微小残留病灶阴性不能克服高危多发性骨髓瘤的不良预后：一项单中心回顾性研究。
Minimal Residual Disease Negativity Does Not Overcome Poor Prognosis in High-Risk Multiple Myeloma: A Single-Center Retrospective Study.
机构信息
Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX.
Division of Diagnostic Imaging, Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX.
出版信息
Clin Lymphoma Myeloma Leuk. 2020 May;20(5):e221-e238. doi: 10.1016/j.clml.2020.01.001. Epub 2020 Jan 15.
BACKGROUND
Minimal residual disease (MRD) is a standard measurement for response assessment in multiple myeloma (MM). Despite new treatments, high-risk MM patients continue to have poor prognosis. We evaluated the effect of MRD negativity in high-risk versus standard-risk patients.
PATIENTS AND METHODS
We retrospectively evaluated all consecutive MM patients who underwent routine MRD testing by 1-tube 8-color advanced flow cytometry with 2,000,000 events and sensitivity level 10 at our center from 2015 to 2018 after initial therapy. Kaplan-Meier and log-rank test were used to assess survival estimates and differences between study groups.
RESULTS
One hundred thirty-six patients with MRD testing after initial therapy or autologous stem-cell transplantation were identified. At a median follow-up of 14 months (range, 1-36 months), progression-free survival and overall survival were significantly worse in high-risk versus standard-risk patients. During the study period, 50% of high-risk group had experienced disease progression (relapse and/or death) versus 20% in the standard-risk group (P = .0006). No patients with standard-risk died, but 4 (14%) in the high-risk group did (P = .0007). Regardless of MRD status, high-risk patients had statistically significant worse progression-free survival than standard-risk patients. At median follow-up, those with disease 10% standard-risk/MRD negative; 20% standard-risk/MRD positive; 40% high-risk/MRD negative; and 45% high-risk/MRD positive had either experienced relapse or died (P = .0041). MRD status did not significantly affect overall survival in either group (P = .0914); however, longer follow-up is needed to assess survival.
CONCLUSION
Genetic abnormalities remain a powerful prognostic indicator for MM, regardless of MRD status. For newly diagnosed MM patients treated with novel triple-drug initial therapy and frontline autologous stem-cell transplantation, MRD-negative status did not mitigate the poor-prognosis outcomes of high-risk MM patients.
背景
微小残留病（MRD）是多发性骨髓瘤（MM）疗效评估的标准测量指标。尽管有新的治疗方法，高危 MM 患者的预后仍然较差。我们评估了 MRD 阴性在高危与标准风险患者中的作用。
患者和方法
我们回顾性评估了自 2015 年至 2018 年在我们中心接受初始治疗后，通过 1 管 8 色高级流式细胞术进行常规 MRD 检测的所有连续 MM 患者，该检测具有 200 万个事件和 10 的灵敏度水平。Kaplan-Meier 和对数秩检验用于评估生存估计和研究组之间的差异。
结果
确定了 136 例在初始治疗或自体干细胞移植后进行 MRD 检测的患者。在中位数为 14 个月（范围为 1-36 个月）的随访中，高危组与标准风险组相比，无进展生存期和总生存期明显较差。在研究期间，50%的高危组经历了疾病进展（复发和/或死亡），而标准风险组为 20%（P=0.0006）。标准风险组无患者死亡，但高危组有 4 例（14%）死亡（P=0.0007）。无论 MRD 状态如何，高危患者的无进展生存期均明显低于标准风险患者。在中位数随访时，疾病为 10%标准风险/MRD 阴性、20%标准风险/MRD 阳性、40%高危/MRD 阴性和 45%高危/MRD 阳性的患者中，有复发或死亡（P=0.0041）。MRD 状态在两组中的总生存期均无显著影响（P=0.0914）；然而，需要更长的随访时间来评估生存情况。
结论
无论 MRD 状态如何，遗传异常仍然是 MM 的强大预后指标。对于接受新型三药初始治疗和一线自体干细胞移植治疗的新诊断 MM 患者，MRD 阴性状态并不能减轻高危 MM 患者的不良预后结局。
Zotero 插件