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de Tute RM, Cook G, Cairns DA, Brown JM, Cavenagh J, Ashcroft AJ, Snowden JA, Yong K, Tholouli E, Jenner M, Hockaday A, Drayson MT, Morris TCM, Rawstron AC, Owen RG. Impact of minimal residual disease (MRD) in salvage autologous stem cell transplantation for relapsed myeloma: results from the NCRI Myeloma X (intensive) trial. Bone Marrow Transplant 2024; 59:431-434. [PMID: 38195983 DOI: 10.1038/s41409-023-02164-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/12/2023] [Accepted: 11/27/2023] [Indexed: 01/11/2024]
Affiliation(s)
- Ruth M de Tute
- Haematological Malignancy Diagnostic Service, Leeds Teaching Hospitals Trust, Leeds, UK.
| | - Gordon Cook
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK.
| | - David A Cairns
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Julia M Brown
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Jamie Cavenagh
- Department of Haematology, Barts & The London NHS Trust, London, UK
| | | | - John A Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust & Department of Endocrinology & Metabolism, University of Sheffield, Sheffield, UK
| | - Kwee Yong
- Department of Haematology, University College London, London, UK
| | - Eleni Tholouli
- Department of Clinical Haematology, Manchester Royal Infirmary, Manchester Foundation Trust, Manchester, UK
| | - Matthew Jenner
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Anna Hockaday
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Mark T Drayson
- Institute of Immunology and Immunotherapy University of Birmingham, Birmingham, UK
| | | | - Andy C Rawstron
- Haematological Malignancy Diagnostic Service, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Roger G Owen
- Haematological Malignancy Diagnostic Service, Leeds Teaching Hospitals Trust, Leeds, UK
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Yong K, Wilson W, de Tute RM, Camilleri M, Ramasamy K, Streetly M, Sive J, Bygrave CA, Benjamin R, Chapman M, Chavda SJ, Phillips EH, Del Mar Cuadrado M, Pang G, Jenner R, Dadaga T, Kamora S, Cavenagh J, Clifton-Hadley L, Owen RG, Popat R. Upfront autologous haematopoietic stem-cell transplantation versus carfilzomib-cyclophosphamide-dexamethasone consolidation with carfilzomib maintenance in patients with newly diagnosed multiple myeloma in England and Wales (CARDAMON): a randomised, phase 2, non-inferiority trial. Lancet Haematol 2023; 10:e93-e106. [PMID: 36529145 DOI: 10.1016/s2352-3026(22)00350-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/16/2022] [Accepted: 10/18/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Standard-of-care treatment for patients with newly diagnosed multiple myeloma is bortezomib-based induction followed by high-dose melphalan and autologous haematopoietic stem-cell transplantation (HSCT) and lenalidomide maintenance. We aimed to evaluate whether an immunomodulatory-free carfilzomib-based induction, consolidation, and maintenance protocol without autologous HSCT was non-inferior to the same induction regimen followed by autologous HSCT and maintenance. METHODS CARDAMON is a randomised, open-label, phase 2 trial in 19 hospitals in England and Wales, UK. Newly diagnosed, transplantation-eligible patients with multiple myeloma aged 18 years or older with an Eastern Cooperative Oncology Group (ECOG) performance status of 0-2 received four 28-day cycles of carfilzomib (56 mg/m2 intravenously on days 1, 2, 8, 9, 15, and 16), cyclophosphamide (500 mg orally on days 1, 8, and 15), and dexamethasone (40 mg orally on days 1, 8, 15, and 22; KCd), followed by peripheral blood stem cell mobilisation. Patients with at least a partial response were randomly assigned (1:1) to either high-dose melphalan and autologous HSCT or four cycles of KCd. All randomised patients received 18 cycles of carfilzomib maintenance (56 mg/m2 intravenously on days 1, 8, and 15). The primary outcomes were the proportion of patients with at least a very good partial response after induction and difference in progression-free survival rate at 2 years from randomisation (non-inferiority margin 10%), both assessed by intention to treat. Safety was assessed in all patients who started treatment. The trial is registered with ClinicalTrials.gov (NCT02315716); recruitment is complete and all patients are in follow-up. FINDINGS Between June 16, 2015, and July 8, 2019, 281 patients were enrolled, with 218 proceeding to randomisation (109 assigned to the KCd consolidation group [99 of whom completed consolidation] and 109 to the HSCT group [104 of whom underwent transplantation]). A further seven patients withdrew before initiation of carfilzomib maintenance (two in the KCd consolidation group vs five in the HSCT group). Median age was 59 years (IQR 52 to 64); 166 (59%) of 281 patients were male and 115 (41%) were female. 