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1
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Zhu LY, Hu QL, Zhang L, Li ZJ. The role of minimal residual disease and serum free light chain ratio in the management of multiple myeloma. Discov Oncol 2024; 15:229. [PMID: 38877340 PMCID: PMC11178694 DOI: 10.1007/s12672-024-01090-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 06/09/2024] [Indexed: 06/16/2024] Open
Abstract
Multiple myeloma (MM) denotes a cancerous growth characterized by abnormal proliferation of plasma cells. Growing evidence suggests that the complexity in addressing MM lies in the presence of minimal residual disease (MRD) within the body. MRD assessment is becoming increasingly important for risk assessment in patients with MM. Similarly, the levels of serum free protein light chain and their ratio play a crucial role in assessing the disease burden and changes in MM. In this paper, we review and explore the utilization of MRD and serum free light chain ratio in the treatment of MM, delving into their respective characteristics, advantages, disadvantages, and their interrelation.
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Affiliation(s)
- Long-Ying Zhu
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, People's Republic of China
- Department of Clinical Laboratory, First People's Hospital of Linping District, Hangzhou, 311100, Zhejiang, People's Republic of China
| | - Qi-Lei Hu
- Department of Clinical Laboratory, First People's Hospital of Linping District, Hangzhou, 311100, Zhejiang, People's Republic of China
| | - Liang Zhang
- Department of Clinical Laboratory, First People's Hospital of Linping District, Hangzhou, 311100, Zhejiang, People's Republic of China
| | - Zuo-Jie Li
- Department of Clinical Laboratory, The People's Hospital of Cangnan Zhejiang, No. 2288 Yucang Road, Cangnan County, Wenzhou, Zhejiang, 325800, People's Republic of China.
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2
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Kriegsmann K, Hundemer M, Hofmeister-Mielke N, Reichert P, Manta CP, Awwad MH, Sauer S, Bertsch U, Besemer B, Fenk R, Hänel M, Munder M, Weisel KC, Blau IW, Neubauer A, Müller-Tidow C, Raab MS, Goldschmidt H, Huhn S. Comparison of NGS and MFC Methods: Key Metrics in Multiple Myeloma MRD Assessment. Cancers (Basel) 2020; 12:cancers12082322. [PMID: 32824635 PMCID: PMC7464347 DOI: 10.3390/cancers12082322] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/05/2020] [Accepted: 08/06/2020] [Indexed: 11/16/2022] Open
Abstract
In order to meet the challenges in data evaluation and comparability between studies in multiple myeloma (MM) minimal residual disease (MRD) assessment, the goal of the current study was to provide a step-by-step evaluation of next-generation sequencing (NGS) and multicolor flow cytometry (MFC) data. Bone marrow (BM) sample pairs from 125 MM patients were analyzed by NGS and MFC MM MRD methods. Tumor load (TL) and limit of detection (LOD) and quantification (LOQ) were calculated. The best-fit MRD cut-off was chosen as 1 × 10−5, resulting in an overall 9.6% (n overall = 12 (NGS n = 2, MFC n = 10)) nonassessable cases. The overall concordance rate between NGS and MFC was 68.0% (n = 85); discordant results were found in 22.4% (11.2% (n = 14) of cases in each direction. Overall, 55.1% (n = 60/109) and 49.5% (n = 54/109) of patients with a serological response ≥ very good partial response (VGPR) showed BM MRD negativity by NGS and MFC, respectively. A good correlation in the TL assessed by both techniques was found (correlation coefficient = 0.8, n = 40, p < 0.001). Overall, our study shows good concordance between MM BM MRD status and TL when comparing NGS and MFC at a threshold of 10–5. However, a sufficient number of analyzed events and calculation of MRD key metrics are essential for the comparison of methods and evaluability of data at a specific MRD cut-off.
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Affiliation(s)
- Katharina Kriegsmann
- Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (N.H.-M.); (P.R.); (C.-P.M.); (M.H.S.A.); (S.S.); (U.B.); (C.M.-T.); (M.S.R.); (H.G.); (S.H.)
- Correspondence: (K.K.); (M.H.); Tel.: +49-6221-5637238 (K.K.); +49-6221-5639481 (M.H.)
| | - Michael Hundemer
- Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (N.H.-M.); (P.R.); (C.-P.M.); (M.H.S.A.); (S.S.); (U.B.); (C.M.-T.); (M.S.R.); (H.G.); (S.H.)
