Plasma cell dyscrasias and normal plasma cells.

Abstract Background: Immunoglobulin-like transcript 2 (ILT2/CD85j) belongs to the Ig superfamily and has homology to the killer cell inhibitory receptors (KIRs). It is expressed on natural killer (NK) cells, monocytes, macrophages, dendritic cells and (naive) B lymphocytes. A differential expression of ILT2 was described for monoclonal gammopathy of undetermined significance (MGUS) and multiple myeloma (MM). Gene expression profiling studies found ILT2 to be downregulated 8.26 fold in myeloma as compared to MGUS, being the most differentially expressed gene between these two subsets. However, as RNA from CD138+ cells was used in this analysis, a varying percentage of normal, non-malignant plasma cells will impact on the results, especially in MGUS cases. Aims: We aimed to delineate ILT2 expression in different plasma cell subsets (normal compared to monoclonal cells) in MGUS and MM and the eventual prognostic impact of a differential expression level. Methods: ILT2 expression was measured by flow cytometry using a PE-conjugated antibody (clone HP-F1, Beckman Coulter) in a series of 30 MGUS patients and 91 myeloma patients. Phenotypically normal and malignant plasma cells were defined by differential expression of CD38, CD45, CD19 and CD56. Expression levels are given as mean fluorescence intensity (MFI) after correction for background staining. Results: ILT2 was not differentially expressed in monoclonal plasma cells from patients with MGUS (MFI median 112.0, range 13.5–274.4) and myeloma (MFI median 96.6, range 0.4–454.5). In contrast, monoclonal cells from MGUS and MM showed a significantly lower expression of ILT2 as compared to phenotypically normal plasma cells in the majority of samples (p=0.007). Results were confirmed by quantitative real time PCR studies in 25 MM patients showing a linear correlation of ILT2 mRNA levels with the intensity of ILT2 protein expression. ILT2 levels did not vary with state of disease and showed no correlation with clinical parameters or prognosis in our series of myeloma patients. Conclusions: In the majority of patients with monoclonal plasma cell disorders, ILT2 seems to be downregulated at an early stage of disease, i.e. upon transformation from a normal plasma cell to the MGUS/MM stage. The expression level of ILT2 in monoclonal plasma cells is neither correlated with the state of disease (MGUS versus newly diagnosed myeloma versus advanced disease) nor to prognosis of myeloma patients or other clinical parameters.

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Cyclooxygenase-2 (COX-2) Is Frequently Expressed in Multiple Myeloma (MM) and Is Associated with Poor Outcome.

Blood ◽

10.1182/blood.v104.11.2450.2450 ◽

2004 ◽

Vol 104 (11) ◽

pp. 2450-2450

Author(s):

Marco Ladetto ◽

Sonia Vallet ◽

Andreas Trojan ◽

Maria Dell’Aquila ◽

Luigia Monitillo ◽

...

Keyword(s):

