Haematologica 2003 - Supplements

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may be related to pesticide exposure. The higher incidence of computer use and lower educational background of the cases is difficult to explain although electromagnetic radiation could be implicated in the former. 019 COEXISTENCE OF PRODUCTIVE AND NON- PRODUCTIVE IGH GENE REARRANGEMENTS IN MULTIPLE MYELOMA E. Novella, E. Albiero, D. Madeo, F. Elice , I. Giaretta and F. Rodeghiero Department of Cell Therapy and Hematology, San Bortolo Hospital, Vicenza Multiple Myeloma (MM) is a B-cell neoplastic disease characterized by clonal expansion of plasma cells in the bone marrow. Analysis of the VDJ rearrangement of the immunoglobulin heavy chain (IgH) gene provides a unique clonotypic marker to monitor the residual tumor cells and to verify the efficacy of chemotherapy. The VDJ rearrangement is considered to remain constant in the patient thorough the course of the disease; furthermore, the presence of independent clones in the same MM patient is rarely reported, mostly in association with a second hematological malignancy. The aim of this study was to assess the recurrence of different clones in a panel of consecutive MM patients included in a highdose treatment program enrolled at our Department from January 1999 to December 2002. Ninety consecutive MM patients were first screened at the genomic DNA level; mRNA analysis was subsequently performed in those patients showing multiple rearrangements to verify the real coexistence of multiple productive clones evolved independently or the presence of rearrangements involving both alleles of a single cell. VDJ rearrangement was determined using different set of VH family-specific primers for FR1. PCR products were subjected to capillary electrophoresis and analyzed by gene scanning in an automated DNA sequencer ABI Prism 310. A monoclonal population was detected in 64/90 (71%); three patients (3%) showed double rearrangements. These rearrangements used different VH, D and JH genes, as confirmed by sequencing. Total RNA from samples collected prior to highdose therapy was reverse transcribed using random primers and cDNA was separately amplified with the same VH familyspecific primers which gave positivity at the DNA level. PCR products were analyzed by gene scanning. The absence of contaminating DNA was assessed using primers for the beta-actin gene, designed to discriminate between DNA and RNA. In two of the three patients a monoclonal peak was detected on cDNA only with one VH-family. This finding confirms the hypothesis of rearrangements involving both alleles, one of which was a non-productive rearrangement. In the third patient, two monoclonal population were identified, for family VH.1 and VH.3 respectively. In this case two monoclonal population are really detectable, although the presence of an associated, clinically silent disease, can not be excluded. Biclonality or oligoclonality are widely documented for ALL and lymphomas; this study strongly suggests that multiple rearrangements could be identified even in a small number of MM patients (∼3%), although the presence of more than one functional clone remains a rare event (∼1%). In these cases mRNA analysis is mandatory to distinguish between real biclonality and productive or non-productive rearrangements involving the same cell and to monitor residual tumor plasma cells. Clinical and molecular follow-up using tumor-specific primers of the patients with double clonality is currently under way. 020 Isolation and culture of human multiple myeloma medullary plasmocytes L. Garderet, C. Mazurier, M. Lagrange, S. Bouchet, J. Frick, NC. Gorin, M. Lopez Department of Hematology, Inserm U76, CHU and Hospital Saint Antoine, Paris, France. Aim: Studies of freshly isolated multiple myeloma patient bone marrow samples are often limited because of massive and rapid cell death. So far, no human myeloma cell line has been obtained from patients with medullary involvement alone. We are developing a plasma cell culture, which keeps some of them alive after a week. Materials and methods: Bone marrow from five multiple myeloma patients (stage III) at diagnosis were collected into heparin with the patient’s informed consent. Mononuclear cells were isolated by Ficoll Hypaque sedimentation, then plasma cells were purified using the anti-CD138 plasma cell isolation system (Miltenyi-Biotec). Purity of isolated plasma cells was determined by incubation with PE anti-CD138 monoclonal antibody and analysed on a FACScalibur flow cytometry system (Becton Dickinson). Purified plasma cells were used immediately or frozen in fetal calf serum containing 10 % DMSO and stored in liquid