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Blood, 15 January 2008, Vol. 111, No. 2, pp. 549-557.
Prepublished online as a Blood First Edition Paper on November 2, 2007; DOI 10.1182/blood-2007-05-090852.


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CLINICAL TRIALS AND OBSERVATIONS

Calreticulin expression in the clonal plasma cells of patients with systemic light-chain (AL-) amyloidosis is associated with response to high-dose melphalan

Ping Zhou1, Julie Teruya-Feldstein2, Ping Lu1, Martin Fleisher3, Adam Olshen4, and Raymond L Comenzo5

1 Sloan-Kettering Institute; Departments of2 Pathology 3 Clinical Laboratories, and 4 Epidemiology and Biostatistics; and 5 Hematology Service, Division of Hematologic Oncology, Department of Medicine; Memorial Sloan-Kettering Cancer Center, New York, NY

In high doses with stem-cell transplantation, melphalan is an effective but toxic therapy for patients with systemic light-chain (AL-) amyloidosis, a protein deposition and monoclonal plasma cell disease. Melphalan can eliminate the indolent clonal plasma cells that cause the disease, an achievement called a complete response. Such a response is usually associated with extended survival, while no response (a less than 50% reduction) is not. Gene-expression studies and a stringently supervised analysis identified calreticulin as having significantly higher expression in the pretreatment plasma cells of patients with systemic AL-amyloidosis who then had a complete response to high-dose melphalan. Calreticulin is a pleiotropic calcium-binding protein found in the endoplasmic reticulum and the nucleus whose overexpression is associated with increased sensitivity to apoptotic stimuli. Real-time PCR and immunohistochemical staining also showed that expression of calreticulin was higher in the plasma cells of those with a complete response. Furthermore, wild-type murine embryonic fibroblasts were significantly more sensitive to melphalan than calreticulin knock-out murine embryonic fibroblasts. These data have important implications for understanding the activity of melphalan in plasma-cell diseases and support further investigation of calreticulin and its modulation in patients with systemic AL-amyloidosis receiving high-dose melphalan.


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P. Zhou, R. L. Comenzo, A. B. Olshen, E. Bonvini, S. Koenig, P. G. Maslak, M. Fleisher, J. Hoffman, S. Jhanwar, J. W. Young, et al.
CD32B is highly expressed on clonal plasma cells from patients with systemic light-chain amyloidosis and provides a target for monoclonal antibody-based therapy
Blood, April 1, 2008; 111(7): 3403 - 3406.
[Abstract] [Full Text] [PDF]



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