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Cao D, Shou L, Wu Y, Dong X. The role of serum-free light chain ratios in the prediction of poor prognosis in multiple myeloma patients: a systematic review and meta-analysis. Hematology 2022; 27:1130-1139. [PMID: 36165782 DOI: 10.1080/16078454.2022.2127460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND The association between the serum free light chain (sFLC) ratio and the prognosis of multiple myeloma (MM) patients is controversial. AIM The purpose of this study is to explore the relationship between the sFLC ratio and the prognosis of MM patients through meta-analysis. METHODS Online public databases were searched to find relevant studies. The retrieval time is limited from the establishment of the database to July 2021. The overall survival (OS) and progression-free survival (PFS) rates were compared. The results were described using hazard ratio (HR) and a 95% confidence interval (CI). Qualitative studies were also included. RESULTS A total of 9 studies involving 2864 participants were included. A pooled analysis based on four studies including newly-diagnosed MM patients, demonstrated that an abnormal sFLC ratio was associated with poor outcomes of OS (HR = 1.82, 95% CI: 1.15-2.90) and PFS (HR = 1.87, 95% CI: 1.20-2.90). Three qualitative studies showed that an abnormal sFLC ratio was related with poor outcomes of OS (studies all included newly diagnosed MM patients) and PFS (two studies included newly-diagnosed MM patients and one study included non-newly-diagnosed MM patients). Two studies stated that the sFLC ratio is not associated with OS (both studies included non-newly-diagnosed MM patients) and one study reported that the sFLC ratio is not associated with PFS (study included non-newly-diagnosed MM patients). CONCLUSION sFLC ratio could be used to predict adverse outcomes in newly-diagnosed MM patients, but is not suitable for non-newly-diagnosed MM patients.
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Affiliation(s)
- Dan Cao
- Department of Hematology, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, Huzhou, People's Republic of China
| | - Lihong Shou
- Department of Hematology, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, Huzhou, People's Republic of China
| | - Ying Wu
- Department of Hematology, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, Huzhou, People's Republic of China
| | - Xiaohui Dong
- Department of Hematology, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, Huzhou, People's Republic of China
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Ferla V, Antonini E, Perini T, Farina F, Masottini S, Malato S, Marktel S, Lupo Stanghellini MT, Tresoldi C, Ciceri F, Marcatti M. Minimal residual disease detection by next-generation sequencing in multiple myeloma: Promise and challenges for response-adapted therapy. Front Oncol 2022; 12:932852. [PMID: 36052251 PMCID: PMC9426755 DOI: 10.3389/fonc.2022.932852] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 07/06/2022] [Indexed: 11/18/2022] Open
Abstract
Assessment of minimal residual disease (MRD) is becoming a standard diagnostic tool for curable hematological malignancies such as chronic and acute myeloid leukemia. Multiple myeloma (MM) remains an incurable disease, as a major portion of patients even in complete response eventually relapse, suggesting that residual disease remains. Over the past decade, the treatment landscape of MM has radically changed with the introduction of new effective drugs and the availability of immunotherapy, including targeted antibodies and adoptive cell therapy. Therefore, conventional serological and morphological techniques have become suboptimal for the evaluation of depth of response. Recently, the International Myeloma Working Group (IMWG) introduced the definition of MRD negativity as the absence of clonal Plasma cells (PC) with a minimum sensitivity of <10−5 either by next-generation sequencing (NGS) using the LymphoSIGHT platform (Sequenta/Adaptative) or by next-generation flow cytometry (NGF) using EuroFlow approaches as the reference methods. While the definition of the LymphoSIGHT platform (Sequenta/Adaptive) as the standard method derives from its large use and validation in clinical studies on the prognostic value of NGS-based MRD, other commercially available options exist. Recently, the LymphoTrack assay has been evaluated in MM, demonstrating a sensitivity level of 10−5, hence qualifying as an alternative effective tool for MRD monitoring in MM. Here, we will review state-of-the-art methods for MRD assessment by NGS. We will summarize how MRD testing supports clinical trials as a useful tool in dynamic risk-adapted therapy. Finally, we will also discuss future promise and challenges of NGS-based MRD determination for clinical decision-making. In addition, we will present our real-life single-center experience with the commercially available NGS strategy LymphoTrack-MiSeq. Even with the limitation of a limited number of patients, our results confirm the LymphoTrack-MiSeq platform as a cost-effective, readily available, and standardized workflow with a sensitivity of 10−5. Our real-life data also confirm that achieving MRD negativity is an important prognostic factor in MM.
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Affiliation(s)
- Valeria Ferla
- Hematology and Bone Marrow Transplantation, San Raffaele Scientific Institute, Milan, Italy
- *Correspondence: Valeria Ferla,
| | - Elena Antonini
- Molecular Hematology Laboratory, San Raffaele Scientific Institute, Milan, Italy
| | - Tommaso Perini
- Hematology and Bone Marrow Transplantation, San Raffaele Scientific Institute, Milan, Italy
- Age Related Diseases Laboratory, Division of Genetics and Cell Biology, San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Farina
- Hematology and Bone Marrow Transplantation, San Raffaele Scientific Institute, Milan, Italy
| | - Serena Masottini
- Molecular Hematology Laboratory, San Raffaele Scientific Institute, Milan, Italy
| | - Simona Malato
- Hematology and Bone Marrow Transplantation, San Raffaele Scientific Institute, Milan, Italy
| | - Sarah Marktel
- Hematology and Bone Marrow Transplantation, San Raffaele Scientific Institute, Milan, Italy
| | | | - Cristina Tresoldi
- Molecular Hematology Laboratory, San Raffaele Scientific Institute, Milan, Italy
| | - Fabio Ciceri
- Hematology and Bone Marrow Transplantation, San Raffaele Scientific Institute, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Magda Marcatti
- Hematology and Bone Marrow Transplantation, San Raffaele Scientific Institute, Milan, Italy
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Alonso R, Lahuerta JJ. Tumor Reduction in Multiple Myeloma: New Concepts for New Therapeutics. Front Oncol 2022; 11:800309. [PMID: 35096603 PMCID: PMC8794792 DOI: 10.3389/fonc.2021.800309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/23/2021] [Indexed: 12/22/2022] Open
Abstract
The development of new resources for a more accurate diagnosis and response assessment in multiple myeloma has been a long process for decades, mainly since the middle of the 20th century. During this time, the succession of technical advances has run parallel to the better knowledge of disease biology and the availability of novel therapeutic strategies. The cornerstone of standardized criteria to uniformly evaluate the disease response in myeloma dates back to the 1990s when the key role of complete remission was established. Since then, different updates have been implemented according to available scientific evidences not always without certain controversies. The progressive improvements in survival results of myeloma patients and the growing quality of responses due to the novel therapies have led to the need of developing new tools for better monitoring of tumor burden. In this way, the concept of minimal residual disease and its key value based on the prognostic significance and the clinical relevance has been consolidated during the last years, overcoming the value of conventional response criteria or classical adverse prognosis markers. Nevertheless, its precise role in the clinical management of myeloma patients to detect early treatment failure and trigger early rescue strategies is still pending to be defined. In this review, we revisit the major milestones in the understanding of tumor reduction in multiple myeloma until the most recent imaging techniques or liquid biopsy approaches, including a critical view of conventional response criteria, whose backbone has remained unchanged during the last 20 years.