nitrogen before use. Fresh or thawed plasma cells were maintained in liquid culture in ISCOVE medium with IL-6, GM- CSF, IL-3 and SCF for 8 days. On day 0, 4 and 8, the plasmocyte culture was examined for viability (using trypan blue dye exclusion), morphology (air-dried cytospin stained with Wright- Giemsa) and cell surface phenotype (CD38 and CD138 monoclonal antibodies). Results: After immunomagnetic bead separation, purity was 76% (55%-98%) and yield was 54% (11%- 100%). On day 0, the culture was started with a cell range from 0.6 to 4.6 X 106 plasmocytes. After a 4-day culture, 41% of myeloma cells (15%-69%) were viable as assayed by trypan blue and checked by morphological examination. On day 8, the mean plasmocyte number decreased to 15% (4%-24%). In terms of viability, we didn’t observe any difference starting the culture with fresh plasma cells or after thawing. FACS analysis was very heterogeneous, CD138 decreasing steadily during the cell culture as cells were dying and failed to express Syndecan-1. CD38 had a higher expression compared to CD138 because of a more nonspecific staining. Conclusion: In this preliminary study, we showed that the combined use of IL-6, GM-CSF, IL-3 and SCF enabled some viability of medullary plasma cells during at least an 8-day culture and as such avoided the common early death of freshly uprooted myeloma cells. This culture method could be used for short-term functional or cytogenetic studies. S96
2. Genetic heterogeneity in MM: impact on diagnosis and therapy 2.1 IGH rearrangement 021 Low frequency of IgH rearrangement in UK plasma cell dyscrasias. Fiona M Ross, Ashraf H Ibrahim, Amy Jones, Rebecca KM Protheroe, Mark O Winfield, Jude BL Gunasekera, Christopher S Wragg, Armelle Vilain-Holmes LRF UK Myeloma Forum Cytogenetics Database, Wessex Regional Genetics Laboratory, Salisbury, UK, and Human Genetics Division, University of Southampton, Southampton, UK. Interphase FISH has been carried out on CD138-purified plasma cells from 251 cases of plasma cell dyscrasia (2 PCL, 219 MM, 27 MGUS, 3 primary amyloidosis) from 32 UK centres. 75% cases were studied at diagnosis. 95% were abnormal when tested for IgH rearrangement, 13q14 loss, p53 loss, or numbers of centromeres of chromosomes 3, 6, 7, 9, 10, 11 and 17. Clear associations between these abnormalities were observed. Only 43% overall showed an IgH translocation (44% MM, 100% PCL, 26% MGUS, 66% PA), much less than expected from the literature. However, the overall rates of t(11;14) (16%), t(4;14) (7%) and t(14;16) (3%) were not significantly different from expected. Part of the explanation for the low IgH abnormality rate may have been due to a higher proportion of older patients in our series, as we saw a clear trend towards decreasing IgH rearrangement with increasing age (53% in the 40s to 32% aged 80+). IgH rearrangement was slightly increased in IgA cases (53%) relative to IgG cases (37%) and t(4;14) was significantly overrepresented in IgA cases (18%) vs 3% in IgG cases. The t(11;14) was seen in 2/3 non-secretory MM. MGUS cases did not show t(4;14) or t(14;16). 29% of t(4;14) cases had lost the signal for the derived 14 in a high proportion of cells, confirming that the FGFR3/IgH fusion is less important in maintenance of myeloma than the MMSET/IgH fusion on the der(4). 37% cases overall showed deletion of Rb and/or D13S319 from chromosome 13. The rate was higher in MM than MGUS (40% vs 15%). The 6 cases of MM known to have had a preceding MGUS had a 66% del(13) rate lending support to the theory that acquisition of del(13) may be involved with the development of MM from MGUS. 64% cases appeared to be substantially hyperdiploid. As expected, these had a lower frequency of del(13) (25%) than those cases that were probably pseudodiploid or hypodiploid (51%). 88% of cases with no visible numerical abnormalities (counting del(13) as a numerical change) had t(11;14). The t(11;14) was rarely associated with del(13) (18%) or hyperdiploidy (15%). The t(4;14) and t(14;16) cases showed del(13) in 76% and 71% respectively. However, conventional cytogenetic results available for 3 of these cases with apparently normal 13s indicated that loss of 13 relative to a near-triploid or near-tetraploid karyotype had been masked. The t(4;14) cases also showed a reduced rate of significant hyperdiploidy (18%) but had evidence of many more abnormalities of single chromosomes than t(11;14) cases. Only 8 cases (3%) had significant deletion of p53. However 78% of 14 cases with an additional 17 centromere did not show an extra p53. It is unclear whether this relative loss of p53 is significant. Only one of 50 cases tested for ATM deletion was abnormal indicating this is not an important cause of chromosome instability in myeloma. Thus FISH studies are continuing to demonstrate and refine patterns of chromosome abnormalities and their association with other features of myeloma. 