Flow Cytometry ◽

Plasma Cell ◽

Cell Separation ◽

Plasma Cells ◽

Mrna Level ◽

Prognostic Indicator ◽

Disease Stage ◽

Plasma Cell Dyscrasias ◽

Cox 2 ◽

Ht 29

Abstract Introduction. A perturbed microenvironment with secretion of inflammatory cytokines is typical of MM. Prostaglandins (pg) are implicated in inflammation and angiogenesis and play a role in the pathogenesis of several solid malignancies. Expression of COX-2, the key enzyme of pg synthesis in inflamed tissues, is common in many of these cancers and plays a major role in their development. Moreover, it often acts as a poor prognostic indicator. Despite a large amount of data concerning COX-2 expression in solid tumors, few data are currently available in hematological malignancies. In MM there are several biological, epidemiological and clinical considerations suggesting a potential involvement of the pg pathway. Aim of this study is to verify the involvement of COX-2 in MM and to assess its prognostic role. Patients and methods. COX-2 expression has been assessed by western blotting (WB) as previously described (Du Bois RN, et al, Gastroenterology, 1996). Our positive control was the COX-2 positive cell line HT-29, while bone marrows (BM) from 15 healthy donors were our negative controls. We assessed a panel of 124 samples obtained by 113 patients with plasma cell dyscrasias. Sixteen samples belonged to subjects with MGUS, 80 to patients with MM at diagnosis, and 28 to patients with relapsed/refractory MM. In 11 patients, samples taken at different treatment phases were available. To confirm WB findings and to demonstrate that COX-2 expression occurs in malignant plasma cells immunohistochemistry (IC), and flow cytometry for COX-2 were also performed in 31 and four patients, respectively. Finally, COX-2 expression has been assessed in BM cells from four COX-2 positive patients following selection for the CD138 antigen using the Miltenyi cell separation system. COX-2 expression at the mRNA level has also been assessed by real time quantitative PCR. Results. A dilution test showed that our technique is sensitive enough to detect 2% HT-29 cells in a background of COX-2 negative cells. The 15 normal BM were COX-2 negative. In contrast, COX-2 expression was noticed in 12.5% of MGUS, 34.6% of MM at diagnosis and 56% of MM at relapse. COX-2 positivity at diagnosis and relapse was unrelated to disease stage, BM plasmacytosis, creatinine, Hb levels and ß2 microglobulin. COX-2 expression appeared to be of prognostic relevance: at diagnosis the median time to progression was 14 months in COX-2 positive and 40 months in COX-2 negative subjects (p<0.001). At relapse, of 14 patients showing COX-2 expression, 10 have already died of MM, and four are still alive. In contrast, of 11 COX-2 negative patients only one patient died while 10 are still alive (p<0.001). IC, cell separation and flow cytometry studies indicate that COX-2 expression is related to the malignant plasma cell population. COX-2 mRNA was overexpressed in patients showing increased COX-2 protein expression. Conclusions: a) COX-2 is frequently expressed in plasma cell dyscrasias; b) COX-2 expression is more frequent in advanced disease phases; c) COX-2 expression correlates to a worse outcome. Future studies are required to verify whether COX-2 might be clinically useful as a prognostic marker and/or therapeutic target.

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Expression of CD126 (IL-R alpha) on Plasma Cells in Monoclonal Gammopathies.

Blood ◽

10.1182/blood.v108.11.5066.5066 ◽

2006 ◽

Vol 108 (11) ◽

pp. 5066-5066

Author(s):

Syed T. Mahmood ◽

Shaji Kumar ◽

Teresa K. Kimlinger ◽

Jessica L. Haug ◽

Michael Timm ◽

...

Keyword(s):

Plasma Cell ◽

Monoclonal Gammopathy ◽

Plasma Cells ◽

Cell Subset ◽

Primary Amyloidosis ◽

Normal Plasma ◽

Plasma Cell Disorders ◽

Plasma Cell Disorder ◽

Cell Disorder

Abstract Background: IL-6 is important for proliferation and inhibition of apoptosis in malignant plasma cells. Understanding the role of IL-6 receptor alpha chain (CD126) in the pathogenesis of plasma cell disorders may help in developing future treatment therapies for these diseases. A previous study has shown that CD126 (alpha subunit of IL-6 receptor) is expressed distinctly in myeloma, monoclonal gammopathy of unknown significance (MGUS), and plasmacytomas when compared to normal. We performed this study in order to confirm and describe the expression of CD126 in different plasma cell disorders. Design and Methods: Using flow cytometry we assessed CD126 expression on clonal plasma cells from patients with Primary Amyloidosis (n=7), monoclonal gammopathy of undetermined significance (MGUS) (n=13), smoldering Myeloma (SMM) (n=19) and active Myeloma (n=22), as well as normal plasma cells (n=9). Plasma cells were identified by their characteristic CD38/45 expression. The expression of CD126 was separately analyzed on the CD45 positive and negative plasma cells. CD 126 expression was considered significant when more than 20% of the cells had expression. Results: CD126 expression was seen distinctly in plasma cell disorder plasma cells and not in normal plasma cells when all plasma cells were studied together. The highest expression percentages were found in Amyloid (28%) followed closely by MGUS 29(%), then SMM (23%), and Myeloma (12%) cells. The CD45 neg subset was similarly positive in the plasma cell disorder group. In this group, MGUS showed the highest expression percentage followed distantly by Amyloid, Myeloma, and SMM. The CD45 pos subset was uniformly positive in expression of CD126. If was found that this subset expressed higher levels of CD126 in all the studied plasma cell disorders and normal plasma cells when compared to the CD45 neg subset. Conclusion: The findings of this study confirm the increased expression of CD126 in plasma cell disorders when compared to normal plasma cells. The higher expression of CD126 in the CD45 pos plasma cell subset has not been previously described. In addition, the CD45 pos subset expressed higher levels of CD126 in all study groups when compared to the CD45 pos subset. This data contributes to the understanding of IL-6 receptor physiology and confirms the important role of the CD45 pos subset in the proliferation of neoplastic plasma cells. The findings are in accordance with the increased proliferative rates seen in the CD45 fraction of malignant plasma cells.