152 (71%) of 214 patients with known ethnicity were White, 37 (17%) were Black, 18 (8%) were Asian, 5 (2%) identified as Mixed, and 2 (1%) identified as other. Median follow-up from randomisation was 40·2 months (IQR 32·7 to 51·8). After induction, 162 (57·7%; 95% CI 51·6 to 63·5) of 281 patients had at least a very good partial response. The 2-year progression-free survival was 75% (95% CI 65 to 82) in the HSCT group versus 68% (95% CI 58 to 76) in the KCd group (difference -7·2%, 70% CI -11·1 to -2·8), exceeding the non-inferiority margin. The most common grade 3-4 events during KCd induction and consolidation were lymphocytopenia (72 [26%] of 278 patients who started induction; 15 [14%] of 109 patients who started consolidation) and infection (50 [18%] of 278 for induction; 15 [14%] of 109 for consolidation), and during carfilzomib maintenance were hypertension (20 [21%] of 97 patients in the KCd consolidation group vs 23 [23%] of 99 patients in the HSCT group) and infection (16 [16%] of 97 patients vs 25 [25%] of 99). Treatment-related serious adverse events at any point during the trial were reported in 109 (39%) of 278 patients who started induction, with infections (80 [29%]) being the most common. Treatment-emergent deaths were reported in five (2%) of 278 patients during induction (three from infection, one from cardiac event, and one from renal failure) and one of 99 patients during maintenance after autologous HSCT (oesophageal carcinoma). INTERPRETATION KCd did not meet the criteria for non-inferiority compared with autologous HSCT, but the marginal difference in progression-free survival suggests that further studies are warranted to explore deferred autologous HSCT in some subgroups, such as individuals who are MRD negative after induction. FUNDING Cancer Research UK and Amgen.
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Affiliation(s)
- Kwee Yong
- Cancer Institute, University College London, London, UK; Clinical Haematology Department, University College London Hospitals NHS Foundation Trust, London, UK.
| | - William Wilson
- Cancer Research UK and UCL Cancer Trials Centre, University College London, London, UK
| | - Ruth M de Tute
- Haematological Malignancy Diagnostic Service, St James's University Hospital, Leeds, UK
| | - Marquita Camilleri
- Cancer Institute, University College London, London, UK; Clinical Haematology Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - Karthik Ramasamy
- Department of Clinical Haematology, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Matthew Streetly
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jonathan Sive
- Clinical Haematology Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ceri A Bygrave
- Department of Haematology, University Hospital of Wales, Cardiff, UK
| | | | - Michael Chapman
- Medical Research Council Toxicology Unit, University of Cambridge, Cambridge, UK
| | | | | | | | - Gavin Pang
- Cancer Research UK and UCL Cancer Trials Centre, University College London, London, UK
| | - Richard Jenner
- Cancer Research UK and UCL Cancer Trials Centre, University College London, London, UK
| | - Tushhar Dadaga
- Cancer Research UK and UCL Cancer Trials Centre, University College London, London, UK
| | - Sumaiya Kamora
- Cancer Research UK and UCL Cancer Trials Centre, University College London, London, UK
| | - James Cavenagh
- Department of Haemato-Oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Laura Clifton-Hadley
- Cancer Research UK and UCL Cancer Trials Centre, University College London, London, UK
| | - Roger G Owen
- Haematological Malignancy Diagnostic Service, St James's University Hospital, Leeds, UK
| | - Rakesh Popat
- Clinical Haematology Department, University College London Hospitals NHS Foundation Trust, London, UK