022 14q32 translocations in multiple myeloma patients Christian Bastard, Dominique Leroux, Jean Soulier, Sylvie Dumont, Catherine Arnould, Sylvie Taviaux, Jean Louis Taillemite1, Nicole Véronique Smadja. centre Henri Becquerel, Rouen, CHU Grenoble, Hopital Saint Louis, Paris, Hopital Saint Antoine, Paris, France Translocations involving the immunoglobulin heavy chain (IgH) genes are frequent in multiple myeloma (MM) patients. Using conventional cytogenetics, MM can be separated into two groups according to the chromosome number pattern, and 14q32 translocations are more frequently associated with hypodiploid than with hyperdiploid karyotypes (Smadja et al, Blood, 2001 : total IgH rearrangements 31%, hyperdiploid group 11%, hypodiploid group 56%). However, conventional cytogenetics misses cryptic translocations, especially t(4;14)(p16;q32). Furthermore, recent interphase fluorescent in situ hybridization (FISH) studies found 14q32 translocations in as much as 75% MM patients. In order to identify in which CC group we failed to detect these translocations, we design a study using FISH with a dual color break appart IgH probe on previously R-banded metaphases, allowing to detect both 14q32 translocations and overall chromosomal abnormalities in a new series of 55 patients with abnormal karyotypes. Upon conventional cytogenetics analysis, 2/29 hyperdiploid (7%) and 9/26 hypodiploid patients (35%) had a 14q32 translocation. Using the FISH assay, twelve t(4;14) were identified, in 2 hyperdiploid (7%) and 10 hypodiploid (38.5%) cases, respectively. This abnormality was always associated with a chromosome 13 monosomy. We therefore confirm that 14q32 translocations are much more frequent in hypodiploid (73.5%) than in hyperdiploid patients (14%), (p< .0001), and that cryptic t(4;14)(p16;q32) is strongly associated with hypodiploid karyotypes (p< .01). This study also confirms the heterogeneity of the hypodiploid group, in which several subgroups can be recognized depending on IgH genes translocations. Using this reliable assay, only 42% of patients had a 14q32 translocation. 023 Detection of chromosomal breakpoints affecting the IGH, IGL and IGK loci by interphase FISH in MM and MGUS with normal karyotype. Borja Saez, José I. Martín-Subero, María D. Odero, Juan C. Cigudosa, Roberto Hernández, Marta Pérez-Salazar, Felipe Prosper, Reiner Siebert, María J. Calasanz 1. Department of Genetics, University of Navarra, Pamplona, Spain 2. Institute of Human Genetics, University Hospital Schleswig- Holstein, Campus Kiel, Germany 3. Department of Human Genetics, Spanish National Cancer Center, Madrid, Spain 4. Department of Hematology, Hospital Txagorritxu, Vitoria, Spain 5. Department of Hematology, Clínica Universitaria, Pamplona, Spain The routine application of conventional cytogenetic techniques for the diagnosis of plasma cell disorders (PCD) is often unsuccessful. The percentage of patients with non-informative karyotypes is around 60-70% in multiple myeloma (MM) and S97
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Focussed Symposia Arsenic trioxide
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assess whether such a program will
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The overall response rate was noted
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Figure 5A Table 1: VEL + THAL for R
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naturally occurring OPG. Present tr
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0.505). Finally, the multiple event
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CLINICOPATHOLOGICAL DEFINITION OF W
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Plenary Sessions 1. Development of
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clonotypic IgH VDJ signature confir
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can be considered as two entities,
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immunofluorescence staining for DKK
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P2.3 DEVELOPMENT OF A MULTIPLE MYEL
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P2.5 MOLECULAR CYTOGENETICS OF MYEL
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clear that the biggest challenge fo
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esponse and have demonstrated that
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variable region of the idiotypic im
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4. From MGUS to symptomatic MM Fig.
