Impact of minimal residual disease detection by next-generation flow cytometry in multiple myeloma patients with sustained complete remission after frontline therapy

Minimal residual disease (MRD) was monitored in 52 patients with sustained CR (≥2 years) after frontline therapy using next-generation flow (NGF) cytometry. 25% of patients initially MRD- reversed to MRD+. 56% of patients in sustained CR were MRD+; 45% at the level of 10−5; 17% at 10−6. All patients who relapsed during follow-up were MRD+ at the latest MRD assessment, including those with ultra-low tumor burden. MRD persistence was associated with specific phenotypic profiles: higher erythroblasts’ and tumor-associated monocytes/macrophages’ predominance in the bone marrow niche. NGF emerges as a suitable method for periodic, reproducible, highly-sensitive MRD-detection at the level of 10−6

Primary gastric non-Hodgkin's lymphoma in Chinese patients: clinical characteristics and prognostic factors

<p>Abstract</p> <p>Background</p> <p>Optimal management and outcome of primary gastric lymphoma (PGL) have not been well defined in the rituximab era. This study aimed to analyze the clinical characteristics, prognostic factors, and roles of different treatment modalities in Chinese patients with PGL.</p> <p>Methods</p> <p>The clinicopathological features of 83 Chinese patients with PGL were retrospectively reviewed. Staging was performed according to the Lugano staging system for gastrointestinal non-Hodgkin's lymphoma.</p> <p>Results</p> <p>The predominant pathologic subtype among Chinese patients with PGL in our study was diffuse large B cell lymphoma (DLBCL), followed by mucosa-associated lymphoid tissue (MALT) lymphoma. Among the 57 patients with gastric DLBCL, 20 patients (35.1%) were classified as the germinal center B cell-like (GCB) subtype and 37 patients (64.9%) as the non-GCB subtype. The 83 patients had a five-year overall survival (OS) and event-free survival (EFS) of 52% and 59%, respectively. Cox regression analysis showed that stage-modified international prognostic index (IPI) and performance status (PS) were independent predictors of survival. In the 67 B-cell lymphoma patients who received chemotherapy, 36 patients treated with rituximab (at least 3 cycles) had a mean OS of 72 months (95% CI 62-81) versus 62 months (95% CI 47-76) for patients without rituximab treatment (P = 0.021).</p> <p>Conclusion</p> <p>The proportion of Chinese gastric DLBCL cases with non-GCB subtype was higher than the GCB subtype. Stage-modified IPI and PS were effective prognostic factors in Chinese patients with PGL. Our data suggested that primary gastric B-cell lymphoma might have an improved outcome with rituximab in addition to chemotherapy. More studies are necessary, preferentially large prospective randomized clinical trials to obtain more information on the impact of the rituximab in the primary gastric B-cell lymphoma.</p

Updates on thrombotic events associated with multiple myeloma

Introduction: Despite the implementation of thromboprophylaxis guidelines, the risk of venous thromboembolism (VTE) in patients with Multiple Myeloma (MM) remains significant. There is, therefore, a need for more sensitive risk stratification tools and optimization of our thromboprophylaxis approach. Areas covered: Since 2015 there have been no breakthrough data in this field. This review aims to cover recent data that have evaluated the effectiveness and extent to which IMWG 2014 guidelines are being applied. In addition, new data on the identification of potential biomarkers of coagulation that reflect the procoagulant processes that take place in these patients and are associated with increased VTE risk will be presented. Recent developments of clinical scores that aim to effectively risk stratify MM patients and guide thromboprophylaxis will be discussed. Finally, new data on the use of direct oral anticoagulants (DOACs) in the context of thrombosis prevention in MM patients will be covered. Expert opinion: There is an ever-increasing need for a Risk assessment model that combines weighted clinical factors with biomarkers of coagulation that can sensitively risk stratify MM patients and guide management of VTE prevention which will also include Direct oral anticoagulants as data from ongoing clinical trials are much anticipated. © 2019, © 2019 Informa UK Limited, trading as Taylor &amp; Francis Group

Angiogenesis in Waldenström&apos;s macroglobulinemia

Angiogenesis represents an essential step of disease progression in several hematological malignancies. In Waldenström&apos;s macroglobulinemia (WM) the bone marrow microvessel density is increased in 30%-40% of patients but seems to have no impact on survival. Angiogenic cytokines, such as angiogenin, vascular endothelial growth factor, and basic fibroblast growth factor are increased in the serum of WM or IgM-MGUS patients, while the ratio of angiopoietin-1/ angiopoietin-2 is reduced in WM but not in IgM-monoclonal gammopathy of undetermined significance (MGUS). Angiogenin and angiopoietin-1/angiopoietin-2 ratio correlates with disease activity and clinical features of WM. Macrophage and mast-cell chemoattractants, such as macrophage inflammatory protein-1 alpha are also elevated in the serum of patients with WM, while both macrophages and mast cells that are increased in the WM microenvironment have angiogenic properties and participate in the angiogenesis process in several malignancies. This review summarizes all data available by November 2008 (end of literature search) for the role of angiogenesis in the biology of WM and its correlation with clinical and laboratory features of the disease

Rituximab-based treatments in Waldenström&apos;s macroglobulinemia

The anti-CD20 monoclonal antibody rituximab has shown activity in approximately one third of patients with Waldenström&apos;s Macroglobulinemia (WM). Because this agents is nonmyelosuppressive, several studies have assessed its combination with chemotherapeutic agents such as fludarabine, cladribine, cyclophosphamide, and doxorubicin. These regimens induce at least partial response in &gt; 70% of previously untreated patients. Recent data suggest that prolonged exposure to nucleoside-containing regimens should be avoided because of concerns of myelodysplasia and disease transformation. Rituximab has also been combined with thalidomide, which is an active and nonmyelosuppressive regimen. The rituximab-based combination represents today the most commonly used primary treatment for WM