High-risk cytogenetics and persistent minimal residual disease by multiparameter flow cytometry predict unsustained complete response after autologous stem cell transplantation in multiple myeloma

• Published in: Blood 2012-01, Vol.119 (3), p.687-691
• Main Authors: Paiva, Bruno, Gutiérrez, Norma C., Rosiñol, Laura, Vídriales, María-Belén, Montalbán, María-Ángeles, Martínez-López, Joaquín, Mateos, María-Victoria, Cibeira, María-Teresa, Cordón, Lourdes, Oriol, Albert, Terol, María-José, Echeveste, María-Asunción, de Paz, Raquel, de Arriba, Felipe, Palomera, Luis, de la Rubia, Javier, Díaz-Mediavilla, Joaquín, Sureda, Anna, Gorosquieta, Ana, Alegre, Adrian, Martin, Alejandro, Hernández, Miguel T., Lahuerta, Juan-José, Bladé, Joan, San Miguel, Jesús F.
• Format: Article
• Language: English
• Subjects: Aged; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Biological and medical sciences; Combined Modality Therapy; Cytogenetic Analysis; Female; Flow Cytometry; Hematologic and hematopoietic diseases; Humans; Immunodeficiencies. Immunoglobulinopathies; Immunoglobulinopathies; Immunopathology; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Male; Medical sciences; Middle Aged; Multiple Myeloma - mortality; Multiple Myeloma - therapy; Neoplasm, Residual - diagnosis; Neoplasm, Residual - etiology; Neoplasm, Residual - mortality; Remission Induction; Risk Factors; Stem Cell Transplantation - adverse effects; Survival Rate; Transplantation, Autologous; Treatment Outcome
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2011-07-370460

The achievement of complete response (CR) after high-dose therapy/autologous stem cell transplantation (HDT/ASCT) is a surrogate for prolonged survival in multiple myeloma; however, patients who lose their CR status within 1 year of HDT/ASCT (unsustained CR) have poor prognosis. Thus, the identification of these patients is highly relevant. Here, we investigate which prognostic markers can predict unsustained CR in a series of 241 patients in CR at day +100 after HDT/ASCT who were enrolled in the Spanish GEM2000 (n = 140) and GEM2005 < 65y (n = 101) trials. Twenty-nine (12%) of the 241 patients showed unsustained CR and a dismal outcome (median overall survival 39 months). The presence of baseline high-risk cytogenetics by FISH (hazard ratio 17.3; P = .002) and persistent minimal residual disease by multiparameter flow cytometry at day +100 after HDT/ASCT (hazard ratio 8.0; P = .005) were the only independent factors that predicted unsustained CR. Thus, these 2 parameters may help to identify patients in CR at risk of early progression after HDT/ASCT in whom novel treatments should be investigated.