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de Tute RM, Pawlyn C, Cairns DA, Davies FE, Menzies T, Rawstron A, Jones JR, Hockaday A, Henderson R, Cook G, Drayson MT, Jenner MW, Kaiser MF, Gregory WM, Morgan GJ, Jackson GH, Owen RG. Minimal Residual Disease After Autologous Stem-Cell Transplant for Patients With Myeloma: Prognostic Significance and the Impact of Lenalidomide Maintenance and Molecular Risk. J Clin Oncol 2022; 40:2889-2900. [PMID: 35377708 DOI: 10.1200/jco.21.02228] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/14/2022] [Accepted: 02/08/2022] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Minimal residual disease (MRD) can predict outcomes in patients with multiple myeloma, but limited data are available on the prognostic impact of MRD when assessed at serial time points in the context of maintenance therapy after autologous stem-cell transplant (ASCT) and the interaction between MRD and molecular risk. METHODS Data from a large phase III trial (Myeloma XI) were examined to determine the relationship between MRD status, progression-free survival (PFS), and overall survival (OS) in post-ASCT patients randomly assigned to lenalidomide maintenance or no maintenance at 3 months after ASCT. MRD status was assessed by flow cytometry (median sensitivity 0.004%) before maintenance random assignment (ASCT + 3) and 6 months later (ASCT + 9). RESULTS At ASCT + 3, 475 of 750 (63.3%) patients were MRD-negative and 275 (36.7%) were MRD-positive. MRD-negative status was associated with improved PFS (hazard ratio [HR] = 0.47; 95% CI, 0.37 to 0.58 P < .001) and OS (HR = 0.59; 95% CI, 0.40 to 0.85; P = .0046). At ASCT + 9, 214 of 326 (65.6%) were MRD-negative and 112 (34.4%) were MRD-positive. MRD-negative status was associated with improved PFS (HR = 0.20; 95% CI, 0.13 to 0.31; P < .0001) and OS (HR = 0.33; 95% CI, 0.15 to 0.75; P = .0077). The findings were very similar when restricted to patients with complete response/near complete response. Sustained MRD negativity from ASCT + 3 to ASCT + 9 or the conversion to MRD negativity by ASCT + 9 was associated with the longest PFS/OS. Patients randomly assigned to lenalidomide maintenance were more likely to convert from being MRD-positive before maintenance random assignment to MRD-negative 6 months later (lenalidomide 30%, observation 17%). High-risk molecular features had an adverse effect on PFS and OS even for those patients achieving MRD-negative status. On multivariable analysis of MRD status, maintenance therapy and molecular risk maintained prognostic impact at both ASCT + 3 and ASCT + 9. CONCLUSION In patients with multiple myeloma, MRD status at both ASCT + 3 and ASCT + 9 is a powerful predictor of PFS and OS.
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Affiliation(s)
- Ruth M de Tute
- Haematological Malignancy Diagnostic Service, Leeds Cancer Centre, Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | - Charlotte Pawlyn
- The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - David A Cairns
- Leeds Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Faith E Davies
- Perlmutter Cancer Center, NYU Langone Health, New York, NY
| | - Tom Menzies
- Leeds Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Andy Rawstron
- Haematological Malignancy Diagnostic Service, Leeds Cancer Centre, Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | - John R Jones
- Eastbourne District General Hospital, Eastbourne, United Kingdom
- Brighton and Sussex Medical School, University of Sussex, Sussex, United Kingdom
- Kings College Hospital, NHS Foundation Trust, London, United Kingdom
| | - Anna Hockaday
- Leeds Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Rowena Henderson
- Leeds Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Gordon Cook
- Leeds Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
- Kings College Hospital, NHS Foundation Trust, London, United Kingdom
| | - Mark T Drayson
- Leeds Cancer Centre, Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | - Matthew W Jenner
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Martin F Kaiser
- The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Walter M Gregory
- Leeds Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | | | - Graham H Jackson
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Roger G Owen
- Haematological Malignancy Diagnostic Service, Leeds Cancer Centre, Leeds Teaching Hospitals Trust, Leeds, United Kingdom