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Affiliation(s)
- Rafael Alonso
- Hematology Department, Hospital Universitario 12 de Octubre, CIBERONC CB16/12/00369, Madrid, Spain
| | - Juan José Lahuerta
- Instituto de Investigación Sanitaria, Hospital Universitario 12 de Octubre (imas12) CIBERONC CB16/12/00369, Madrid, Spain
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4
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The clinical significance of stringent complete response in multiple myeloma is surpassed by minimal residual disease measurements. PLoS One 2020; 15:e0237155. [PMID: 32866200 PMCID: PMC7458342 DOI: 10.1371/journal.pone.0237155] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 07/21/2020] [Indexed: 11/19/2022] Open
Abstract
Background Stringent complete response (sCR) is used as a deeper response category than complete response (CR) in multiple myeloma (MM) but may be of limited value in the era of minimal residual disease (MRD) testing. Methods Here, we used 4-colour multiparametric flow cytometry (MFC) or next-generation sequencing (NGS) of immunoglobulin genes to analyse and compare the prognostic impact of sCR and MRD monitoring. We included 193 treated patients in two institutions achieving CR, for which both bone marrow aspirates and biopsies were available. Results We found that neither the serum free light chain ratio, clonality by immunohistochemistry (IHC) nor plasma cell bone marrow infiltration identified CR patients at distinct risk. Patients with sCR had slightly longer progression-free survival. Nevertheless, persistent clonal bone marrow disease was detectable using MFC or NGS and was associated with significantly inferior outcomes compared with MRD-negative cases. Conclusion Our results confirm that sCR does not predict a different outcome and indicate that more sensitive techniques are able to identify patients with differing prognoses. We suggest that MRD categories should be implemented over sCR for the future classification of MM responses.
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Rossi G, Falcone AP, Minervini MM, De Cillis GP, De Waure C, Sisti LG, Giambra V, Valente D, Chiello V, Scalzulli PR, Carella AM, Cascavilla N. 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 PART B-CLINICAL CYTOMETRY 2018; 96:195-200. [PMID: 30549231 DOI: 10.1002/cyto.b.21755] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 10/15/2018] [Accepted: 11/14/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Optimization of chemotherapy regimens in the treatment of multiple myeloma (MM) has led to increase the frequency of cases with complete response (CR). Nonetheless, many MM patients still experience relapse, suggesting that CR represents a suboptimal response criteria, and that new therapeutic strategies are needed after single transplant. However, the role of double autologous stem cell transplant (ASCT) as new adjunctive strategy remains to be elucidated. Indeed, we investigated the role of minimal residual disease (MRD) and log-reduction of plasma cells (PCs) as predictors of outcome and in quantifying the degree of tumor reduction after any ASCT. METHODS MRD and log-reduction were assessed by a six-color flow cytometry (FC) at different time-points: post induction, post first-, and post-second ASCT. RESULTS A significant difference was evidenced among the three time points for both log-reduction (P < 0.001) and MRD (P = 0.005). MRD levels after double ASCT were lower than MRD levels achieved after single ASCT (P = 0.005) and after induction (P < 0.001). Frequency of MRD positive patients after double ASCT was significantly lower rather than after the first ASCT (P = 0.008) and after induction (P = 0.004). Interestingly, a significant reduction of PFS was observed in patients with an unfavorable-risk cytogenetic (P < 0.001) and patients with MRD over 0.01% (P = 0.001) as well as log-reduction lower than 2.57 (P = 0.018) after double ASCT. CONCLUSIONS Our results show that a better clearance of myeloma cells is observed after the double ASCT, and a longer PFS is associated with a lower MRD. © 2018 International Clinical Cytometry Society.
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Affiliation(s)
- Giovanni Rossi
- Department of Hematology and Stem Cell Transplant Unit, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy
| | - Antonietta Pia Falcone
- Department of Hematology and Stem Cell Transplant Unit, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy
| | - Maria Marta Minervini
- Department of Hematology and Stem Cell Transplant Unit, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy
| | - Giovanni Pio De Cillis
- Department of Hematology and Stem Cell Transplant Unit, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy
| | - Chiara De Waure
- Department of Hygiene, Catholic University of Sacred Heart, Rome, Italy
| | | | - Vincenzo Giambra
- Institute of Stem Cells Biology, Regenerative Medicine and Innovative Therapies (ISBReMIT), Fondazione IRCCS "Casa Sollievo della Sofferenza-IRCCS", San Giovanni Rotondo, Italy
| | - Daniela Valente
- Department of Hematology and Stem Cell Transplant Unit, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy
| | - Vincenzo Chiello
- Department of Hematology and Stem Cell Transplant Unit, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy
| | - Potito Rosario Scalzulli
- Department of Hematology and Stem Cell Transplant Unit, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy
| | - Angelo Michele Carella
- Department of Hematology and Stem Cell Transplant Unit, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy
| | - Nicola Cascavilla
- Department of Hematology and Stem Cell Transplant Unit, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy
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Oliva S, Gambella M, Gilestro M, Muccio VE, Gay F, Drandi D, Ferrero S, Passera R, Pautasso C, Bernardini A, Genuardi M, Patriarca F, Saraci E, Petrucci MT, Pescosta N, Liberati AM, Caravita T, Conticello C, Rocci A, Musto P, Boccadoro M, Palumbo A, Omedè P. Minimal residual disease after transplantation or lenalidomide-based consolidation in myeloma patients: a prospective analysis. Oncotarget 2018; 8:5924-5935. [PMID: 27779105 PMCID: PMC5351601 DOI: 10.18632/oncotarget.12641] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 09/21/2016] [Indexed: 11/25/2022] Open
Abstract
We analyzed 50 patients who achieved at least a very good partial response in the RV-MM-EMN-441 study. Patients received consolidation with autologous stem-cell transplantation (ASCT) or cyclophosphamide-lenalidomide-dexamethasone (CRD), followed by Lenalidomide-based maintenance. We assessed minimal residual disease (MRD) by multi-parameter flow cytometry (MFC) and allelic-specific oligonucleotide real-time quantitative polymerase chain reaction (ASO-RQ-PCR) after consolidation, after 3 and 6 courses of maintenance, and thereafter every 6 months until progression. By MFC analysis, 19/50 patients achieved complete response (CR) after consolidation, and 7 additional patients during maintenance. A molecular marker was identified in 25/50 patients, 4/25 achieved molecular-CR after consolidation, and 3 additional patients during maintenance. A lower MRD value by MFC was found in ASCT patients compared with CRD patients (p=0.0134). Tumor burden reduction was different in patients with high-risk vs standard-risk cytogenetics (3.4 vs 5.2, ln-MFC; 3 vs 6 ln-PCR, respectively) and in patients who relapsed vs those who did not (4 vs 5, ln-MFC; 4.4 vs 7.8 ln-PCR). MRD progression anticipated clinical relapse by a median of 9 months while biochemical relapse by a median of 4 months. MRD allows the identification of a low-risk group, independently of response, and a better characterization of the activity of treatments.