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(MRI); some have claimed that level
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P4.5 CYTOKINES IN MGUS: THERAPEUTIC
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preventing phosphorylation of p70S6
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transducing component of the interl
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survive initial drug exposure and a
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quiescent counterpart, the human um
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transcriptional activity of NF-êB;
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manifestations and anomalous protei
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P7.4 ROLE OF SERUM FREE LIGHT CHAIN
Page 53 and 54: P7.6 IMMUNOPHENOTYPIC INVESTIGATION
Page 55 and 56: presumably through the circulation,
Page 57 and 58: 9. Chemotherapy, maintenance treatm
Page 59 and 60: stratified according to their antim
Page 61 and 62: explore higher doses of zoledronic
Page 63 and 64: initial therapy. However, the role
Page 65 and 66: P10.2.2 SINGLE VERSUS TANDEM HIGH D
Page 67 and 68: With a median follow-up of 38 month
Page 69 and 70: cells could be harvested following
Page 71 and 72: 11. What is the role of allogeneic
Page 73 and 74: found that 75% of patients who were
Page 75 and 76: patients with responsive disease 3
Page 77 and 78: 9. Giralt S, Estey E, Albitar M, et
Page 79 and 80: Badros A, Barlogie B, Siegel E, et
Page 81 and 82: Figure 3b. Event-free Survival 4-Ye
Page 83 and 84: improve patient outcome in MM. Impo
Page 85 and 86: myeloma and in 40% of previously un
Page 87 and 88: degrade OPG in the same way as myel
Page 89 and 90: P12.2.5 MONOCLONAL ANTIBODY THERAPY
Page 91 and 92: myeloma. Blood 2001; 98:210-216. 6.
Page 93 and 94: MHC molecules, in effectively prese
Page 95 and 96: mice demonstrate that class II-spec
Page 97 and 98: detected in 293 and NIH3T3 cells. S
Page 99 and 100: hypothesis that (1) CCND1 and FGFR3
Page 101 and 102: patient samples. In addition, the p
Page 103: 016 NEUTRAL ENDOPEPTIDASE (CD10) KN
Page 107 and 108: evidence from two t(11;14) cases wh
Page 109 and 110: immunoglobulin heavy chain (IgH) lo
Page 111 and 112: 034 Instability of Pericentromeric
Page 113 and 114: clusters were found, the first was
Page 115 and 116: MGUS but most likely not crucial fo
Page 117 and 118: Objective: To compare the impact on
Page 119 and 120: 4 patients had MMSET/IgH but did no
Page 121 and 122: and clonal PC from MGUS, MM and PCL
Page 123 and 124: 059 VEGF receptor expresion in Mult
Page 125 and 126: two HLA-A2+ myeloma patients with C
Page 127 and 128: molecules expressed on the surface
Page 129 and 130: Recognition of these antigens appea
Page 131 and 132: Diagnosis requires a single area of
Page 133 and 134: 081 Incidence of solid tumors in co
Page 135 and 136: Growth Factor (VEGF), Hepatocyte Gr
Page 137 and 138: PC-AI levels of MGUS and SMM patien
Page 139 and 140: 093 The predominant pathway of tran
Page 141 and 142: was associated with I.V. line, whil
Page 143 and 144: 103 Vascular amyloidosis induces se
Page 145 and 146: 5. Signal transduction pathways and
Page 147 and 148: integrin in IGF-1-triggered MM cell
Page 149 and 150: 118 IL-6- Induced Phosphorylation o
Page 151 and 152: 123 THE IGF/IGF-1R SYSTEM IS A MAJO
Page 153 and 154: human myeloma cell line (HMCL) to a
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ligation or dexamethasone (Georgii-
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6. Role of microenvironment 6.1 Cel
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141 Human myeloma cells adhere to f
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145 STUDY OF BONE MARROW ANGIOGENES
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patients, the growth of primary mye
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tibia (con=49.1±0.7mg/cm2 vs 5T2=4
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157 The Nitrogen-Containing Bisphos
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7. New prognostic criteria for clas
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atio of >3. This system has subdivi
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Patient 1 (IgG/κ);IgG - 16.5 days,
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176 Pro-inflammatory and angiogenic
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180 Clinical study on the bone lesi
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7.2 Imaging studies 185 99mTc-MIBI
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189 Factors Predicting Occult Spina
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vivo detected resonances was invest
