Abstract Background. Genome-wide association studies (GWAS) have identified 35 genetic susceptibility single-nucleotide polymorphisms (SNPs) for multiple myeloma (MM) in individuals of European ancestry (EA) and shown strong genetic correlation between MM and its precursor, monoclonal gammopathy of undetermined significance (MGUS). We evaluate the contribution of the 35 MM variants to MGUS susceptibility overall and by prognostic subgroups. Methods. The study included 20,756 participants (14,486 controls, 1,883 with MGUS, and 2,163 with MM) from the Mayo Clinic. Logistic regression assuming an additive model estimated odds ratios (ORs) and 95% confidence intervals (CIs) for individual SNPs and for the MM-PRS, adjusted for age, sex, study, and principal components. The PRS was a weighted sum of 35 SNPs with effect estimates from the largest MM GWAS and was modeled continuously (per SD) and by quintiles (Q1-Q5). SNPnexus annotated variants that replicated in MGUS (P < 0.05 and OR > 1.01) versus those that did not (P > 0.05 and OR < 1.01). Results. The 35-SNP MM-PRS was strongly associated with MM risk and modestly with MGUS. Compared with the middle quintile (Q3), MM odds rose from OR=0.55 (CI=0.46-0.65, P=2.2e-11) in Q1 to OR = 1.82 (CI=1.59-2.09, P=6.2e-18) in Q5. MGUS showed a similar, attenuated pattern (Q1 OR = 0.74, CI=0.64-0.84, P=6.4e-6 / Q5 OR=1.36, CI=1.21-1.53, P=3.4e-7). Each SD increase in PRS corresponded to OR=1.52 (CI=1.45-1.59, P=1.3e-66) for MM and OR = 1.22 (CI=1.18-1.27, P=1.0e-23) for MGUS. Higher PRS values were linked to larger M-protein ((0.1-1.5 g/dL: OR=1.40, CI=1.18-1.65, P=5.8e-12) vs <0.1 g/dL: OR = 1.19, CI=1.13-1.24, P=5.8e-12)) and abnormal free light chain (FLC) ratio ((OR = 1.33, CI=1.21-1.46, P=1.0e-9) vs normal ratio (OR=1.19, CI=1.14-1.25, P=1.4e-13)). Ten risk loci replicated in MGUS, mapping to genes involved in plasma-cell function, immune regulation, and DNA repair and enriched for Rho GTPase signaling, NF-κB-mediated apoptosis, and RNA polymerase II transcription, implicating early plasma-cell activation and transcriptional control. The 12 non-replicating loci, including PHC3, ATG5, and NFIC, mapped to genes involved in chromatin remodeling, autophagy, and SUMOylation, suggesting roles in stress response and genomic maintenance. Conclusions. The MM-PRS captures shared heritability between MM and MGUS and correlates with MGUS subtype and severity. Replicating variants highlight immune and cell-cycle pathways relevant to MGUS onset, whereas non-replicating loci cluster in DNA-repair and stress-response processes, underscoring their potential role in progression. Citation Format: Alyssa Ione Clay-Gilmour, Angelica Macauda, Cristine Allmer, Danelle Moonen, Aaron D. Norman, Nicholas Boddicker, Janet E. Olson, Elizabeth E. Brown, Vincent S. Rajkumar, Esteban Braggio, David Murray, Susan Slager, Shaji Kunnathu Kumar, Celine Vachon. Implications of multiple myeloma polygenic risk scores (PRS) for MGUS [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2026; Part 1 (Regular Abstracts); 2026 Apr 17-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2026;86(7 Suppl):Abstract nr 3603.