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Affiliation(s)
- Stefania Oliva
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospeadliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Manuela Gambella
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospeadliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Milena Gilestro
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospeadliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Vittorio Emanuele Muccio
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospeadliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Francesca Gay
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospeadliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Daniela Drandi
- Division of Hematology, Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
| | - Simone Ferrero
- Division of Hematology, Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
| | - Roberto Passera
- Division of Nuclear Medicine, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Chiara Pautasso
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospeadliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Annalisa Bernardini
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospeadliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Mariella Genuardi
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospeadliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Francesca Patriarca
- Azienda Ospedaliera-Universitaria di Udine, DISM Università di Udine, Udine, Italy
| | - Elona Saraci
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospeadliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Maria Teresa Petrucci
- Division of Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Rome, Italy
| | - Norbert Pescosta
- Ematologia e Centro TMO, Ospedale Centrale Bolzano, Bozen, Italy
| | | | | | - Concetta Conticello
- Divisione di Ematologia, Azienda Policlinico-OVE, Università di Catania, Catania, Italy
| | - Alberto Rocci
- Department of Haematology, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Pellegrino Musto
- Scientific Direction, IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero in Vulture (Pz), Italy
| | - Mario Boccadoro
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospeadliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Antonio Palumbo
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospeadliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Paola Omedè
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospeadliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
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Zhang L, Pan L, Xiang B, Zhu H, Wu Y, Chen M, Guan P, Zou X, Valencia CA, Dong B, Li J, Xie L, Ma H, Wang F, Dong T, Shuai X, Niu T, Liu T. Potential role of exosome-associated microRNA panels and in vivo environment to predict drug resistance for patients with multiple myeloma. Oncotarget 2017; 7:30876-91. [PMID: 27129167 PMCID: PMC5058725 DOI: 10.18632/oncotarget.9021] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 03/31/2016] [Indexed: 02/05/2023] Open
Abstract
Multiple myeloma (MM) is the second most common hematologic neoplasms and an appropriate in vivo environment for myeloma cells has potential implications for initiation, progression, and metastasis of MM. Exosomes, entities carrying microRNAs (miRNAs) to target locations, participate in the cross-talk between myeloma cells and nonmalignant components of the in vivo environment. This study disclosed the emerging roles of circulating exosome-associated miRNAs in drug resistance (DR) of MM. To this end, the medical records of consecutively hospitalized MM patients, who received novel agents-based therapies, were analyzed. Then, an optimized procedure was established for exosome isolation and exosomal RNA analysis. The exosome-associated miRNA expression patterns for predicting bortezomib (Bz) resistance of MM were further examined using a microarray. In total, 204 patients were enrolled with DR rates of 36.5%, 73.1% and 81.8% in the bortezomib (Bz), thalidomide and lenalidomide containing groups. The serum total light chain ratio ≥ 100, CRP ≥ 20 mg/L, and the second-line usage increased risks of acquired Bz-resistance. Among 68 cases having genetic tests, a high risk factor for predicting de novo DR was 1q21 amplification, which also correlated with lower levels of cholesterol and LDL-C. Moreover, nano-sized exosomes were isolated with significantly increasing internal RNAs and down-regulation of exosomal miR-16-5p, miR-15a-5p and miR-20a-5p, miR-17-5p was revealed in the patients resistant to Bz. The routine workup of MM hardly suggested a value for DR prediction. The circulating exosomes carrying miRNAs provided a window that permits a better understanding of the in vivo intercellular crosstalk in MM patients.
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Affiliation(s)
- Li Zhang
- Department of Hematology, West China Hospital, Sichuan University, Chengdu, China.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Ling Pan
- Department of Hematology, West China Hospital, Sichuan University, Chengdu, China
| | - Bing Xiang
- Department of Hematology, West China Hospital, Sichuan University, Chengdu, China
| | - Huanling Zhu
- Department of Hematology, West China Hospital, Sichuan University, Chengdu, China
| | - Yu Wu
- Department of Hematology, West China Hospital, Sichuan University, Chengdu, China
| | - Meng Chen
- Department of Hematology, West China Hospital, Sichuan University, Chengdu, China
| | - Pujun Guan
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xingli Zou
- Department of Hematology, Affiliated Hospital of North Sichuan Medical College, Nanchang, China
| | - C Alexander Valencia
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Biao Dong
- State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Jianjun Li
- Department of Hematology, West China Hospital, Sichuan University, Chengdu, China
| | - Liping Xie
- Department of Hematology, West China Hospital, Sichuan University, Chengdu, China
| | - Hongbing Ma
- Department of Hematology, West China Hospital, Sichuan University, Chengdu, China
| | - Fangfang Wang
- Department of Hematology, West China Hospital, Sichuan University, Chengdu, China
| | - Tian Dong
- Department of Hematology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiao Shuai
- Department of Hematology, West China Hospital, Sichuan University, Chengdu, China
| | - Ting Niu
- Department of Hematology, West China Hospital, Sichuan University, Chengdu, China
| | - Ting Liu
- Department of Hematology, West China Hospital, Sichuan University, Chengdu, China
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8
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Xu B, Tang Y, Zhou J, Zhang P, Li H. Disease spectrum of abnormal serum free light chain ratio and its diagnostic significance. Oncotarget 2017; 8:82268-82279. [PMID: 29137262 PMCID: PMC5669888 DOI: 10.18632/oncotarget.19391] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 06/11/2017] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To analyze the spectrum of abnormal serum free light chain ratio (sFLC κ/λ ratio), and to redefine the range of sFLC κ/λ ratio, so as to achieve hierarchical diagnosis of diseases with abnormal sFLC κ/λ ratio, resulting in the increased sensitivity and specificity in the diagnosis of monoclonal plasma diseases. METHODS Enrolled 1,340 patients with abnormal sFLC κ/λ ratio (<0.26 or >1.65) were grouped: (1) group A: malignant plasma diseases; (2) group B: monoclonal gammopathies of undetermined significance (MGUS); (3) group C: reactive plasma diseases. These patients were further divided by renal function eGFR <60 or >60 ml/min/1.73m2 to eliminate renal diseases influencing the results. Statistical analyses was performed by using SPSS 22 software. RESULTS When sFLC κ/λ ratio >3.49 and eGFR >60ml/min/1.73m2, the sensitivity and specificity of the diagnosis of malignant plasma diseases were 86.1% and 94.0%, respectively. When sFLC κ/λ ratio >2.89 and eGFR <60ml/min/1.73m2, the sensitivity and specificity of the diagnosis of malignant plasma diseases were 92.0% and 97.0%, respectively. CONCLUSION The sensitivity and specificity of the diagnosis of monoclonal plasma diseases can be significantly improved by redefining the cut-off value of sFLC κ/λ ratio and the renal function index of eGFR.
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Affiliation(s)
- Bin Xu
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yi Tang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jianfeng Zhou
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Peiling Zhang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Huijun Li
- Department of Clinical Laboratory, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
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9
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Innao V, Allegra A, Russo S, Gerace D, Vaddinelli D, Alonci A, Allegra AG, Musolino C. Standardisation of minimal residual disease in multiple myeloma. Eur J Cancer Care (Engl) 2017; 26. [PMID: 28671297 DOI: 10.1111/ecc.12732] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2017] [Indexed: 12/16/2022]
Abstract
The assessment of the effectiveness of chemotherapy in oncology cannot disregard the concept of minimal residual disease (MRD). In fact, the efforts of numerous scientific groups all over the world are currently focusing on this issue, with the sole purpose of defining sensitive, effective assessment criteria that are, above all, able to give acceptable, easily repeatable results worldwide. Regarding this issue, especially with the advent of new drugs, multiple myeloma is one of the haematologic malignancies for which a consensus has not yet been reached. In this review, we analyse various techniques that have been used to improve the sensitivity of response, aimed at reducing the cut-off values previously allowed, as well as serological values like serum-free light chain, or immunophenotypic tools on bone marrow or peripheral blood, like multi-parameter flow cytometry, or molecular ones such as allele-specific oligonucleotide (ASO)-qPCR and next-generation/high-throughput sequencing technologies (NGS). Moreover, our discussion makes a brief reference to promising techniques, such as mass spectrometry for identifying Ig light chain (LC) in peripheral blood, and the assessment of gene expression profile not only in defining prognostic risk at the diagnosis but also as a tool for evaluation of response.
