Sickle Cell Anemia: Types, Symptoms, and Treatment

Multiple Myeloma Cured After Hepatitis Treatment Reveals That This Cancer Can Be Caused By Viruses

The effect of antiviral treatment in hepatitis C virus- and hepatitis B virus-infected multiple myeloma cohorts. (A) Study design and flowchart of hepatitis B virus (HBV)+ (orange) and hepatitis C virus (HCV)+ (blue) cohorts. A total of 1,367 (HBV+) or 1,192 (HCV+) patients from 49 out of the 73 health care organizations (HCO) of the TriNetX network were included in the cohort of patients diagnosed with multiple myeloma (MM) after HBV or HCV infection. Anti-viral treatments (AVT) were tenofovir disoproxil, lamivudine, peginterferon alfa-2a, interferon alfa-2b, tenofovir alafenamide, entecavir. Anti-HCV treatments were elbasvir, grazoprevir, glecaprevir, pibrentasvir, sofosbuvir, velpatasvir, voxilaprevir, or combinations of these drugs. (B) Survival analysis of the HBV+ and HCV+ cohorts. Number of patients and log-rank test in each cohort, with outcome and survival probability at the end of time window in HBV or HCV cohorts. Df: degree of freedom. (C) Kaplan-Meier plots comparing overall survival since the time of MM diagnosis of patients with HBV or HCV infection who received AVT (purple) or not (green). Since no differences in age or sex among groups of AVT treated versus untreated patients were observed, analyses were performed without propensity score matching (HBV+ patients: P=0.270; HCV+ patients: P=0.466). Credit: Haematologica (2023). DOI: 10.3324/haematol.2023.283096

A few years ago, a patient was cured of multiple myeloma after being treated for hepatitis C, astounding researchers from the group led by Joaquín Martínez, from the H12O-CNIO Hematological Tumours Clinical Research Unit, a collaboration between the Hospital 12 de Octubre (H12O) and the National Cancer Research Centre (CNIO). Multiple myeloma is one of the most common cancers of the blood.

The desire to understand how this patient was cured has led to the discovery that hepatitis B and C viruses are one of the causes of multiple myeloma, and that eliminating infection with antivirals is often the way to fight this type of cancer.

The discovery made by the CNIO group and the Hospital 12 de Octubre, in collaboration with Sylvie Hermouet, of the University of Nantes (France), warranted a recent article in the journal Haematologica.

"The recognition of this association between viral hepatitis and multiple myeloma, as well as the pathologies known to precede the appearance of myeloma, monoclonal gammopathies, has important clinical implications," says the article.

"Early identification of hepatitis B or C virus infection in these individuals can lead to appropriate antiviral treatment and consequent improvement in outcomes."

It is unknown what causes multiple myeloma, and although it has long been suspected to be related to infectious pathogens, this connection has never been verified or the reason understood.

The researchers María Linares and Alba Rodríguez-García, from the H12O-CNIO Hematological Cancer Clinical Unit and the Complutense University of Madrid (UCM) decided to study the surprising cure of the patient with hepatitis. To do this, they turned to the theory that attributes the cause of multiple myeloma to the chronic exposure of the organism to an infectious agent.

An excess of antibodies halted by antivirals

Multiple myeloma (MM) is an excessive proliferation of blood cells that make antibodies (also called immunoglobulins), the proteins that defend the body from infections. In myeloma, a certain antibody—different in each case, depending on the infectious agent—is produced continuously and excessively. One theory proposes that this anomaly is due to chronic exposure to the infectious agent, which alters the biochemical signals involved in the production of the specific antibody against that agent.

The case of the patient who was cured of myeloma after being treated for hepatitis C seems to support this theory. Linares and Rodríguez-García conjectured that the body was no longer chronically exposed to the hepatitis virus because the antiviral drug eliminated it, and that is why the myeloma disappeared—the cells that make anti-hepatitis C antibodies stopped reproducing in excess.

To investigate whether this had actually happened, two studies were conducted, including 54 patients with monoclonal gammopathy (the pathology that precedes multiple myeloma) and hepatitis: 9 patients with hepatitis C in an initial study and 45 patients with hepatitis B in the study published in Haematologica. Most of them found that the antibody they were consistently and excessively producing was indeed targeting the hepatitis virus.

They then went on to analyze a much broader cohort of multiple myeloma patients (more than 1,300) infected with hepatitis B and hepatitis C (more than 1,200). In both cohorts, they concluded that in those who received antiviral treatment, "the probability of survival was significantly higher".

New options for early detection and treatments

The authors say, "In patients infected with the hepatitis B or hepatitis C virus, multiple myeloma or gammopathy may be caused by these viruses, and the study demonstrates the importance of antiviral treatment in these patients."

The journal article concludes, "The association between viral hepatitis and the development of multiple myeloma and other monoclonal gammopathies has become an important field of research. Chronic hepatitis B or hepatitis C virus infections contribute to the pathogenesis of these hematological neoplasms, which justifies an increase in awareness, detection and treatment strategies."

It adds that in patients with gammopathies targeted by these hepatitis viruses—which can be identified after analysis of the antibody they are producing in excess—"antiviral therapy should be prescribed as soon as possible."