Monoclonal gammopathy of undetermined significance (MGUS) is a necessary precursor condition to multiple myeloma (MM). Given the role of autophagy in modulating MM risk, we investigated whether genetic variation in autophagy-related genes influences susceptibility to MGUS. We analyzed the association of 34,042 common autophagy-related single nucleotide polymorphisms (SNPs) with MGUS across six independent cohorts, five from Europe and one from North America, comprising 2317 MGUS cases and 282,358 controls. We also assessed their impact on immune parameters, including absolute counts of 91 blood-derived immune cell subsets and 103 circulating immunological proteins. Meta-analysis revealed a genome-wide significant association between the ULK4rs6599175C allele and increased MGUS risk (p = 3.35 × 10-8). Carriers of this allele showed reduced counts of memory B cell subsets (IgM+CD38+CD27+ and IgD+IgM+CD27+; p = .0038 and p = .0056, respectively) and natural effector B cells (CD24+CD38+IgD+IgM+ cells; p = .0060). Although these associations were not statistically significant after multiple testing correction, they suggest a role of ULK4 in early B-cell differentiation. Additionally, the CDKN2Ars2811710 variant showed a suggestive association with MGUS risk (p = 2.17 × 10-4), affecting transcription factor binding involved in B-cell proliferation and differentiation, although it lacked association with immune markers. In conclusion, we confirm a genome-wide significant association of the ULK4 locus and MGUS risk, supporting its role in early B-cell differentiation, and identify CDKN2A as a candidate susceptibility locus warranting further investigation.

Genome-wide association studies (GWAS) of multiple myeloma (MM) in individuals of genetic European ancestry (EA) have identified 35 susceptibility loci. Co-heritability analyses have revealed a strong genetic correlation between MM and its precursor condition, monoclonal gammopathy of undetermined significance (MGUS). Previous research validated the association between a polygenic risk score (PRS) based on 23 MM risk loci and the risk of MGUS. Went and colleagues recently reported 12 new MM risk loci. We constructed a MM-PRS using all 35 MM risk variants and assessed its association with MGUS. Additionally, among individuals with MGUS, we assessed associations of MM-PRS with established prognostic factors [M-protein (<0.2 g/dL; 0.2-1.5 g/dL; >1.5 g/dL); isotype (IgG, IgA, IgM); free light chain (FLC) ratio (Normal (0.26-1.65), Abnormal (<0.26 or >1.65))]. Our study population included 1,723 individuals with MGUS seen at Mayo Clinic, Rochester, MN and 14,175 controls from the Mayo Clinic Biobank who lived in the 27-county region around Rochester, MN, and screened negative for MGUS using MALDI-TOF MS. The majority of MGUS patients and controls were of EA. We used logistic or multinomial regression to calculate odds ratios (ORs) and 95% confidence intervals (CIs). All models were adjusted for age, sex, and the first three principal components. The MM-PRS was significantly associated with MGUS when assessed continuously (OR, 1.28 per standard deviation (SD); 95% CI, 1.22-1.35). When comparing to the middle quintile of the MM-PRS distribution, individuals in the highest quintile had 1.41-fold increased risk of MGUS (95% CI, 1.21-1.64), and individuals in the lowest quintile had 0.68 decreased risk of MGUS (95% CI, 0.57-0.81). Of the 35 SNPs evaluated, 27 demonstrated consistent directions of effect for risk of MGUS with published risk estimates for MM. The effect of MM-PRS differed by isotype (P = 2.2 x 105), with higher MM-PRS associated with IgA MGUS (OR, 1.40 per SD; 95% CI, 1.08-1.81) and a lower MM-PRS associated with IgM (OR, 0.66 per SD; 95% CI, 0.52-0.84) compared to IgG MGUS. The MM-PRS was higher in MGUS patients with M-protein > 1.5 g/dL compared to M-protein of size 0.2-1.5 g/dL, although not statistically significant (OR, 1.41 per SD; 95% CI, 0.95-2.08); there were no differences in the MM-PRS between MGUS patients with M-protein size <0.2 g/dL compared to 0.2-1.5 g/dL (OR, 1.01 per SD;95% CI, 0.81-1.26). There were also no differences in MM-PRS by FLC ratio, (OR, 0.95 per SD; 95% CI, 0.852-1.10 for abnormal vs. normal). Our findings of an association of the MM-PRS with risk of MGUS provides further evidence for shared heritability between MGUS and MM. Future studies are needed to examine whether the expanded MM-PRS adds to existing models for MGUS progression. Angelica Macauda, Alyssa Clay-Gilmour, Cristine Allmer, Danelle Moonen, Aaron D. Normann, Nicholas J. Boddicker, Joselle M. Cook, Linda Baughn, Elizabeth E. Brown, Vincent S. Rajkumar, Esteban Braggio, David L. Murray, Susan L. Slager, Shaji Kumar, Celine M. Vachon. Implications of multiple myeloma polygenic risk scores (PRS) for MGUS [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 2274.

