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Published in: BMC Cancer 1/2017

Open Access 01-12-2017 | Case report

Constitutional mutation in CDKN2A is associated with long term survivorship in multiple myeloma: a case report

Authors: Vallari Shah, Kevin D. Boyd, Richard S. Houlston, Martin F. Kaiser

Published in: BMC Cancer | Issue 1/2017

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Abstract

Background

Multiple Myeloma is a cancer of plasma cells associated with significantly reduced survival. Long term survivorship from myeloma is very rare and despite advances in its treatment the disease is generally considered incurable. We report a patient diagnosed with myeloma carrying a germline mutation of a tumour suppressor gene who has effectively been cured.

Case presentation

A 36-year-old woman was diagnosed with IgG lambda myeloma in 1985. She was treated with melphalan chemotherapy followed by high-dose melphalan and autologous stem cell rescue and since remained in complete remission despite not having received any additional therapy. After eliciting a prior history of multiple primary melanomas and breast cancer, she was tested for and shown to be a carrier for a germline mutation in CDKN2A.

Conclusions

This is the second case report of germline mutation of CDKN2A being associated with myeloma. CDKN2A is a stabiliser of p53. Long term survivorship after high dose DNA damaging chemotherapy with melphalan in this patient is compatible with an increased chemo-sensitivity due to impairment of the DNA repair pathway.
Literature
1.
go back to reference Song X, Cong Z, Wilson K. Real-world treatment patterns, comorbidities, and disease-related complications in patients with multiple myeloma in the United States. Curr Med Res Opin. 2016;32(1):95–103.CrossRefPubMed Song X, Cong Z, Wilson K. Real-world treatment patterns, comorbidities, and disease-related complications in patients with multiple myeloma in the United States. Curr Med Res Opin. 2016;32(1):95–103.CrossRefPubMed
2.
go back to reference Alexanian R, et al. Treatment for multiple myeloma. Combination chemotherapy with different melphalan dose regimens. JAMA. 1969;208(9):1680–5.CrossRefPubMed Alexanian R, et al. Treatment for multiple myeloma. Combination chemotherapy with different melphalan dose regimens. JAMA. 1969;208(9):1680–5.CrossRefPubMed
4.
go back to reference Rosinol L, et al. Superiority of bortezomib, thalidomide, and dexamethasone (VTD) as induction pretransplantation therapy in multiple myeloma: a randomized phase 3 PETHEMA/GEM study. Blood. 2012;120(8):1589–96.CrossRefPubMed Rosinol L, et al. Superiority of bortezomib, thalidomide, and dexamethasone (VTD) as induction pretransplantation therapy in multiple myeloma: a randomized phase 3 PETHEMA/GEM study. Blood. 2012;120(8):1589–96.CrossRefPubMed
5.
go back to reference Johnson DC, et al. Genome-wide association study identifies variation at 6q25.1 associated with survival in multiple myeloma. Nat Commun. 2016;7:10290.CrossRefPubMedPubMedCentral Johnson DC, et al. Genome-wide association study identifies variation at 6q25.1 associated with survival in multiple myeloma. Nat Commun. 2016;7:10290.CrossRefPubMedPubMedCentral
7.
8.
go back to reference Soufir N, et al. Prevalence of p16 and CDK4 germline mutations in 48 melanoma-prone families in France. The French familial melanoma study group. Hum Mol Genet. 1998;7(2):209–16.CrossRefPubMed Soufir N, et al. Prevalence of p16 and CDK4 germline mutations in 48 melanoma-prone families in France. The French familial melanoma study group. Hum Mol Genet. 1998;7(2):209–16.CrossRefPubMed
9.
go back to reference Bishop DT, et al. Geographical variation in the penetrance of CDKN2A mutations for melanoma. J Natl Cancer Inst. 2002;94(12):894–903.CrossRefPubMed Bishop DT, et al. Geographical variation in the penetrance of CDKN2A mutations for melanoma. J Natl Cancer Inst. 2002;94(12):894–903.CrossRefPubMed
10.
go back to reference Goldstein AM, et al. Features associated with germline CDKN2A mutations: a GenoMEL study of melanoma-prone families from three continents. J Med Genet. 2007;44(2):99–106.CrossRefPubMed Goldstein AM, et al. Features associated with germline CDKN2A mutations: a GenoMEL study of melanoma-prone families from three continents. J Med Genet. 2007;44(2):99–106.CrossRefPubMed
