Multiparameter flow cytometric remission is the most relevant prognostic factor for multiple myeloma patients who undergo autologous stem cell transplantation.
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 http://clinicaltrials.gov under identifier NCT00560053.
Paiva
Bruno
B
Hospital Universitario de Salamanca, Salamanca, Spain.
Vidriales
Maria-Belén
MB
Cerveró
Jorge
J
Mateo
Gema
G
Pérez
Jose J
JJ
Montalbán
Maria A
MA
Sureda
Anna
A
Montejano
Laura
L
Gutiérrez
Norma C
NC
García de Coca
Alfonso
A
de Las Heras
Natalia
N
Mateos
Maria V
MV
López-Berges
Maria C
MC
García-Boyero
Raimundo
R
Galende
Josefina
J
Hernández
Jose
J
Palomera
Luis
L
Carrera
Dolores
D
Martínez
Rafael
R
de la Rubia
Javier
J
Martín
Alejandro
A
Bladé
Joan
J
Lahuerta
Juan J
JJ
Orfao
Alberto
A
San Miguel
Jesús F
JF
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D001761:Bleomycin / Q000008:administration & dosage; D002330:Carmustine / Q000008:administration & dosage; D002945:Cisplatin / Q000008:administration & dosage; D003907:Dexamethasone / Q000008:administration & dosage; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D005434:Flow Cytometry / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D009101:Multiple Myeloma / Q000097:blood* / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D018365:Neoplasm, Residual; D011237:Predictive Value of Tests; D033581:Stem Cell Transplantation / Q000379:methods; D015996:Survival Rate; D014182:Transplantation, Autologous; D014750:Vincristine / Q000008:administration & dosage
D001761:Bleomycin; D016685:Mitomycin; D014750:Vincristine; D003907:Dexamethasone; D004317:Doxorubicin; D002945:Cisplatin; D002330:Carmustine