Yang G Z, Wang G R, Wang H J, Zhang Y R, Wu Y, Li Y C, Liu A J, Leng Y, Gao W, Chen W M
Department of Hematology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China.
Zhonghua Yi Xue Za Zhi. 2022 Aug 16;102(30):2345-2350. doi: 10.3760/cma.j.cn112137-20211226-02892.
To investigate the clinical prognostic value of dynamic minimal residual disease (MRD) after autologous hematopoietic stem cell transplantation (AHSCT) in patients with multiple myeloma (MM). Patients with MM who underwent AHSCT in Beijing Chao-Yang Hospital from February 2016 to December 2019 were enrolled in this study. All the patients in the study had complete baseline data at the diagnosis. AHSCT was performed after induction chemotherapy. Response evaluation was performed after induction therapy. All the patients were assessed at approximately 100 days after AHSCT. Bone marrow MRD by NGF was performed every three months and dynamically monitored for at least 12 months. All the patients were divided into different groups according to cytogenetics and MRD status. Survivals in different groups were analyzed by IBM SPSS 22.0 statistical software. A total of 150 patients with MM were enrolled in this study at last, including 66 patients in the cytogenetic standard risk group and 84 patients in the cytogenetic high-risk group. The median age was 54 years (range 30-68 years) and 87 male patients (58.0%) was in the study. The median follow-up was 36 months (range 16-72 months). Patients in the standard-risk group had better clinical prognosis than those in the high-risk group [median PFS in the standard-risk group was not achieved, and median PFS in the high-risk group was 45 months (<0.001); median OS of both groups was not reached, and the estimated 3-year OS rate of the standard-risk group and the high-risk group was 95.2% and 78.9%, respectively (=0.001)]. According to MRD status of patients, patients in each group were divided into three subgroups: persistent positive (Ppos), transient negative (Tneg) and persistent negative (Pneg). The median OS and median PFS of all subgroups in the standard-risk group was not reached (0.324 and 0.086). In high-risk group, the median OS of MRD Pneg subgroup was not reached, and the estimated 3-year OS rate was 100%; The median OS of MRD Ppos subgroup was 52 months, and MRD Tneg subgroup only 31 months (=0.002); the median PFS of MRD Pneg group was not reached, and the estimated 3-year PFS rate was 85.4%; median PFS of MRD Ppos subgroup was 40 months, and MRD Tneg subgroup only 17 months (=0.001). MRD Pneg might overcome the adverse prognosis of MM patients with high-risk cytogenetics. However, MRD Tneg might be a poor prognostic factor for the patients with cytogenetic high-risk MM.
探讨自体造血干细胞移植（AHSCT）后动态微小残留病（MRD）在多发性骨髓瘤（MM）患者中的临床预后价值。选取2016年2月至2019年12月在北京朝阳医院接受AHSCT的MM患者纳入本研究。研究中的所有患者在诊断时均有完整的基线数据。诱导化疗后进行AHSCT。诱导治疗后进行疗效评估。所有患者在AHSCT后约100天进行评估。每三个月进行一次基于NGF的骨髓MRD检测，并动态监测至少12个月。根据细胞遗传学和MRD状态将所有患者分为不同组。采用IBM SPSS 22.0统计软件分析不同组的生存率。本研究最终共纳入150例MM患者，其中细胞遗传学标准风险组66例，细胞遗传学高危组84例。中位年龄为54岁（范围30 - 68岁），研究中有87例男性患者（58.0%）。中位随访时间为36个月（范围16 - 72个月）。标准风险组患者的临床预后优于高危组[标准风险组未达到中位无进展生存期（PFS），高危组中位PFS为45个月（<0.001）；两组中位总生存期（OS）均未达到，标准风险组和高危组的3年OS估计率分别为95.2%和78.9%（=0.001）]。根据患者的MRD状态，每组患者又分为三个亚组：持续阳性（Ppos）、短暂阴性（Tneg）和持续阴性（Pneg）。标准风险组所有亚组的中位OS和中位PFS均未达到（0.324和0.086）。高危组中，MRD Pneg亚组的中位OS未达到，3年OS估计率为100%；MRD Ppos亚组的中位OS为52个月，而MRD Tneg亚组仅为31个月（=0.002）；MRD Pneg组的中位PFS未达到，3年PFS估计率为85.4%；MRD Ppos亚组的中位PFS为40个月，MRD Tneg亚组仅为17个月（=0.001）。MRD Pneg可能克服细胞遗传学高危MM患者的不良预后。然而，MRD Tneg可能是细胞遗传学高危MM患者的不良预后因素。