- Correspondence: (K.K.); (M.H.); Tel.: +49-6221-5637238 (K.K.); +49-6221-5639481 (M.H.)
| | - Nicole Hofmeister-Mielke
- Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (N.H.-M.); (P.R.); (C.-P.M.); (M.H.S.A.); (S.S.); (U.B.); (C.M.-T.); (M.S.R.); (H.G.); (S.H.)
| | - Philipp Reichert
- Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (N.H.-M.); (P.R.); (C.-P.M.); (M.H.S.A.); (S.S.); (U.B.); (C.M.-T.); (M.S.R.); (H.G.); (S.H.)
| | - Calin-Petru Manta
- Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (N.H.-M.); (P.R.); (C.-P.M.); (M.H.S.A.); (S.S.); (U.B.); (C.M.-T.); (M.S.R.); (H.G.); (S.H.)
| | - Mohamed H.S. Awwad
- Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (N.H.-M.); (P.R.); (C.-P.M.); (M.H.S.A.); (S.S.); (U.B.); (C.M.-T.); (M.S.R.); (H.G.); (S.H.)
| | - Sandra Sauer
- Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (N.H.-M.); (P.R.); (C.-P.M.); (M.H.S.A.); (S.S.); (U.B.); (C.M.-T.); (M.S.R.); (H.G.); (S.H.)
| | - Uta Bertsch
- Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (N.H.-M.); (P.R.); (C.-P.M.); (M.H.S.A.); (S.S.); (U.B.); (C.M.-T.); (M.S.R.); (H.G.); (S.H.)
- National Center for Tumor Diseases Heidelberg, 69120 Heidelberg, Germany
| | - Britta Besemer
- Department of Hematology, Oncology and Immunology, University Hospital Tübingen, 72076 Tübingen, Germany;
| | - Roland Fenk
- Department of Hematology, Oncology and Clinical Immunology, University Hospital Düsseldorf, 40225 Düsseldorf, Germany;
| | - Mathias Hänel
- Department of Internal Medicine III, Klinikum Chemnitz, 09113 Chemnitz, Germany;
| | - Markus Munder
- Department of Internal Medicine III, University Medical Center Mainz, 55131 Mainz, Germany;
| | - Katja C. Weisel
- Department of Oncology, Hematology and Bone Marrow Transplantation with Department of Pneumology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany;
| | - Igor W. Blau
- Medical Clinic, Charité University Medicine Berlin, 10117 Berlin, Germany;
| | - Andreas Neubauer
- Department of Hematology, Oncology and Immunology, Philipps-University Marburg, 35043 Marburg, Germany;
| | - Carsten Müller-Tidow
- Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (N.H.-M.); (P.R.); (C.-P.M.); (M.H.S.A.); (S.S.); (U.B.); (C.M.-T.); (M.S.R.); (H.G.); (S.H.)
| | - Marc S. Raab
- Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (N.H.-M.); (P.R.); (C.-P.M.); (M.H.S.A.); (S.S.); (U.B.); (C.M.-T.); (M.S.R.); (H.G.); (S.H.)
| | - Hartmut Goldschmidt
- Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (N.H.-M.); (P.R.); (C.-P.M.); (M.H.S.A.); (S.S.); (U.B.); (C.M.-T.); (M.S.R.); (H.G.); (S.H.)
- National Center for Tumor Diseases Heidelberg, 69120 Heidelberg, Germany
| | - Stefanie Huhn
- Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (N.H.-M.); (P.R.); (C.-P.M.); (M.H.S.A.); (S.S.); (U.B.); (C.M.-T.); (M.S.R.); (H.G.); (S.H.)