Monoclonal gammopathy of undetermined significance (MGUS) is a precursor to multiple myeloma (MM). Clonal hematopoiesis of indeterminate potential (CHIP) is a precursor to either myeloid or lymphoid malignancy, depending on whether the mutation is in a gene associated with lymphoid (L-CHIP) or myeloid (M-CHIP) outcome. Little is known about the association between CHIP and MGUS and their combined effect on risk of MM. We examined this question within Mayo Clinic Biobank cohort of participants aged 50 years or older with no prior history of hematological malignancies. Using whole blood, individuals were screened for MGUS using a matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF) mass spectrometry assay. M-CHIP and L-CHIP were defined based on mutations in 56 genes associated with myeloid malignancies or mutations in 235 genes associated with lymphoid malignancies, respectively, using whole-exome-sequencing. Incident MM was identified using International Classification of Diseases (ICD) codes and confirmed via medical record review. Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals for the association of CHIP and MGUS. Cox proportional hazards regression was used to estimate hazard ratios (HR), with time defined as date between blood sample and the first incident MM, date of death, or 12/31/2023. All models were adjusted for age and sex. Of the 16, 479 individuals (median age 65 years, 45% male) screened, 12.3% were positive for MGUS, 9.8% were positive for M-CHIP, and 1.5% were positive for L-CHIP. There was no evidence of an association between M-CHIP and MGUS (OR=0.97, 95% CI:0.83-1.12) nor L-CHIP and MGUS (OR=1.12, 95% CI:0.78-1.57), including with any MGUS isotype (IgA, IgG, or IgM; P-values>0.22). Next, we investigated the association of these precursors on risk of MM. Median follow-up was 11.7 years (range 0.1-15.1), and 46 individuals developed incident MM. Both MGUS (HR=29.7, 95% CI: 14.1-62.4) and L-CHIP (HR=4.1, 95% CI: 1.3-13.2) were significantly associated with incident MM, but not M-CHIP (HR-1.0, 95% CI: 0.4-2.5). Investigating the combined effect of MGUS and L-CHIP, we found those with MGUS alone had a 27.5-fold (95% CI: 13.0-58.2) increased risk of incident MM compared to those with no precursors. No individuals with L-CHIP only developed MM, but those with both L-CHIP and MGUS had a 129.4-fold (95% CI: 34.4-486.4) increased risk of incident MM. In the largest cohort with screened MGUS and CHIP, we found no evidence of an association between either definition of CHIP with MGUS. However, individuals with both L-CHIP and MGUS were at the highest risk of developing MM. Nicholas J. Boddicker, Cristine Allmer, Danelle H. Moonen, Aaron D. Norman, Angelica Macauda, Alyssa Clay-Gilmour, Janet E. Olson, Mrinal S. Patnaik, Vincent Rajkumar, Esteban Braggio, David L. Murray, Shaji Kumar, Susan L. Slager, Celine M. Vachon. The association between MGUS and CHIP and their impact on multiple myeloma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 4917.

Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal cancers with patients having unresectable or metastatic disease at diagnosis, with poor prognosis and very short survival. Given that genetic variation within autophagy-related genes influences autophagic flux and susceptibility to solid cancers, we decided to investigate whether 55,583 single nucleotide polymorphisms (SNPs) within 234 autophagy-related genes could influence the risk of developing PDAC in three large independent cohorts of European ancestry including 12,754 PDAC cases and 324,926 controls. The meta-analysis of these populations identified, for the first time, the association of the BIDrs9604789 variant with an increased risk of developing the disease (ORMeta = 1.31, p = 9.67 × 10-6). We also confirmed the association of TP63rs1515496 and TP63rs35389543 variants with PDAC risk (OR = 0.89, p = 6.27 × 10-8 and OR = 1.16, p = 2.74 × 10-5). Although it is known that BID induces autophagy and TP63 promotes cell growth, cell motility and invasion, we also found that carriers of the TP63rs1515496G allele had increased numbers of FOXP3+ Helios+ T regulatory cells and CD45RA+ T regulatory cells (p = 7.67 × 10-4 and p = 1.56 × 10-3), but also decreased levels of CD4+ T regulatory cells (p = 7.86 × 10-4). These results were in agreement with research suggesting that the TP63rs1515496 variant alters binding sites for FOXA1 and CTCF, which are transcription factors involved in modulating specific subsets of regulatory T cells. In conclusion, this study identifies BID as new susceptibility locus for PDAC and confirms previous studies suggesting that the TP63 gene is involved in the development of PDAC. This study also suggests new pathogenic mechanisms of the TP63 locus in PDAC.