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Support Unit (CTSU) with flexibilit
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(β2m) & C reactive protein (CRP).
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plasmids carrying the clonotypic in
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newly diagnosed multiple myeloma as
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216 Transgenic expression of Myc an
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221 Prolonged survival in the 5T2MM
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9. Chemotherapy, maintenance, treat
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229 EFFECTIVENESS OF STANDARD CHEMO
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234 Melphalan and Dexamethasone- Is
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Methods. We investigated the VECD p
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9.2 Renal complications. 243 MERIT
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cost of SRE-related care was $10,24
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those with Hb >13 g/dL. Analysis of
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sustained response, lasting from 52
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proportion of bone abnormality. IgD
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disease. The lack of response to in
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yielding a median of 3x106/kg CD34
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patients(pts) aged ≥60 yrs. We co
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PBSC mobilizing regimen utilizing C
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their leukocytes and platelets. No
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25 Gy to marrow. The tracer dose wa
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non-CR after the first transplant a
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296 PERIPHERAL BLOOD STEM CELL TRAN
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References Effect of dose-intensive
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with cyclosporine A and methotrexat
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11.Role of novel therapies targetin
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312 Thalidomide as Rescue of Relaps
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patients, light chain in 1 patients
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platelets of 207 (76-402), B2M of 3
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325 Low Dose Thalidomide plus Dexam
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in 5 pts (11%), M protein decreased
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time from diagnosis was 3.7 years a
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339 Thalidomide, Clarithromycin and
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344 COMBINATION OF THALIDOMIDE, DEX
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experienced early death during the
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untreated patients with high tumor
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357 Thalidomide protects endothelia
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362 EOSINOPHILIA IS A VERY COMMON F
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11.5 CC 4047, PS 341 and arsenic tr
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without chromosome 13. Mean IC50 fo
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myeloma patients. Phase I data indi
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11.6 Other drugs 380 EFFECT OF STI5
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significant inhibition of cell prol
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which acts to prevent the synthesis
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of B and its metabolites, however,
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and 10 months after start of therap
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terminal kinase (JNK) pathway which
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lymphocytes was tested by Ellispot.
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411 Dendritic Cell-Based Idiotype V
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Author Index Abe M 74 160 Abelman W
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De La Serna J 291 De Laurenzi A P11
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Hull DR 338 Hullen C P10.2.1 Humes
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Morra E 249 280 359 Morris CM 226 M
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Siegel D 70 115 250 Sierra J 304 30
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