this study if they had untreated myeloma requiring therapy, were evaluated at our institution between 1984 and 1993, and had a sample of blood analyzed with a sensitive immunofluorescence technique for monoclonal plasma cells and the blood B-cell labelling index (BLI). The % blood monoclonal plasma cells (%BPC) and the BLI were analyzed along with stage, marrow plasma cell LI, % marrow plasma cells, calcium, creatinine, albumin, beta-2-microglobulin, and C-reactive protein as univariate and multivariate factors for survival. Eighty percent of the 254 patients accrued to this study had monoclonal BPC detected. The median % BPC was 6% and 57% (144 of 254) of patients had a high number (> or = 4%). Patients with > or = 4% BPC had a median survival of 2.4 years vs 4.4 years for those with < 4% BPC (P < .001). The BLI was also prognostic (P = .008). In a multivariate analysis, the % BPC, age, albumin, stage, marrow plasma cell LI, and the BLI were independent factors for survival. The %BPC and the marrow plasma cell LI best separated the group into low, intermediate, and high risk myeloma with median survivals of 52, 35, and 26 months, respectively. Patients with high %BPC were less likely to have lytic bone disease from their MM (P = .002). The %BPC and the BLI are independent prognostic factors for survival and are useful in identifying patients as low, intermediate, and high risk. Clonal cells in the blood should be quantified in future clinical trials for myeloma.

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Expression of VEGF Receptors on Plasma Cells: Evidence of Heterogeneity.

Blood ◽

10.1182/blood.v104.11.3361.3361 ◽

2004 ◽

Vol 104 (11) ◽

pp. 3361-3361

Author(s):

Teresa K. Kimlinger ◽

Thomas E. Witzig ◽

S. Vincent Rajkumar

Keyword(s):

Bone Marrow ◽

Plasma Cell ◽

Plasma Cells ◽

Receptor Expression ◽

Vegf Receptors ◽

Flow Cytometric Assay ◽

Blocking Antibody ◽

R And D ◽

Flow Cytometric ◽

Indirect Assay

Abstract Background: In previous studies quantitating VEGF receptors we have found no significant differences in expression between plasma cells from normal controls, multiple myeloma (MM), monoclonal gammopathy of undetermined significance (MGUS), or smoldering myeloma (SMM). (Kumar S, Blood, May 2004; 10.1182/blood-2003-11-3811 ePub). These studies were done using immunohistochemistry or Western Blotting (on CD138+ plasma cells) and may have been limited by low levels of receptor expression and by heterogeneity of expression. We measured expression of VEGF receptors (VEGFR1, VEGFR2 and VEGFR3) on the surface of plasma cells and in plasma cell subsets using direct and indirect flow cytometric assays to determine if significant differences in VEGF receptor expression existed between MGUS, SMM and MM. Methods: In the indirect flow cytometric assay, 32 bone marrow samples (3 amyloid, 9 MGUS, 12 MM, 8 SMM) were ACK lysed and tested using the FLUOROKINE TM rhVEGF biotin kit (R and D Systems, Minneapolis, MN) according to manufacturer’s instructions. In brief, in one tube (tube 1) cells were incubated with VEGF biotin. In tube 2, VEGF biotin preincubated with a blocking antibody was added to the cells (specificity control), while in a third tube a non-specific biotinylated protein (negative control) was added. After incubation, FITC-avidin, CD38 APC and CD45 Percp was added to each tube. Gates were drawn around the cells of interest and fitc staining was evaluated for the % positive cells. The % of signal blocked was calculated by comparing the fitc intensity (channel number) of the blocked VEGF peak (tube 2) to FITC intensity of tube 1. This system does not determine the identity of the receptor, but indicates the presence of VEGF receptors. In the direct flow cytometric assay, bone marrow from 25 individuals (2 amyloid, 5 MGUS, 7 MM, 7 SMM, and 4 normals) were lysed and blocked with mouse Ig and stained with CD38/CD45. In individual tubes, PE labeled VEGF R1, R2, R3 antibodies (R and D Systems, Minneapolis, MN) or isotype control were added. Plasma cells were identified, divided according to CD45 expression, and analyzed for % and intensity of receptor staining. Results: In the indirect assay, plasma cells in all groups bound VEGF ( 96% positive) at high intensity. There was also no difference in VEGF binding between CD45+ and CD45- plasma cell fractions (93 and 98% respectively).The specificity of VEGF binding (to one of the VEGF specific receptors) was confirmed by a significant drop in peak channel numbers of FITC intensity in the presence of blocking antibody. Specific VEGF binding at a similar intensity was seen in monocytes (95%) and at a lower intensity in lymphocytes (66%) and granulocytes (28%). Staining for VEGFR1, 2, and 3 in plasma cells using the direct assay revealed that except for 2 patients (1 amyloid and 1 SMM) none had >20% cells staining for any of the 3 receptors. The same results were seen in the CD45− fraction as well. In contrast, the CD45+ plasma cell fraction was highly positive for all 3 of the receptors in nearly all cases, with no significant differences between MGUS, SMM, amyloid, or MM. Conclusions: Plasma cells in MM and related disorders have specific VEGF receptors on the cell surface. The expression of VEGFR1, 2, and 3 seems to be primarily restricted to the CD 45+ subset of plasma cells. The finding of specific VEGF binding in CD45− plasma cells seen in the indirect assay may reflect the higher sensitivity of this assay due to the inbuilt amplification process or the presence of additional VEGF receptors such as neuropilin 1.

