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Böckle D, Tabares P, Zhou X, Schimanski S, Steinhardt MJ, Bittrich M, Seebacher E, Ulbrich M, Wilnit A, Metz C, Heidemeier A, Bley T, Werner R, Buck A, Einsele H, Kortüm KM, Beilhack A, Rasche L. Minimal residual disease and imaging-guided consolidation strategies in newly diagnosed and relapsed refractory multiple myeloma. Br J Haematol 2022; 198:515-522. [PMID: 35582835 DOI: 10.1111/bjh.18249] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/08/2022] [Accepted: 05/02/2022] [Indexed: 12/16/2022]
Abstract
Measurement of minimal residual disease (MRD) by next-generation flow cytometry (NGF) is an important tool to define deep responses in multiple myeloma (MM). However, little is known about the value of combining NGF with functional imaging and its role for MRD-based consolidation strategies in clinical routine. In the present study, we report our experience investigating these issues with 102 patients with newly diagnosed (n = 57) and relapsed/refractory MM (n = 45). Imaging was performed using either positron emission tomography or diffusion-weighted magnetic resonance imaging. In all, 45% of patients achieved MRD-negativity on both NGF and imaging (double-negativity), and 8% and 40% of patients were negative on either NGF or imaging respectively. Thus, in a minority of patients imaging was the only technique to detect residual disease. Imaging-positivity despite negativity on NGF was more common in heavily pretreated disease (four or more previous lines) compared to newly diagnosed MM (p < 0.01). Among the 29 patients undergoing MRD-triggered consolidation, 51% responded with MRD conversion and 21% with improved serological response. MRD-triggered consolidation led to superior progression-free survival (PFS) when compared to standard treatment (p = 0.04). In conclusion, we show that combining NGF with imaging is helpful particularly in patients with heavily pretreated MM, and that MRD-based consolidation could lead to improved PFS.
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Affiliation(s)
- David Böckle
- Division of Oncology and Hematology, Department of Internal Medicine II, Würzburg University Hospital, Würzburg, Germany
| | - Paula Tabares
- Division of Oncology and Hematology, Department of Internal Medicine II, Würzburg University Hospital, Würzburg, Germany.,Interdisciplinary Center for Clinical Research Laboratory, Würzburg University Hospital, Würzburg, Germany
| | - Xiang Zhou
- Division of Oncology and Hematology, Department of Internal Medicine II, Würzburg University Hospital, Würzburg, Germany
| | - Sven Schimanski
- Division of Oncology and Hematology, Department of Internal Medicine II, Würzburg University Hospital, Würzburg, Germany
| | - Maximilian J Steinhardt
- Division of Oncology and Hematology, Department of Internal Medicine II, Würzburg University Hospital, Würzburg, Germany
| | - Max Bittrich
- Division of Oncology and Hematology, Department of Internal Medicine II, Würzburg University Hospital, Würzburg, Germany
| | - Elena Seebacher
- Division of Oncology and Hematology, Department of Internal Medicine II, Würzburg University Hospital, Würzburg, Germany.,Interdisciplinary Center for Clinical Research Laboratory, Würzburg University Hospital, Würzburg, Germany
| | - Maria Ulbrich
- Division of Oncology and Hematology, Department of Internal Medicine II, Würzburg University Hospital, Würzburg, Germany.,Interdisciplinary Center for Clinical Research Laboratory, Würzburg University Hospital, Würzburg, Germany
| | - Amy Wilnit
- Division of Oncology and Hematology, Department of Internal Medicine II, Würzburg University Hospital, Würzburg, Germany.,Interdisciplinary Center for Clinical Research Laboratory, Würzburg University Hospital, Würzburg, Germany
| | - Corona Metz
- Department of Radiology, Würzburg University Hospital, Würzburg, Germany
| | - Anke Heidemeier
- Department of Radiology, Würzburg University Hospital, Würzburg, Germany
| | - Thorsten Bley
- Department of Radiology, Würzburg University Hospital, Würzburg, Germany
| | - Rudolf Werner
- Department of Nuclear Medicine, Würzburg University Hospital, Würzburg, Germany
| | - Andreas Buck
- Department of Nuclear Medicine, Würzburg University Hospital, Würzburg, Germany
| | - Hermann Einsele
- Division of Oncology and Hematology, Department of Internal Medicine II, Würzburg University Hospital, Würzburg, Germany
| | - K Martin Kortüm
- Division of Oncology and Hematology, Department of Internal Medicine II, Würzburg University Hospital, Würzburg, Germany
| | - Andreas Beilhack
- Division of Oncology and Hematology, Department of Internal Medicine II, Würzburg University Hospital, Würzburg, Germany.,Interdisciplinary Center for Clinical Research Laboratory, Würzburg University Hospital, Würzburg, Germany
| | - Leo Rasche