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Affiliation(s)
- V Innao
- Division of Hematology, Dipartimento di Patologia Umana dell'Adulto e dell'Età Evolutiva, Policlinico G Martino, University of Messina, Messina, Italy
| | - A Allegra
- Division of Hematology, Dipartimento di Patologia Umana dell'Adulto e dell'Età Evolutiva, Policlinico G Martino, University of Messina, Messina, Italy
| | - S Russo
- Division of Hematology, Dipartimento di Patologia Umana dell'Adulto e dell'Età Evolutiva, Policlinico G Martino, University of Messina, Messina, Italy
| | - D Gerace
- Division of Hematology, Dipartimento di Patologia Umana dell'Adulto e dell'Età Evolutiva, Policlinico G Martino, University of Messina, Messina, Italy
| | - D Vaddinelli
- Division of Hematology, Dipartimento di Patologia Umana dell'Adulto e dell'Età Evolutiva, Policlinico G Martino, University of Messina, Messina, Italy
| | - A Alonci
- Division of Hematology, Dipartimento di Patologia Umana dell'Adulto e dell'Età Evolutiva, Policlinico G Martino, University of Messina, Messina, Italy
| | - A G Allegra
- Division of Hematology, Dipartimento di Patologia Umana dell'Adulto e dell'Età Evolutiva, Policlinico G Martino, University of Messina, Messina, Italy
| | - C Musolino
- Division of Hematology, Dipartimento di Patologia Umana dell'Adulto e dell'Età Evolutiva, Policlinico G Martino, University of Messina, Messina, Italy
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10
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Özkurt ZN, Sucak GT, Akı ŞZ, Yağcı M, Haznedar R. Early Prognostic Value of Monitoring Serum Free Light Chain in Patients with Multiple Myeloma Undergoing Autologous Stem Cell Transplantation. Cancer Invest 2017; 35:195-201. [PMID: 28112977 DOI: 10.1080/07357907.2016.1270958] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We hypothesized the levels of free light chains obtained before and after autologous stem cell transplantation can be useful in predicting transplantation outcome. We analyzed 70 multiple myeloma patients. Abnormal free light chain ratios before stem cell transplantation were found to be associated early progression, although without any impact on overall survival. At day +30, the normalization of levels of involved free light chain related with early progression. According to these results almost one-third reduction of free light chain levels can predict favorable prognosis after autologous stem cell transplantation.
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Affiliation(s)
- Zübeyde Nur Özkurt
- a Department of Hematology , Gazi University School of Medicine , Ankara , Turkey
| | - Gülsan Türköz Sucak
- a Department of Hematology , Gazi University School of Medicine , Ankara , Turkey
| | - Şahika Zeynep Akı
- a Department of Hematology , Gazi University School of Medicine , Ankara , Turkey
| | - Münci Yağcı
- a Department of Hematology , Gazi University School of Medicine , Ankara , Turkey
| | - Rauf Haznedar
- a Department of Hematology , Gazi University School of Medicine , Ankara , Turkey
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11
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Zhai L, Zhao Y, Peng S, Zhu K, Yu R, Chen H, Lin T, Lin L. Detection of the value of consecutive serum total light chain (sTLC) in patients diagnosed with diffuse large B cell lymphoma. Ann Hematol 2016; 95:1999-2007. [PMID: 27623628 DOI: 10.1007/s00277-016-2794-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 08/08/2016] [Indexed: 11/25/2022]
Abstract
There are limited data on serum total light chain (sTLC) in lymphoma and its relative role on the outcome of diffuse large B cell lymphoma (DLBCL) patients. Blood samples from 46 cases newly diagnosed with DLBCL were collected consecutively during chemotherapy to detect sTLC, IgG, IgA, and IgM levels. Clinical data and survival outcomes were analyzed according to the results of sTLC measurements. In summary, 22 patients (47.8 %) had abnormal k or λ light chain, respectively, and 6 patients (13.0 %) had both abnormal k and λ light chains before chemotherapy. Patients with elevated k light chain more frequently displayed multiple extra-nodal organ involvement (P = 0.01) and had an inferior overall survival (OS) (P = 0.041) and progression-free survival (PFS) (P = 0.044) compared to patients with normal level of k light chain. Furthermore, patients with elevated level of both k and λ also exhibited significant association with shorter OS (P = 0.002) and PFS (P = 0.009). Both elevated k alone and concurrent elevated k and λ had independent adverse effects on PFS (P = 0.031 and P = 0.019, respectively). sTLC level was reduced gradually by treatment in this study and reached the lowest point after the fourth cycle of chemotherapy, which was consistent with the disease behavior during chemotherapy. Considering the small sample size of this study, these results should be confirmed in a larger prospective study.
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Affiliation(s)
- Linzhu Zhai
- Department of Medical Oncology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, People's Republic of China
| | - Yuanyuan Zhao
- Department of Medical Oncology, Cancer Centre of Sun Yat-sen University, State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, People's Republic of China
| | - Songguo Peng
- Department of Medical Oncology, Cancer Centre of Sun Yat-sen University, State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, People's Republic of China
| | - Ke Zhu
- Department of Medical Oncology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, People's Republic of China
| | - Rongjian Yu
- Department of Medical Oncology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, People's Republic of China
| | - Hailong Chen
- Department of Medical Oncology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, People's Republic of China
| | - Tongyu Lin
- Department of Medical Oncology, Cancer Centre of Sun Yat-sen University, State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, People's Republic of China
| | - Lizhu Lin
- Department of Medical Oncology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, People's Republic of China.
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12
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Tacchetti P, Cavo M, Rocchi S, Pezzi A, Pantani L, Brioli A, Testoni N, Terragna C, Zannetti BA, Mancuso K, Marzocchi G, Borsi E, Martello M, Rizzello I, Zamagni E. Prognostic impact of serial measurements of serum-free light chain assay throughout the course of newly diagnosed multiple myeloma treated with bortezomib-based regimens. Leuk Lymphoma 2016; 57:2058-64. [PMID: 26763357 DOI: 10.3109/10428194.2015.1124994] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We retrospectively investigated the role of serial serum-free light chain (sFLC) evaluations in 150 multiple myeloma (MM) patients treated with first-line bortezomib-based regimens. Baseline sFLC ratio (sFLCR) identified three groups of patients - normal, lightly abnormal (<100), and highly abnormal (≥100) - with different progression-free survival (PFS: 3-year estimate 72% versus 61% versus 44%, respectively, p = 0.03). Moreover, the achievement of a normal sFLCR correlated with extended PFS (49 versus 17 months, p < 0.0001) and overall survival (75 versus 43 months, p < 0.0001) as compared with abnormal sFLCR, a gain maintained in a multivariate analysis for PFS. At relapse, a high sFLCR was associated with earlier start of salvage therapy compared with sFLCR <100 (3-month probability: 89% versus 64%, p = 0.0426). In 20% of patients, sFLC escape preceded the conventional relapse by a median of 3.8 months. Our results highlight the role of sFLC assay in the prognosis and follow-up of MM.