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Rituximab in CD20 Positive Multiple Myeloma: A Prospective Study from the IFM Group.

Blood ◽

10.1182/blood.v108.11.3577.3577 ◽

2006 ◽

Vol 108 (11) ◽

pp. 3577-3577

Author(s):

Philippe Moreau ◽

Laurent Voillat ◽

Lotfi Benboubker ◽

Charles Dumontet ◽

Claire Mathiot ◽

...

Keyword(s):

Multiple Myeloma ◽

Bone Marrow ◽

Tumor Cells ◽

Stable Disease ◽

Plasma Cells ◽

Single Agent ◽

Stage I ◽

Minor Response ◽

Cd20 Expression ◽

Anti Cd20

Abstract Multiple myeloma (MM) is a heterogenous disease. A strong association between small mature plasma cell morphology, t(11;14) and CD20 expression has been described in approximately 10% of the patients with MM (Robillard et al, Blood 2003). In this subgroup of patients with MM expressing CD20, rituximab (anti-CD20 chimeric monoclonal antibody) could target the antigen and could have a clinical impact. Thus we conducted a prospective phase II trial of 4 weekly IV infusions of 375 mg/m2 rituximab in patients with MM expressing CD20 on at least 33% of tumor cells. From 07/2004 to 02/2006, 14 consecutive patients, median age 65 years, with either stage I MM never pretreated (n = 7) or stage III MM in relapse or refractory after a median of 2 lines of therapy (n= 7) were treated. Immunophenotype using flow cytometry revealed that a median of 75% of tumor cells were expressing CD20 (range, 33–100%) at the onset of therapy. Responses were evaluated 3 months after therapy according to EBMT criteria. At the reference date of June 1st, 2006, a single patient, who had relapsed 8 months after a double autologous SCT, experienced a minor response, ongoing 18 months after rituximab therapy. At the time of rituximab therapy, 100% of its plasma cells were expressing CD20, and 3 months after treatment, bone marrow examination showed 0.6% of plasma cells, none of them expressing CD20. Five patients (1 with relapsed MM and 4 with stage I MM) experienced stable disease, ongoing for 3, 4, 4, 11 and 12 months, respectively. Three patients with stage I MM had stable disease but subsequently progressed 10, 11, and 15 months after therapy, respectively. The last 5 patients with relapsed MM did not respond to anti-CD20 therapy, despite partial clearance of CD20+ plasma cells in the bone marrow in 2 cases. Conversely in the 3 latter cases, the percentage of CD20+ plasma cells did not decrease despite rituximab therapy. Several factors have been described to explain resistance against rituximab in a variety of B-cell malignancies such as the level of CD20 expression, dissociated action of complement-dependent cytotoxicity and antibody-dependant cellular cytotoxicity, polymorphism in FcgammaRIIIA receptor, and may be inadequate dose schedule. These mechanisms could explain the marginal activity of rituximab as single-agent in CD20+ MM.

