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The mutagenic impact of melphalan in multiple myeloma

Abstract

The introduction of whole genome and exome sequencing partnered with advanced bioinformatic pipelines has allowed the comprehensive characterization of mutational processes (i.e., mutational signatures) in individual cancer patients. Studies focusing on multiple myeloma have defined several mutational processes, including a recently identified mutational signature (called “SBS-MM1”) directly caused by exposure to high-dose melphalan (i.e., autologous stem cell transplant). High-dose melphalan exposure increases both the overall and nonsynonymous mutational burden detected between diagnosis and relapse by ~10–20%. Nevertheless, most of these mutations are acquired within the heterochromatin and late-replicating regions, rarely involving key myeloma driver genes. In this review, we summarize key studies that made this discovery possible, and we discuss potential clinical implications.

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Fig. 1: History of melphalan mutational signature in multiple myeloma.
Fig. 2: Melphalan mutational signatures.
Fig. 3: SBS-MM1 is detectable only in relapsed multiple myeloma exposed to melphalan.
Fig. 4: Scheme summarizing the single cell expansion and engraftment models.

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Acknowledgements

This work was supported by the Sylvester Comprehensive Cancer Center NCI Core Grant (P30 CA 240139), by the Memorial Sloan Kettering Cancer Center NCI Core Grant (P30 CA 008748), by the Multiple Myeloma Research Foundation (MMRF), by the Perelman Family Foundation, and by the Riney Family Multiple Myeloma Research Program Fund. FM is supported by the American Society of Hematology, the International Myeloma Foundation and The Society of Memorial Sloan Kettering Cancer Center. BD is supported by Myeloma Crowd and Conquer Cancer.

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FM, NW, GM, LR, DK, BD and OL designed and supervised the study, collected and analyzed the data and wrote the paper.

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Correspondence to Francesco Maura or Ola Landgren.

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Maura, F., Weinhold, N., Diamond, B. et al. The mutagenic impact of melphalan in multiple myeloma. Leukemia 35, 2145–2150 (2021). https://doi.org/10.1038/s41375-021-01293-3

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