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多发性骨髓瘤不同疾病阶段骨髓内残留正常浆细胞的临床意义。

Clinical implications of residual normal plasma cells within bone marrow across various disease stages in multiple myeloma.

作者信息

Yan Wenqiang, Shi Lihui, Xu Jingyu, Li Lingna, Cui Jian, Liu Yuntong, Zhou Jieqiong, Du Chenxing, Yu Tengteng, Zhang Shuaishuai, Lv Rui, Sui Weiwei, Deng Shuhui, Li Xiaoqing, Du Xin, Xu Yan, Zou Dehui, Qiu Lugui, Hao Mu, An Gang

机构信息

State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China.

Tianjin Institutes of Health Science, Tianjin, 301600, China.

出版信息

Leukemia. 2024 Oct;38(10):2235-2245. doi: 10.1038/s41375-024-02366-9. Epub 2024 Aug 2.


DOI:10.1038/s41375-024-02366-9
PMID:39095502
Abstract

Residual normal plasma cells (NPCs), which compete with tumor plasma cells, play an important role in multiple myeloma. However, large-scale cohort studies investigating residual NPCs, especially at the minimal residual disease (MRD) phase, are currently lacking. In this study, we conducted a comprehensive investigation into the clinical significance of residual NPCs throughout the entire disease course in 1363 myeloma patients from the NICHE cohort (NCT04645199). Our results revealed that myeloma patients with high baseline NPCs ratio (≥5%) exhibited distinct indolent features, characterized by lower tumor burden, reduced frequencies of cytopenia, immunoparesis, and high-risk cytogenetics. Importantly, high residual NPCs ratio at diagnosis or relapse was independently associated with favorable survival. High absolute percentages of NPCs at undetectable MRD were related with superior clinical benefit and immune reconstitution. At MRD-positive phases, grouping based on NPCs ratio (<50%, 50-90%, ≥90%) demonstrated better risk stratification compared to residual tumor log levels. Based on the time-dependent NPCs ratio trend, we developed a dynamic MRD model that classifies patients into three groups with diverse longitudinal trends, leading to distinct prognoses. Collectively, residual NPCs serves not only as a valuable complementary biomarker for risk stratification but also provides valuable insights on reclassifications and kinetics of MRD.

摘要

与肿瘤浆细胞相互竞争的残留正常浆细胞(NPCs)在多发性骨髓瘤中发挥着重要作用。然而,目前缺乏对残留NPCs进行大规模队列研究,尤其是在微小残留病(MRD)阶段。在本研究中,我们对来自NICHE队列(NCT04645199)的1363例骨髓瘤患者整个疾病过程中残留NPCs的临床意义进行了全面调查。我们的结果显示,基线NPCs比例高(≥5%)的骨髓瘤患者表现出明显的惰性特征,其特点是肿瘤负荷较低、血细胞减少、免疫球蛋白缺乏和高危细胞遗传学的发生率降低。重要的是,诊断或复发时高残留NPCs比例与良好的生存独立相关。在不可检测的MRD时,NPCs的高绝对百分比与更好的临床获益和免疫重建相关。在MRD阳性阶段,基于NPCs比例(<50%、50-90%、≥90%)分组比残留肿瘤对数水平显示出更好的风险分层。基于时间依赖性NPCs比例趋势,我们开发了一种动态MRD模型,将患者分为具有不同纵向趋势的三组,导致不同的预后。总体而言,残留NPCs不仅作为风险分层的有价值的补充生物标志物,而且为MRD的重新分类和动力学提供了有价值的见解。

相似文献

[1]
Clinical implications of residual normal plasma cells within bone marrow across various disease stages in multiple myeloma.

Leukemia. 2024-10

[2]
Minimal residual disease and log-reduction of plasma cells are associated with superior response after double autologous stem cell transplant in younger patients with multiple myeloma.

Cytometry B Clin Cytom. 2018-12-13

[3]
Utility and feasibility of a six-color multiparametric flow cytometry for measurable residual disease analysis in plasma cell myeloma in resource-limited settings with 5-year survival data.

J Cancer Res Ther. 2021

[4]
Clinical Benefit of Autologous Stem Cell Transplantation for Patients with Multiple Myeloma Achieving Undetectable Minimal Residual Disease after Induction Treatment.

Cancer Res Commun. 2023-9

[5]
Prognostic value of minimal residual disease and polyclonal plasma cells in myeloma patients achieving a complete response to therapy.

Am J Hematol. 2019-4-30

[6]
Minimal residual disease negativity using deep sequencing is a major prognostic factor in multiple myeloma.

Blood. 2018-9-24

[7]
Monitoring the cytogenetic architecture of minimal residual plasma cells indicates therapy-induced clonal selection in multiple myeloma.

Leukemia. 2019-10-7

[8]
Longitudinal minimal residual disease assessment in multiple myeloma patients in complete remission - results from the NMSG flow-MRD substudy within the EMN02/HO95 MM trial.

BMC Cancer. 2022-2-5

[9]
Longitudinal genetically detectable minimal residual disease by fluorescence hybridization confers a poor prognosis in myeloma.

Ther Adv Med Oncol. 2024-1-19

[10]
Methodological considerations for the high sensitivity detection of multiple myeloma measurable residual disease.

Cytometry B Clin Cytom. 2020-3

本文引用的文献

[1]
Determining hemodilution in diagnostic bone marrow aspirated samples in plasma cell disorders by next-generation flow cytometry: Proposal for a bone marrow quality index.

Blood Cancer J. 2023-12-1

[2]
Immunophenotypic correlates of sustained MRD negativity in patients with multiple myeloma.

Nat Commun. 2023-9-2

[3]
Single cell clonotypic and transcriptional evolution of multiple myeloma precursor disease.

Cancer Cell. 2023-6-12

[4]
Single cell characterization of myeloma and its precursor conditions reveals transcriptional signatures of early tumorigenesis.

Nat Commun. 2022-11-17

[5]
MRD in multiple myeloma: does CR really matter?

Blood. 2022-12-8

[6]
Minimal Residual Disease After Autologous Stem-Cell Transplant for Patients With Myeloma: Prognostic Significance and the Impact of Lenalidomide Maintenance and Molecular Risk.

J Clin Oncol. 2022-9-1

[7]
Diagnosis and Management of Multiple Myeloma: A Review.

JAMA. 2022-2-1

[8]
Roadmap to cure multiple myeloma.

Cancer Treat Rev. 2021-11

[9]
Dynamics of minimal residual disease in patients with multiple myeloma on continuous lenalidomide maintenance: a single-arm, single-centre, phase 2 trial.

Lancet Haematol. 2021-6

[10]
Multiple myeloma.

Lancet. 2021-1-30

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