Minimal residual disease status is the prognostic determinant following high-dose treatment for patients with multiple myeloma.
minimum residual disease
multiple myeloma prognosis
Journal
Cancer medicine
ISSN: 2045-7634
Titre abrégé: Cancer Med
Pays: United States
ID NLM: 101595310
Informations de publication
Date de publication:
Nov 2023
Nov 2023
Historique:
revised:
30
08
2023
received:
12
06
2023
accepted:
30
09
2023
pubmed:
3
11
2023
medline:
3
11
2023
entrez:
3
11
2023
Statut:
ppublish
Résumé
The presence of minimal residual disease (MRD+) following autologous stem cell transplantation (ASCT) in multiple myeloma represents a poor prognostic factor for progression-free survival (PFS) and overall survival (OS). At our department, we recommend lenalidomide maintenance for patients who are MRD+ after ASCT, while MRD-negative (MRD-) patients, after information about the national guidelines, were not advised to follow this regimen. Out of the total 228 patients, 175 received ASCT following first-line induction (MRD- 92 (53%), MRD+ 83 (47%), at 2 months post-ASCT), while 53 underwent ASCT after second-line treatment (MRD- 27 (51%), MRD+ 26 (49%), at the same time point). Comparatively, MRD- patients who did not receive maintenance demonstrated better OS than MRD+ patients who received upfront ASCT and maintenance treatment (96% vs. 86%, p = 0.030, at 3 years). However, nonsignificant difference was found in PFS (76% vs. 62%, at 3 years). Furthermore, second-line ASCT, MRD- non-maintained patients exhibited significantly better PFS than MRD+ (71% vs. 27%, p > 0.001, at 3 years). However, OS was better but nonsignificant (96% vs. 76%, at 3 years). Fluorescence in situ hybridization (FISH) analysis was performed on 141 out of the 228 patients. Of these, 85 (60%) patients were deemed standard risk (SR), and 56 (40%) were classified as high risk (HR). In the SR cohort, MRD- patients exhibited better PFS and OS than MRD+ patients (71% vs. 59% and 100% vs. 85%, respectively). In the HR cohort, the MRD- patients showed superior PFS but similar OS compared to MRD+ patients (66% vs. 42% and 81% vs. 80%, respectively). Our results indicate that being MRD- is a more crucial prognostic factor for the 3-year PFS and OS than the presence of high-risk cytogenetic markers or undergoing maintenance treatment. The latter appears insufficient, particularly for MRD+ patients following ASCT in the second-line setting, suggesting that these patients may require a more intensive treatment approach.
Sections du résumé
BACKGROUND
BACKGROUND
The presence of minimal residual disease (MRD+) following autologous stem cell transplantation (ASCT) in multiple myeloma represents a poor prognostic factor for progression-free survival (PFS) and overall survival (OS).
METHODS
METHODS
At our department, we recommend lenalidomide maintenance for patients who are MRD+ after ASCT, while MRD-negative (MRD-) patients, after information about the national guidelines, were not advised to follow this regimen.
RESULTS
RESULTS
Out of the total 228 patients, 175 received ASCT following first-line induction (MRD- 92 (53%), MRD+ 83 (47%), at 2 months post-ASCT), while 53 underwent ASCT after second-line treatment (MRD- 27 (51%), MRD+ 26 (49%), at the same time point). Comparatively, MRD- patients who did not receive maintenance demonstrated better OS than MRD+ patients who received upfront ASCT and maintenance treatment (96% vs. 86%, p = 0.030, at 3 years). However, nonsignificant difference was found in PFS (76% vs. 62%, at 3 years). Furthermore, second-line ASCT, MRD- non-maintained patients exhibited significantly better PFS than MRD+ (71% vs. 27%, p > 0.001, at 3 years). However, OS was better but nonsignificant (96% vs. 76%, at 3 years). Fluorescence in situ hybridization (FISH) analysis was performed on 141 out of the 228 patients. Of these, 85 (60%) patients were deemed standard risk (SR), and 56 (40%) were classified as high risk (HR). In the SR cohort, MRD- patients exhibited better PFS and OS than MRD+ patients (71% vs. 59% and 100% vs. 85%, respectively). In the HR cohort, the MRD- patients showed superior PFS but similar OS compared to MRD+ patients (66% vs. 42% and 81% vs. 80%, respectively).
CONCLUSIONS
CONCLUSIONS
Our results indicate that being MRD- is a more crucial prognostic factor for the 3-year PFS and OS than the presence of high-risk cytogenetic markers or undergoing maintenance treatment. The latter appears insufficient, particularly for MRD+ patients following ASCT in the second-line setting, suggesting that these patients may require a more intensive treatment approach.
Identifiants
pubmed: 37921243
doi: 10.1002/cam4.6640
pmc: PMC10709722
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
20736-20744Informations de copyright
© 2023 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.
Références
Ann Hematol. 2023 Jan;102(1):1-11
pubmed: 36462062
N Engl J Med. 1996 Jul 11;335(2):91-7
pubmed: 8649495
N Engl J Med. 2012 May 10;366(19):1782-91
pubmed: 22571202
Leukemia. 2017 Oct;31(10):2094-2103
pubmed: 28104919
J Clin Oncol. 2022 Sep 1;40(25):2889-2900
pubmed: 35377708
J Clin Oncol. 2017 Oct 10;35(29):3279-3289
pubmed: 28742454
Blood Cancer J. 2022 Apr 13;12(4):63
pubmed: 35418120
Cytometry B Clin Cytom. 2016 Jan;90(1):31-9
pubmed: 25619868
Blood Adv. 2020 Dec 8;4(23):5988-5999
pubmed: 33284948
Lancet Oncol. 2015 Dec;16(16):1617-29
pubmed: 26596670
Biol Blood Marrow Transplant. 2015 Dec;21(12):2039-2051
pubmed: 26428082
Blood. 2018 Dec 6;132(23):2456-2464
pubmed: 30249784
N Engl J Med. 2003 May 8;348(19):1875-83
pubmed: 12736280
Eur J Haematol. 2016 Jan;96(1):46-54
pubmed: 25779478
Blood. 2022 Jan 27;139(4):492-501
pubmed: 34269818
Eur J Haematol. 2022 Jan;108(1):34-44
pubmed: 34536308
Lancet Oncol. 2019 Jan;20(1):57-73
pubmed: 30559051
N Engl J Med. 2014 Sep 4;371(10):895-905
pubmed: 25184862
Blood. 2008 Oct 15;112(8):3115-21
pubmed: 18492953
Cancer Med. 2023 Nov;12(22):20736-20744
pubmed: 37921243