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Inhibition of Interleukin-6 Signaling with CNTO 328 Sensitizes Plasma Cell Dyscrasias to the Effects of Melphalan in Association with Suppression of Signaling through Protein Kinase B/Akt.

Blood ◽

10.1182/blood.v114.22.1836.1836 ◽

2009 ◽

Vol 114 (22) ◽

pp. 1836-1836

Author(s):

Sally A. Hunsucker ◽

Valeria Magarotto ◽

Jairo A. Matthews ◽

Michael Wang ◽

Veerabhadran Baladandayuthapani ◽

...

Keyword(s):

Multiple Myeloma ◽

Protein Kinase ◽

Cell Lines ◽

Plasma Cell ◽

Stromal Cells ◽

Plasma Cells ◽

Protein Kinase B ◽

Myeloma Cell ◽

Ortho Biotech ◽

Plasma Cell Dyscrasias

Abstract Abstract 1836 Poster Board I-862 Background: The neutralizing anti-interleukin (IL)-6 monoclonal antibody (MAb) CNTO 328 acts in an additive to synergistic manner to enhance the activity of bortezomib and dexamethasone against models of multiple myeloma by suppressing several IL-6-induced anti-apoptotic signaling pathways. We therefore sought to evaluate the possibility that blockade of IL-6 signaling could also augment the activity of melphalan, and to determine the potential mechanisms underlying this interaction. Methods: A panel of myeloma cell lines was studied both in suspension and with bone marrow stromal cells to evaluate the activity of CNTO 328 with and without melphalan. The CNTO 328 + melphalan combination was also tested in primary cells from patients with a variety of plasma cell dyscrasias. Results: Treatment of IL-6-dependent KAS-6/1, INA-6, and ANBL-6 myeloma cell lines with CNTO 328 + melphalan reduced plasma cell viability in an additive-to-synergistic manner compared to melphalan with a control MAb. Isobologram analysis demonstrated that the combination was synergistic in KAS-6/1 cells regardless of the sequence of drug treatment (combination indices (CIs) from 0.275-0.607), although the strongest synergy was seen with CNTO 328 pretreatment (CIs from 0.275-0.493). These anti-proliferative effects were accompanied by an enhanced activation of drug-specific apoptosis, and this increased cell death was not rescued by the trophic effects of co-culture of plasma cells with the human-derived stromal cell line HS-5. CNTO 328 increased melphalan-mediated induction of both extrinsic, caspase-8-mediated apoptosis, as well as intrinsic, caspase-9-mediated death, which converged to produce increased levels of caspase-3 activity. Apoptosis was enhanced in part by CNTO 328-stimulated cleavage of Bid to tBid, and alterations in the phosphorylation status of BimEL, as well as increased conversion of Bak and, to a lesser extent, of Bax, to their active forms. Neutralization of IL-6 by CNTO 328 also suppressed signaling through the protein kinase B/Akt pathway, as evidenced by decreased levels of phospho-Akt, and decreased activation of several downstream Akt targets, including p70 S6 kinase and 4E-BP1. Importantly, CNTO 328 + melphalan showed enhanced anti-proliferative effects compared to melphalan and a control MAb against primary CD138+ plasma cells derived from patients with multiple myeloma, monoclonal gammopathy of undetermined significance, and amyloidosis, while demonstrating less toxicity to stromal cells. The enhanced effect of the CNTO 328 + melphalan combination was statistically significant compared to either drug alone (p<0.05) in CD138+ cells isolated from patients who had not received prior melphalan therapy. Conclusions: These studies provide a rationale for translation of CNTO 328 into the clinic in combination with melphalan-based therapies, including either high dose therapy in transplant-eligible patients, or standard dose melphalan-containing induction regimens in transplant-ineligible patients, such as with the combination of bortezomib, melphalan, and prednisone. Disclosures: Voorhees: Millennium Pharmaceuticals: Speakers Bureau; Celgene: Speakers Bureau. Xie:Centocor Ortho Biotech Inc.: Employment. Cornfeld:Centocor Ortho Biotech Inc.: Employment. Nemeth:Centocor Ortho Biotech Inc.: Employment.

