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. 2024 May 1;130(9):1663-1672.
doi: 10.1002/cncr.35171. Epub 2023 Dec 21.

Impact of pretransplant minimal residual disease in patients with multiple myeloma and a very good partial response or better receiving autologous hematopoietic stem cell transplantation

Oren Pasvolsky  1 , Sarah Pasyar  2 , Roland L Bassett  2 , Hina N Khan  3   4 , Mark R Tanner  3 , Qaiser Bashir  3 , Samer Srour  3 , Neeraj Saini  3 , Paul Lin  3 , Jeremy Ramdial  3 , Yago Nieto  3 , Hans C Lee  1 , Krina K Patel  1 , Partow Kebriaei  3 , Sheeba K Thomas  1 , Donna M Weber  1 , Robert Z Orlowski  1 , Elizabeth J Shpall  3 , Richard E Champlin  3 , Muzaffar H Qazilbash  3
Affiliations

Impact of pretransplant minimal residual disease in patients with multiple myeloma and a very good partial response or better receiving autologous hematopoietic stem cell transplantation

Oren Pasvolsky et al. Cancer. .

Abstract

Background: The prognostic significance of minimal residual disease (MRD) status before autologous hematopoietic stem cell transplantation (autoHCT) in patients with multiple myeloma (MM) has not been clearly elucidated.

Methods: Retrospective single-center study of adult MM patients who achieved ≥very good partial response (VGPR) after induction therapy from 2015 to 2021 received upfront autoHCT and had available pretransplant MRD status by next-generation flow cytometry. The cohort was divided into pretransplant MRD-negative (MRDneg) and MRD-positive (MRDpos) groups.

Results: A total of 733 patients were included in our analysis; 425 were MRDneg and 308 MRDpos at autoHCT. In the MRDpos group, more patients had high-risk cytogenetic abnormalities (48% vs. 38%, respectively; p = .025), whereas fewer patients achieved ≥CR before autoHCT (14% vs. 40%; p < .001). At day 100 after autoHCT, 37% of the MRDpos versus 71% of the MRDneg achieved ≥CR, and at best posttransplant response 65% versus 88% achieved ≥CR, respectively. After a median follow-up of 27.6 months (range, 0.7-82.3), the median PFS was significantly shorter for patients in the MRDpos group compared to the MRDneg group: 48.2 months (95% confidence interval [CI], 0.3-80.5) versus 80.1 months (95% CI, 0.5-80.1), respectively (p < .001). There was no significant difference in overall survival between the two groups (p = .41). Pretransplant MRDpos status was predictive of shorter PFS in multivariate analysis (hazard ratio, 1.80; 95% CI, 1.31-2.46; p < .001). The impact of pretransplant MRD status was retained in most of the examined subgroups.

Conclusions: In patients achieving ≥VGPR to induction, pretransplant MRDpos status was associated with a lower CR rate after autoHCT and a shorter PFS.

Keywords: autologous; minimal residual disease; multiple myeloma; transplantation.

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Conflict of interest statement

Conflict of Interest disclosure: HCL reports: Consultancy: BMS, Celgene, Genentech, Janssen, GSK, Sanofi, Pfizer, Takeda, Allogene Therapeutics, Regeneron. Research funding: BMS, Janssen, GSK, Takeda, Regeneron, Amgen.

Figures

Figure 1.
Figure 1.
CONSORT flow diagram
Figure 2.
Figure 2.
Post-transplant hematological responses at day 100 and at best response, according to pre-transplant MRD status.
Figure 3.
Figure 3.
Progression free survival (A) and overall survival (B), according to pre-transplant MRD status.
Figure 4.
Figure 4.
Forest plot of subgroup analysis: impact of pre-transplant MRD status on progression free survival.
See this image and copyright information in PMC

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