- National Center for Tumor Diseases Heidelberg, 69120 Heidelberg, Germany
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3
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Patel DA, Gopalakrishnan R, Engelhardt BG, McArthur E, Sengsayadeth S, Culos KA, Byrne M, Goodman S, Savani BN, Chinratanalab W, Jagasia M, Mosse CA, Cornell RF, Kassim AA. Minimal residual disease negativity and lenalidomide maintenance therapy are associated with superior survival outcomes in multiple myeloma. Bone Marrow Transplant 2020; 55:1137-1146. [PMID: 31992845 DOI: 10.1038/s41409-020-0791-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 12/02/2019] [Accepted: 01/13/2020] [Indexed: 12/19/2022]
Abstract
Modern combinations of therapies for multiple myeloma have led to improvement in survival outcomes with near 100% overall response rate and 25% complete response rates, particularly with autologous hematopoietic cell transplant (AHCT). Minimal residual disease (MRD) assessment with multiparameter flow cytometry is a valid prognostic biomarker for progression-free survival (PFS) and overall survival (OS). However, few data exist regarding whether MRD positivity or negativity will meaningfully influence treatment decisions. We evaluated 433 patients who received induction therapy, followed by AHCT. Participants had MRD assessment by multiparameter flow cytometry before and at days +100 and +365 following AHCT. They also received either lenalidomide, bortezomib, or no maintenance therapy following AHCT. Maintenance treatment with lenalidomide improved MRD negativity at day +365 compared to bortezomib (92.9% vs 41.6%, p = 0.01), or no maintenance therapy (92.9% vs 24.4%, p = 0.012). The median PFS for patients who were MRD negative at day + 365 was 42 vs 17.5 months (p < 0.001) and median OS was 80.6 vs 59 months (p = 0.02). Maintenance therapy following AHCT for multiple myeloma improves the depth of response as assessed by MRD.
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Affiliation(s)
- Dilan A Patel
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ragisha Gopalakrishnan
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Brian G Engelhardt
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Medicine, Division of Hematology/Oncology, Hematology and Stem Cell Transplant, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Evonne McArthur
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Salyka Sengsayadeth
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Medicine, Division of Hematology/Oncology, Hematology and Stem Cell Transplant, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Katie A Culos
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael Byrne
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Medicine, Division of Hematology/Oncology, Hematology and Stem Cell Transplant, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Stacey Goodman
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Medicine, Division of Hematology/Oncology, Hematology and Stem Cell Transplant, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bipin N Savani
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Medicine, Division of Hematology/Oncology, Hematology and Stem Cell Transplant, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Wichai Chinratanalab
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Medicine, Division of Hematology/Oncology, Hematology and Stem Cell Transplant, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Madan Jagasia
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Medicine, Division of Hematology/Oncology, Hematology and Stem Cell Transplant, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Claudio A Mosse
- Department of Pathology, Microbiology, Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
- Pathology and Laboratory Medicine, VA Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Robert F Cornell
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Medicine, Division of Hematology/Oncology, Hematology and Stem Cell Transplant, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Adetola A Kassim
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA.
- Department of Medicine, Division of Hematology/Oncology, Hematology and Stem Cell Transplant, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA.
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4
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Tyler J, Kumer L, Fisher C, Casey H, Shike H. Personalized Chimerism Test that Uses Selection of Short Tandem Repeat or Quantitative PCR Depending on Patient's Chimerism Status. J Mol Diagn 2019; 21:483-490. [PMID: 30797064 DOI: 10.1016/j.jmoldx.2019.01.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 01/14/2019] [Accepted: 01/29/2019] [Indexed: 12/11/2022] Open
Abstract
Chimerism testing is used to monitor engraftment and risk of relapse after allogeneic hematopoietic stem cell transplantation for hematologic malignancies. Although short tandem repeat (STR) method is widely used among clinical laboratories, quantitative PCR (qPCR) provides better sensitivity (0.1%) than STR (1% to 5%) but is less accurate than STR for patients in mixed chimerism. qPCR chimerism allows evaluation of residual recipient cells as a surrogate of measurable residual disease. To achieve higher sensitivity and accuracy, we applied qPCR or STR based on patient chimerism status (recipient alleles <5% or ≥5%, respectively). Of the 230 patients tested by STR in a 1-year period, excluding 10 deceased patients, 30 qPCR markers were genotyped and 167 patients converted to qPCR chimerism (76%), including eight patients undergoing multiple-donor transplantation. STR was continued on 53 patients (24%) for the following reasons: mixed chimerism (n = 23), lack of donor or pretransplantation DNA (n = 22), and insufficient qPCR informative markers [8 of 60 patients with related donors (13.3%)]. qPCR detected residual recipient chimerism in 85.5% of patients with complete chimerism by STR (<5% recipient). Selecting STR or qPCR testing based on each patient's chimerism status facilitates sensitive and accurate chimerism testing in clinical settings. In addition, we discuss clinical relevance of chimerism testing for measurable residual disease detection in various hematologic malignancies.
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Affiliation(s)
- Jennifer Tyler
- Department of Pathology, Histocompatibility, and Immunogenetics, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Lorie Kumer
- Department of Pathology, Histocompatibility, and Immunogenetics, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Carolyn Fisher
- Department of Pathology, Histocompatibility, and Immunogenetics, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Heather Casey
- Department of Pathology, Histocompatibility, and Immunogenetics, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Hiroko Shike
- Department of Pathology, Histocompatibility, and Immunogenetics, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania.
