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Will Mass Spectrometry Replace Current Techniques for Both Routine Monitoring and MRD Detection in Multiple Myeloma? 质谱法会取代目前多发性骨髓瘤常规监测和MRD检测的技术吗?
Q4 HEMATOLOGY Pub Date : 2021-12-09 DOI: 10.3390/hemato2040052
K. Thoren
In recent years, mass spectrometry has been increasingly used for the detection of monoclonal proteins in serum. Mass spectrometry is more analytically sensitive than serum protein electrophoresis and immunofixation, can help distinguish therapeutic monoclonal antibodies from M-proteins, and can detect the presence of post-translational modifications. Mass spectrometry also shows promise as a less-invasive, peripheral-blood-based test for detecting minimal residual disease in multiple myeloma. Studies comparing the clinical utility of mass spectrometry to current blood- and bone-marrow-based techniques have been conducted. Although still primarily limited to research settings, clinical laboratories are starting to adopt this technique for patient care. This review will discuss the current status of mass spectrometry testing for multiple myeloma, the benefits and challenges of this technique, and how it may be incorporated into clinical practice in the future.
近年来,质谱法越来越多地用于检测血清中的单克隆蛋白。质谱分析比血清蛋白电泳和免疫固定更灵敏,可以帮助区分治疗性单克隆抗体和M-蛋白,并可以检测翻译后修饰的存在。质谱法也显示出作为一种微创、基于外周血的检测多发性骨髓瘤最小残留疾病的前景。已经进行了将质谱法的临床实用性与当前基于血液和骨髓的技术进行比较的研究。尽管仍主要局限于研究环境,但临床实验室已开始将这项技术用于患者护理。这篇综述将讨论多发性骨髓瘤质谱检测的现状、这项技术的优势和挑战,以及未来如何将其纳入临床实践。
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引用次数: 2
The Current Understanding of and Treatment Paradigm for Newly-Diagnosed TP53-Mutated Acute Myeloid Leukemia 目前对新诊断的tp53突变急性髓系白血病的认识和治疗模式
Q4 HEMATOLOGY Pub Date : 2021-12-09 DOI: 10.3390/hemato2040051
R. Shallis, M. Stahl, J. Bewersdorf, A. Zeidan
About 10% of newly diagnosed and 20–30% of therapy-related acute myeloid leukemia (AML) harbors a TP53 mutation (mTP53-AML). Unfortunately, this biological subset predicts one of the worst prognoses among patients with AML, specifically a median overall survival of about 7 months with fewer than 10% of patients eventually cured of disease. Although remission rates appear to be increased with venetoclax-based, less-intensive regimens when compared with contemporary, intensive chemotherapy (55–65% vs. 40%), survival appears to be no different between the two approaches. Attempts to discern whether or not the prognosis of mTP53-AML is universally poor have centered around the study of concurrent cytogenetic risk and predicted TP53 allelic state, measurable residual disease status and the impact of conditioning intensity for patients proceeding to allogeneic hematopoietic stem cell transplantation. We discuss these considerations in this review and offer the current treatment approach to TP53-mutated AML.
大约10%的新诊断和20-30%的治疗相关急性髓细胞白血病(AML)携带TP53突变(mTP53AML)。不幸的是,这一生物学子集预测了AML患者中最差的预后之一,特别是中位总生存期约为7个月,最终治愈的患者不到10%。尽管与当代强化化疗相比,以venetoclax为基础的低强度化疗方案的缓解率似乎有所提高(55-65%对40%),但两种方法的生存率似乎没有什么不同。辨别mTP53 AML预后是否普遍较差的尝试集中在对同时发生的细胞遗传学风险和预测的TP53等位基因状态、可测量的残余疾病状态以及条件强度对异基因造血干细胞移植患者的影响的研究上。我们在这篇综述中讨论了这些考虑因素,并提供了目前TP53突变AML的治疗方法。
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引用次数: 2
Treatment in AL Amyloidosis: Moving towards Individualized and Clone-Directed Therapy AL淀粉样变性的治疗:走向个体化和克隆导向治疗
Q4 HEMATOLOGY Pub Date : 2021-12-07 DOI: 10.3390/hemato2040050
U. Hegenbart, M. Raab, S. Schönland
Systemic amyloid light chain (AL) amyloidosis is a rare protein deposition disease caused by a clonal B cell disorder of the bone marrow. The underlying diseases can be plasma cell disorders (monoclonal gammopathy of clinical significance, smoldering or symptomatic myeloma) or B cell non-Hodgkin’s lymphoma (e.g., Waldenstrom’s disease or marginal zone lymphoma) with secretory activity. It is crucial to characterize the underlying disease very precisely as the treatment of AL amyloidosis is directed against the (often small) B cell clone. Finally, the detection of cytogenetic aberrations of the plasma cell clone will likely play an important role for choosing an effective drug in the near future.
