Pawlyn, C., Morgan, G. J. (2017) Evolutionary biology of high-risk multiple myeloma. NATURE REVIEWS CANCER, 17 (9). pp. 543-556. ISSN 1474-175X

Full text not available from this repository.

Abstract

The outcomes for the majority of patients with myeloma have improved over recent decades, driven by treatment advances. However, there is a subset of patients considered to have high-risk disease who have not benefited. Understanding how high-risk disease evolves from more therapeutically tractable stages is crucial if we are to improve outcomes. This can be accomplished by identifying the genetic mechanisms and mutations driving the transition of a normal plasma cell to one with the features of the following disease stages: monoclonal gammopathy of undetermined significance, smouldering myeloma, myeloma and plasma cell leukaemia. Although myeloma initiating events are clonal, subsequent driver lesions often occur in a subclone of cells, facilitating progression by Darwinian selection processes. Understanding the co-evolution of the clones within their microenvironment will be crucial for therapeutically manipulating the process. The end stage of progression is the generation of a state associated with treatment resistance, increased proliferation, evasion of apoptosis and an ability to grow independently of the bone marrow microenvironment. In this Review, we discuss these end-stage high-risk disease states and how new information is improving our understanding of their evolutionary trajectories, how they may be diagnosed and the biological behaviour that must be addressed if they are to be treated effectively.

Item Type:	Review Article
All Authors:	Pawlyn, C., Morgan, G. J.
Additional Information:	ISI Document Delivery No.: FE5EQ Times Cited: 0 Cited Reference Count: 183 Pawlyn, Charlotte Morgan, Gareth J. Wellcome Trust [102363/Z/13/Z] C.P. is a Wellcome Trust clinical research fellow (102363/Z/13/Z). The authors would like to thank F. Davies, M. Greaves, J. Jones, C. Messiou, L. Rasche, J. Sawyer, C. Stein, B. Walker, N. Weinhold and S. Yaccoby for contributing to the figures, helpful discussions and/or critical reading of the manuscript. 0 Nature publishing group London 1474-1768
Uncontrolled Keywords:	international staging system bone-marrow microenvironment plasma-cell dyscrasias in-situ hybridization multiparameter flow-cytometry independent prognostic-factor acute lymphoblastic-leukemia newly-diagnosed myeloma tumor-suppressor genes copy-number alteration Oncology
Research teams:	ICR divisions > Cancer Therapeutics > Signal Transduction & Molecular Pharmacology Clinical Units > Haemato-Oncology Unit
Depositing User:	Barry Jenkins
Date Deposited:	11 Sep 2017 10:15
Last Modified:	11 Sep 2017 10:15
URI:	http://publications.icr.ac.uk/id/eprint/16225

Actions (login required)

View Item