Chronic lymphocytic leukemia (CLL) is the most common leukemia among adults worldwide. Although genome-wide association studies (GWAS) have uncovered the germline genetic component underlying CLL susceptibility, the potential use of GWAS-identified risk variants to predict disease progression and patient survival remains unexplored. Here, we evaluated whether 41 GWAS-identified risk variants for CLL could influence overall survival (OS) and disease progression, defined as time to first treatment (TTFT) in a cohort of 1039 CLL cases ascertained through the CRuCIAL consortium. Although this is the largest study assessing the effect of GWAS-identified susceptibility variants for CLL on OS, we only found a weak association of ten single nucleotide polymorphisms (SNPs) with OS (p < 0.05) that did not remain significant after correction for multiple testing. In line with these results, polygenic risk scores (PRSs) built with these SNPs in the CRuCIAL cohort showed a modest association with OS and a low capacity to predict patient survival, with an area under the receiver operating characteristic curve (AUROC) of 0.57. Similarly, seven SNPs were associated with TTFT (p < 0.05); however, these did not reach the multiple testing significance threshold, and the meta-analysis with previous published data did not confirm any of the associations. As expected, PRSs built with these SNPs showed reduced accuracy in prediction of disease progression (AUROC = 0.62). These results suggest that susceptibility variants for CLL do not impact overall survival and disease progression in CLL patients.

Background Genetic factors have proven to have an impact on multiple myeloma (MM) susceptibility, with genome-wide association studies (GWAS) discovering 23 loci associated with MM risk. However, much of the heritability of MM remains unexplained. The stringent significance threshold used in GWAS (p<5×10-8) accounts for the numerous statistical tests being performed but is prone to the risk of false negatives. One strategy for reducing the number of tests is to consider only SNPs with heightened prior probabilities of association, according to meaningful biological criteria. The best candidate SNPs identified with this approach can then be tested in additional MM cases and controls from independent populations. We aimed at surveying the effect of single nucleotide polymorphisms (SNPs), predicted to have a functional role, on MM risk. Methods The association study consisted of two GWAS as discovery datasets, namely the InterLymph consortium and the German GWAS and a replication dataset, namely the the International Multiple Myeloma rESEarch (IMMEnSE) consortium, for an overall total of 5442 MM cases and 6174 controls. SNPs were first ranked according to p-value and concordance of the association between the two discovery datasets, then ranked by functional annotation, using bioinformatic tools and databases. We considered the following classes of functional SNPs: missense, synonymous and non-sense SNPs, expression quantitative trait loci (eQTLs), splicing quantitative trait loci (sQTLs),), SNPs in SNPs affecting function of long non-coding RNAs (lncRNA), and SNPs modifying transcription factor binding sites. We prioritized the resulting SNPs for replication in IMMEnSE by p-values for association in InterLymph and German GWAS and by evidence for a functional role. Results In the two discovery datasets, 136 SNPs fit the criteria of association with MM risk with p<10-4 and did not map close to known MM risk loci. After pruning for linkage disequilibrium, four SNPs (rs12038685, rs2664188, rs12652920, rs29794) were chosen for replication in IMMEnSE. Among these, rs2664188 showed to be significantly associated also in the replication dataset (OR=1.30, 95% CI = 1.16-1.46, p=0.001). The final meta-analysis including the three datasets, using a random-effect model, confirmed the association (OR=1.18, 95% CI = 1.07-1.30, p=0.0007). Conclusion The G-allele of rs2664188, that showed a consistent association with increased risk of developing MM in all phases of our analysis is an eQTL, according to GTEx., The G-allele is associated with increased expression of the N4BP2 gene in whole blood. N4BP2 encodes a protein which binds to B-cell leukemia/lymphoma 3 (BCL-3), a well-known proto-oncogene, known to play a role in cell proliferation and apoptosis inhibition in myeloma cell lines. Genetic factors have proven to have an impact on multiple myeloma (MM) susceptibility, with genome-wide association studies (GWAS) discovering 23 loci associated with MM risk. However, much of the heritability of MM remains unexplained. The