系统性淀粉样蛋白轻链(AL)淀粉样变性是一种罕见的由骨髓克隆性B细胞紊乱引起的蛋白质沉积疾病。基础疾病可以是浆细胞疾病(有临床意义的单克隆伽玛病、阴燃或症状性骨髓瘤)或具有分泌活性的B细胞非霍奇金淋巴瘤(如瓦尔登斯特罗姆病或边缘带淋巴瘤)。由于AL淀粉样变的治疗是针对(通常是小的)B细胞克隆的,因此非常精确地描述潜在疾病的特征是至关重要的。最后,在不久的将来,检测浆细胞克隆的细胞遗传学畸变可能会在选择有效药物方面发挥重要作用。
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引用次数: 0
New Targets for PET Imaging of Myeloma 骨髓瘤PET成像的新靶点
Q4 HEMATOLOGY Pub Date : 2021-12-02 DOI: 10.3390/hemato2040049
M. Revheim, C. Stokke, J. N. Nørgaard, Hilde Feiring Phillips, A. Sherwani, F. Schjesvold, James Connelly
Recent advances in the treatment of multiple myeloma (MM) have increased the need for accurate diagnosis and detection of minimal residual disease (MRD), disease characterization and localization, and response evaluation and prognostication. Positron emission tomography (PET)/computed tomography (CT) imaging combines molecular and morphological information and has been shown to be especially valuable in this disease. The most frequently used PET tracer in MM is the glucose analog 18F-fluorodeoxyglucose ([18F]FDG). [18F]FDG PET/CT has a sensitivity for detection of MM between 80% to 100% and is currently the main imaging modality for assessing treatment response and for determining MRD. However, 18F-FDG PET/CT has some limitations, and imaging with alternative tracers that may overcome these constraints should be further explored. This article discusses new targets for PET/CT imaging in the assessment of MM.
多发性骨髓瘤(MM)治疗的最新进展增加了对微小残留病(MRD)的准确诊断和检测、疾病特征和定位以及反应评估和预后的需求。正电子发射断层扫描(PET)/计算机断层扫描(CT)结合了分子和形态信息,已被证明在这种疾病中特别有价值。MM中最常用的PET示踪剂是葡萄糖类似物18F-氟脱氧葡萄糖([18F]FDG)。[18F]FDG PET/CT对MM的检测灵敏度在80%至100%之间,是目前评估治疗反应和确定MRD的主要成像方式。然而,18F-FDG PET/CT存在一些局限性,应该进一步探索替代示踪剂的成像方法,以克服这些局限性。本文讨论了PET/CT成像评估MM的新靶点。
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引用次数: 2
Light Chain Stabilization: A Therapeutic Approach to Ameliorate AL Amyloidosis. 轻链稳定:一种改善AL淀粉样变性的治疗方法。
Q4 HEMATOLOGY Pub Date : 2021-12-01 Epub Date: 2021-10-05 DOI: 10.3390/hemato2040042
Gareth J Morgan, Joel N Buxbaum, Jeffery W Kelly

Non-native immunoglobulin light chain conformations, including aggregates, appear to cause light chain amyloidosis pathology. Despite significant progress in pharmacological eradication of the neoplastic plasma cells that secrete these light chains, in many patients impaired organ function remains. The impairment is apparently due to a subset of resistant plasma cells that continue to secrete misfolding-prone light chains. These light chains are susceptible to the proteolytic cleavage that may enable light chain aggregation. We propose that small molecules that preferentially bind to the natively folded state of full-length light chains could act as pharmacological kinetic stabilizers, protecting light chains against unfolding, proteolysis and aggregation. Although the sequence of the pathological light chain is unique to each patient, fortunately light chains have highly conserved residues that form binding sites for small molecule kinetic stabilizers. We envision that such stabilizers could complement existing and emerging therapies to benefit light chain amyloidosis patients.