11.
go back to reference Fischer M. Analysis of exon 2 of MTS1 in HPV-positive and HPV-negative tumors of the head and neck region. Eur Arch Otorhinolaryngol. 2007;264(7):801–7.CrossRefPubMed Fischer M. Analysis of exon 2 of MTS1 in HPV-positive and HPV-negative tumors of the head and neck region. Eur Arch Otorhinolaryngol. 2007;264(7):801–7.CrossRefPubMed
12.
go back to reference McKenzie HA, et al. Predicting functional significance of cancer-associated p16(INK4a) mutations in CDKN2A. Hum Mutat. 2010;31(6):692–701.CrossRefPubMed McKenzie HA, et al. Predicting functional significance of cancer-associated p16(INK4a) mutations in CDKN2A. Hum Mutat. 2010;31(6):692–701.CrossRefPubMed
13.
go back to reference Dilworth D, et al. Germline CDKN2A mutation implicated in predisposition to multiple myeloma. Blood. 2000;95(5):1869–71.PubMed Dilworth D, et al. Germline CDKN2A mutation implicated in predisposition to multiple myeloma. Blood. 2000;95(5):1869–71.PubMed
14.
16.
go back to reference Camp NJ, Werner TL, Cannon-Albright LA. Familial myeloma. N Engl J Med. 2008;359(16):1734–5. author reply 1735CrossRefPubMed Camp NJ, Werner TL, Cannon-Albright LA. Familial myeloma. N Engl J Med. 2008;359(16):1734–5. author reply 1735CrossRefPubMed
17.
go back to reference Altieri A, et al. Familial risks and temporal incidence trends of multiple myeloma. Eur J Cancer. 2006;42(11):1661–70.CrossRefPubMed Altieri A, et al. Familial risks and temporal incidence trends of multiple myeloma. Eur J Cancer. 2006;42(11):1661–70.CrossRefPubMed
18.
go back to reference Kristinsson SY, et al. Risk of solid tumors and myeloid hematological malignancies among first-degree relatives of patients with monoclonal gammopathy of undetermined significance. Haematologica. 2009;94(8):1179–81.CrossRefPubMedPubMedCentral Kristinsson SY, et al. Risk of solid tumors and myeloid hematological malignancies among first-degree relatives of patients with monoclonal gammopathy of undetermined significance. Haematologica. 2009;94(8):1179–81.CrossRefPubMedPubMedCentral
19.
go back to reference Lynch HT, et al. Familial multiple myeloma: a family study and review of the literature. J Natl Cancer Inst. 2001;93(19):1479–83.CrossRefPubMed Lynch HT, et al. Familial multiple myeloma: a family study and review of the literature. J Natl Cancer Inst. 2001;93(19):1479–83.CrossRefPubMed
20.
go back to reference Zhang Y, Xiong Y. Mutations in human ARF exon 2 disrupt its nucleolar localization and impair its ability to block nuclear export of MDM2 and p53. Mol Cell. 1999;3(5):579–91.CrossRefPubMed Zhang Y, Xiong Y. Mutations in human ARF exon 2 disrupt its nucleolar localization and impair its ability to block nuclear export of MDM2 and p53. Mol Cell. 1999;3(5):579–91.CrossRefPubMed
21.
go back to reference Zhang Y, Xiong Y, Yarbrough WG. ARF promotes MDM2 degradation and stabilizes p53: ARF-INK4a locus deletion impairs both the Rb and p53 tumor suppression pathways. Cell. 1998;92(6):725–34.CrossRefPubMed Zhang Y, Xiong Y, Yarbrough WG. ARF promotes MDM2 degradation and stabilizes p53: ARF-INK4a locus deletion impairs both the Rb and p53 tumor suppression pathways. Cell. 1998;92(6):725–34.CrossRefPubMed
22.
go back to reference Lin YC, et al. Human p16gamma, a novel transcriptional variant of p16(INK4A), coexpresses with p16(INK4A) in cancer cells and inhibits cell-cycle progression. Oncogene. 2007;26(49):7017–27.CrossRefPubMed Lin YC, et al. Human p16gamma, a novel transcriptional variant of p16(INK4A), coexpresses with p16(INK4A) in cancer cells and inhibits cell-cycle progression. Oncogene. 2007;26(49):7017–27.CrossRefPubMed
23.
go back to reference Kamijo T, et al. Tumor suppression at the mouse INK4a locus mediated by the alternative reading frame product p19ARF. Cell. 1997;91(5):649–59.CrossRefPubMed Kamijo T, et al. Tumor suppression at the mouse INK4a locus mediated by the alternative reading frame product p19ARF. Cell. 1997;91(5):649–59.CrossRefPubMed
24.
go back to reference Borg A, et al. Novel germline p16 mutation in familial malignant melanoma in southern Sweden. Cancer Res. 1996;56(11):2497–500.PubMed Borg A, et al. Novel germline p16 mutation in familial malignant melanoma in southern Sweden. Cancer Res. 1996;56(11):2497–500.PubMed