stringent significance threshold used in GWAS (p<5×10-8) accounts for the numerous statistical tests being performed but is prone to the risk of false negatives. One strategy for reducing the number of tests is to consider only SNPs with heightened prior probabilities of association, according to meaningful biological criteria. The best candidate SNPs identified with this approach can then be tested in additional MM cases and controls from independent populations. We aimed at surveying the effect of single nucleotide polymorphisms (SNPs), predicted to have a functional role, on MM risk. The association study consisted of two GWAS as discovery datasets, namely the InterLymph consortium and the German GWAS and a replication dataset, namely the the International Multiple Myeloma rESEarch (IMMEnSE) consortium, for an overall total of 5442 MM cases and 6174 controls. SNPs were first ranked according to p-value and concordance of the association between the two discovery datasets, then ranked by functional annotation, using bioinformatic tools and databases. We considered the following classes of functional SNPs: missense, synonymous and non-sense SNPs, expression quantitative trait loci (eQTLs), splicing quantitative trait loci (sQTLs),), SNPs in SNPs affecting function of long non-coding RNAs (lncRNA), and SNPs modifying transcription factor binding sites. We prioritized the resulting SNPs for replication in IMMEnSE by p-values for association in InterLymph and German GWAS and by evidence for a functional role. In the two discovery datasets, 136 SNPs fit the criteria of association with MM risk with p<10-4 and did not map close to known MM risk loci. After pruning for linkage disequilibrium, four SNPs (rs12038685, rs2664188, rs12652920, rs29794) were chosen for replication in IMMEnSE. Among these, rs2664188 showed to be significantly associated also in the replication dataset (OR=1.30, 95% CI = 1.16-1.46, p=0.001). The final meta-analysis including the three datasets, using a random-effect model, confirmed the association (OR=1.18, 95% CI = 1.07-1.30, p=0.0007). The G-allele of rs2664188, that showed a consistent association with increased risk of developing MM in all phases of our analysis is an eQTL, according to GTEx., The G-allele is associated with increased expression of the N4BP2 gene in whole blood. N4BP2 encodes a protein which binds to B-cell leukemia/lymphoma 3 (BCL-3), a well-known proto-oncogene, known to play a role in cell proliferation and apoptosis inhibition in myeloma cell lines.

Multiple myeloma (MM) arises following malignant proliferation of plasma cells in the bone marrow, that secrete high amounts of specific monoclonal immunoglobulins or light chains, resulting in the massive production of unfolded or misfolded proteins. Autophagy can have a dual role in tumorigenesis, by eliminating these abnormal proteins to avoid cancer development, but also ensuring MM cell survival and promoting resistance to treatments. To date no studies have determined the impact of genetic variation in autophagy-related genes on MM risk. We performed meta-analysis of germline genetic data on 234 autophagy-related genes from three independent study populations including 13,387 subjects of European ancestry (6863 MM patients and 6524 controls) and examined correlations of statistically significant single nucleotide polymorphisms (SNPs; p < 1 × 10−9) with immune responses in whole blood, peripheral blood mononuclear cells (PBMCs), and monocyte-derived macrophages (MDM) from a large population of healthy donors from the Human Functional Genomic Project (HFGP). We identified SNPs in six loci, CD46, IKBKE, PARK2, ULK4, ATG5, and CDKN2A associated with MM risk (p = 4.47 × 10−4−5.79 × 10−14). Mechanistically, we found that the ULK4rs6599175 SNP correlated with circulating concentrations of vitamin D3 (p = 4.0 × 10−4), whereas the IKBKErs17433804 SNP correlated with the number of transitional CD24+CD38+ B cells (p = 4.8 × 10−4) and circulating serum concentrations of Monocyte Chemoattractant Protein (MCP)-2 (p = 3.6 × 10−4). We also found that the CD46rs1142469 SNP correlated with numbers of CD19+ B cells, CD19+CD3− B cells, CD5+IgD− cells, IgM− cells, IgD−IgM− cells, and CD4−CD8− PBMCs (p = 4.9 × 10−4−8.6 × 10−4) and circulating concentrations of interleukin (IL)-20 (p = 0.00082). Finally, we observed that the CDKN2Ars2811710 SNP correlated with levels of CD4+EMCD45RO+CD27− cells (p = 9.3 × 10−4). These results suggest that genetic variants within these six loci influence MM risk through the modulation of specific subsets of immune cells, as well as vitamin D3−, MCP-2−, and IL20-dependent pathways.

