“Lytic” lesions in autologous bone grafts: demonstration of medullary air pockets on post mortem computed tomography

Donor bone grafts are an important aspect of orthopaedic surgery. The use of plain film as a pathological screening tool before donor bone dispatch has revealed “lytic” lesions in proximal humeri. Donor demographics did not support the diagnosis of myeloma and subsequent computed tomography (CT) scans of these bones identified the lesions as air, not pathology. In total, 27 long bones were scanned and 100% (27/27 cases) exhibited air within the trabecular bone. Three distinct patterns were found: ovoid, linear/branching, and broad channel. A longitudinal course of CT scans was performed to identify at which stage air appeared within the bone. Pre-retrieval, preprocessing, and postprocessing scans revealed that air originated between the retrieval and preprocessing stages of donor bone preparation. There may be multiple aetiology of this phenomenon, including bone retrieval and natural decomposition.     

κ及λ轻链测定在多发性骨髓瘤诊断中的应用

目的：寻求准确，可靠的免疫球蛋白及κ和λ轻链测定方法，提高多发性骨髓瘤分型和鉴别诊断水平。     

Prognostic Factors in Myeloma: What They Tell Us About the Pathophysiology of the Disease

Prognostic factors in myeloma are not only important for allowing comparisons to be made between therapeutic protocols but they also provide us with an insight into the pathophysiology of the disease and important mechanisms which result in disease progression. Prognostic factors in myeloma relate to the inherent proliferative capacity of the malignant clone, tumor bulk, renal function and other factors which reflect tumor host and host tumor interactions. The highly significant effect of the labelling index (LI) suggests that the clonogenic cell is ontologically very close to the malignant plasma cell on which the labelling index is derived. The explanation for the important role of the β2-microglobulin (β2M) level over and above its reflection of renal function is as yet unclear.     

A human myeloma immunoglobulin G binding four moles of calcium associated with asymptomatic hypercalcemia

A calcium-binding immunoglobulin G (IgG_I^RUP) was identified in the serum of a patient with multiple myeloma, asymptomatic hypercalcemia, and a normal ionized serum calcium. Calcium binding by IgG^RUP was confirmed by two-dimensional electrophoresis with calcium-45 and equilibrium dialysis. Amino acid analyses indicated an unusually high number of glutamic (or glutamine) residues in the L chain and Fab fragment but no detectable -carboxyglutamic acid. As determined by equilibrium dialysis with⁴⁵Ca, the intact IgG^RUP and its Fab fragments bound calcium at an optimum pH of 7.4. There was minimal binding of calcium to H chains and no binding by L chains or the Fc fragment. Recombination of H and L chains partially restored the binding activity. By Scatchard analysis, the binding affinity (K _d) of IgG^RUP was 1.7×10^–3 M and the binding capacity was 4 mol of calcium/mol of IgG. The binding of 4 mol of calcium/mol of IgG is twice that reported previously for two other calcium-binding myeloma proteins and suggests unique properties of IgG^RUP.     

Human multiple myeloma cells express peroxisome proliferator-activated receptor gamma and undergo apoptosis upon exposure to PPARgamma ligands

Multiple myeloma is essentially an incurable malignancy and it is therefore of great interest to develop new therapeutic approaches. We previously reported that human B cell-lymphomas express the nuclear receptor peroxisome proliferator-activated receptor gamma (PPARgamma) and are killed by PPARgamma ligands. Herein, we investigate the therapeutic potential of PPARgamma ligands for multiple myeloma. The human multiple myeloma cell lines ANBL6 and 8226 express PPARgamma mRNA and protein. The PPARgamma ligands, 15-deoxy-Delta12,14-prostaglandin J2 (15d-PGJ2) and ciglitazone, induced multiple myeloma cell apoptosis as determined by terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL) assay, loss of mitochondrial membrane potential, and caspase activation. Importantly, the ability of PPARgamma ligands to kill both multiple myeloma cell lines was not abrogated by Interleukin-6 (IL-6), a multiple myeloma growth survival factor. Finally, the RXR ligand 9-cis retinoic acid (9-cis RA) in combination with PPARgamma ligands greatly enhanced multiple myeloma cell killing. These new findings support that PPARgamma ligands may represent a novel therapy for multiple myeloma.     