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Affiliation(s)
- Paola Tacchetti
- a Department of Experimental, Diagnostic and Specialty Medicine, "Seràgnoli" Institute of Hematology , Bologna University School of Medicine , Bologna , Italy
| | - Michele Cavo
- a Department of Experimental, Diagnostic and Specialty Medicine, "Seràgnoli" Institute of Hematology , Bologna University School of Medicine , Bologna , Italy
| | - Serena Rocchi
- a Department of Experimental, Diagnostic and Specialty Medicine, "Seràgnoli" Institute of Hematology , Bologna University School of Medicine , Bologna , Italy
| | - Annalisa Pezzi
- a Department of Experimental, Diagnostic and Specialty Medicine, "Seràgnoli" Institute of Hematology , Bologna University School of Medicine , Bologna , Italy
| | - Lucia Pantani
- a Department of Experimental, Diagnostic and Specialty Medicine, "Seràgnoli" Institute of Hematology , Bologna University School of Medicine , Bologna , Italy
| | - Annamaria Brioli
- a Department of Experimental, Diagnostic and Specialty Medicine, "Seràgnoli" Institute of Hematology , Bologna University School of Medicine , Bologna , Italy
| | - Nicoletta Testoni
- a Department of Experimental, Diagnostic and Specialty Medicine, "Seràgnoli" Institute of Hematology , Bologna University School of Medicine , Bologna , Italy
| | - Carolina Terragna
- a Department of Experimental, Diagnostic and Specialty Medicine, "Seràgnoli" Institute of Hematology , Bologna University School of Medicine , Bologna , Italy
| | - Beatrice Anna Zannetti
- a Department of Experimental, Diagnostic and Specialty Medicine, "Seràgnoli" Institute of Hematology , Bologna University School of Medicine , Bologna , Italy
| | - Katia Mancuso
- a Department of Experimental, Diagnostic and Specialty Medicine, "Seràgnoli" Institute of Hematology , Bologna University School of Medicine , Bologna , Italy
| | - Giulia Marzocchi
- a Department of Experimental, Diagnostic and Specialty Medicine, "Seràgnoli" Institute of Hematology , Bologna University School of Medicine , Bologna , Italy
| | - Enrica Borsi
- a Department of Experimental, Diagnostic and Specialty Medicine, "Seràgnoli" Institute of Hematology , Bologna University School of Medicine , Bologna , Italy
| | - Marina Martello
- a Department of Experimental, Diagnostic and Specialty Medicine, "Seràgnoli" Institute of Hematology , Bologna University School of Medicine , Bologna , Italy
| | - Ilaria Rizzello
- a Department of Experimental, Diagnostic and Specialty Medicine, "Seràgnoli" Institute of Hematology , Bologna University School of Medicine , Bologna , Italy
| | - Elena Zamagni
- a Department of Experimental, Diagnostic and Specialty Medicine, "Seràgnoli" Institute of Hematology , Bologna University School of Medicine , Bologna , Italy
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Abstract
Assessment of minimal residual disease (MRD) is becoming standard diagnostic care for potentially curable neoplasms such as some acute leukemias as well as chronic myeloid and lymphocytic leukemia. Although multiple myeloma (MM) remains as an incurable disease, around half of the patients achieve complete remission (CR), and recent data suggests increasing rates of curability with "total-therapy-like" programs. This landscape is likely to be improved with the advent of new antibodies and small molecules. Therefore, conventional serological and morphological techniques have become suboptimal for sensitive evaluation of highly effective treatment strategies. Although, existing data suggests that MRD could be used as a biomarker to evaluate treatment efficacy, help on therapeutic decisions, and act as surrogate for overall survival, the role of MRD in MM is still a matter of extensive debate. Here, we review the different levels of remission used to define depth of response in MM and their clinical significance, as well as the prognostic value and unique characteristics of MRD detection using immunophenotypic, molecular, and imaging techniques. Key facts The higher efficacy of new treatment strategies for MM demand the incorporation of highly sensitive techniques to monitor treatment efficacy MRD could be used as a more potent surrogate biomarker for survival than standard CR We need to understand the pros and cons of the different MRD techniques The time has come to incorporate highly sensitive, cost-effective, readily available, and standardized MRD techniques into clinical trials to assess its role in therapeutic decisions.
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Affiliation(s)
- Bruno Paiva
- Centro de Investigacion Medica Aplicada (CIMA), Clinica Universidad de Navarra, IDISNA, Pamplona, Spain
| | - Ramón García-Sanz
- Hospital Universitario de Salamanca, Centro de Investigación Del Cancer (IBMCC-USAL, CSIC), Instituto de Investigaion Biomedica de Salamanca (IBSAL), Salamanca, Spain
| | - Jesús F San Miguel
- Centro de Investigacion Medica Aplicada (CIMA), Clinica Universidad de Navarra, IDISNA, Pamplona, Spain.
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Deep Response in Multiple Myeloma: A Critical Review. BIOMED RESEARCH INTERNATIONAL 2015; 2015:832049. [PMID: 26783530 PMCID: PMC4689894 DOI: 10.1155/2015/832049] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 11/23/2015] [Indexed: 11/17/2022]
Abstract
Novel and more effective treatment strategies against multiple myeloma (MM) have significantly prolonged patients' survival and raised interest in the depth of response and its association with clinical outcome. Minimal residual disease (MRD) has emerged as one of the most relevant prognostic factors in MM and should be included in a new definition of complete response (CR). Although further standardization is still required, MRD monitoring should be applied in prospective clinical trials as a sensitive tool to compare and evaluate the efficacy of different treatment strategies, particularly in the consolidation and maintenance settings, and implement individualized therapy-monitoring approaches. Here, we review current definition of deep response in MM, advantages and limitations of current MRD assessment assays, clinical evidences for MRD monitoring as a prognostic tool for therapeutic decisions in MM, and challenges to develop uniform criteria for MRD monitoring.
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Critical analysis of the stringent complete response in multiple myeloma: contribution of sFLC and bone marrow clonality. Blood 2015; 126:858-62. [PMID: 26089396 DOI: 10.1182/blood-2015-04-638742] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 06/08/2015] [Indexed: 10/23/2022] Open
Abstract
Stringent complete response (sCR) criteria are used in multiple myeloma as a deeper response category compared with CR, but prospective validation is lacking, it is not always clear how evaluation of clonality is performed, and is it not known what the relative clinical influence is of the serum free light chain ratio (sFLCr) and bone marrow (BM) clonality to define more sCR. To clarify this controversy, we focused on 94 patients that reached CR, of which 69 (73%) also fulfilled the sCR criteria. Patients with sCR displayed slightly longer time to progression (median, 62 vs 53 months, respectively; P = .31). On analyzing this contribution to the prognosis of sFLCr or clonality, it was found that the sFLCr does not identify patients in CR at distinct risk; by contrast, low-sensitive multiparametric flow cytometry (MFC) immunophenotyping (2 colors), which is equivalent to immunohistochemistry, identifies a small number of patients (5 cases) with high residual tumor burden and dismal outcome; nevertheless, using traditional 4-color MFC, persistent clonal BM disease was detectable in 36% of patients, who, compared with minimal residual disease-negative cases, had a significantly inferior outcome. These results show that the current definition of sCR should be revised.
