Early human cytomegalovirus replication after transplantation is associated with a decreased relapse risk: evidence for a putative virus-versus-leukemia effect in acute myeloid leukemia patients.

The impact of early human cytomegalovirus (HCMV) replication on leukemic recurrence was evaluated in 266 consecutive adult (median age, 47 years; range, 18-73 years) acute myeloid leukemia patients, who underwent allogeneic stem cell transplantation (alloSCT) from 10 of 10 high-resolution human leukocyte Ag-identical unrelated (n = 148) or sibling (n = 118) donors. A total of 63% of patients (n = 167) were at risk for HCMV reactivation by patient and donor pretransplantation HCMV serostatus. In 77 patients, first HCMV replication as detected by pp65-antigenemia assay developed at a median of 46 days (range, 25-108 days) after alloSCT. Taking all relevant competing risk factors into account, the cumulative incidence of hematologic relapse at 10 years after alloSCT was 42% (95% confidence interval [CI], 35%-51%) in patients without opposed to 9% (95% CI, 4%-19%) in patients with early pp65-antigenemia (P < .0001). A substantial and independent reduction of the relapse risk associated with early HCMV replication was confirmed by multivariate analysis using time-dependent covariate functions for grades II to IV acute and chronic graft-versus-host disease, and pp65-antigenemia (hazard ratio = 0.2; 95% CI, 0.1-0.4, P < .0001). This is the first report that demonstrates an independent and substantial reduction of the leukemic relapse risk after early replicative HCMV infection in a homogeneous population of adult acute myeloid leukemia patients.

Azotemia associated with use of lenalidomide in plasma cell dyscrasias.

Azotemia associated with the use of lenalidomide, a new and effective therapy for multiple myeloma, has not been reported in patients with multiple myeloma. We describe five patients with plasma cell dyscrasias and renal insufficiency (AL amyloidosis, monoclonal gammopathy of undetermined significance with Fanconi syndrome, and multiple myeloma) treated with lenalidomide and dexamethasone who developed progressive azotemia. Onset of azotemia after initiation of lenalidomide was variable (2 weeks to several months) and was irreversible in four patients. Four patients required hemodialysis after exposure to lenalidomide; two previously were untreated for their plasma cell dyscrasia. The mechanism of azotemia is unknown, but the combination of potentially nephrotoxic paraproteins and lenalidomide, which is immunomodulatory and anti-angiogenic, may underlie this process. We conclude that azotemia is an uncommon, but serious, potential complication of lenalidomide therapy in plasma cell dyscrasias with associated renal insufficiency. We advise careful monitoring of renal function after initiation of lenalidomide in this setting.

Collective cell migration in morphogenesis and cancer.

The movement of cells that maintain cell-cell junctions yet protrude along or within tissues is an important mechanism for cell positioning in morphogenesis, tissue repair and cancer. Collective cell migration shares similarities but also important differences to individually migrating cells. Coherent groups of cells are arranged and held together by cell-cell adhesion molecules, including cadherins, integrins, ALCAM and NCAM. Integrins of the beta 1 and beta 3 families further provide polarized interactions with the extracellular tissue environment, while matrix-degrading proteases become focalized to substrate contacts to widen tissue space for the advancing cell mass. By generating one functional unit, in contrast to individual cell migration, collective migration provides the active and passive translocation of mobile and non-mobile cells, respectively. This review highlights cellular and molecular principles of collective migration in the context of morphogenic tissue patterning and tumor cell invasion.

Collective cell movement in primary melanoma explants: plasticity of cell-cell interaction, beta1-integrin function, and migration strategies.

Collective cell movement represents an efficient dissemination strategy in neoplastic epithelial and mesenchymal cancer. In primary melanoma explants cultured in three-dimensional collagen lattices, invasive migration of multicellular clusters was dependent on the function of beta1 integrins, as shown by preferential beta1-integrin expression and clustering in a subset of promigratory cells at the leading edge ("guiding cells") and the abrogation of multicellular migration by adhesion-perturbing anti-beta1-integrin antibody. Interference with beta1-integrin function induced complex changes in cluster polarity and cohesion, including development of two or several opposing leading edges, cluster disruption, and the detachment of individual cells followed by beta1-integrin-independent "amoeboid" crawling and dissemination. The conversion from beta1-integrin-dependent collective movement to beta1-integrin-independent single-cell motility suggests efficient cellular and molecular plasticity in tumor cell migration strategies.