非天然免疫球蛋白轻链构象,包括聚集体,似乎引起轻链淀粉样变病理。尽管在药物根除分泌这些轻链的肿瘤浆细胞方面取得了重大进展,但在许多患者中受损的器官功能仍然存在。损伤显然是由于抗性浆细胞亚群继续分泌易发生错误折叠的轻链。这些轻链易受蛋白水解裂解的影响,这可能使轻链聚集。我们提出,优先结合全长轻链的天然折叠状态的小分子可以作为药理学动力学稳定剂,保护轻链免受展开,蛋白质水解和聚集。尽管病理性轻链的序列对每个患者都是独特的,但幸运的是,轻链具有高度保守的残基,形成小分子动力学稳定剂的结合位点。我们设想这种稳定剂可以补充现有的和新兴的治疗方法,使轻链淀粉样变性患者受益。
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引用次数: 11
KSHV/HHV8-Associated Lymphoproliferative Disorders: Lessons Learnt from People Living with HIV KSHV/HHV8相关淋巴增生性疾病:从HIV感染者身上吸取的教训
Q4 HEMATOLOGY Pub Date : 2021-11-24 DOI: 10.3390/hemato2040047
M. Bower, A. Carbone
In 1992, Kaposi sarcoma herpesvirus (KSHV/HHV8) was discovered and identified as the causative agent for Kaposi sarcoma. Subsequently, the presence of this virus has been detected in a number of lymphoproliferative disorders in people living with HIV (PLWH), including: KSHV-associated multicentric Castleman disease, primary effusion lymphoma, KSHV-positive diffuse large B-cell lymphoma, and germinotropic lymphoproliferative disorder. Each of these rare entities has subsequently been diagnosed in HIV-negative individuals. The recognition of some of these KSHV/HHV8-associated lymphoproliferative disorders has led to their inclusion in the WHO classification of lymphomas in 2008 and the revision of 2016; however, further revision is under way to update the classification. The relatively recent recognition of these lymphoproliferative disorders and their low incidence, particularly in the HIV-negative population, means that there is little published evidence and consensus on their clinical features and management. The publication of a new WHO classification of lymphomas should yield diagnostic clarity, providing an impetus for retrospective case series and prospective clinical trials in these KSHV/HHV8-associated lymphoproliferative disorders.
1992年,卡波西肉瘤疱疹病毒(KSHV/HHV8)被发现并确定为卡波西肿瘤的病原体。随后,在HIV感染者的许多淋巴增生性疾病中检测到了这种病毒的存在,包括:KSHV相关的多中心Castleman病、原发性渗出性淋巴瘤、KSHV阳性的弥漫性大B细胞淋巴瘤和生殖性淋巴增生性病。这些罕见的实体中的每一个随后都在HIV阴性个体中被诊断出来。对其中一些KSHV/HHW8相关淋巴增生性疾病的认识导致其被纳入2008年世界卫生组织淋巴瘤分类和2016年修订;不过,目前正在进行进一步修订,以更新分类。最近对这些淋巴增生性疾病及其低发病率的认识,特别是在HIV阴性人群中,意味着对其临床特征和治疗几乎没有公开的证据和共识。世界卫生组织淋巴瘤新分类的公布应能提高诊断的清晰度,为这些KSHV/HHW8相关淋巴增生性疾病的回顾性病例系列和前瞻性临床试验提供动力。
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引用次数: 5
Alterations of Peripheral Blood T Cell Subsets following Donor Lymphocyte Infusion in Patients after Allogeneic Stem Cell Transplantation 同种异体干细胞移植患者供体淋巴细胞输注后外周血T细胞亚群的改变
Q4 HEMATOLOGY Pub Date : 2021-11-22 DOI: 10.3390/hemato2040046
Ann-Kristin Schmaelter, J. Waidhauser, Dina Kaiser, Tatjana Lenskaja, Stefanie Gruetzner, R. Claus, M. Trepel, C. Schmid, A. Rank
Donor lymphocyte infusion (DLI) after allogeneic stem cell transplantation (alloSCT) is an established method to enhance the Graft-versus-Leukemia (GvL) effect. However, alterations of cellular subsets in the peripheral blood of DLI recipients have not been studied. We investigated the changes in lymphocyte subpopulations in 16 patients receiving DLI after successful alloSCT. Up to three DLIs were applied in escalating doses, prophylactically for relapse prevention in high-risk disease (n = 5), preemptively for mixed chimerism and/or a molecular relapse/persistence (n = 8), or as part of treatment for hematological relapse (n = 3). We used immunophenotyping to measure the absolute numbers of CD4+, CD8+, NK, and CD56+ T cells and their respective subsets in patients’ peripheral blood one day before DLI (d-1) and compared the results at day + 1 and + 7 post DLI to the values before DLI. After the administration of 1 × 106 CD3+ cells/kg body weight, we observed an overall increase in the CD8+ and CD56+ T cell counts. We determined significant changes between day − 1 compared to day + 1 and day + 7 in memory and activated CD8+ subsets and CD56+ T cells. Applying a higher dose of DLI (5 × 106 CD3+ cells/kg) led to a significant increase in the overall counts and subsets of CD8+, CD4+, and NK cells. In conclusion, serial immune phenotyping in the peripheral blood of DLI recipients revealed significant changes in immune effector cells, in particular for various CD8+ T cell subtypes, indicating proliferation and differentiation.