More information: Alba Rodríguez-García et al, Impact of viral hepatitis therapy in multiple myeloma and other monoclonal gammopathies linked to hepatitis B or C viruses, Haematologica (2023). DOI: 10.3324/haematol.2023.283096

Citation: Multiple myeloma cured after hepatitis treatment reveals that this cancer can be caused by viruses (2024, January 19) retrieved 28 January 2024 from https://medicalxpress.Com/news/2024-01-multiple-myeloma-hepatitis-treatment-reveals.Html

This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no part may be reproduced without the written permission. The content is provided for information purposes only.

Bone Marrow Adipocytes Provide Early Sign Of Progression From MGUS To Multiple Myeloma

image: 

Figure 1: Histological analysis of iliac crest bone biopsy.

view more 

Credit: 2024 El-Masri et al.

A new research perspective was published in Oncotarget's Volume 15 on January 16, 2024, entitled, "Bone marrow adipocytes provide early sign for progression from MGUS to multiple myeloma."

Multiple Myeloma (MM) is the second most common hematological malignancy and is characterized by clonal expansion of malignant plasma cells in the bone marrow. In spite of recent advances in the field of MM, the disease has remained incurable. MM is preceded by a premalignant state known as monoclonal gammopathy of undetermined significance (MGUS), with a risk of progression to MM of 1% per year. Establishing a scalable approach that refines the identification of MGUS patients at high risk of progression to MM can transform the clinical management of the disease, improve the patient's quality of life, and will have significant socioeconomic implications. 

In this new perspective, researchers Bilal M. El-Masri, Benedeta Leka, Fatima Mustapha, Michael Tveden Gundesen, Maja Hinge, Thomas Lund, Thomas L. Andersen, Marta Diaz-delCastillo, and Abbas Jafari from the Danish Spatial Imaging Consortium, University of Southern Denmark, University of Copenhagen, University of Aarhus, Odense University Hospital, and Lillebaelt Hospital provide evidence that changes in the bone marrow adipose tissue (BMAT) provide an early sign for progression from MGUS to MM. 

"We employed AI-assisted histological analysis of unstained bone marrow biopsies from MGUS subjects with or without progression to MM within 10 years (n = 24, n = 17 respectively)." 

Although the BMAT fraction was not different between the two groups, bone marrow adipocyte (BMAd) density was decreased in MGUS patients who developed MM, compared to non-progressing MGUS patients. Importantly, the distribution profile for BMAd size and roundness was significantly different between the two groups, indicating a shift toward increased BMAd size and roundness in MGUS patients who developed MM. These early changes in the BMAT could serve as valuable early indicators for the transition from MGUS to MM, potentially enabling timely interventions and personalized treatment strategies. 

"[...] the AI-based approach for histological characterization of unstained bone marrow biopsies is cost-effective and fast, rendering its clinical implementation feasible." 

Read the full paper: DOI: https://doi.Org/10.18632/oncotarget.28548 

Correspondence to: Abbas Jafari, Marta Diaz-delCastillo, Thomas L. Andersen

Emails: ajafari@sund.Ku.Dk, marta@forens.Au.Dk, thomas.Levin.Andersen@rsyd.Dk 

Keywords: multiple myeloma, MGUS, bone marrow adipocyte

Click here to sign up for free Altmetric alerts about this article.

About Oncotarget: Oncotarget (a primarily oncology-focused, peer-reviewed, open access journal) aims to maximize research impact through insightful peer-review; eliminate borders between specialties by linking different fields of oncology, cancer research and biomedical sciences; and foster application of basic and clinical science.

To learn more about Oncotarget, visit Oncotarget.Com and connect with us on social media:

 

Click here to subscribe to Oncotarget publication updates.

For media inquiries, please contact media@impactjournals.Com.

Oncotarget Journal Office

6666 East Quaker Street., Suite 1A

Orchard Park, NY 14127

Phone: 1-800-922-0957 (option 2)

###

Method of Research

Commentary/editorial

Subject of Research

People

Article Title

Bone marrow adipocytes provide early sign for progression from MGUS to multiple myeloma

Article Publication Date

16-Jan-2024

Disclaimer: AAAS and EurekAlert! Are not responsible for the accuracy of news releases posted to EurekAlert! By contributing institutions or for the use of any information through the EurekAlert system.

Multiple Myeloma

ALL/AML

Alopecia

Asthma

Atopic Dermatitis

Autoimmune

Biosimilars

Breast Cancer

CLL/SLL

COPD

COVID-19

Cardiovascular

Cholangiocarcinoma

Chronic Kidney Disease

Colorectal Cancer

DLBCL

Dermatology

Diabetes

Digital Health

Duchenne Muscular Dystrophy

Employers

Epilepsy

Gastroenterology

Gene Therapy

HIV

Heart Failure

Hemophilia

Immuno-Oncology

Infectious Disease

Inflammation

Leukemia and Lymphoma

Liver

Lung Cancer

Lupus

Major Depressive Disorder

Medicare

Mental Health

Multiple Myeloma

Multiple Sclerosis

Myasthenia Gravis

Myelodysplastic Syndromes

Non-Small Cell Lung Cancer

Obesity

Oncology

Ophthalmology

Ovarian Cancer

Parkinson Disease

Population Health

Prostate Cancer

Psoriasis

Pulmonary Arterial Hypertension

RSV

Rare Blood

Rare Disease

Reimbursement

Respiratory

Rheumatology

Skin Cancer

Sleep

Spinal Muscular Atrophy

Type 1 Diabetes

Vaccines

Women's Health

---