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Increased Expression of Cyclin-D1 on Trephine Bone Marrow Biopsies Independently Predicts for Shorter Overall Survival In Patients with Multiple Myeloma Treated with Novel Agents

Blood ◽

10.1182/blood.v116.21.2965.2965 ◽

2010 ◽

Vol 116 (21) ◽

pp. 2965-2965

Author(s):

Evangelos Terpos ◽

Maria Roussou ◽

Anna Tasidou ◽

Magdalini Migkou ◽

Maria Gavriatopoulou ◽

...

Keyword(s):

Multiple Myeloma ◽

Bone Marrow ◽

Overall Survival ◽

Cyclin D1 ◽

Plasma Cells ◽

Univariate Analysis ◽

Novel Agents ◽

Positive Staining ◽

Newly Diagnosed ◽

Immunohistochemical Expression

Abstract Abstract 2965 The cyclin-D1 proto-oncogene is an important cell regulator of G1 to S phase progression. The overexpression of cyclin-D1 has been linked to the development and progression of several malignancies. The aim of our study was to evaluate the impact of the immunohistochemical expression of cyclin-D1on the plasma cells of trephine biopsies on survival of newly-diagnosed patients with multiple myeloma (MM) who were treated with novel agents. We evaluated formalin-fixed, paraffin-embedded, bone marrow sections of 130 consecutive patients with newly-diagnosed MM (67M/63F; median age 68 years) before any kind of therapy administration. One hundred and fifteen patients had symptomatic disease that required therapy: 29 (25%) received bortezomib-based regimens and 31 (26%) received thalidomide-based regimens as first line therapy, while all patients received regimens containing bortezomib or an IMiD at some point during the course of their disease. Immunohistochemistry was performed in all trephine biopsies using monoclonal antibodies against cyclin-D1 (Cell Marque Corp., Rocklin, CA, USA), but also against CD56 (Cell Marque Corp., Rocklin, CA, USA), CD27 (Novocastra, Newcastle upon Tyne, UK), CD117 and MUM-1 (DAKO A/S, Glostrup, Denmark), as recommended by the manufacturers. A case was considered positive if there was unequivocal positive staining of at least 20% of the plasma cells for cyclin-D1, CD56 and MUM-1 and a positive staining of at least 10% of the plasma cells for CD117 and CD27. Among patients with symptomatic myeloma (N=115), positive staining for cyclin-D1 was found in 35 (30%) patients, for CD56 in 45 (39%), for CD117 in 94 (81%) and for CD27 in 72 (62%) patients. In patients with asymptomatic myeloma, positive staining for Cyclin-D1 was found only in 1 (7%) patient, for CD56 in 9 (64%), and for CD117 in 6 (43%) (p<0.01 for all comparisons compared to symptomatic patients). There were significant positive correlations between positivity for CD27 and CD56 (p<0.001), between positivity for cyclin-D1 and CD117 (p=0.045) and a negative correlation between positivity for CD117 and CD56 (p=0.001). We also observed significant correlations between CD56 positivity and ISS-1 or ISS-2 (p=0.01) and between CD117 positivity and ISS-3 disease (p=0.002). The median overall survival (OS) for patients with symptomatic MM was 57 months (range 22–120 months). In the univariate analysis, positivity for cyclin-D1 (41 vs. 62 months, p=0.03) and for CD117 (50 vs. 75 months p=0.018) were associated with inferior survival, while positivity for CD56 (47 vs. 62 months, p=0.286), MUM-1 (52.7 vs. 63.8 months, p=0.528) and CD27 (57 vs. 50 months, p=0.445) were not. Other factors associated with inferior OS, in the univariate analysis, included ISS-3 (median OS 37 months, vs. 57 months for ISS-2 and 73 months for ISS-1, p=0.005), Hb <10 g/dl (56 vs. 73 months, p=0.044), corrected serum calcium >11.5 g/dl (29 vs. 62 months, p=0.02), serum LDH above upper normal limit (31 vs. 61 months, p=0.05), serum creatinine >2 mg/dl (26 vs. 64 months, p=0.007), low platelet counts (<100,000/ml) (22 vs. 62 months, p=0.031) and age >65 years (45 months vs. not reached for younger patients, p=0.002). In the multivariate analysis, positivity for cyclin-D1 (HR: 2.6; p=0.001), ISS stage (HR: 1.8; p=0.001) and age >65 (HR 2.7, p=0.003) were independently associated with inferior survival. Immunohistochemistry for cyclin-D1 identified subgroups of patients in ISS-2 and in ISS-3 who had extremely poor outcome. Patients with cyclin-D1 positivity had a median survival of 22 months in ISS-2 (vs. 64 months for the rest of ISS-2 patients, p=0.01) and of 13 months in ISS-3 (vs. 47 months for the rest of ISS-3, p=0.012). Our findings underline that the immunohistochemical expression of cyclin-D1 in the bone marrow trephine biopsies has independent prognostic value in MM patients, even in the era of novel agents. This marker can easily be assessed in patients who undergo a trephine biopsy as part of their initial evaluation and offers significant prognostic information. Furthermore, novel agents targeting cyclin-D1 may be of therapeutic value in MM. Disclosures: No relevant conflicts of interest to declare.