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Barley K, Tindle S, Bagiella E, Jagannath S, Chari A. Serum Free Light Chain Assessment Early After Stem Cell Transplantation as a Prognostic Factor in Multiple Myeloma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2015; 15:541-5. [PMID: 26119495 DOI: 10.1016/j.clml.2015.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 03/31/2015] [Accepted: 05/29/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Multiple myeloma is an incurable cancer commonly treated with stem cell transplantation (SCT). Response is traditionally evaluated 100 days after SCT, both to allow for hematopoietic reconstitution and due to immunoglobulins' long half-lives. Free light chains (FLC) have significantly shorter half-lives and may provide evidence of response or treatment failure earlier after SCT. PATIENTS AND METHODS We retrospectively studied 83 consecutive patients with multiple myeloma who underwent SCT and found 69 who had FLC measured 30 or 60 days after SCT. Using conventional FLC response criteria, we considered a patient to be at high risk for early relapse if he or she failed to experience a partial response by day 30 or 60. RESULTS After a median overall follow-up of only 335 days, these high-risk patients had significantly shorter progression-free survival (median, 98 vs. 335 days, P = .001) and overall survival (366 days vs. median not reached, P = .016). CONCLUSION Early FLC assessment either 1 or 2 months after SCT using standard FLC response criteria was able to identify a subset of patients at high risk of early relapse, and these patients may benefit from earlier interventions.
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Affiliation(s)
- Kevin Barley
- Multiple Myeloma Program, Mount Sinai School of Medicine, New York, NY
| | - Sharon Tindle
- Multiple Myeloma Program, Mount Sinai School of Medicine, New York, NY
| | - Emilia Bagiella
- Department of Health Evidence and Policy, Mount Sinai School of Medicine, New York, NY
| | - Sundar Jagannath
- Multiple Myeloma Program, Mount Sinai School of Medicine, New York, NY
| | - Ajai Chari
- Multiple Myeloma Program, Mount Sinai School of Medicine, New York, NY.
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Radocha J, Pour L, Pika T, Maisnar V, Špička I, Gregora E, Krejčí M, Minařík J, Machálková K, Straub J, Pavlíček P, Hájek R, Žák P. Multicentered patient-based evidence of the role of free light chain ratio normalization in multiple myeloma disease relapse. Eur J Haematol 2015; 96:119-27. [PMID: 25816709 DOI: 10.1111/ejh.12556] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The normalization of free light chain ratio (FLCr) has been introduced as a marker of stringent complete remission (CR) of multiple myeloma (MM). There is currently a lack of literature assessing the role of FLCr on MM disease progression and remission status. PATIENTS AND METHODS A multicentered retrospective review of 125 patients with MM in CR and various FLCr values was completed. Parameters of interest included patient demographics, FLCr values, complete remission (CR)/relapse status, and time to progression (TTP). The FLCr values were recorded to provide time-dependent findings on the role of FLCr on progression-free survival and overall survival (OS). RESULTS The mean follow-up time of 125 patients from five hospitals in the Czech Republic was 31 months. A total of 47.2% of patients relapsed (54 of 125) during the follow-up period. The median TTP of patients with normal FLCr (n = 66) was 54.4 and 40.2 months for patients with abnormal FLCr (n = 59) (P = 0.217). None of the patients reached median overall survival regardless of FLCr values (P = 0.821). In the subgroup of newly diagnosed patients after upfront autologous stem cell transplantation (ASCT), there were 55.6% of patients (35 of 63) with normal FLCr and 44.4% (28 of 64) with abnormal FLCr. A total of 34.9% of patients (22 of 63) relapsed in this subgroup. Within the abnormal FLCr patients, a median TTP was 56.3 months, but no median TTP was reached among the normal FLCr patients (P = 0.746). Median OS in patients with normal (nFLCr) and abnormal FLCr (aFLCr) was not reached (P = 0.787). CONCLUSION We did not observe any benefit from FLCr normalization in CR in myeloma patients in terms of progression-free survival or overall survival.
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Affiliation(s)
- Jakub Radocha
- 4th Department of Medicine - Hematology, Charles University Hospital and Faculty of Medicine Hradec, Králové, Czech Republic
| | - Luděk Pour
- Department of Internal Medicine-Hematooncology, University Hospital Brno, Brno, Czech Republic
| | - Tomáš Pika
- Department of Internal Medicine III, Palacky University and University Hospital Olomouc, Olomouc, Czech Republic
| | - Vladimír Maisnar
- 4th Department of Medicine - Hematology, Charles University Hospital and Faculty of Medicine Hradec, Králové, Czech Republic
| | - Ivan Špička
- First Department of Medicine-Department of Hematology, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - Evžen Gregora
- Department of Clinical Hematology, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Marta Krejčí
- Department of Internal Medicine-Hematooncology, University Hospital Brno, Brno, Czech Republic
| | - Jiří Minařík
- Department of Internal Medicine III, Palacky University and University Hospital Olomouc, Olomouc, Czech Republic
| | - Kateřina Machálková
- 4th Department of Medicine - Hematology, Charles University Hospital and Faculty of Medicine Hradec, Králové, Czech Republic
| | - Jan Straub
- First Department of Medicine-Department of Hematology, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - Petr Pavlíček
- Department of Clinical Hematology, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Roman Hájek
- Department of Clinical Hematology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Pavel Žák
- 4th Department of Medicine - Hematology, Charles University Hospital and Faculty of Medicine Hradec, Králové, Czech Republic
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New criteria for response assessment: role of minimal residual disease in multiple myeloma. Blood 2015; 125:3059-68. [PMID: 25838346 DOI: 10.1182/blood-2014-11-568907] [Citation(s) in RCA: 215] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 01/17/2015] [Indexed: 12/26/2022] Open
Abstract
Assessment of minimal residual disease (MRD) is becoming standard diagnostic care for potentially curable neoplasms such as acute lymphoblastic leukemia. In multiple myeloma (MM), the majority of patients will inevitably relapse despite achievement of progressively higher complete remission (CR) rates. Novel treatment protocols with inclusion of antibodies and small molecules might well be able to further increase remission rates and potentially also cure rates. Therefore, MRD diagnostics becomes essential to assess treatment effectiveness. This review summarizes reports from the past 2 decades, which demonstrate that persistent MRD by multiparameter flow cytometry, polymerase chain reaction, next-generation sequencing, and positron emission tomography/computed tomography, predicts significantly inferior survival among CR patients. We describe the specific features of currently available techniques for MRD monitoring and outline the arguments favoring new criteria for response assessment that incorporate MRD levels. Extensive data indicate that MRD information can potentially be used as biomarker to evaluate the efficacy of different treatment strategies, help on treatment decisions, and act as surrogate for overall survival. The time has come to address within clinical trials the exact role of baseline risk factors and MRD monitoring for tailored therapy in MM, which implies systematic usage of highly sensitive, cost-effective, readily available, and standardized MRD techniques.