同种异体干细胞移植(alloSCT)后供体淋巴细胞输注(DLI)是一种增强移植物抗白血病(GvL)效果的方法。然而,DLI受体外周血中细胞亚群的改变尚未被研究。我们研究了16例移植成功后接受DLI的患者淋巴细胞亚群的变化。最多三种lis以递增剂量应用,预防高危疾病复发(n = 5),预防混合嵌合和/或分子复发/持续性(n = 8),或作为血液复发治疗的一部分(n = 3)。我们使用免疫表型来测量CD4+, CD8+, NK,DLI前1天患者外周血CD56+ T细胞及其亚群(d-1),并将DLI后+ 1和+ 7天的结果与DLI前的值进行比较。在给予1 × 106个CD3+细胞/kg体重后,我们观察到CD8+和CD56+ T细胞计数的总体增加。我们发现,与第1天和第7天相比,第1天的记忆和激活的CD8+亚群和CD56+ T细胞发生了显著变化。应用较高剂量的DLI (5 × 106 CD3+细胞/kg)导致CD8+、CD4+和NK细胞的总计数和亚群显著增加。综上所述,DLI受者外周血的系列免疫表型显示免疫效应细胞,特别是各种CD8+ T细胞亚型发生了显著变化,表明增殖和分化。
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引用次数: 1
Differences and Similarities in Treatment Paradigms and Goals Between AL Amyloidosis and Multiple Myeloma AL淀粉样变性与多发性骨髓瘤治疗模式及目标的异同
Q4 HEMATOLOGY Pub Date : 2021-11-18 DOI: 10.3390/hemato2040045
M. Minnema, R. Oostvogels, R. Raymakers, M. Jak
Although there are similarities in the treatment paradigms between AL amyloidosis and multiple myeloma, there are also fundamental differences. A similarity is of course the use of anti-plasma cell drugs in both diseases; however, the most serious mistake a hemato-oncologist can make is to use the same treatment schedule in dosing and frequency in AL amyloidosis patients as in multiple myeloma patients. AL amyloidosis patients with >10% bone marrow plasma cell infiltration in particular are at risk of receiving a more intensive treatment than they can tolerate. This difference in dosing and frequency is true for many anti-clonal drugs, but it is most apparent in the use of high-dose melphalan and autologous stem cell transplantation. While in multiple myeloma in the age group of ≤70 years, more than 80% of patients are fit enough to receive this intensive treatment, this is the case in less than 20% of AL amyloidosis patients. A similarity is the alignment in the goal of treatment. Although in AL amyloidosis has long been recognized that the goal should be complete hematological remission, this has become more apparent in multiple myeloma in recent years. A common goal in the coming years will be to evaluate the role of minimal residual disease to improve survival in both diseases.
尽管AL淀粉样变性和多发性骨髓瘤的治疗模式有相似之处,但也有根本的区别。这两种疾病的相似之处当然是抗浆细胞药物的使用;然而,血液肿瘤学家可能犯的最严重的错误是在AL淀粉样变患者中使用与多发性骨髓瘤患者相同的剂量和频率的治疗方案。特别是骨髓浆细胞浸润率为b> - 10%的AL淀粉样变患者,接受超出其承受能力的强化治疗的风险更大。这种剂量和频率的差异适用于许多抗克隆药物,但在大剂量美法兰和自体干细胞移植的使用中最为明显。而在≤70岁年龄组的多发性骨髓瘤中,超过80%的患者适合接受这种强化治疗,而AL淀粉样变患者的这种情况不到20%。相似之处在于治疗目标的一致性。虽然在AL淀粉样变中,长期以来人们认为目标应该是完全血液缓解,但近年来在多发性骨髓瘤中变得更加明显。未来几年的共同目标将是评估微小残留疾病在提高两种疾病患者生存率方面的作用。
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引用次数: 1
Diffusion-Weighted MRI—The Way Forward for MRI in Myeloma? 弥散加权MRI:骨髓瘤MRI的发展方向?