Multiple myeloma (MM) is an incurable disease characterized by the presence of malignant plasma cells in the bone marrow that secrete specific monoclonal immunoglobulins into the blood. Obesity has been associated with the risk of developing solid and hematological cancers, but its role as a risk factor for MM needs to be further explored. Here, we evaluated whether 32 genome-wide association study (GWAS)-identified variants for obesity were associated with the risk of MM in 4189 German subjects from the German Multiple Myeloma Group (GMMG) cohort (2121 MM cases and 2068 controls) and 1293 Spanish subjects (206 MM cases and 1087 controls). Results were then validated through meta-analysis with data from the UKBiobank (554 MM cases and 402,714 controls) and FinnGen cohorts (914 MM cases and 248,695 controls). Finally, we evaluated the correlation of these single nucleotide polymorphisms (SNPs) with cQTL data, serum inflammatory proteins, steroid hormones, and absolute numbers of blood-derived cell populations (n = 520). The meta-analysis of the four European cohorts showed no effect of obesity-related variants on the risk of developing MM. We only found a very modest association of the POC5rs2112347G and ADCY3rs11676272G alleles with MM risk that did not remain significant after correction for multiple testing (per-allele OR = 1.08, p = 0.0083 and per-allele OR = 1.06, p = 0.046). No correlation between these SNPs and functional data was found, which confirms that obesity-related variants do not influence MM risk.

Topic: 13. Myeloma and other monoclonal gammopathies - Biology & Translational Research Background: Multiple myeloma (MM) is one of the most common hematological malignancies, accounting for 20% of all newly diagnosed hematological cancers. The most recent data from Globocan show that in 2020, worldwide, the number of new cases was 159,985. Although the current 5-year survival rate is over 50% MM is still considered an incurable disease since most of the patients eventually relapse. Presence of RAS genes is reported in about 50% of newly diagnosed MM and about 75% of relapsed/refractory MM (rrMM). Interestingly, more than half of patients with RAS activation harbor activating mutations in NRAS or KRAS genes, most of which clustered into codons 12, 13, or 61 and associated with a shorter overall and progression-free survival. The NRAS Gln61Arg mutation (Q61R) with a frequency of 6.82% represents the most frequent point mutation in patients with MM. NRAS Q61R is a hotspot mutation that lies within a GTP-binding region of the NRAS protein resulting in an increased GTP-bound NRAS and leading to activation of MAPK signaling and cell transformation. The exact functional consequences of the NRAS Q61R mutation in the context of MM are not yet well known. Aims: Explore the transformations resulting from the overexpression of NRAS with the Q61R mutation in MM cell lines through functional studies. Methods: The human U266B1 MM cell line was stably transduced with an overexpression construct carrying the human NRAS Q61R hotspot mutation. The functional effects of the overexpression were assessed through cell migration and cell viability assays (respectively Transwell and celltitle glow) and compared with a control cell line with an empty vector and a control carrying no vector (U266B1 wild type). Results: Overexpression of the NRAS Q61R mutation induces remarkable changes in MM cell lines. Namely, it appears to have a negative effect, with reduced metabolic activity and reduced cell proliferation. Specifically, a 45% reduction in cell proliferation was observed in the cells overexpressing NRAS Q61R in comparison with the ones with the empty vector. The migration assays however revealed a more aggressive phenotypic behavior with increased tendency to migration and invasiveness. In particular, the overexpressing cells migrated 10 times more than the wild type cells and 3 times more than their control without vector (Figure 1). Summary/Conclusion: This study aimed to explore the functional effects of NRAS Q61R overexpression in MM cell lines. The results showed that overexpression of NRAS Q61R negatively affects cell proliferation but increases cell migration and invasiveness. These findings suggest mechanisms by which NRAS Q61R may play a significant role in the progression and aggressiveness of MM. Figure 1. Representative Transwell migration assay images (10× magnification)a-f a) U266B1 WT on fixed membrane with fluorescent dye DAPI b) visualization of U266B1 WT cell outlines c) U266B1 OE NRAS Q61R on fixed membrane with fluorescent dye DAPI d) visualization of U266B1 OE NRAS Q61R cell outlines e) U266B1 Ctrl Puromycin on fixed membrane with fluorescent dye DAPI f) visualization of U266B1 Ctrl Puromycin cell outlinesKeywords: Point mutation, Multiple myeloma