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5
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Scott SD, Fletcher M, Whitehouse H, Whitby L, Yuan C, Mazzucchelli S, Lin P, de Tute R, Dorwal P, Wallace PK, Tembhare P, Arroz M, Snowden JA, Chantry AD, Barnett D. Assessment of plasma cell myeloma minimal residual disease testing by flow cytometry in an international inter‐laboratory study: Is it ready for primetime use? CYTOMETRY PART B-CLINICAL CYTOMETRY 2018; 96:201-208. [DOI: 10.1002/cyto.b.21754] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 10/26/2018] [Accepted: 11/15/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Stuart D. Scott
- UK NEQAS for Leucocyte ImmunophenotypingSheffield Teaching Hospitals Sheffield UK
- Department of Oncology and Metabolism, Faculty of Medicine, Dentistry and HealthUniversity of Sheffield Sheffield UK
| | - Matthew Fletcher
- UK NEQAS for Leucocyte ImmunophenotypingSheffield Teaching Hospitals Sheffield UK
| | - Helen Whitehouse
- UK NEQAS for Leucocyte ImmunophenotypingSheffield Teaching Hospitals Sheffield UK
| | - Liam Whitby
- UK NEQAS for Leucocyte ImmunophenotypingSheffield Teaching Hospitals Sheffield UK
| | - Constance Yuan
- Clinical Flow Cytometry Laboratory, Laboratory of PathologyCCR, NCI, NIH Bethesda Maryland
| | - Silvia Mazzucchelli
- Department of Haematology and Flow CytometrySynlab Suisse SA Bioggio Switzerland
| | - Pei Lin
- Department of HematopathologyMD Anderson Cancer Center Houston Texas
| | - Ruth de Tute
- HMDS, Department of HaematologySt. James's Institute of Oncology Leeds UK
| | - Pranav Dorwal
- Flow Cytometry LaboratoryWaikato Hospital Hamilton New Zealand
| | - Paul K. Wallace
- Department of Flow and Image CytometryRoswell Park Cancer Institute Buffalo New York
| | - Prashant Tembhare
- Hematopathology LaboratoryTata Memorial Center Mumbai Maharashtra India
| | - Maria Arroz
- Flow Cytometry Laboratory, Department of Clinical PathologyCHLO S. Francisco Xavier Hospital Lisbon Portugal
| | - John A. Snowden
- Department of Oncology and Metabolism, Faculty of Medicine, Dentistry and HealthUniversity of Sheffield Sheffield UK
- Department of HaematologySheffield Teaching Hospitals NHS Foundation Trust Sheffield UK
| | - Andrew D. Chantry
- Department of Oncology and Metabolism, Faculty of Medicine, Dentistry and HealthUniversity of Sheffield Sheffield UK
- Department of HaematologySheffield Teaching Hospitals NHS Foundation Trust Sheffield UK
| | - David Barnett
- UK NEQAS for Leucocyte ImmunophenotypingSheffield Teaching Hospitals Sheffield UK
- Department of Oncology and Metabolism, Faculty of Medicine, Dentistry and HealthUniversity of Sheffield Sheffield UK
- Department of HaematologySheffield Teaching Hospitals NHS Foundation Trust Sheffield UK
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6
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Clark CA, Mosse CA, Chen H, Byrne M, Chinratanalab W, Engelhardt BG, Goodman SA, Harrell SL, Kassim AA, Savani BN, Sengsayadeth S, Jagasia M, Cornell RF. Prospective trial of minimal residual disease assessment by multiparametric flow cytometry for multiple myeloma in the era of bortezomib-based chemotherapy. Bone Marrow Transplant 2018; 53:1589-1592. [PMID: 29915217 DOI: 10.1038/s41409-018-0241-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/06/2018] [Accepted: 05/11/2018] [Indexed: 12/31/2022]
Affiliation(s)
- C Amos Clark
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Claudio A Mosse
- Department of Hematopathology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Heidi Chen