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19
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Barbee MS, Nooka A, Kaufman JL, Kim S, Chen Z, Heffner LT, Lonial S, Harvey RD. Predictors of survival outcomes in phase 1 relapsed or refractory multiple myeloma patients. Cancer 2015; 121:853-62. [DOI: 10.1002/cncr.29136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 09/29/2014] [Accepted: 10/08/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Meagan S. Barbee
- Department of Pharmacy; Memorial Sloan Kettering Cancer Center; New York New York
| | - Ajay Nooka
- Department of Hematology and Medical Oncology; Winship Cancer Institute; Emory University; Atlanta Georgia
| | - Jonathan L. Kaufman
- Department of Hematology and Medical Oncology; Winship Cancer Institute; Emory University; Atlanta Georgia
| | - Sungjin Kim
- Biostatistics Shared Core Resource; Winship Cancer Institute; Emory University; Atlanta Georgia
| | - Zhengjia Chen
- Biostatistics Shared Core Resource; Winship Cancer Institute; Emory University; Atlanta Georgia
- Department of Biostatistics and Bioinformatics; Rollins School of Public Health; Emory University; Atlanta Georgia
| | - Leonard T. Heffner
- Department of Hematology and Medical Oncology; Winship Cancer Institute; Emory University; Atlanta Georgia
| | - Sagar Lonial
- Department of Hematology and Medical Oncology; Winship Cancer Institute; Emory University; Atlanta Georgia
| | - R. Donald Harvey
- Department of Hematology and Medical Oncology; Winship Cancer Institute; Emory University; Atlanta Georgia
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Yağcı M, Karakaya F, Suyanı E, Haznedar R. Serum free light chain response after 2 courses of induction chemotherapy predicts prognosis in myeloma patients. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2014; 15:98-102. [PMID: 25441109 DOI: 10.1016/j.clml.2014.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 08/18/2014] [Accepted: 08/25/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND The aim of this study was to investigate the prognostic effect of serum free light chain (sFLC) response after 2 cycles of first-line chemotherapy (CT) in multiple myeloma (MM) patients. MATERIALS AND METHODS The data of 78 newly diagnosed MM patients who had sFLC levels at diagnosis and after 2 cycles of first-line CT were included in the study. The prognostic effect of sFLCs were evaluated with normalization of sFLC κ/λ ratio after 2 cycles of CT and involved/uninvolved (i/u) sFLCs. RESULTS At the end of follow-up the probability of overall survival (OS) was 95.7% versus 68.5% in patients with and without normalized sFLC κ/λ ratio, respectively (P = .072). The probability of OS with i/u sFLC assessment was 97.4% versus 55.8% with regard to i/u sFLC ≤ 10 and > 10, respectively (P = .001). In univariate and multivariate analysis including sFLC ratio, age, sex, and International Staging System, i/u sFLC ratio > 10 after 2 cycles of CT was identified as an independent risk factor for OS (P = .015; hazard ratio [HR], 13.2; 95% confidence interval [CI], 1.668-104.65 vs. P = .011; HR, 15.17; 95% CI, 1.85-123.89). CONCLUSION Early response assessment in terms of sFLC after 2 courses of induction CT seems to have a prognostic effect in MM patients. The methodology and timing of the evaluation based on sFLCs needs to be validated in prospective studies.
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Affiliation(s)
- Münci Yağcı
- Gazi University, Faculty of Medicine, Department of Hematology, Ankara, Turkey.
| | - Fatih Karakaya
- Gazi University, Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Elif Suyanı
- Gazi University, Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Rauf Haznedar
- Gazi University, Faculty of Medicine, Department of Hematology, Ankara, Turkey
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Ozsan GH, Dispenzieri A. Serum free light chain analysis in multiple myeloma and plasma cell dyscrasias. Expert Rev Clin Immunol 2014; 7:65-73. [DOI: 10.1586/eci.10.80] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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22
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Tan D, Chng WJ, Chou T, Nawarawong W, Hwang SY, Chim CS, Chen W, Durie BGM, Lee JH. Management of multiple myeloma in Asia: resource-stratified guidelines. Lancet Oncol 2013; 14:e571-81. [PMID: 24176575 DOI: 10.1016/s1470-2045(13)70404-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Treatment of multiple myeloma has undergone substantial developments in the past 10 years. The introduction of novel drugs has changed the treatment of the disease and substantially improved survival outcomes. Clinical practice guidelines based on evidence have been developed to provide recommendations on standard treatment approaches. However, the guidelines do not take into account resource limitations encountered by developing countries. The huge disparities in economy, health-care infrastructure, and access to novel drugs in Asian countries hinder the delivery of optimum care to every patient with multiple myeloma in Asia. In this Review we outline the guidelines that correspond with different levels of health-care resources and expertise, with the aim to unify diagnostic and therapeutic guidelines and help with the design of future studies in Asia.
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Affiliation(s)
- Daryl Tan
- Raffles Cancer Center, Raffles Hospital, Singapore, Singapore; Department of Haematology, Singapore General Hospital, Singapore, Singapore.
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23
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Graziani MS, Merlini G. Serum free light chain analysis in the diagnosis and management of multiple myeloma and related conditions. Expert Rev Mol Diagn 2013; 14:55-66. [DOI: 10.1586/14737159.2014.864557] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Honek T, Krejčí J, Špinarová L, Hude P, Němec P, Adam Z, Sirotková A, Žampachová V, Vítovec J. Heart transplantation for cardiac light chain amyloidosis with subsequent autologous stem cell transplantation. COR ET VASA 2013. [DOI: 10.1016/j.crvasa.2012.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Murng SHK, Follows L, Whitfield P, Snowden JA, Swallow K, Green K, Sargur R, Egner W. Defining the impact of individual sample variability on routine immunoassay of serum free light chains (sFLC) in multiple myeloma. Clin Exp Immunol 2013; 171:201-9. [PMID: 23286947 DOI: 10.1111/cei.12011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2012] [Indexed: 11/27/2022] Open
Abstract
Serum free light chain (sFLC) measurement has gained widespread acceptance and is incorporated into various diagnostic and response criteria. Non-linearity and antigen excess are the main causes of 'variability' in the measurement of sFLC using immunoassay, but the impact of these on measurement has been unclear. We performed a retrospective evaluation using a dilutional strategy to detect these phenomena. A total of 464 samples in 2009 and 373 samples in 2010 were analysed for sFLC. Non-linearity was detected in both high and apparently normal sFLC. Major non-linearity of more than twofold is common in high kappa (20·2%) and lambda (14·1%). It is less common in samples with apparently normal levels - kappa (6·4%) and lambda (9·5%). 9·4% of kappa and 15·5% of lambda showed antigen excess at screening dilutions. 34·4% of the samples had either non-linearity or antigen excess. We conclude that significant measurement variability is common in the measurement of sFLC. There is currently no reliable technique to detect non-linearity phenomena unless a serial dilution strategy is applied to every analysis. We recommend that laboratories routinely reporting sFLC results for clinical services need appropriate strategies for addressing these issues. Clinicians should be aware of these limitations in interpretation of sFLC assay for individual patients. Future guidelines should adopt action thresholds which are grounded firmly in test performance parameters.
