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Efficacy of thalidomide- or lenalidomide-based therapy in proliferative multiple myeloma

Leukemia volume 25, pages 1195–1197 (2011)Cite this article

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The proliferative activity of neoplastic plasma cells (PCs) is an independent determinant of the clinical course of patients with multiple myeloma (MM). It can be measured by the plasma cell labeling index (PCLI), which denotes the percentage of bone marrow PCs in the S-phase of the cell cycle.1 Typically, MM is a slow-growing tumor with very few PCs synthesizing DNA at a given time. Proliferative myeloma, characterized by a high PCLI (⩾1%), constitutes nearly a third of all MM cases, and has a poorer outcome.1 Although technical difficulties have limited its widespread application, the slide-based PCLI provides valuable insight into the tumor biology, with higher PCLI predictive of an aggressive course.1, 2, 3 There is a direct correlation between the cytogenetic abnormalities and the rate of PC division perhaps because these chromosomal abnormalities impart a distinct proliferative advantage to the myeloma cells.4 Conversely, it can be argued that rapid PC division leads to sufficient genetic instability to cause secondary chromosomal abnormalities, which adversely affect the prognosis of the patients.

Both conventional chemotherapies and more aggressive approaches such as high-dose therapy and autologous stem cell transplantation fail to alter the inherently aggressive behavior of highly proliferative myeloma.5 Whether the integration of novel immunomodulatory therapies to the treatment paradigm of newly diagnosed MM favorably modifies the clinical course of such patients remains unknown.

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Acknowledgements

This study is supported in part by the grants CA 62242, CA 107476 and CA 62242 from the National Cancer Institute, National Institutes of Health, Bethesda, MD and the Eastern Cooperative Oncology Group, Boston, MA (SVR).

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Authors and Affiliations

  1. Division of Hematology, Mayo Clinic, Rochester, MN, USA

    P Kapoor, S Kumar, A Dispenzieri, M Q Lacy, D Dingli, M A Gertz, R A Kyle, P R Greipp, S V Rajkumar & T E Witzig

  2. Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA

    S J Mandrekar & K M Laumann

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  1. P Kapoor
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Correspondence to T E Witzig.

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Competing interests

Shaji Kumar receives research support for clinical trials from Celgene, Novartis, Millennium, Bayer, Genzyme, Merck and Cephalon. Angela Dispenzieri and Martha Q Lacy receive research funding from Celgene. Philip R. Greipp receives research funding grants from Celgene and Novartis, and is on the advisory board of Amgen. Morie A Gertz receives research support from Millennium and Novartis, and honorarium from Celgene and Millennium. Robert A Kyle has been on the disease and/or data monitoring committees of Celgene, Novartis, Merck, Bristol-Myers Squibb Keryx Biopharmaceuticals, Onyx Pharmaceuticals and Johnson and Johnson sponsored studies. He is also a consultant for Millennium and receives honoraria from Binding Site. Thomas E Witzig receives research support from Celgene and Novartis. He has participated in Celgene advisory boards of Celgene, but has deferred the honorarium to Mayo Clinic, Rochester, MN, USA. The remaining authors declare no conflict of interest.

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Kapoor, P., Kumar, S., Mandrekar, S. et al. Efficacy of thalidomide- or lenalidomide-based therapy in proliferative multiple myeloma. Leukemia 25, 1195–1197 (2011). https://doi.org/10.1038/leu.2011.54

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