We conducted the first large genome‐wide association study to identify novel genetic variants that predict better (or poorer) prognosis in colorectal cancer patients receiving standard first‐line oxaliplatin‐based chemotherapy vs chemotherapy without oxaliplatin. We used data from two phase III trials, NCCTG N0147 and NCCTG N9741 and a population‐based patient cohort, DACHS. Multivariable Cox proportional hazards models were employed, including an interaction term between each SNP and type of treatment for overall survival (OS) and progression‐free survival. The analysis was performed for studies individually, and the results were combined using fixed‐effect meta‐analyses separately for resected stage III colon cancer (3098 patients from NCCTG N0147 and 549 patients from DACHS) and mCRC (505 patients from NCCTG N9741 and 437 patients from DACHS). We further performed gene‐based analysis as well as in silico bioinformatics analysis for CRC‐relevant functional genomic annotation of identified loci. In stage III colon cancer patients, a locus on chr22 (rs11912167) was associated with significantly poorer OS after oxaliplatin‐based chemotherapy vs chemotherapy without oxaliplatin (Pinteraction < 5 × 10−8). For mCRC patients, three loci on chr1 (rs1234556), chr12 (rs11052270) and chr15 (rs11858406) were found to be associated with differential OS (P < 5 × 10−7). The locus on chr1 located in the intronic region of RCSD1 was replicated in an independent cohort of 586 mCRC patients from ALGB/SWOG 80405 (Pinteraction = .04). The GWA gene‐based analysis yielded for RCSD1 the most significant association with differential OS in mCRC (P = 6.6 × 10−6). With further investigation into its biological mechanisms, this finding could potentially be used to individualize first‐line treatment and improve clinical outcomes.

Myeloma bone disease (MBD) is the most visible aspect of plasma cell myeloma (PCM), which is characterized by the displacement of hematopoiesis and the formation of osteolytic bone lesions. The secreted glycoprotein Dickkopf-1 (DKK1), an inhibitor of the Wnt signaling pathway, is broadly expressed in myeloma cells but highly restricted in normal tissues. DKK1 plays a critical role in several aspects of bone biology and actively participates in regulating MBD by inhibiting osteoblasts and by activating osteoclasts. Based on these findings, ongoing research has been targeting DKK1 to find novel therapeutic strategies for MBD, such as DKK1-neutralizing antibodies, proteasome inhibitors, and vaccines. All these strategies have produced encouraging clinical results and consequently, revealed the significance of DKK1 in MBD. This review discusses the recent advances in our understanding of the DKK1 pathway signaling and how DKK1 can be exploited in the therapeutic intervention of MBD.

Autophagy is a highly conserved metabolic pathway via which unwanted intracellular materials, such as unfolded proteins or damaged organelles, are digested. It is activated in response to conditions of oxidative stress or starvation, and is essential for the maintenance of cellular homeostasis and other vital functions, such as differentiation, cell death, and the cell cycle. Therefore, autophagy plays an important role in the initiation and progression of tumors, including hematological malignancies, where damaged autophagy during hematopoiesis can cause malignant transformation and increase cell proliferation. Over the last decade, the importance of autophagy in response to standard pharmacological treatment of hematological tumors has been observed, revealing completely opposite roles depending on the tumor type and stage. Thus, autophagy can promote tumor survival by attenuating the cellular damage caused by drugs and/or stabilizing oncogenic proteins, but can also have an antitumoral effect due to autophagic cell death. Therefore, autophagy-based strategies must depend on the context to create specific and safe combination therapies that could contribute to improved clinical outcomes. In this review, we describe the process of autophagy and its role on hematopoiesis, and we highlight recent research investigating its role as a potential therapeutic target in hematological malignancies. The findings suggest that genetic variants within autophagy-related genes modulate the risk of developing hemopathies, as well as patient survival.