- Division of Biostatistics and Quantitative Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michael Byrne
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Wichai Chinratanalab
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Brian G Engelhardt
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Stacey A Goodman
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Shelton L Harrell
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Adetola A Kassim
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Bipin N Savani
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Salyka Sengsayadeth
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Madan Jagasia
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - R Frank Cornell
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
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7
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Tembhare PR, Ghogale S, Tauro W, Badrinath Y, Deshpande N, Kedia S, Cherian K, Patkar NV, Chatterjee G, Gujral S, Subramanian PG. Evaluation of CD229 as a new alternative plasma cell gating marker in the flow cytometric immunophenotyping of monoclonal gammopathies. CYTOMETRY PART B-CLINICAL CYTOMETRY 2018; 94:509-519. [DOI: 10.1002/cyto.b.21619] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Revised: 12/07/2017] [Accepted: 12/21/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Prashant R. Tembhare
- Hematopathology Laboratory; ACTREC, Tata Memorial Centre; Kharghar, Navi, Mumbai 410210 India
| | - Sitaram Ghogale
- Hematopathology Laboratory; ACTREC, Tata Memorial Centre; Kharghar, Navi, Mumbai 410210 India
| | - Wilma Tauro
- Hematopathology Laboratory; ACTREC, Tata Memorial Centre; Kharghar, Navi, Mumbai 410210 India
| | - Yajamanam Badrinath
- Hematopathology Laboratory; ACTREC, Tata Memorial Centre; Kharghar, Navi, Mumbai 410210 India
| | - Nilesh Deshpande
- Hematopathology Laboratory; ACTREC, Tata Memorial Centre; Kharghar, Navi, Mumbai 410210 India
| | - Shweta Kedia
- Hematopathology Laboratory; ACTREC, Tata Memorial Centre; Kharghar, Navi, Mumbai 410210 India
| | - Keziah Cherian
- Hematopathology Laboratory; ACTREC, Tata Memorial Centre; Kharghar, Navi, Mumbai 410210 India
| | - Nikhil V. Patkar
- Hematopathology Laboratory; ACTREC, Tata Memorial Centre; Kharghar, Navi, Mumbai 410210 India
| | - Gaurav Chatterjee
- Hematopathology Laboratory; ACTREC, Tata Memorial Centre; Kharghar, Navi, Mumbai 410210 India
| | - Sumeet Gujral
- Department of Pathology; Tata Memorial Hospital; Parel, Mumbai 400012 India
| | - Papagudi G. Subramanian
- Hematopathology Laboratory; ACTREC, Tata Memorial Centre; Kharghar, Navi, Mumbai 410210 India
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8
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ELDA qASO-PCR for High Sensitivity Detection of Tumor Cells in Bone Marrow and Peripheral Blood. Methods Mol Biol 2018; 1792:1-14. [PMID: 29797248 DOI: 10.1007/978-1-4939-7865-6_1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A quantitative allele-specific polymerase chain reaction in combination with an extreme limiting dilution approach (ELDA qASO-PCR) enables the detection of tumor cells in patients with multiple myeloma (MM) in bone marrow (BM) samples and in peripheral blood (PB) with a sensitivity of <10-6. The two-step procedure of patient-specific tumor cell identification via the immunoglobulin heavy chain (IgH) and kappa/lambda light chain (k/λ LC) locus, followed by tumor cells quantification by ELDA qASO-PCR allows for the application of this method to the majority of MM patients, including those with Bence Jones proteinuria.
