Lasa Marta, Notarfranchi Laura, Agullo Cristina, Gonzalez Carmen, Castro Sergio, Perez Jose J, Burgos Leire, Guerrero Camila, Calasanz Maria Jose, Flores-Montero Juan, Oriol Albert, Bargay Joan, Rios Rafael, Cabañas Valentin, Cabrera Carmen, Martinez-Martinez Rafael, Encinas Cristina, De Arriba Felipe, Hernandez Miguel-Teodoro, Palomera Luis, Orfao Alberto, Martinez-Lopez Joaquin, Mateos Maria-Victoria, San-Miguel Jesus, Lahuerta Juan Jose, Rosiñol Laura, Blade Joan, Cedena Maria Teresa, Puig Noemi, Paiva Bruno
Cancer Center Clinica Universidad de Navarra, Centro de Investigacion Medica Aplicada, Instituto de Investigacion Sanitaria de Navarra, CIBER-ONC CB16/12/00369 and CB16/12/00489, Pamplona, Spain.
Department of Medicine and Surgery, University of Parma, Parma, Italy.
J Clin Oncol. 2025 Jan 10;43(2):125-132. doi: 10.1200/JCO.24.00635. Epub 2024 Oct 1.
JCO In multiple myeloma (MM), measurable residual disease (MRD) is assessed in bone marrow (BM). However, less invasive evaluation of peripheral residual disease (PRD) in blood could be advantageous and less cumbersome. We investigated the prognostic value of PRD monitoring after 24 cycles of maintenance in 138 transplant-eligible patients with MM enrolled in the GEM2012MENOS65/GEM2014MAIN clinical trials. PRD was assessed using next-generation flow (NGF) and mass spectrometry (MS). Positive PRD by NGF in 16/138 (11.5%) patients was associated with a 13-fold increased risk of progression and/or death; median progression-free survival (PFS) and overall survival (OS) were 2.5 and 47 months, respectively. Considering patients' MRD status in BM as the reference, PRD detection using NGF showed positive and negative predictive values of 100% and 73%, respectively. Presence of PRD helped identifying patients at risk of imminent progression among those with positive MRD in BM. Patients with undetectable PRD according to both NGF and MS showed 2-year PFS and OS rates of 97% and 100%, respectively. In multivariate analyses including the Revised International Staging System and the complete remission status, only MRD in BM and PRD by NGF showed independent prognostic value for PFS. This study supports the use of less invasive PRD monitoring during maintenance or observation in transplant-eligible patients with MM.
在多发性骨髓瘤（MM）中，可测量残留病（MRD）是在骨髓（BM）中进行评估的。然而，对外周血中残留病（PRD）进行侵入性较小的评估可能更具优势且更简便。我们在参加GEM2012MENOS65/GEM2014MAIN临床试验的138例适合移植的MM患者中，研究了24个周期维持治疗后PRD监测的预后价值。使用下一代流式细胞术（NGF）和质谱法（MS）评估PRD。138例患者中有16例（11.5%）通过NGF检测出PRD阳性，其疾病进展和/或死亡风险增加了13倍；无进展生存期（PFS）和总生存期（OS）的中位数分别为2.5个月和47个月。以患者BM中的MRD状态作为参考，使用NGF检测PRD的阳性预测值和阴性预测值分别为100%和73%。PRD的存在有助于在BM中MRD阳性的患者中识别出即将进展的高危患者。根据NGF和MS均检测不到PRD的患者，其2年PFS率和OS率分别为97%和100%。在包括修订的国际分期系统和完全缓解状态的多变量分析中，仅BM中的MRD和NGF检测的PRD对PFS具有独立的预后价值。本研究支持在适合移植的MM患者维持治疗或观察期间使用侵入性较小的PRD监测。