25.
go back to reference Hewitt C, et al. Germline mutation of ARF in a melanoma kindred. Hum Mol Genet. 2002;11(11):1273–9.CrossRefPubMed Hewitt C, et al. Germline mutation of ARF in a melanoma kindred. Hum Mol Genet. 2002;11(11):1273–9.CrossRefPubMed
26.
go back to reference Caldas C, et al. Frequent somatic mutations and homozygous deletions of the p16 (MTS1) gene in pancreatic adenocarcinoma. Nat Genet. 1994;8(1):27–32.CrossRefPubMed Caldas C, et al. Frequent somatic mutations and homozygous deletions of the p16 (MTS1) gene in pancreatic adenocarcinoma. Nat Genet. 1994;8(1):27–32.CrossRefPubMed
27.
go back to reference Liu Q, et al. MTS-1 (CDKN2) tumor suppressor gene deletions are a frequent event in esophagus squamous cancer and pancreatic adenocarcinoma cell lines. Oncogene. 1995;10(3):619–22.PubMed Liu Q, et al. MTS-1 (CDKN2) tumor suppressor gene deletions are a frequent event in esophagus squamous cancer and pancreatic adenocarcinoma cell lines. Oncogene. 1995;10(3):619–22.PubMed
28.
go back to reference Walker BA, et al. Mutational Spectrum, copy number changes, and outcome: results of a sequencing study of patients with newly diagnosed myeloma. J Clin Oncol. 2015;33(33):3911–20.CrossRefPubMed Walker BA, et al. Mutational Spectrum, copy number changes, and outcome: results of a sequencing study of patients with newly diagnosed myeloma. J Clin Oncol. 2015;33(33):3911–20.CrossRefPubMed
29.
go back to reference Simon M, et al. Role of p16 and p14ARF in radio- and chemosensitivity of malignant gliomas. Oncol Rep. 2006;16(1):127–32.PubMed Simon M, et al. Role of p16 and p14ARF in radio- and chemosensitivity of malignant gliomas. Oncol Rep. 2006;16(1):127–32.PubMed
30.
go back to reference Iwadate Y, et al. Alteration of CDKN2/p16 in human astrocytic tumors is related with increased susceptibility to antimetabolite anticancer agents. Int J Oncol. 2000;17(3):501–5.PubMed Iwadate Y, et al. Alteration of CDKN2/p16 in human astrocytic tumors is related with increased susceptibility to antimetabolite anticancer agents. Int J Oncol. 2000;17(3):501–5.PubMed
31.
go back to reference Andreeff M, et al. Results of the phase I trial of RG7112, a small-molecule MDM2 antagonist in leukemia. Clin Cancer Res. 2016;22(4):868–76.CrossRefPubMed Andreeff M, et al. Results of the phase I trial of RG7112, a small-molecule MDM2 antagonist in leukemia. Clin Cancer Res. 2016;22(4):868–76.CrossRefPubMed
32.
go back to reference Gu D, et al. Inhibition of the MDM2 E3 ligase induces apoptosis and autophagy in wild-type and mutant p53 models of multiple myeloma, and acts synergistically with ABT-737. PLoS One. 2014;9(9):e103015.CrossRefPubMedPubMedCentral Gu D, et al. Inhibition of the MDM2 E3 ligase induces apoptosis and autophagy in wild-type and mutant p53 models of multiple myeloma, and acts synergistically with ABT-737. PLoS One. 2014;9(9):e103015.CrossRefPubMedPubMedCentral
33.
go back to reference Reis B, et al. Acute myeloid leukemia patients' clinical response to idasanutlin (RG7388) is associated with pre-treatment MDM2 protein expression in leukemic blasts. Haematologica. 2016;101(5):e185–8.CrossRefPubMedPubMedCentral Reis B, et al. Acute myeloid leukemia patients' clinical response to idasanutlin (RG7388) is associated with pre-treatment MDM2 protein expression in leukemic blasts. Haematologica. 2016;101(5):e185–8.CrossRefPubMedPubMedCentral
34.
go back to reference Linggi B, et al. The t(8;21) fusion protein, AML1 ETO, specifically represses the transcription of the p14(ARF) tumor suppressor in acute myeloid leukemia. Nat Med. 2002;8(7):743–50.CrossRefPubMed Linggi B, et al. The t(8;21) fusion protein, AML1 ETO, specifically represses the transcription of the p14(ARF) tumor suppressor in acute myeloid leukemia. Nat Med. 2002;8(7):743–50.CrossRefPubMed
Metadata
Title
Constitutional mutation in CDKN2A is associated with long term survivorship in multiple myeloma: a case report
Authors
Vallari Shah
Kevin D. Boyd
Richard S. Houlston
Martin F. Kaiser
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2017
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-017-3715-5

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