Pleiotropy, which consists of a single gene or allelic variant affecting multiple unrelated traits, is common across cancers, with evidence for genome‐wide significant loci shared across cancer and noncancer traits. This feature is particularly relevant in multiple myeloma (MM) because several susceptibility loci that have been identified to date are pleiotropic. Therefore, the aim of this study was to identify novel pleiotropic variants involved in MM risk using 28 684 independent single nucleotide polymorphisms (SNPs) from GWAS Catalog that reached a significant association (P < 5 × 10−8) with their respective trait. The selected SNPs were analyzed in 2434 MM cases and 3446 controls from the International Lymphoma Epidemiology Consortium (InterLymph). The 10 SNPs showing the strongest associations with MM risk in InterLymph were selected for replication in an independent set of 1955 MM cases and 1549 controls from the International Multiple Myeloma rESEarch (IMMEnSE) consortium and 418 MM cases and 147 282 controls from the FinnGen project. The combined analysis of the three studies identified an association between DNAJB4‐rs34517439‐A and an increased risk of developing MM (OR = 1.22, 95%CI 1.13‐1.32, P = 4.81 × 10−7). rs34517439‐A is associated with a modified expression of the FUBP1 gene, which encodes a multifunctional DNA and RNA‐binding protein that it was observed to influence the regulation of various genes involved in cell cycle regulation, among which various oncogenes and oncosuppressors. In conclusion, with a pleiotropic scan approach we identified DNAJB4‐rs34517439 as a potentially novel MM risk locus.

Background: Multiple myeloma (MM) is the second most common blood malignancy, caused by an uncontrolled growth of plasma cells in the bone marrow, accounting for 20% of all newly diagnosed hematological cancers. Although the current 5-year survival rate is ranging between 40-60%, MM is still considered an incurable disease since most of the patients eventually relapse. While the causes of MM are incompletely understood, several genome-wide association studies (GWAS) have been conducted to identify germline variants that predispose to MM. Up to date, a total of 24 loci were found to be associated with MM risk, but very little information is available about their functional role. Aims: The principal goal is to explore in silico the function of the germline variants associated with MM risk. As we do not know if the GWAS-identified SNPs are the causal variants or just markers of risk, the functional characterization of the causal risk variants would lead to a better understanding of disease development. Methods: GWAS design takes advantage of the linkage disequilibrium (LD) structure of the human genome, thus the main GWAS findings are single-nucleotide polymorphisms (SNPs) that show the strongest association with MM risk (measured as the lowest p-values), but they are not necessarily the functionally causal variants. In this project, we used bioinformatics tools (GTEx, HaploReg v4.1, Roadmap, LDlinke, SNPnexus, RegulomeDB 2.0.3, SNP2TFBS, miRNASNP v3, GeneMANIA) to perform fine mapping of all GWAS-identified loci and to prioritize in each locus the polymorphism with the highest chance of being functionally relevant. In particular, we focused on the loci with the smallest number of SNPs in high LD (r2>0.8) in order to maximize the probability to capture the casual variant. Results: Four of the 24 MM risk loci had a relatively small number of SNPs in high LD and within them we found that the locus located at chromosome 16 contained the greatest number of functionally annotated SNPs. Of particular functional interest was rs3747481 (chr16:30666367 C/T) due to the following reasons: it is a missense variant (protein change: P359L), it is located in the PRR14 gene, that contributes to chromatin hierarchical organization and has a role in gene regulation, has a high CADD PHRED score (22.1). Additionally, according to GTEx portal, rs3747481 is associated with the expression level of the RNF40 gene (which plays a central role in histone code and gene regulation) in whole blood cells (p=3.02-12). It has a score of “1d” in RegulomeDB (eQTL+ TF binding + any motif + DNase peak), meaning that this variant has a high likelihood to affect binding of transcription factors. Some other SNPs (like rs35629860 and rs67128646) in the same LD block show the co-occurrence of H3K4me3 and H3K27me3 histone marks (associated with gene activation and repression, respectively) in promoters and enhancers in B lymphocytes. rs6565197 is predicted to affect the binding of the KLF4 and KLF5 transcription factors which play key roles in cell cycle regulation. Summary/Conclusion: Through a fine mapping of MM risk loci by bioinformatics tools, we found a variant in the locus 16p11.2 that shows in silico a very high probability to have biological role in the risk disease.