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Affiliation(s)
- S H K Murng
- Immunology Department, Northern General Hospital, Sheffield, UK
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Iwama KI, Chihara D, Tsuda K, Ugai T, Sugihara H, Nishida Y, Yamakura M, Takeuchi M, Matsue K. Normalization of free light chain kappa/lambda ratio is a robust prognostic indicator of favorable outcome in patients with multiple myeloma. Eur J Haematol 2013; 90:134-41. [DOI: 10.1111/ejh.12050] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2012] [Indexed: 01/29/2023]
Affiliation(s)
- Kan-ichi Iwama
- Division of Hematology/Oncology, Department of Medicine; Kameda Medical Center; Chiba; Japan
| | - Dai Chihara
- Department of Epidemiology; Aichi Cancer Center; Nagoya; Japan
| | - Kenji Tsuda
- Division of Hematology/Oncology, Department of Medicine; Kameda Medical Center; Chiba; Japan
| | - Tomotaka Ugai
- Division of Hematology/Oncology, Department of Medicine; Kameda Medical Center; Chiba; Japan
| | - Hiroyuki Sugihara
- Division of Hematology/Oncology, Department of Medicine; Kameda Medical Center; Chiba; Japan
| | - Yuhki Nishida
- Division of Hematology/Oncology, Department of Medicine; Kameda Medical Center; Chiba; Japan
| | - Masayuki Yamakura
- Division of Hematology/Oncology, Department of Medicine; Kameda Medical Center; Chiba; Japan
| | - Masami Takeuchi
- Division of Hematology/Oncology, Department of Medicine; Kameda Medical Center; Chiba; Japan
| | - Kosei Matsue
- Division of Hematology/Oncology, Department of Medicine; Kameda Medical Center; Chiba; Japan
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27
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Mori S, Crawford BS, Roddy JVF, Phillips G, Elder P, Hofmeister CC, Efebera Y, Benson DM. Serum free light chains in myeloma patients with an intact M protein by immunofixation: potential roles for response assessment and prognosis during induction therapy with novel agents. Hematol Oncol 2012; 30:156-62. [PMID: 22028144 PMCID: PMC3557798 DOI: 10.1002/hon.1019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Revised: 09/06/2011] [Accepted: 09/22/2011] [Indexed: 11/08/2022]
Abstract
The ascertainment of serum free light chain (sFLC) levels has been shown to be valuable in screening for the presence of plasma cell dyscrasia as well as for baseline prognosis in newly diagnosed patients. For patients with amyloidosis and those with oligo-secretory or non-secretory multiple myeloma (MM), serial measurement of sFLC has also been shown to be valuable in monitoring disease status. However, in patients with a measureable, intact monoclonal protein by immunofixation (M protein), the serial measurement of sFLC remains undefined and is currently not recommended in professional guidelines. Herein, we provide data comparing sFLC with M protein as biomarkers of response in newly diagnosed patients with MM undergoing induction therapy with the novel agents thalidomide, lenalidomide and/or bortezomib. We show that although M protein appears to outperform sFLC comparatively over the course of induction therapy, the addition of FLC to M protein further informs the characterization of residual disease status post-induction. Moreover, sFLC at the time of stem cell mobilization appears to hold prognostic power for survival endpoints following high-dose chemotherapy/autologous stem cell transplant (HDC/SCT). These findings suggest potentially novel roles for sFLC in patients with MM with an intact M protein receiving novel agent-based induction strategies followed by HDC/SCT.
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Affiliation(s)
- Sherry Mori
- Department of Pharmacy, The Ohio State University Comprehensive Cancer Center
| | - Brooke S Crawford
- Department of Pharmacy, The Ohio State University Comprehensive Cancer Center
| | - Julianna VF Roddy
- Department of Pharmacy, The Ohio State University Comprehensive Cancer Center
| | - Gary Phillips
- Department of Biostatistics, The Ohio State University Comprehensive Cancer Center
| | - Pat Elder
- Blood and Marrow Transplant Program, The Ohio State University Comprehensive Cancer Center
| | - Craig C Hofmeister
- Blood and Marrow Transplant Program, The Ohio State University Comprehensive Cancer Center
- Division of Hematology, The Ohio State University Comprehensive Cancer Center
| | - Yvonne Efebera
- Blood and Marrow Transplant Program, The Ohio State University Comprehensive Cancer Center
- Division of Hematology, The Ohio State University Comprehensive Cancer Center
| | - Don M Benson
- Blood and Marrow Transplant Program, The Ohio State University Comprehensive Cancer Center
- Division of Hematology, The Ohio State University Comprehensive Cancer Center
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28
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Hart AJ, Jagasia MH, Kim AS, Mosse CA, Savani BN, Kassim A. Minimal residual disease in myeloma: are we there yet? Biol Blood Marrow Transplant 2012; 18:1790-9. [PMID: 22626785 DOI: 10.1016/j.bbmt.2012.05.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 05/03/2012] [Indexed: 12/20/2022]
Abstract
Measurement of minimal residual disease is routine in diseases such as chronic myelogenous leukemia, precursor B cell acute lymphoblastic leukemia, and acute promyelocytic leukemia because it provides important prognostic information. However, the role of minimal residual disease testing has not been widely adopted in multiple myeloma (MM), with other parameters such as the International Staging System (ISS) and cytogenetic analysis primarily guiding therapy and determination of prognosis. Until recently, achieving a complete response (CR), as defined by the International Myeloma Working Group (IMWG) criteria, was rare in patients with MM. The use of novel agents with or without autologous peripheral blood stem cell transplantation (auto-PBSCT) has significantly increased CR rates, thus increasing overall survival (OS) rates. The majority of patients with MM have persistent levels of residual disease that are below the sensitivity of bone marrow (BM) morphology, protein electrophoresis with immunofixation, and light chain quantitation even after attaining CR and will eventually relapse. Measurement of minimal residual disease by more sensitive methods, and the use of these methods as a tool for predicting patient outcomes and guiding therapeutic decisions, has thus become more relevant. Methods available for monitoring minimal residual disease in MM include PCR and multiparameter flow cytometry (MFC), both of which have been shown to be valuable in other hematologic malignancies; however, neither has become a standard of care in MM. Here, we review current evidence for using minimal residual disease measurement for risk assessment in MM as well as incorporating pretreatment factors and posttreatment minimal residual disease monitoring as a prognostic tool for therapeutic decisions, and we outline challenges to developing uniform criteria for minimal residual disease monitoring.
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Affiliation(s)
- Andrew J Hart
- Department of Medicine, Division of Hematology/Oncology, Section of Hematology and Stem Cell Transplant, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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29
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[Value of serum free light chains assay in plasma cell disorders]. Med Clin (Barc) 2010; 135:368-74. [PMID: 20598719 DOI: 10.1016/j.medcli.2010.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Revised: 04/13/2010] [Accepted: 04/20/2010] [Indexed: 11/23/2022]
Abstract
The identification and quantification of the monoclonal immunoglobulin in Plasma Cell Disorders (PCD) is based on electrophoresis, immunofixation (IFE) and on immunoglobulins nephelometric measurement. Even though the combination of these techniques is highly sensitive, there are two entities which pose a diagnostic challenge: Non-secretory Multiple Myeloma (MM) and Amyloidosis (AL) patients. Furthermore, when it comes to the results, these techniques have a degree of subjective interpretation and the IFE does not provide quantitative results. Within these limitations a new assay capable of quantifying free light chains (FLC) in serum has been developed. This is a great improvement in PCD and its major indication is the diagnosis and monitoring of patients with AL and non-secretory MM. In addition, its use has been recommended in the screening of all gammopathies; in the prognostic evaluation of MM and other PCD; and the definition of the stringent complete response for patients who achieve a complete remission (CR) with negative IFE and a normalized FLC ratio.
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