Molecular Aberrations in Bone Marrow Stromal Cells in Multiple Myeloma

Multiple myeloma (MM) is a B-cell malignancy characterized by an accumulation of malignant plasma cells within the bone marrow. Bone marrow mesenchymal stromal cells (BMMSCs) represent a crucial component of MM microenvironment supporting its progression and proliferation. Alterations in BMMSC of MM (MM-BMMSC) have become an important research focus. In this study, we analyzed MM-BMMSC and their modification through interaction with plasma cells in 128 MM patients. MM-BMMSC displayed a senescence-like state that was accompanied by an increase in senescence-associated β-galactosidase activity, a reduced number of colony-forming units, an accumulation of cells in S phase of the cell cycle, and the overexpression of microRNAs (miR-16, miR-223, miR-485-5p, and miR-519d) and p21. MM-BMMSC showed a reduced expression of mitochondrial stress response protein SIRT3 and an increased mitochondrial DNA mass that led to a higher amount of reactive oxygen species compared to healthy donor BMMSC. The interaction between MM cells and MM-BMMSC is a complex mechanism that relies on multiple interacting signaling pathways. Observed aberrations in MM-BMMSC should be confirmed in an in vivo model in order to clarify the importance for the pathogenesis of MM. Eventually, the result of MM therapy could be improved by understanding the interaction between MM cells and MM-BMSCs

CD4+ T Cell Dependent B Cell Recovery and Function After Autologous Hematopoietic Stem Cell Transplantation

Introduction: High-dose chemotherapy followed by autologous hematopoietic stem cell transplantation (auto-HSCT) represents a standard treatment regime for multiple myeloma (MM) patients. Common and potentially fatal side effects after auto-HSCT are infections due to a severely compromised immune system with hampered humoral and cellular immunity. This study delineates in depth the quantitative and functional B cell defects and investigates underlying extrinsic or intrinsic drivers. Methods: Peripheral blood of MM patients undergoing high-dose chemotherapy and auto-HSCT (before high-dose chemotherapy and in early reconstitution after HSCT) was studied. Absolute numbers and distribution of B cell subsets were analyzed ex vivo using flow cytometry. Additionally, B cell function was assessed with T cell dependent (TD) and T cell independent (TI) stimulation assays, analyzing proliferation and differentiation of B cells by flow cytometry and numbers of immunoglobulin secreting cells in ELISpots. Results: Quantitative B cell defects including a shift in the B cell subset distribution occurred after auto-HSCT. Functionally, these patients showed an impaired TD as well as TI B cell immune response. Individual functional responses correlated with quantitative alterations of CD19+, CD4+, memory B cells and marginal zone-like B cells. The TD B cell function could be partially restored upon stimulation with CD40L/IL-21, successfully inducing B cell proliferation and differentiation into plasmablasts and immunoglobulin secreting cells. Conclusion: Quantitative and functional B cell defects contribute to the compromised immune defense in MM patients undergoing auto-HSCT. Functional recovery upon TD stimulation and correlation with CD4+ T cell numbers, indicate these as extrinsic drivers of the functional B cell defect. Observed correlations of CD4+, CD19+, memory B and MZ-like B cell numbers with the B cell function suggest that these markers should be tested as potential biomarkers in prospective studies

Risk factors and characteristics influencing humoral response to COVID-19 vaccination in patients after allogeneic stem cell transplantation