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The Tao of myeloma

Blood ◽

10.1182/blood-2014-05-578732 ◽

2014 ◽

Vol 124 (12) ◽

pp. 1873-1879 ◽

Cited By ~ 35

Author(s):

Lawrence H. Boise ◽

Jonathan L. Kaufman ◽

Nizar J. Bahlis ◽

Sagar Lonial ◽

Kelvin P. Lee

Keyword(s):

Molecular Characterization ◽

Plasma Cell ◽

Cell Biology ◽

Cancer Biology ◽

Plasma Cells ◽

Proteasome Inhibitors ◽

Novel Therapies ◽

Highly Active ◽

Normal Plasma ◽

Genomic Landscape

Abstract Multiple myeloma is a plasma cell malignancy in which significant advances have been observed during the last 15 years. Our understanding of the disease has been advanced through its molecular characterization. We have also seen improvements in patient care with the development of 2 new classes of active agents, proteasome inhibitors and immunomodulatory drugs (IMiDs), resulting in a significant improvement in overall survival of myeloma patients such that it can now be debated as to whether some subsets of myeloma patients can be cured. However, the advances in our understanding of myeloma biology occurred in parallel with advances in treatment as opposed to being directly informed by the research. Moreover, the molecular characterization of malignant plasma cells would not have predicted the effectiveness of these novel therapies. We hypothesize that proteasome inhibitors and IMiDs are highly active because malignant plasma cells are constrained by many of the characteristics of their normal counterparts and these novel therapies target both normal plasma cell biology and the cancer biology of myeloma. Thus, a better understanding of normal plasma cell biology will likely yield as many actionable targets as mapping the genomic landscape of this disease.

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Neutrophil Extracellular Traps (NETs) and Hypercoagulability in Plasma Cell Dyscrasias—Is This Phenomenon Worthy of Exploration?

Journal of Clinical Medicine ◽

10.3390/jcm10225243 ◽

2021 ◽

Vol 10 (22) ◽

pp. 5243

Author(s):

Olga Ciepiela ◽

Milena Małecka-Giełdowska ◽

Emilia Czyżewska

Keyword(s):