细胞性一氧化氮供体的建立及其对肿瘤细胞凋亡的诱导效应

目的一氧化氮（ＮＯ）供体细胞系的建立及其对肿瘤细胞凋亡的诱导效应研究。方法采用３Ｈ－胍氨酸转换法进行ＮＯ合成酶（ＮＯＳ）活性测定；亚硝酸盐检测；ＤＮＡ片段的提取及凝胶电泳分析；凋亡细胞的ＤＡＰＩ染色观察；Ｗｅｓｔｅｒｎｂｌｏｔ分析。结果将ｉＮＯＳ真核表达质粒、ｐＣＭＶ／ｉＮＯＳ转染至Ｓｐ２／０骨髓瘤的变异株中，并获得能稳定表达ｉＮＯＳ和合成ＮＯ的重组细胞系（ＳＰｍｔ／ｉＮＯＳ），表达ｉＮＯＳ的效率为每升培养物含４００μｇ蛋白。利用该细胞作ＮＯ细胞性供体，成功地证实ＮＯ能诱导Ｓｐ２／０骨髓瘤细胞发生凋亡。结论所建细胞性ＮＯ供体应用于ＮＯ的生物学功能研究具有ＮＯ合成稳定；更能模拟体内细胞间ＮＯ的信息传递过程；不需任何外源刺激即可合成ＮＯ等独特优点。所建ＮＯ供体细胞可以用于肿瘤细胞凋亡的研究。     

A pilot study of bortezomib in Korean patients with relapsed or refractory myeloma

Recent clinical trials showed that bortezomib, a novel proteasome inhibitor, had therapeutic activity in multiple myeloma. However, there was no data about the feasibility of bortezomib in Korean patients. We performed a pilot study of bortezomib in patients with relapsed or refractory myeloma (1.3 mg/m2 twice weekly for 2 week in a 3-week cycle). Seven patients were enrolled. The median age of patients was 59 yr. All patients previously received VAD (vincristine, doxorubicin and dexamethasone) and thalidomide chemotherapy. Three patients previously received alkylator-containing chemotherapy and 4 patients, autologous stem cell transplantation. Bortezomib monotherapy resulted in 3 partial remissions (43%), 3 no changes (43%) and 1 progressive disease (14%). One patient who had no response to bortezomib monotherapy experienced partial remission after addition of dexamethasone to bortezomib. The most common serious toxicity was thrombocytopenia (grade 3/4, 10 of 20 cycles (50%)) and grade 3 peripheral neuropathy was developed in 2 of 20 cycles (10%). Drug-related adverse event led to discontinuation of bortezomib in 1 patient. There was no treatment related mortality. Overall, bortezomib seems to be effective and feasible. Conduction of larger clinical studies on Korean patients is necessary to characterize clinical efficacy and safety of bortezomib more precisely.     

Multiple myeloma: Early vertebral involvement assessed by computerised tomography

Routine radiography is the primary method of evaluating skeletal involvement by myeloma. In contrast, radio-isotope bone scans have a low sensitivity, the medium being taken up only at sites of active or reactive bone formation. A group of six patients with multiple myeloma, established by clinical and laboratory findings, had no radiological evidence of bone involvement. Computerised tomography (CT) of the vertebral column revealed limited lytic lesions of the vertebral spongiosa in four of the patients. The three-dimensional ability of CT to look inside the vertebrae permits early detection of spinal lesions associated with myeloma. As a supplementary investigation, three additional patients, with frank radiographic evidence of extensive myelomatous bone lesions were examined similarly by CT. In these patients the technique showed involvement of the vertebral column to be more widespread and to affect many more vertebral bodies than had been evident in orthodox radiological examinations. CT permits earlier demonstration of early vertebral lesions and is more accurate in the delineation of the extent of vertebral involvement than conventional radiography.     

Rb蛋白在多发性骨髓瘤细胞中的表达及临床意义

目的：探讨多发性骨髓瘤（MM）细胞Rb蛋白的表达与临床化疗的关系,方法：采用免疫细胞化学S－P法,借助抗Rb蛋白单抗,对47例多发性骨髓瘤患者进行了检测,结果：47例中有11例（11／47）呈阴性表达,阴性表达率30．6％,免疫人型各亚型之间差异显著无显著性（P＞0．05）,所有患者采用常规化疗方案化疗个疗程,Rb蛋白阴性组化疗有效率为36．4％,而Rb蛋白阳性组总有效率为77．9％,两组比较差异显著（P＜0．05）,多变量分析显示,除去血清β2－微球蛋白,乳酸脱氨酶,肌酐三因素对化疗结果的影响,Rb蛋白阴性可作为影响化疗疗效的独立负性因素,结论：Rb蛋白阴性表达在多发性骨髓瘤细胞中较易见,且Rb蛋白不表达者对化疗疗效差。     

多发性骨髓瘤骨髓细胞学特性与预后的关系

1目的　探求多发性骨髓瘤骨髓细胞学特性与预后的关系。 2方法　回顾性调查 ,两个样本均数的 t检验 ,多个样本均数的方差分析 ,二元线性回归分析。 3结果　成浆细胞型 MM与幼浆细胞型 MM比较 ,生存期差异显著 (P<0 .0 5 ) ,而各骨髓有核细胞增生程度间的 MM生存期则差异无显著性 (P>0 .0 5 ) ,瘤细胞比例的高低与生存期呈直线负相关。 4结论　幼浆细胞型 MM和瘤细胞比例高的 MM预后差