IntroductionVaccination against severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) is approved and recommended for immunocompromised patients such as patients after allogeneic stem cell transplantation (allo-SCT). Since infections represent a relevant cause of transplant related mortality we analyzed the advent of immunization to SARS-CoV-2 vaccination in a bicentric population of allogeneic transplanted patients.MethodsWe retrospectively analyzed data of allo-SCT recipients in two German transplantation centers for safety and serologic response after two and three SARS-CoV-2 vaccinations. Patients received mRNA vaccines or vector-based vaccines. All patients were monitored for antibodies against SARS-CoV2-spike protein (anti-S-IgG) with an IgG ELISA assay or an EIA Assay after two and three doses of vaccination.ResultsA total of 243 allo-SCT patients underwent SARS-CoV-2 vaccination. The median age was 59 years (range 22-81). While 85% of patients received two doses of mRNA vaccines, 10% had vector-based vaccines and 5% received a mixed vaccination. The two vaccine doses were well tolerated with only 3% patients developing a reactivation of graft versus host disease (GvHD). Overall, 72% of patients showed a humoral response after two vaccinations. In the multivariate analysis age at time of allo-SCT (p=0.0065), ongoing immunosuppressive therapy (p= 0.029) and lack of immune reconstitution (CD4-T-cell counts <200/μl, p< 0.001) were associated with no response. Sex, intensity of conditioning and the use of ATG showed no influence on seroconversion. Finally, 44 out of 69 patients that did not respond after the second dose received a booster and 57% (25/44) showed a seroconversion.DiscussionWe showed in our bicentric allo-SCT patient cohort, that a humoral response could be achieve after the regular approved schedule, especially for those patients who underwent immune reconstitution and were free from immunosuppressive drugs. In over 50% of the initial non-responders after 2-dose vaccination, a seroconversion can be achieved by boostering with a third dose

a randomized, open, multicenter phase III trial of lenalidomide/dexamethasone versus lenalidomide/dexamethasone plus subsequent autologous stem cell transplantation and lenalidomide maintenance in patients with relapsed multiple myeloma

Background Despite novel therapeutic agents, most multiple myeloma (MM) patients eventually relapse. Two large phase III trials have shown significantly improved response rates (RR) of lenalidomide/dexamethasone compared with placebo/dexamethasone in relapsed MM (RMM) patients. These results have led to the approval of lenalidomide for RMM patients and lenalidomide/dexamethasone has since become a widely accepted second-line treatment. Furthermore, in RMM patients consolidation with high-dose chemotherapy plus autologous stem cell transplantation has been shown to significantly increase progression free survival (PFS) as compared to cyclophosphamide in a phase III trial. The randomized prospective ReLApsE trial is designed to evaluate PFS after lenalidomide/dexamethasone induction, high-dose chemotherapy consolidation plus autologous stem cell transplantation and lenalidomide maintenance compared with the well-established lenalidomide/dexamethasone regimen in RMM patients. Methods/Design ReLApsE is a randomized, open, multicenter phase III trial in a planned study population of 282 RMM patients. All patients receive three lenalidomide/dexamethasone cycles and - in absence of available stem cells from earlier harvesting - undergo peripheral blood stem cell mobilization and harvesting. Subsequently, patients in arm A continue on consecutive lenalidomide/dexamethasone cycles, patients in arm B undergo high dose chemotherapy plus autologous stem cell transplantation followed by lenalidomide maintenance until discontinuation criteria are met. Therapeutic response is evaluated after the 3rd (arm A + B) and the 5th lenalidomide/dexamethasone cycle (arm A) or 2 months after autologous stem cell transplantation (arm B) and every 3 months thereafter (arm A + B). After finishing the study treatment, patients are followed up for survival and subsequent myeloma therapies. The expected trial duration is 6.25 years from first patient in to last patient out. The primary endpoint is PFS, secondary endpoints include overall survival (OS), RR, time to best response and the influence of early versus late salvage high dose chemotherapy plus autologous stem cell transplantation on OS. Discussion This phase III trial is designed to evaluate whether high dose chemotherapy plus autologous stem cell transplantation and lenalidomide maintenance after lenalidomide/dexamethasone induction improves PFS compared with the well-established continued lenalidomide/dexamethasone regimen in RMM patients. Trial registration: ISRCTN16345835 (date of registration 2010-08-24)

Induktion von Autoimmunität durch Kreuzreaktivität und "Bystander-Aktivierung" in transgenen Mäusen

