Multiparameter flow cytometric remission is the most relevant prognostic factor for multiple myeloma patients who undergo autologous stem cell transplantation
Bruno Paiva, Maria-Belén Vidriales, Jorge Cerveró, Gema Mateo, Jose J Pérez, Maria A Montalbán, Anna Sureda, Laura Montejano, Norma C Gutiérrez, Alfonso García de Coca, Natalia de Las Heras, Maria V Mateos, Maria C López-Berges, Raimundo García-Boyero, Josefina Galende, Jose Hernández, Luis Palomera, Dolores Carrera, Rafael Martínez, Javier de la Rubia, Alejandro Martín, Joan Bladé, Juan J 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, Bruno Paiva, Maria-Belén Vidriales, Jorge Cerveró, Gema Mateo, Jose J Pérez, Maria A Montalbán, Anna Sureda, Laura Montejano, Norma C Gutiérrez, Alfonso García de Coca, Natalia de Las Heras, Maria V Mateos, Maria C López-Berges, Raimundo García-Boyero, Josefina Galende, Jose Hernández, Luis Palomera, Dolores Carrera, Rafael Martínez, Javier de la Rubia, Alejandro Martín, Joan Bladé, Juan J 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
Abstract
Minimal residual disease (MRD) assessment is standard in many hematologic malignancies but is considered investigational in multiple myeloma (MM). We report a prospective analysis of the prognostic importance of MRD detection by multiparameter flow cytometry (MFC) in 295 newly diagnosed MM patients uniformly treated in the GEM2000 protocol VBMCP/VBAD induction plus autologous stem cell transplantation [ASCT]). MRD status by MFC was determined at day 100 after ASCT. Progression-free survival (PFS; median 71 vs 37 months, P < .001) and overall survival (OS; median not reached vs 89 months, P = .002) were longer in patients who were MRD negative versus MRD positive at day 100 after ASCT. Similar prognostic differentiation was seen in 147 patients who achieved immunofixation-negative complete response after ASCT. Moreover, MRD(-) immunofixation-negative (IFx(-)) patients and MRD(-) IFx(+) patients had significantly longer PFS than MRD(+) IFx(-) patients. Multivariate analysis identified MRD status by MFC at day 100 after ASCT as the most important independent prognostic factor for PFS (HR = 3.64, P = .002) and OS (HR = 2.02, P = .02). Our findings demonstrate the clinical importance of MRD evaluation by MFC, and illustrate the need for further refinement of MM re-sponse criteria. This trial is registered at https://ichgcp.net/clinical-trials-registry/NCT00560053" title="See in ClinicalTrials.gov">NCT00560053.
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Source: PubMed