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9
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Huhn S, Weinhold N, Nickel J, Pritsch M, Hielscher T, Hummel M, Bertsch U, Huegle-Doerr B, Vogel M, Angermund R, Hänel M, Salwender HJ, Weisel K, Dürig J, Görner M, Kirchner H, Peter N, Graeven U, Lordick F, Hoffmann M, Reimer P, Blau IW, Jauch A, Dembowsky K, Möhler T, Wuchter P, Goldschmidt H. Circulating tumor cells as a biomarker for response to therapy in multiple myeloma patients treated within the GMMG-MM5 trial. Bone Marrow Transplant 2017; 52:1194-1198. [PMID: 28504661 PMCID: PMC5543255 DOI: 10.1038/bmt.2017.91] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- S Huhn
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - N Weinhold
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany.,Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - J Nickel
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - M Pritsch
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - T Hielscher
- Division of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | - M Hummel
- Division of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | - U Bertsch
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Tumor Diseases Heidelberg, Heidelberg, Germany
| | - B Huegle-Doerr
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - M Vogel
- Janssen-Cilag, Neuss, Germany
| | | | - M Hänel
- Department of Internal Medicine III, Klinikum Chemnitz gGmbH, Chemnitz, Germany
| | - H J Salwender
- Department of Hematology/Oncology, Asklepios Klinik Altona, Hamburg, Germany
| | - K Weisel
- Department of Internal Medicine II-Hematology and Oncology, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - J Dürig
- Department of Hematology, University Hospital Essen, Essen, Germany
| | - M Görner
- Department of Hematology, Oncology and Palliative Care, Community Hospital Bielefeld, Bielefeld, Germany
| | - H Kirchner
- Medical Clinic III Hematology and Oncology, Städt. Krankenhaus Siloah, Hannover, Germany
| | - N Peter
- 2nd Medical Department, Academic Teaching Hospital of the Charité, Carl-Thiem-Klinikum Cottbus, Cottbus, Germany
| | - U Graeven
- Hematology, Oncology and Gastroenterology, Maria-Hilf-Krankenhaus, Mönchengladbach, Germany
| | - F Lordick
- 3rd Medical Department, Haematology and Oncology, Klinikum Braunschweig, Braunschweig, Germany.,University Cancer Center Leipzig (UCCL), University Medical Center Leipzig, Leipzig, Germany
| | - M Hoffmann
- Medical Clinic A, Klinikum der Stadt Ludwigshafen gGmbH, Ludwigshafen am Rhein, Germany
| | - P Reimer
- Hematology, Oncology and Stem Cell Transplantation, Evangelisches Krankenhaus Essen-Werden gGmbH, Essen, Germany
| | - I W Blau
- Medical Clinic III Hematology and Oncology, Charité University Medicine Berlin, Berlin, Germany
| | - A Jauch
- Institute of Human Genetics, University of Heidelberg, Heidelberg, Germany
| | | | - T Möhler
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany.,inVentiv Health, Boston, MA, USA
| | - P Wuchter
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany.,Institute of Transfusion Medicine and Immunology, German Red Cross Blood Service Baden-Württemberg-Hessen, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - H Goldschmidt
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Tumor Diseases Heidelberg, Heidelberg, Germany
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10
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Multiple myeloma patients in long-term complete response after autologous stem cell transplantation express a particular immune signature with potential prognostic implication. Bone Marrow Transplant 2017; 52:832-838. [PMID: 28368375 DOI: 10.1038/bmt.2017.29] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 01/10/2017] [Accepted: 01/20/2017] [Indexed: 01/20/2023]
Abstract
The proportion of multiple myeloma patients in long-term complete response (LTCR-MM) for more than 6 years after autologous stem cell transplantation (ASCT) is small. To evaluate whether this LTCR is associated with a particular immune signature, peripheral blood samples from 13 LTCR-MM after ASCT and healthy blood donors (HBD) were analysed. Subpopulations of T-cells (naïve, effector, central memory and regulatory), B-cells (naïve, marginal zone-like, class-switched memory, transitional and plasmablasts) and NK-cells expressing inhibitory and activating receptors were quantified by multiparametric flow cytometry (MFC). Heavy/light chains (HLC) were quantified by nephelometry. The percentage of CD4+ T-cells was lower in patients, whereas an increment in the percentage of CD4+ and CD8+ effector memory T-cells was associated with the LTCR. Regulatory T-cells and NK-cells were similar in both groups but a particular redistribution of inhibitory and activating receptors in NK-cells were found in patients. Regarding B-cells, an increase in naïve cells and a corresponding reduction in marginal zone-like and class-switched memory B-cells was observed. The HLC values were normal. Our results suggest that LTCR-MM patients express a particular immune signature, which probably reflects a 'high quality' immune reconstitution that could exert a competent anti-tumor immunological surveillance along with a recovery of the humoral immunity.
