1. Minimal residual disease after transplantation or lenalidomide-based consolidation in myeloma patients: a prospective analysis.
- Author
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Oliva S, Gambella M, Gilestro M, Muccio VE, Gay F, Drandi D, Ferrero S, Passera R, Pautasso C, Bernardini A, Genuardi M, Patriarca F, Saraci E, Petrucci MT, Pescosta N, Liberati AM, Caravita T, Conticello C, Rocci A, Musto P, Boccadoro M, Palumbo A, and Omedè P
- Subjects
- Antineoplastic Combined Chemotherapy Protocols therapeutic use, Consolidation Chemotherapy, Disease Progression, Female, Humans, Lenalidomide, Maintenance Chemotherapy, Male, Middle Aged, Multiple Myeloma genetics, Multiple Myeloma pathology, Neoplasm, Residual, Prospective Studies, Thalidomide administration & dosage, Thalidomide therapeutic use, Treatment Outcome, Antineoplastic Combined Chemotherapy Protocols administration & dosage, Biomarkers, Tumor genetics, Multiple Myeloma therapy, Thalidomide analogs & derivatives, Transplantation, Autologous methods
- Abstract
We analyzed 50 patients who achieved at least a very good partial response in the RV-MM-EMN-441 study. Patients received consolidation with autologous stem-cell transplantation (ASCT) or cyclophosphamide-lenalidomide-dexamethasone (CRD), followed by Lenalidomide-based maintenance. We assessed minimal residual disease (MRD) by multi-parameter flow cytometry (MFC) and allelic-specific oligonucleotide real-time quantitative polymerase chain reaction (ASO-RQ-PCR) after consolidation, after 3 and 6 courses of maintenance, and thereafter every 6 months until progression. By MFC analysis, 19/50 patients achieved complete response (CR) after consolidation, and 7 additional patients during maintenance. A molecular marker was identified in 25/50 patients, 4/25 achieved molecular-CR after consolidation, and 3 additional patients during maintenance. A lower MRD value by MFC was found in ASCT patients compared with CRD patients (p=0.0134). Tumor burden reduction was different in patients with high-risk vs standard-risk cytogenetics (3.4 vs 5.2, ln-MFC; 3 vs 6 ln-PCR, respectively) and in patients who relapsed vs those who did not (4 vs 5, ln-MFC; 4.4 vs 7.8 ln-PCR). MRD progression anticipated clinical relapse by a median of 9 months while biochemical relapse by a median of 4 months. MRD allows the identification of a low-risk group, independently of response, and a better characterization of the activity of treatments.
- Published
- 2017
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