The persistence of immunophenotypically normal residual bone marrow plasma cells at diagnosis identifies a good prognostic subgroup of symptomatic multiple myeloma patients
Bruno Paiva, Maria-Belén Vidriales, Gema Mateo, Jose J Pérez, Maria Angeles Montalbán, Anna Sureda, Laura Montejano, Norma C Gutiérrez, Alfonso García de Coca, Natalia de las Heras, Maria Victoria Mateos, Maria Consuelo López-Berges, Raimundo García-Boyero, Josefina Galende, Jose Hernández, Luis Palomera, Dolores Carrera, Rafael Martínez, Javier de la Rubia, Alejandro Martín, Yolanda González, Joan Bladé, Juan José Lahuerta, Alberto Orfao, Jesús F San-Miguel, GEM (Grupo Español de MM)/PETHEMA (Programa para el Estudio de la Terapéutica en Hemopatías Malignas) Cooperative Study Groups, A Modolell, F Prosper, J Besalduch, A Sureda, P Lorente, E Monzó, A Alcalá Muñoz, R Martínez-Martínez, M T Hernández-García, L Palomera, J L Bello, M J Terol, F J Fernández Calvo, J C García Ruíz, J A Hernández Ribas, J M Ojanguren, M Vargas Pabón, K Pérez Equiza, I Navarro, J Serena, J Galende del Canto, A Altes, E Abella, J A Soler, J García Frade, M Callis De Nadal, P Ribas García, M J Fernández Llavador, R García-Boyero, R Herraez, M Subirà, L Rodríguez Fernández, J M Hernández-Martín, F de Arriba, R Ferrer, C Rivas González, M Orero, J C Gómez-García, A León Lara, J M Ribera, L Escoda, S Gardella, A Barez, B Hernández-Ruíz, F Solano, J Ibañez, C Burgaleta, R Butrón, J García-Laraña, F Ortega Rivas, M L Martín-Mateos, P Sánchez-Godoy, J Bargay, J J Lahuerta, L García Alonso, A Alegre, J D González San Miguel, J De la Rubia, E Conde García, I Pérez-Fernández, L Font Ferré, P Galán, A Martín, F Casado, C Poderos, M J Busto, Bruno Paiva, Maria-Belén Vidriales, Gema Mateo, Jose J Pérez, Maria Angeles Montalbán, Anna Sureda, Laura Montejano, Norma C Gutiérrez, Alfonso García de Coca, Natalia de las Heras, Maria Victoria Mateos, Maria Consuelo López-Berges, Raimundo García-Boyero, Josefina Galende, Jose Hernández, Luis Palomera, Dolores Carrera, Rafael Martínez, Javier de la Rubia, Alejandro Martín, Yolanda González, Joan Bladé, Juan José Lahuerta, Alberto Orfao, Jesús F San-Miguel, GEM (Grupo Español de MM)/PETHEMA (Programa para el Estudio de la Terapéutica en Hemopatías Malignas) Cooperative Study Groups, A Modolell, F Prosper, J Besalduch, A Sureda, P Lorente, E Monzó, A Alcalá Muñoz, R Martínez-Martínez, M T Hernández-García, L Palomera, J L Bello, M J Terol, F J Fernández Calvo, J C García Ruíz, J A Hernández Ribas, J M Ojanguren, M Vargas Pabón, K Pérez Equiza, I Navarro, J Serena, J Galende del Canto, A Altes, E Abella, J A Soler, J García Frade, M Callis De Nadal, P Ribas García, M J Fernández Llavador, R García-Boyero, R Herraez, M Subirà, L Rodríguez Fernández, J M Hernández-Martín, F de Arriba, R Ferrer, C Rivas González, M Orero, J C Gómez-García, A León Lara, J M Ribera, L Escoda, S Gardella, A Barez, B Hernández-Ruíz, F Solano, J Ibañez, C Burgaleta, R Butrón, J García-Laraña, F Ortega Rivas, M L Martín-Mateos, P Sánchez-Godoy, J Bargay, J J Lahuerta, L García Alonso, A Alegre, J D González San Miguel, J De la Rubia, E Conde García, I Pérez-Fernández, L Font Ferré, P Galán, A Martín, F Casado, C Poderos, M J Busto
Abstract
Multiparameter flow cytometry immunophenotyping allows discrimination between normal (N-) and myelomatous (MM-) plasma cells (PCs) within the bone marrow plasma cell compartment (BMPCs). Here we report on the prognostic relevance of detecting more than 5% residual normal plasma cells from all bone marrow plasma cells (N-PCs/BMPCs) by multiparameter flow cytometry in a series of 594 newly diagnosed symptomatic MM patients, uniformly treated according to the Grupo Español de MM 2000 (GEM2000) protocol. Our results show that symptomatic MM patients with more than 5% N-PCs/BMPCs (n = 80 of 594; 14%) have a favorable baseline clinical prospect, together with a significantly lower frequency of high-risk cytogenetic abnormalities and higher response rates. Moreover, this group of patients had a significantly longer progression-free survival (median, 54 vs 42 months, P = .001) and overall survival (median, not reached vs 89 months, P = .04) than patients with less than or equal to 5% N-PCs/BMPCs. Our findings support the clinical value of detecting residual normal PCs in MM patients at diagnosis because this reveals a good prognostic category that could benefit from specific therapeutic approaches. This trial was registered at www.clinicaltrials.gov as NCT00560053.
Source: PubMed