- Division of Oncology and Hematology, Department of Internal Medicine II, Würzburg University Hospital, Würzburg, Germany.,Mildred Scheel Early Career Center, Würzburg University Hospital, Würzburg, Germany
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Dahlhoff J, Manz H, Steinfatt T, Delgado-Tascon J, Seebacher E, Schneider T, Wilnit A, Mokhtari Z, Tabares P, Böckle D, Rasche L, Martin Kortüm K, Lutz MB, Einsele H, Brandl A, Beilhack A. Transient regulatory T-cell targeting triggers immune control of multiple myeloma and prevents disease progression. Leukemia 2021; 36:790-800. [PMID: 34584204 PMCID: PMC8885410 DOI: 10.1038/s41375-021-01422-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 09/07/2021] [Accepted: 09/10/2021] [Indexed: 12/11/2022]
Abstract
Multiple myeloma remains a largely incurable disease of clonally expanding malignant plasma cells. The bone marrow microenvironment harbors treatment-resistant myeloma cells, which eventually lead to disease relapse in patients. In the bone marrow, CD4+FoxP3+ regulatory T cells (Tregs) are highly abundant amongst CD4+ T cells providing an immune protective niche for different long-living cell populations, e.g., hematopoietic stem cells. Here, we addressed the functional role of Tregs in multiple myeloma dissemination to bone marrow compartments and disease progression. To investigate the immune regulation of multiple myeloma, we utilized syngeneic immunocompetent murine multiple myeloma models in two different genetic backgrounds. Analyzing the spatial immune architecture of multiple myeloma revealed that the bone marrow Tregs accumulated in the vicinity of malignant plasma cells and displayed an activated phenotype. In vivo Treg depletion prevented multiple myeloma dissemination in both models. Importantly, short-term in vivo depletion of Tregs in mice with established multiple myeloma evoked a potent CD8 T cell- and NK cell-mediated immune response resulting in complete and stable remission. Conclusively, this preclinical in-vivo study suggests that Tregs are an attractive target for the treatment of multiple myeloma.
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Affiliation(s)
- Julia Dahlhoff
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany.,Center for Interdisciplinary Clinical Research, University of Würzburg, Würzburg, Germany.,Graduate School of Life Sciences, University of Würzburg, Würzburg, Germany
| | - Hannah Manz
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany.,Center for Interdisciplinary Clinical Research, University of Würzburg, Würzburg, Germany.,Graduate School of Life Sciences, University of Würzburg, Würzburg, Germany
| | - Tim Steinfatt
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany.,Center for Interdisciplinary Clinical Research, University of Würzburg, Würzburg, Germany.,Graduate School of Life Sciences, University of Würzburg, Würzburg, Germany
| | - Julia Delgado-Tascon
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany.,Center for Interdisciplinary Clinical Research, University of Würzburg, Würzburg, Germany
| | - Elena Seebacher
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany.,Center for Interdisciplinary Clinical Research, University of Würzburg, Würzburg, Germany
| | - Theresa Schneider
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany.,Center for Interdisciplinary Clinical Research, University of Würzburg, Würzburg, Germany
| | - Amy Wilnit
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany.,Center for Interdisciplinary Clinical Research, University of Würzburg, Würzburg, Germany
| | - Zeinab Mokhtari
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany.,Center for Interdisciplinary Clinical Research, University of Würzburg, Würzburg, Germany
| | - Paula Tabares
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany.,Center for Interdisciplinary Clinical Research, University of Würzburg, Würzburg, Germany
| | - David Böckle
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Leo Rasche
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany.,Mildred Scheel Early Career Center, University Hospital of Würzburg, Würzburg, Germany
| | - K Martin Kortüm
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Manfred B Lutz
- Graduate School of Life Sciences, University of Würzburg, Würzburg, Germany.,Institute for Virology and Immunobiology, Würzburg University, Würzburg, Germany
| | - Hermann Einsele
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Andreas Brandl
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany.,Center for Interdisciplinary Clinical Research, University of Würzburg, Würzburg, Germany
| | - Andreas Beilhack
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany. .,Center for Interdisciplinary Clinical Research, University of Würzburg, Würzburg, Germany. .,Graduate School of Life Sciences, University of Würzburg, Würzburg, Germany.
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