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11
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Cornell RF, D'Souza A, Kassim AA, Costa LJ, Innis-Shelton RD, Zhang MJ, Huang J, Abidi M, Aiello J, Akpek G, Bashey A, Bashir Q, Cerny J, Comenzo R, Diaz MA, Freytes C, Gale RP, Ganguly S, Hamadani M, Hashmi S, Holmberg L, Hossain N, Kamble RT, Kharfan-Dabaja M, Kindwall-Keller T, Kyle R, Kumar S, Lazarus H, Lee C, Maiolino A, Marks DI, Meehan K, Mikhael J, Nath R, Nishihori T, Olsson RF, Ramanathan M, Saad A, Seo S, Usmani S, Vesole D, Vij R, Vogl D, Wirk BM, Yared J, Krishnan A, Mark T, Nieto Y, Hari P. Maintenance versus Induction Therapy Choice on Outcomes after Autologous Transplantation for Multiple Myeloma. Biol Blood Marrow Transplant 2017; 23:269-277. [PMID: 27864161 PMCID: PMC5346183 DOI: 10.1016/j.bbmt.2016.11.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 11/11/2016] [Indexed: 02/07/2023]
Abstract
Bortezomib (V), lenalidomide (R), cyclophosphamide (C), and dexamethasone (D) are components of the most commonly used modern doublet (RD, VD) or triplet (VRD, CVD) initial induction regimens before autologous hematopoietic cell transplantation (AHCT) for multiple myeloma (MM) in the United States. In this study we evaluated 693 patients receiving "upfront" AHCT after initial induction therapy with modern doublet or triplet regimens using data reported to the Center for International Blood and Marrow Transplant Research from 2008 to 2013. Analysis was limited to those receiving a single AHCT after 1 line of induction therapy within 12 months from treatment initiation for MM. In multivariate analysis, progression-free survival (PFS) and overall survival were similar irrespective of induction regimen. However, high-risk cytogenetics and nonreceipt of post-transplant maintenance/consolidation therapy were associated with higher risk of relapse. Patients receiving post-transplant therapy had significantly improved 3-year PFS versus no post-transplant therapy (55% versus 39%, P = .0001). This benefit was most evident in patients not achieving at least a complete response post-AHCT (P = .005). In patients receiving upfront AHCT, the choice of induction regimen (doublet or triplet therapies) appears to be of lower impact than use of post-transplant therapy.
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Affiliation(s)
- Robert F Cornell
- Division of Hematology/Oncology Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Anita D'Souza
- Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Adetola A Kassim
- Division of Hematology/Oncology Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Luciano J Costa
- Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Racquel D Innis-Shelton
- Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mei-Jie Zhang
- Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jiaxing Huang
- Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Muneer Abidi
- Division of BMT, Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | | | - Gorgun Akpek
- Stem Cell Transplantation and Cell Therapy, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Asad Bashey
- Blood and Marrow Transplant Program at Northside Hospital, Atlanta, Georgia
| | - Qaiser Bashir
- Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jan Cerny
- Division of Hematology and Oncology, Department of Medicine, UMass Memorial Medical Center, Worchester, Massachusetts
| | | | - Miguel Angel Diaz
- Department of Hematology/Oncology, Hospital Infantil Universitario Nino Jesus, Madrid, Spain
| | - César Freytes
- South Texas Veterans Health Care System and University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Robert Peter Gale
- Hematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, United Kingdom
| | - Siddhartha Ganguly
- Blood and Marrow Transplantation, Division of Hematology and Oncology, University of Kansas Medical Center, Kansas City, Kansas
| | - Mehdi Hamadani
- Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Leona Holmberg
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Rammurti T Kamble
- Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, Texas
| | - Mohamed Kharfan-Dabaja
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Tamila Kindwall-Keller
- Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, Virginia
| | | | | | - Hillard Lazarus
- Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Cindy Lee
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Angelo Maiolino
- Hospital Universitbrio Clementinio Fraga Filho, Universidade Federal do Rio de Janerio, Rio de Janerio, Brazil
| | - David I Marks
- Adult Bone Marrow Transplant, University Hospitals Bristol NHS Trust, Bristol, United Kingdom
| | - Kenneth Meehan
- Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Joe Mikhael
- Mayo Clinic Arizona and Phoenix Children's Hospital, Phoenix, Arizona
| | - Rajneesh Nath
- Division of Hematology and Oncology, Department of Medicine, UMass Memorial Medical Center, Worchester, Massachusetts
| | - Taiga Nishihori
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Richard F Olsson
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinksa Institutet, Stockholm, Sweden; Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden
| | - Muthalagu Ramanathan
- Division of Hematology and Oncology, Department of Medicine, UMass Memorial Medical Center, Worchester, Massachusetts
| | - Ayman Saad
- Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Sachiko Seo
- National Cancer Research Center, East Hospital, Chiba, Japan