Plasma Cell ◽

Deoxyribonucleic Acid ◽

Plasma Cells ◽

Neutrophil Extracellular Traps ◽

Related Factors ◽

Neoplastic Diseases ◽

Extracellular Traps ◽

Cancer Metastases ◽

Induce Activity ◽

Plasma Cell Dyscrasias

Plasma cell dyscrasias (PCDs) are neoplastic diseases derived from plasma cells. Patients suffering from PCDs are at high risk of hypercoagulability and thrombosis. These conditions are associated with disease-related factors, patient-related factors, or the use of immunomodulatory drugs. As PCDs belong to neoplastic diseases, some other factors related to the cancer-associated hypercoagulability state in the course of PCDs are also considered. One of the weakest issues studied in PCDs is the procoagulant activity of neutrophil extracellular traps (NETs). NETs are web-like structures released from neutrophils in response to different stimuli. These structures are made of deoxyribonucleic acid (DNA) and bactericidal proteins, such as histones, myeloperoxidase, neutrophil elastase, and over 300 other proteins, which are primarily stored in neutrophil granules. NETs immobilize, inactivate the pathogens, and expose them to specialized cells of immune response. Despite their pivotal role in innate immunity, they contribute to the development and exacerbation of autoimmune diseases, trigger inflammatory response, or even facilitate the formation of cancer metastases. NETs were also found to induce activity of coagulation and are considered one of the most important factors inducing thrombosis. Here, we summarize how PCDs influence the release of NETs, and hypothesize whether NETs contribute to hypercoagulability in PCDs patients.

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Immunophenotypic heterogeneity of normal plasma cells: comparison with minimal residual plasma cell myeloma

Journal of Clinical Pathology ◽

10.1136/jclinpath-2012-200881 ◽

2012 ◽

Vol 65 (9) ◽

pp. 823-829 ◽

Cited By ~ 30

Author(s):

Dingsheng Liu ◽

Pei Lin ◽

Ying Hu ◽

Yi Zhou ◽

Guilin Tang ◽

...

Keyword(s):

Plasma Cell ◽

Plasma Cells ◽

Plasma Cell Myeloma ◽

Normal Plasma ◽

Minimal Residual

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Combined method of PAP immunocytochemistry and autoradiography: application to cell kinetic study in plasma cell dyscrasias.

Journal of Histochemistry & Cytochemistry ◽

10.1177/35.10.3305704 ◽

1987 ◽

Vol 35 (10) ◽

pp. 1157-1160

Author(s):

T Kanoh ◽

T Ohnaka ◽

H Uchino

Keyword(s):

Plasma Cell ◽

Plasma Cells ◽

Cell Labeling ◽

Combined Method ◽

Cell Kinetic ◽

Diagnosis And Prognosis ◽

Plasma Cell Dyscrasias ◽

Pap Method ◽

Combined Technique

The plasma cell labeling index (LI), in spite of being a reliable indicator for diagnosis and prognosis of multiple myeloma, has been measured in a limited number of laboratories because of technical difficulties. We have developed a new combined technique, using the peroxidase-antiperoxidase (PAP) method and autoradiography, which has several advantages over previously described methods. The primary advantages of our method in the determination of lymphoid-plasma cell LI% are: (a) no damage to slides during storage of more than 1 year; (b) an exact LI measurement in each morphological variety of pleomorphic immunoglobulin-containing cells; (c) no problem in differentiation of lymphoid plasma cells from early red cell precursors; and (d) a separate LI measurement for those lymphoid-plasma cells composed chiefly, if not exclusively, of monoclonal or neoplastic cells. Because of these advantages, this accurate and less difficult technique will facilitate performance of lymphoid plasma cell LI in a number of laboratories.

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Plasma Cell Dyscrasias

Musculoskeletal Imaging Volume 2 ◽

10.1093/med/9780190938178.003.0076 ◽

2019 ◽

pp. 33-38

Author(s):

Kevin B. Hoover

Keyword(s):

Multiple Myeloma ◽

Bone Marrow ◽

Clinical Trials ◽

African Americans ◽

Plasma Cell ◽

Plasma Cells ◽

Organ Damage ◽

Disease Staging ◽

Plasma Cell Dyscrasias ◽

Urine Testing

Chapter 76 discusses plasma cell dyscrasias, which are currently incurable diseases resulting from the proliferation of plasma cells and the secretion of immunoglobulins with associated anemia and end-organ damage. These diseases are more common in men than women and more common in African Americans than whites. Multiple myeloma is the most common of the plasma cell dyscrasias. Blood and urine testing, bone marrow biopsy, and radiography are the primary tests used for diagnosis. Radiographs are the standard tools in disease staging and monitoring with advanced imaging used primarily for evaluating symptomatic patients with negative radiographs and patients in clinical trials.

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