Department of Hematology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Department of Hematology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Biol Blood Marrow Transplant. 2018 Dec;24(12):2568-2574. doi: 10.1016/j.bbmt.2018.07.040. Epub 2018 Aug 22.
Many questions about minimal residual disease (MRD) still need to be answered for multiple myeloma (MM). Flow MRD was monitored in 104 consecutive patients with MM after induction and at the 3rd, 6th, 9th, 12th, 18th, and 24th months post-transplant. Four MRD evolution patterns were revealed: Pattern 1 patients had persistent MRD-negative status after post-induction with no progression; pattern 2 patients had MRD-positive status postinduction but became MRD negative within 24 months post-transplant; pattern 3 patients had MRD-negative status postinduction but became MRD positive within 24 months post-transplant; and pattern 4 patients had persistent MRD-positive status after postinduction. Patients with MRD evolution pattern 1 had a better time to progression than did patients with the other evolution patterns (not reached versus not reached, versus 15.4 ± 2.4 months, versus 16.9 ± 3.0 months; log-rank test, P = .003, P = .000, and P = .000, respectively). Patients with MRD pattern 1 had a significantly longer overall survival than did patients with pattern 3 (not reached versus 35.2 ± 18.6 months; log-rank test, P = .000) and pattern 4 (not reached versus 23.8 ± 15.0 months, log-rank test, P = .000) but had a similar overall survival as pattern 2 patients (not reached versus not reached; log-rank test, P = .229). For progressing patients with MRD evolution pattern 2 or 3, the median interval of a sustained MRD-negative status was only 17 months and the median time from MRD reappearance to disease progression was only 4.6 months. A more complete MRD evolution pattern was developed to predict the outcomes for patients with MM. The optimal time of MRD assessment should include postinduction and 3rd and 24th month post-transplant. Regular MRD assessments will help detect relapse early. A sustained negative MRD status should last for at least 24 months.
许多关于微小残留病 (MRD) 的问题仍需要回答多发性骨髓瘤 (MM)。对 104 例接受诱导治疗后，在移植后第 3、6、9、12、18 和 24 个月进行了流式细胞术 MRD 监测。揭示了四种 MRD 演变模式：模式 1 患者在诱导后持续 MRD 阴性且无进展；模式 2 患者诱导后 MRD 阳性，但在移植后 24 个月内转为 MRD 阴性；模式 3 患者诱导后 MRD 阴性，但在移植后 24 个月内转为 MRD 阳性；模式 4 患者在诱导后持续 MRD 阳性。MRD 演变模式 1 的患者进展时间优于其他演变模式的患者（未达到与未达到，与 15.4 ± 2.4 个月，与 16.9 ± 3.0 个月；对数秩检验，P=0.003，P=0.000，P=0.000）。MRD 模式 1 的患者总生存期明显长于模式 3（未达到与 35.2 ± 18.6 个月；对数秩检验，P=0.000）和模式 4（未达到与 23.8 ± 15.0 个月，对数秩检验，P=0.000），但与模式 2 患者的总生存期相似（未达到与未达到；对数秩检验，P=0.229）。对于 MRD 演变模式 2 或 3 的进展患者，持续 MRD 阴性状态的中位间隔仅为 17 个月，从 MRD 再现到疾病进展的中位时间仅为 4.6 个月。开发了更完整的 MRD 演变模式来预测 MM 患者的结局。MRD 评估的最佳时间应包括诱导后和移植后第 3 个月和第 24 个月。定期进行 MRD 评估将有助于早期发现复发。持续的阴性 MRD 状态应至少持续 24 个月。
