Division of Hematology/Oncology, Department of Medicine, Kameda Medical Center, Chiba, Japan.
Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan.
Blood Adv. 2024 Jan 9;8(1):37-46. doi: 10.1182/bloodadvances.2023011890.
We aimed to improve prognostic predictors in patients with transplant-ineligible multiple myeloma (TIE-MM) by combining baseline circulating clonal tumor cells (CTCs) and positron emission tomography/computed tomography (PET/CT) findings. The factors associated with prognosis were retrospectively investigated in 126 patients with TIE-MM who underwent CTC quantification by multiparameter flow cytometry and PET/CT at the initial presentation. The total lesion glycolysis (TLG) level was calculated using the Metavol software. The median percentage of CTC was 0.06% (range, 0%-4.82%), and 54 patients (42.9%) demonstrated high CTC levels. High CTC levels were associated with significantly poorer progression-free survival (PFS, 2-year 43.4% vs 68.1%; P < .001) and overall survival (OS, 5-year 39.0% vs 68.3%; P < .001). Similarly, high TLG levels significantly worsened the PFS (2-year, 41.2% vs 67.6%; P = .038) and OS (5-year, 37.7% vs 63.1%; P = .019). The multivariate analyses showed that Revised International Staging System (R-ISS) III, high CTC and TLG levels, and complete response were significant prognostic factors for PFS and OS. A novel predictive model was constructed using CTCs, TLG, and R-ISS III. The patients were stratified into 3 groups according to the number of risk factors, revealing an extremely high-risk group with a 2-year PFS of 0% and a 5-year OS of 20%. Patients without any high-risk features had better prognosis, with a 2-year PFS of 78.6% and a 5-year OS of 79.5%. The combination of CTCs and volumetric assessment of PET/CT at diagnosis augments the existing stratification systems and may pave the way for a risk-adapted treatment approach.
我们旨在通过结合基线循环克隆肿瘤细胞（CTC）和正电子发射断层扫描/计算机断层扫描（PET/CT）结果，改善不适合移植的多发性骨髓瘤（TIE-MM）患者的预后预测指标。我们回顾性研究了 126 例 TIE-MM 患者的预后相关因素，这些患者在初始就诊时通过多参数流式细胞术进行了 CTC 定量检测，并进行了 PET/CT 检查。使用 Metavol 软件计算总病变糖酵解（TLG）水平。CTC 的中位数百分比为 0.06%（范围，0%-4.82%），54 例（42.9%）患者的 CTC 水平较高。高 CTC 水平与无进展生存期（PFS，2 年 43.4% vs 68.1%；P<.001）和总生存期（OS，5 年 39.0% vs 68.3%；P<.001）显著更差相关。同样，高 TLG 水平显著恶化 PFS（2 年，41.2% vs 67.6%；P=.038）和 OS（5 年，37.7% vs 63.1%；P=.019）。多变量分析显示，修订后的国际分期系统（R-ISS）III、高 CTC 和 TLG 水平以及完全缓解是 PFS 和 OS 的显著预后因素。使用 CTCs、TLG 和 R-ISS III 构建了一种新的预测模型。根据危险因素的数量将患者分为 3 组，发现一个极高危组 2 年 PFS 为 0%，5 年 OS 为 20%。没有任何高危特征的患者预后更好，2 年 PFS 为 78.6%，5 年 OS 为 79.5%。在诊断时结合 CTC 和 PET/CT 容积评估可增强现有的分层系统，并为适应风险的治疗方法铺平道路。
