Prognostic Impact of Serum Heavy/Light Chain Pairs in Patients With Monoclonal Gammopathy of Undetermined Significance and Smoldering Myeloma: Long-Term Results From a Single Institution.

BACKGROUND: Asymptomatic monoclonal gammopathies, such as monoclonal gammopathy of undetermined significance (MGUS) and smoldering myeloma (SMM), are clinical conditions that usually precede symptomatic multiple myeloma. Therefore, risk stratification is crucial owing to the heterogeneous progression rate among these patients. In previous years, suppression of the uninvolved chain of specific heavy/light chain (HLC) pairs in serum has been identified as a new risk factor in MGUS. The aim of the present study was to investigate the prognostic effect of involved and uninvolved HLC pairs and HLC ratios on progression in a series of patients with MGUS and SMM. PATIENTS AND METHODS: All specific serum HLC pairs were measured in 114 patients diagnosed with SMM (n = 27) and MGUS (n = 87) from 1983 to 2003. Also, the HLC ratios were calculated. RESULTS: Progression to symptomatic multiple myeloma was observed in 13 patients (8 with SMM and 5 with MGUS). The risk of progression was 6 times greater in those with SMM (P = .001) and 4 times greater for those with the IgA isotype (P = .01). The suppression of any IgM isotypes (IgMκ or IgMλ) in patients with IgA or IgG gammopathy or any IgA isotypes (IgAκ or IgAλ) in patients with IgG or IgM gammopathy was associated with a shorter time to progression to symptomatic gammopathy (P = .001 and P = .03, respectively). On multivariate analysis, the evolving pattern and suppression of any IgM HLC pair remained significant. CONCLUSION: HLC ratios could be a valuable tool in the risk stratification of patients with SMM and MGUS, especially patients with IgG isotypes.

A serum microRNA signature associated with complete remission and progression after autologous stem-cell transplantation in patients with multiple myeloma.

We have examined serum microRNA expression in multiple myeloma (MM) patients at diagnosis and at complete response (CR) after autologous stem-cell transplantation (ASCT), in patients with stable monoclonal gammopathy of undetermined significance, and in healthy controls. MicroRNAs were first profiled using TaqMan Human MicroRNA Arrays. Differentially expressed microRNAs were then validated by individual TaqMan MicroRNA assays and correlated with CR and progression-free survival (PFS) after ASCT. Supervised analysis identified a differentially expressed 14-microRNA signature. The differential expression of miR-16 (P = 0.028), miR-17 (P = 0.016), miR-19b (P = 0.009), miR-20a (P = 0.017) and miR-660 (P = 0.048) at diagnosis and CR was then confirmed by individual assays. In addition, high levels of miR-25 were related to the presence of oligoclonal bands (P = 0.002). Longer PFS after ASCT was observed in patients with high levels of miR-19b (6 vs. 1.8 years; P < 0.001) or miR-331 (8.6 vs. 2.9 years; P = 0.001). Low expression of both miR-19b and miR-331 in combination was a marker of shorter PFS (HR 5.3; P = 0.033). We have identified a serum microRNA signature with potential as a diagnostic and prognostic tool in MM.

Doença arterial coronariana e suporte familiar em idosos / Coronary artery disease and family support in older adults / Enfermedad arterial coronaria y apoyo familiar en ancianos

Estudo quantitativo, com aplicação de questionário através de entrevista, realizado em 2010, com o objetivo de analisar fatores de risco para doença arterial coronária e a relação de suporte familiar em idosos cadastrados na Estratégia Saúde da Família de Uberaba/MG. Foram pesquisados 853 idosos. A faixa etária prevalente foi de 60 a 79 anos (88,6%); mulheres (63,7%); aposentados (81,1%); com até dois salários mínimos (78,1%); hipertensão arterial (65%); sedentarismo (59%); diabetes mellitus (28%); tabagismo (21%); etilismo (12,1%); dislipidemia (4,8%); convívio familiar ótimo (49,7%), e bom (42%); tem acompanhamento familiar do estado de saúde (81,7); mas não há cooperação familiar no exercício físico (86%), medicação (66,7%), recursos financeiros (61,4%) e alimentação (60,5%). Conclui-se neste estudo que profissionais de saúde devem estimular o suporte familiar, e juntamente com o Estado, atuar criando políticas e estratégias na redução dos fatores de risco para doenças cardiovasculares.

This quantitative study, based on questionnaires applied at interview, was conducted in 2010 to analyze risk factors for coronary artery disease and the relationship of family support in 853 older adults registered with the family health program in Uberaba, Minas Gerais, Brazil. The group was prevalently aged 60 to 79 years (88.6%); women (63.7%) and retirees (81.1%); with income up to 2 minimum wages (78.1%); arterial hypertension (65%); sedentary lifestyle (59%); diabetes mellitus (28%); smoking (21%); alcohol (12.1%); dyslipidemia (4.8%); family relations excellent (49.7%) and good (42%); family monitors state of health (81.7); but does not cooperate with physical exercise (86%), medication (66.7%), financial resources (61.4%) and food(60.5%). It was concluded that health professionals should encourage family support, and together with the State, act to formulate policies and strategies to reduce risk factors for cardiovascular diseases.

Estudio cuantitativo, con cuestionarios a través de entrevista, realizado en 2010, con el objetivo de analizar los factores de riesgo para enfermedad arterial coronaria y la relación del apoyo familiar en ancianos inscritos en la estrategia salud de la familia de Uberaba / MG, Brasil. Fueron encuestados 853 ancianos. El grupo etario predominante fue de 60 a79 años (88,6%) mujeres (63,7%); jubilados (81,1%); con hasta dos salarios mínimos (78,1%); hipertensión arterial (65%); sedentarios (59%); diabetes mellitus (28%); fumantes (21%); y alcoholismo (12,1%); dislipidemi (4,8%); convivencia familiar ótima (49,7%) y buena (42%); tiene monitoreo familiar del estado de salud (81,7); pero no hay ninguna cooperación en ejercicio físico (86%), medicamentos (66,7%), recursos financieros (61,4%) y alimentos (60,5%). Este estudio concluyó que profesionales de salud deben estimular el apoyo familiar y, junto con el Estado, actuar creando políticas y estrategias en la reducción de factores de riesgo para enfermedades cardiovasculares.

Differential humoral responses against heat-shock proteins after autologous stem cell transplantation in multiple myeloma.

Heat-shock proteins (HSP) are important molecules in the pathogenesis of multiple myeloma (MM). Their blockages by drugs or cellular immune response have been investigated, and a possible association with the presence of oligoclonal bands (OB) has been postulated in patients with MM after allogenic stem cell transplantation. The aim of the present study was to ascertain the serum antibody levels against three HSP (60, 70 and 90) by ELISA in patients with MM in complete remission after autologous stem cell transplantation (ASCT), with or without OB, and compare them with those patients with stable gammopathy of undetermined significance (MGUS) and healthy controls. Our results in samples after ASCT showed no differential levels of anti-HSP according to the presence or absence of the oligoclonal response. However, higher levels of anti-HSP90 were found in patients with stable MGUS in comparison with MM patients (p = 0.004). In the same line, a longer progression-free survival was observed in those patients who presented higher anti-HSP90 levels after ASCT (p = 0.042). These results suggest, for first time, the potential of anti-HSP90 humoral immune response for long-term control of malignant plasma cell disorders.