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Clinical Trial
. 2008 Nov 15;112(10):4017-23.
doi: 10.1182/blood-2008-05-159624. Epub 2008 Jul 31.

Multiparameter flow cytometric remission is the most relevant prognostic factor for multiple myeloma patients who undergo autologous stem cell transplantation

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Clinical Trial

Multiparameter flow cytometric remission is the most relevant prognostic factor for multiple myeloma patients who undergo autologous stem cell transplantation

Bruno Paiva et al. Blood. .

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 http://clinicaltrials.gov under identifier NCT00560053.

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Figures

Figure 1
Figure 1
Progression-free survival and overall survival according to the presence or absence of MM-PCs in the bone marrow at day 100 after ASCT. (A,B) Progression-free survival (PFS) and overall survival (OS) for all patients included in the present analysis (N = 295). (C,D) PFS and OS among the subset of patients achieving CR (n = 147).
Figure 2
Figure 2
Prognostic influence of MRD status by MFC and IFX status at day 100 after ASCT. Progression-free survival (A) and overall survival (B) among specific risk groups of patients.
Figure 3
Figure 3
Prognostic influence of sequential MRD status by MFC before and after ASCT. (A) PFS and (B) OS (n = 157).

Comment in

References

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