Q4 HEMATOLOGY Pub Date : 2021-11-12 DOI: 10.3390/hemato2040044
J. Hillengass, M. Merz, R. Alberico, M. Chalian
Multiple myeloma and other plasma cell disorders infiltrate the bone marrow in different patterns. While some patients show a homogeneous distribution of the clonal plasma cells others present with focal accumulations, commonly called focal lesions. Novel imaging techniques can provide information on these infiltration patterns and, due to their low invasiveness, can be performed repeatedly and therefore be used for monitoring. Conventional magnetic resonance imaging (MRI) has a high sensitivity for bone marrow assessment but cannot safely differentiate between active and inactive lesions. Therefore, positron emission tomography, especially combined with computed tomography (PET/CT), has been more widely used, at least for the monitoring of treatment response. Comparative, but mostly retrospective studies, have shown that functional MRI techniques, namely diffusion-weighted imaging (DWI), which assesses the movement of water molecules, can evaluate tissue cellularity with high sensitivity, which challenges the dominance of PET/CT in treatment response assessment. This review will discuss the benefits and challenges of DWI and compare it to other available imaging techniques used in patients with monoclonal plasma cell disorders.
多发性骨髓瘤和其他浆细胞疾病以不同的模式浸润骨髓。虽然一些患者表现出克隆浆细胞的均匀分布,但其他患者则出现局灶性积聚,通常称为局灶性病变。新的成像技术可以提供关于这些渗透模式的信息,并且由于其低侵入性,可以重复进行,因此可以用于监测。传统的磁共振成像(MRI)对骨髓评估具有高灵敏度,但不能安全地区分活动性和非活动性病变。因此,正电子发射断层扫描,特别是与计算机断层扫描(PET/CT)相结合,已被更广泛地使用,至少用于监测治疗反应。比较但主要是回顾性研究表明,功能性MRI技术,即评估水分子运动的扩散加权成像(DWI),可以高灵敏度地评估组织细胞性,这挑战了PET/CT在治疗反应评估中的主导地位。这篇综述将讨论DWI的益处和挑战,并将其与单克隆浆细胞疾病患者使用的其他可用成像技术进行比较。
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引用次数: 0
Current Status of CAR-T Cell Therapy in Multiple Myeloma CAR-T细胞治疗多发性骨髓瘤的研究现状
Q4 HEMATOLOGY Pub Date : 2021-10-21 DOI: 10.3390/hemato2040043
Juan Luis Reguera-Ortega, Estefanía García‐Guerrero, J. Pérez-Simón
Current data on CAR-T cell-based therapy is really promising in multiple myeloma, especially in terms of response. In heavily pretreated patients, who have already received proteasome inhibitors, immunomodulatory drugs and monoclonal antibodies, current trials report an overall response rate ranging from 81 to 97% and 45 to 67% of complete remission rates. Data are less encouraging in terms of duration of response, although most recent trials have shown significant improvements in terms of event-free survival, with medians ranging from 8 to 14 months and up to 77% progression-free survival at 12 months with an acceptable toxicity profile. These data will be consolidated in future years and will provide new evidence on the best timing for CAR-T cell therapy. Moreover, new CAR-T designs are underway and will challenge the current results.
目前基于CAR-T细胞疗法的数据在多发性骨髓瘤中确实很有希望,特别是在反应方面。在已经接受蛋白酶体抑制剂、免疫调节药物和单克隆抗体的重度预处理患者中,目前的试验报告总体缓解率为81%至97%,完全缓解率为45%至67%。在反应持续时间方面,数据不太令人鼓舞,尽管最近的大多数试验显示无事件生存期有显着改善,中位数为8至14个月,12个月时无进展生存期高达77%,毒性谱可接受。这些数据将在未来几年得到巩固,并将为CAR-T细胞治疗的最佳时机提供新的证据。此外,新的CAR-T设计正在进行中,并将挑战目前的结果。
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引用次数: 2
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Hemato
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