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The Frequency of Genetic Anomalies According to Clonal Plasma Cells' Phenotype in Patients with Newly Diagnosed (ND) Multiple Myeloma (MM)

Blood ◽

10.1182/blood.v126.23.5316.5316 ◽

2015 ◽

Vol 126 (23) ◽

pp. 5316-5316

Author(s):

Andrei Garifullin ◽

Irina Martynkevich ◽

Sergei Voloshin ◽

Alexei Kuvshinov ◽

Ludmila Martynenko ◽

...

Keyword(s):

Multiple Myeloma ◽

Bone Marrow ◽

Plasma Cells ◽

Conflicts Of Interest ◽

Risk Group ◽

Risk Groups ◽

Fish Analysis ◽

Newly Diagnosed ◽

Definition Of ◽

Standard Risk

Abstract Background. Genetic anomalies (GA) are primary link of pathogenesis in MM. GA lead to formation of clonal plasma cells, which has different phenotype. Aim. To estimate the incidence of GA and their correlation with clonal plasma cells' phenotype in patients with ND MM. Methods. We analysed 22 patients with ND MM (median age 57 years, range 38-80; male/female - 1:1.75). Cytogenetic analysis was performed on bone marrow samples using standard GTG-method. Metaphase FISH analysis was performed according to the manufacturer's protocol using DNA probes: LSI 13(RB1)13q14, IGH/CCND1, IGH/FGFR3, LSI TP53 (17q13.1). 8-color immunophenotypic by flow cytometry using antibody to CD45, CD38, CD138, CD56, CD19, CD20, CD27 and CD117 antigenes. Results. Translocation t(11;14) was detected in 3/14 (21.4%) patients, del(13q) - 2/14 (14.3%), t(11;14) - 3/14 (21.4%), hypodyploidy - 1/20 (5%), del(17р) - 0% patients. Clonal plasma cells' phenotype CD38+CD138+CD45- was detected in 100%. Expression CD56+ was revealed in 11/22 (50%) patients, CD19+ in 9/22 (40.9%), CD117+ in 5/22 (22.7%), CD20+ in 1/22 (4.5%), CD27+ in 1/22 (4.5%). The frequency of GA didn't depend on clonal plasma cells' phenotype and was 27.3%(3/11) in CD56+ phenotype, 23.8%(5/21) - CD20-, 23.8%(5/21) - CD27-, 23.5%(4/17) - CD117-, 23%(3/13) - CD19-, 22.2%(2/9) - CD19+, 20%(1/5) - CD117+, 18.2%(2/11) - CD56-, 0%(0/1) - CD20+, 0%(0/1) - in CD27+ phenotype. Patients of standard risk group according to mSMART 2.0 with GA had CD19-negative plasma cells' phenotype vs. CD19-positive phenotype in patients of intermediate and high-risk groups (p<0.05). 3-years overall survival in standard risk group with CD19- phenotype was 92,3%, CD19+ - 77,7% (p>0.05). Conclusion . Identification of GA, which has adverse forecast, correlates with CD19+ plasma cells phenotype. The combined definition of plasma cells phenotype and GA can improve the system of risk stratification in MM. Disclosures No relevant conflicts of interest to declare.

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