Division of Hematology, Mayo Clinic, Rochester, MN, USA.
Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL, USA.
Blood Cancer J. 2023 Apr 5;13(1):47. doi: 10.1038/s41408-023-00820-y.
Bone marrow (BM) assessment of minimal residual disease (MRD) is prognostic for survival in multiple myeloma (MM). BM is still hypocellular at month 1 post CAR-T, thus the value of MRD negative (MRDneg) status at this timepoint is unclear. We examined the impact of month 1 BM MRD status in MM patients who received CART at Mayo Clinic between 8/2016 and 6/2021. Among 60 patients, 78% were BM-MRDneg at month 1; and 85% (40/47) of these patients also had decreased to less than normal level of both involved and uninvolved free light chain (FLC < NL). Patients who achieved CR/sCR had higher rates of month 1 BM-MRDneg and FLC < NL. The rate of sustained BM-MRDneg was 40% (19/47). Rate of conversion from MRDpos to MRDneg was 5%(1/20). At month 1, 38%(18/47) of the BM-MRDneg were hypocellular. Recovery to normal cellularity was observed in 50%(7/14) with a median time to normalization at 12 months (range: 3-Not reached). Compared to Month 1 BM-MRDpos patients, patients who were BM-MRDneg had longer PFS irrespective of BM cellularity [PFS: 2.9 months (95% CI, 1.2-NR) vs. 17.5 months (95% CI, 10.4-NR), p < 0.0001]. Month 1 BM-MRDneg and FLC below normal were associated with prolonged survival. Our data support the continued evaluation of BM early post-CART infusion as a prognostic tool.
骨髓（BM）微小残留病灶（MRD）评估对多发性骨髓瘤（MM）的生存具有预后价值。CAR-T 治疗后 1 个月时骨髓仍呈低细胞状态，因此此时 MRD 阴性（MRDneg）状态的价值尚不清楚。我们研究了在 2016 年 8 月至 2021 年 6 月期间在梅奥诊所接受 CART 的 MM 患者中，1 个月时 BM MRD 状态的影响。在 60 例患者中，78%在 1 个月时为 BM-MRDneg；其中 85%（40/47）的患者同时也使受累和未受累游离轻链（FLC）均降至低于正常值（FLC<NL）。达到完全缓解/严格意义完全缓解（CR/sCR）的患者 1 个月时 BM-MRDneg 和 FLC<NL 的比例更高。持续 BM-MRDneg 的比例为 40%（19/47）。从 MRDpos 转为 MRDneg 的转化率为 5%（1/20）。在 1 个月时，47%的 BM-MRDneg 骨髓呈低细胞状态。有 50%（7/14）的患者恢复到正常细胞状态，中位恢复正常细胞时间为 12 个月（范围：3-未达到）。与 1 个月时 BM-MRDpos 患者相比，无论 BM 细胞数量如何，BM-MRDneg 的患者无进展生存期（PFS）更长[PFS：2.9 个月（95%CI，1.2-NR）与 17.5 个月（95%CI，10.4-NR），p<0.0001]。1 个月时 BM-MRDneg 和 FLC 低于正常与生存期延长相关。我们的数据支持在 CAR-T 输注后早期继续评估 BM 作为一种预后工具。