| | - Saad Usmani
- Department of Hematology v Medical Oncology, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, North Carolina
| | - David Vesole
- John Theurer Cancer Center at Hackensack UMC, Hackensack, New Jersey
| | - Ravi Vij
- Divison of Hematology and Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Dan Vogl
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Baldeep M Wirk
- Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, Washington
| | - Jean Yared
- Blood & Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Cancer Center, University of Maryland, Baltimore, Maryland
| | | | - Tomer Mark
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Yago Nieto
- Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Parameswaran Hari
- Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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12
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González-Calle V, Cerdá S, Labrador J, Sobejano E, González-Mena B, Aguilera C, Ocio EM, Vidriales MB, Puig N, Gutiérrez NC, García-Sanz R, Alonso JM, López R, Aguilar C, de Coca AG, Hernández R, Hernández JM, Escalante F, Mateos MV. Recovery of polyclonal immunoglobulins one year after autologous stem cell transplantation as a long-term predictor marker of progression and survival in multiple myeloma. Haematologica 2017; 102:922-931. [PMID: 28126960 PMCID: PMC5477611 DOI: 10.3324/haematol.2016.158345] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 01/11/2017] [Indexed: 12/22/2022] Open
Abstract
Immunoparesis or suppression of polyclonal immunoglobulins is a very common condition in newly diagnosed myeloma patients. However, the recovery of polyclonal immunoglobulins in the setting of immune reconstitution after autologous stem cell transplantation and its effect on outcome has not yet been explored. We conducted this study in a cohort of 295 patients who had undergone autologous transplantation. In order to explore the potential role of immunoglubulin recovery as a dynamic predictor of progression or survival after transplantation, conditional probabilities of progression-free survival and overall survival were estimated according to immunoglobulin recovery at different time points using a landmark approach. One year after transplant, when B-cell reconstitution is expected to be completed, among 169 patients alive and progression free, 88 patients (52%) showed immunoglobulin recovery and 81 (48%) did not. Interestingly, the group with immunoglobulin recovery had a significantly longer median progression-free survival than the group with persistent immunoparesis (median 60.4 vs. 27.9 months, respectively; Hazard Ratio: 0.45, 95%Confidence Interval: 0.31-0.66; P<0.001), and improved overall survival (11.3 vs. 7.3 years; Hazard Ratio: 0.45, 95%Confidence Interval: 0.27-0.74; P=0.002). Furthermore, the percentage of normal plasma cells detected by flow cytometry in the bone marrow assessed at day 100 after transplantation was associated with the immunoglobulin recovery at that time and may predict immunoglobulin recovery in the subsequent months: nine months and one year. In conclusion, the recovery of polyclonal immunoglobulins one year after autologous transplantation in myeloma patients is an independent long-term predictor marker for progression and survival.
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Affiliation(s)
- Verónica González-Calle
- Complejo Asistencial Universitario de Salamanca/Instituto de Investigación Biomédica de Salamanca (CAUSA/IBSAL), Spain
| | | | | | - Eduardo Sobejano
- Complejo Asistencial Universitario de Salamanca/Instituto de Investigación Biomédica de Salamanca (CAUSA/IBSAL), Spain
| | | | | | - Enrique María Ocio
- Complejo Asistencial Universitario de Salamanca/Instituto de Investigación Biomédica de Salamanca (CAUSA/IBSAL), Spain
| | - María Belén Vidriales
- Complejo Asistencial Universitario de Salamanca/Instituto de Investigación Biomédica de Salamanca (CAUSA/IBSAL), Spain
| | - Noemí Puig
- Complejo Asistencial Universitario de Salamanca/Instituto de Investigación Biomédica de Salamanca (CAUSA/IBSAL), Spain
| | - Norma Carmen Gutiérrez
- Complejo Asistencial Universitario de Salamanca/Instituto de Investigación Biomédica de Salamanca (CAUSA/IBSAL), Spain
| | - Ramón García-Sanz
- Complejo Asistencial Universitario de Salamanca/Instituto de Investigación Biomédica de Salamanca (CAUSA/IBSAL), Spain
| | | | - Rosa López
- Hospital Virgen del Puerto de Plasencia, Spain
| | | | | | | | | | | | - María-Victoria Mateos
- Complejo Asistencial Universitario de Salamanca/Instituto de Investigación Biomédica de Salamanca (CAUSA/IBSAL), Spain
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13
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Braunstein M, Niesvizky R. Deferring autologous stem cell transplantation for consolidation of minimal residual disease in multiple myeloma. Semin Oncol 2016; 43:709-711. [DOI: 10.1053/j.seminoncol.2016.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 11/07/2016] [Indexed: 11/11/2022]
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14
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MRD-driven treatment paradigm for newly diagnosed transplant eligible multiple myeloma patients. Bone Marrow Transplant 2016; 51:913-4. [PMID: 26926231 DOI: 10.1038/bmt.2016.24] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 01/15/2016] [Indexed: 11/08/2022]
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