In der Arbeit wurde die Rolle von Bakterien für das Entstehen von Autoimmunität untersucht. Insbesondere wurde untersucht, inwieweit Bakterien entweder spezifisch (über "Kreuzreaktivität") oder antigenunabhängig (über "Bystander-Aktivierung") eine Aktivierung von autoreaktiven CD4+- T-Zellen induzieren können. Es konnte gezeigt werden, dass es bei dem untersuchten, MBP-spezifischen T-Zellrezeptor multiple, natürlich vorkommende, kreuzreaktive Peptide mikrobiellen Ursprungs gibt, die eine Aktivierung der T-Zellen hervorrufen und in vivo experimentelle autoimmune Enzephalomyelitis (EAE) induzieren können. Weiterhin wurde untersucht, inwieweit Lipopolysaccharid (LPS) als unspezifischer Aktivator des Immunsystems eine Aktivierung der autoreaktiven T-Zellen in vitro hervorrufen kann und inwieweit in vivo EAE durch LPS hervorgerufen werden kann. Es wurde gezeigt, dass LPS in vitro einen kleinen Anteil der CD4+ - T-Zellen aktiviert. Wurden den transgenen T+alpha- -Mäusen LPS appliziert, erkrankten diese an EAE. Somit gibt es sowohl in vitro als auch in vivo in den T+alpha- -Mäusen Hinweise für eine Relevanz von "Bystander-Aktivierung". Abschließend wurde diskutiert, inwieweit entweder "Kreuzreaktivität" oder "Bystander-Aktivierung" als Auslöser für Autoimmunität unter physiologischen Bedingungen in Frage kommt. Aufgrund der in dieser Arbeit gezeigten Ergebnisse wurde postuliert, dass keine der beiden Mechanismen alleiniger Auslöser sei, da es aufgrund der Häufigkeit von Infektionen, kreuzreaktiven Peptiden und des Vorkommens von autoreaktiven T-Zellen auch in gesunden Individuen ansonsten sehr viel häufiger zu Autoimmunität kommen müsste. Unter bestimmten Bedingungen könnte die Aktivierung von T-Zellen über Kreuzreaktivität oder über "Bystander-Aktivierung" Autoimmunität auslösen oder verstärken, wenn bereits andere Mechanismen des Immubnsystems, die Autoimmunität verhindern, versagt haben.In this thesis the role of bacteria for the induction of autoimmunity was investigated. In detail, it was examined whether bacteria are able to activate autoreactive CD4+-T-cells antigen-specific ("cross-reactivity") or antigen-unspecific ("bystander-activation"). It was shown that the examined transgenic MBP-peptide specific T-cell-receptor recognized many natural occurring cross-reactive peptides of microbial origin, which induced an activation of the T-cells in vitro and which could induce autoimmune encephalomyelitis (EAE) in the T-cell-receptor transgenic mice in vivo. Furthermore, it was examined, whether lipopolysaccharide (LPS) as activator of the innate immune system could induce an unspecific activation of the autoreactive T-cells in vitro and whether administration of LPS in the transgenic mice could induce EAE in vivo. It was shown that LPS activates a small percentage of CD4+ - T-cells. Application of LPS to the transgenic T+alpha- mice induced EAE. Therefore, the role of bystander-activation was indicated in vitro and in vivo. Finally, it was discussed, whether either cross-reactivity or bystander-activation could be sufficient for inducing autoimmunity under physiologic conditions. Due to the results presented in this work, it is postulated that none of the both mechanisms could be inductor of autoimmunity alone. If one of these mechanisms was sufficient, autoimmunity in humans should be a frequent event, because infections and autoreactive T cells are both findings which occur in healthy humans very often. However, under certain conditions either cross-reactivity or bystander-activation could trigger or exacerbate autoimmunity, when other mechanisms which inhibit autoimmunity have failed