Gene scanning of VDJH-amplified segments is a clinically relevant technique to detect contaminating tumor cells in the apheresis products of multiple myeloma patients undergoing autologous peripheral blood stem cell transplantation.
Contaminating tumour cells in apheresis products have proved to influence the outcome of patients with multiple myeloma (MM) undergoing autologous stem cell transplantation (APBSCT). The gene scanning of clonally rearranged VDJ segments of the heavy chain immunoglobulin gene (VDJH) is a reproducible and easy to perform technique that can be optimised for clinical laboratories. We used it to analyse the aphereses of 27 MM patients undergoing APBSCT with clonally detectable VDJH segments, and 14 of them yielded monoclonal peaks in at least one apheresis product. The presence of positive results was not related to any pre-transplant characteristics, except the age at diagnosis (lower in patients with negative products, P = 0.04). Moreover, a better pre-transplant response trended to associate with a negative result (P = 0.069). Patients with clonally free products were more likely to obtain a better response to transplant (complete remission, 54% vs 28%; >90% reduction in the M-component, 93% vs 43% P = 0.028). In addition, patients transplanted with polyclonal products had longer progression-free survival, (39 vs 19 months, P = 0.037) and overall survival (81% vs 28% at 5 years, P = 0.045) than those transplanted with monoclonal apheresis. In summary, the gene scanning of apheresis products is a useful and clinically relevant technique in MM transplanted patients.
López-Pérez
R
R
Haematology Service, University Hospital of Salamanca and Centre for Cancer Research of Salamanca, Paseo de San Vicente, 58-182, Salamanca, 37007, Spain.
García-Sanz
R
R
González
D
D
Balanzategui
A
A
Chillón
M C
MC
Alaejos
I
I
Mateos
M V
MV
Caballero
M D
MD
Corral
M
M
Orfão
A
A
González
M
M
San Miguel
J F
JF
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001781:Blood Component Removal; D016465:Bone Marrow Purging / Q000379:methods*; D002452:Cell Count; D002999:Clone Cells / Q000737:chemistry; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000494:pharmacology; D003907:Dexamethasone / Q000008:administration & dosage; D018572:Disease-Free Survival; D015326:Gene Rearrangement, B-Lymphocyte, Heavy Chain; D016179:Granulocyte Colony-Stimulating Factor / Q000494:pharmacology; D019650:Hematopoietic Stem Cell Mobilization / Q000379:methods; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D016130:Immunophenotyping; D007372:Interferons / Q000008:administration & dosage; D015993:Life Tables; D008875:Middle Aged; D009101:Multiple Myeloma / Q000097:blood / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D009194:Myeloma Proteins / Q000235:genetics*; D009360:Neoplastic Cells, Circulating / Q000737:chemistry*; D010950:Plasma Cells / Q000737:chemistry*; D016133:Polymerase Chain Reaction / Q000379:methods*; D011446:Prospective Studies; D015203:Reproducibility of Results; D016879:Salvage Therapy; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D014182:Transplantation, Autologous; D016896:Treatment Outcome
D009194:Myeloma Proteins; D016179:Granulocyte Colony-Stimulating Factor; D003907:Dexamethasone; D003520:Cyclophosphamide; D007372:Interferons