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Study is first to link multiple myeloma protein to extramedullary disease.

Multiple myeloma, also known as myeloma, is a type of bone marrow cancer.  Multiple myeloma affects the plasma cells, blood cell, inside the bone marrow.  Myeloma does not take the form of a lump or tumour, with the myeloma cells dividing and expanding within the bone marrow, damaging bones and affecting the production of healthy blood cells.  Approximately 25% of patients with multiple myeloma also simultaneously develop extramedullary disease (EMD). This disease occurs when the myeloma cells form tumours outside of the bone marrow in the soft tissues or organs of the body. The prognosis of myeloma patients with EMD behaves like other metastatic cancers and is extremely poor because its clinical course is very aggressive.  It is known that multiple myeloma with EMD involvement has an extremely poor outcome, however, not much is known about the mechanism in which EMD progresses.  Now, a study from researchers led by the University of Louisville links AF1q, a multiple myeloma protein, with EMD.  The group presented their findings at the European Hematology Association’s 21st Congress.

Previous studies show that EMD is an uncommon manifestation in multiple myeloma and can either accompany newly diagnosed disease or develop with disease progression or relapse.  EMD is a poor prognostic marker in both newly diagnosed and relapsed myeloma patients and, therefore, is a therapeutic challenge even with the use of novel agents.  A better understanding of how myeloma cells grow and thrive, as well as the biology of extramedullary tumours, is needed in order to develop better strategies for the treatment of EMD. Research has shown that myeloma patients with EMD have a poorer prognosis than those without.  Therefore, the researchers looked at the oncogene, AF1q, which is expressed in hematological cancer cells and is known to be related to multiple myeloma. Most importantly, its presence, like EMD, indicates a poor prognosis for the patient.  The current study investigates whether the high expression of AF1q is a poor prognostic factor of multiple myeloma and associated with EMD.

The current study investigates newly diagnosed multiple myeloma patients in National Center for Global Health and Medicine hospital from January 2001 to March 2013.  The degree of expression of AF1q in 117 patients with multiple myeloma was analysed using the immuno-staining of bone marrow clot samples.  Results show that EMD was present in 25% of patients with a low AF1q expression and in 44.7% of patients with a high AF1q expression.

The lab state that, to their knowledge, this is the first study to demonstrate a molecular marker associated with myeloma with EMD.  They go on to conclude that the high expression of AF1q is an adverse prognostic factor in multiple myeloma.

The team surmise that their findings show the incidence of EMD is significantly higher in patients with high expression of AF1q than those with low expression.  For the future, the researchers state that the significance of this finding gives the medical community a tentative approach to target this marker and could lead to new therapies for this subtype of myeloma.

Source: University of Louisville


Multiple Myeloma.  Credit: Merck and the Merck Manuals.
Multiple Myeloma. Credit: Merck and the Merck Manuals.

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