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Jackson GH, Pawlyn C, Cairns DA, de Tute RM, Hockaday A, Collett C, Jones JR, Kishore B, Garg M, Williams CD, Karunanithi K, Lindsay J, Rocci A, Snowden JA, Jenner MW, Cook G, Russell NH, Drayson MT, Gregory WM, Kaiser MF, Owen RG, Davies FE, Morgan GJ. Carfilzomib, lenalidomide, dexamethasone, and cyclophosphamide (KRdc) as induction therapy for transplant-eligible, newly diagnosed multiple myeloma patients (Myeloma XI+): Interim analysis of an open-label randomised controlled trial. PLoS Med 2021; 18:e1003454. [PMID: 33428632 PMCID: PMC7799846 DOI: 10.1371/journal.pmed.1003454] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 11/23/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Carfilzomib is a second-generation irreversible proteasome inhibitor that is efficacious in the treatment of myeloma and carries less risk of peripheral neuropathy than first-generation proteasome inhibitors, making it more amenable to combination therapy. METHODS AND FINDINGS The Myeloma XI+ trial recruited patients from 88 sites across the UK between 5 December 2013 and 20 April 2016. Patients with newly diagnosed multiple myeloma eligible for transplantation were randomly assigned to receive the combination carfilzomib, lenalidomide, dexamethasone, and cyclophosphamide (KRdc) or a triplet of lenalidomide, dexamethasone, and cyclophosphamide (Rdc) or thalidomide, dexamethasone, and cyclophosphamide (Tdc). All patients were planned to receive an autologous stem cell transplantation (ASCT) prior to a randomisation between lenalidomide maintenance and observation. Eligible patients were aged over 18 years and had symptomatic myeloma. The co-primary endpoints for the study were progression-free survival (PFS) and overall survival (OS) for KRdc versus the Tdc/Rdc control group by intention to treat. PFS, response, and safety outcomes are reported following a planned interim analysis. The trial is registered (ISRCTN49407852) and has completed recruitment. In total, 1,056 patients (median age 61 years, range 33 to 75, 39.1% female) underwent induction randomisation to KRdc (n = 526) or control (Tdc/Rdc, n = 530). After a median follow-up of 34.5 months, KRdc was associated with a significantly longer PFS than the triplet control group (hazard ratio 0.63, 95% CI 0.51-0.76). The median PFS for patients receiving KRdc is not yet estimable, versus 36.2 months for the triplet control group (p < 0.001). Improved PFS was consistent across subgroups of patients including those with genetically high-risk disease. At the end of induction, the percentage of patients achieving at least a very good partial response was 82.3% in the KRdc group versus 58.9% in the control group (odds ratio 4.35, 95% CI 3.19-5.94, p < 0.001). Minimal residual disease negativity (cutoff 4 × 10-5 bone marrow leucocytes) was achieved in 55% of patients tested in the KRdc group at the end of induction, increasing to 75% of those tested after ASCT. The most common adverse events were haematological, with a low incidence of cardiac events. The trial continues to follow up patients to the co-primary endpoint of OS and for planned long-term follow-up analysis. Limitations of the study include a lack of blinding to treatment regimen and that the triplet control regimen did not include a proteasome inhibitor for all patients, which would be considered a current standard of care in many parts of the world. CONCLUSIONS The KRdc combination was well tolerated and was associated with both an increased percentage of patients achieving at least a very good partial response and a significant PFS benefit compared to immunomodulatory-agent-based triplet therapy. TRIAL REGISTRATION ClinicalTrials.gov ISRCTN49407852.
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Affiliation(s)
- Graham H. Jackson
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Charlotte Pawlyn
- The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - David A. Cairns
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Ruth M. de Tute
- Haematological Malignancy Diagnostic Service, St James’s University Hospital, Leeds, United Kingdom
| | - Anna Hockaday
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Corinne Collett
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - John R. Jones
- Kings College Hospital NHS Foundation Trust, London, United Kingdom
| | - Bhuvan Kishore
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Mamta Garg
- Leicester Royal Infirmary, Leicester, United Kingdom
| | - Cathy D. Williams
- Centre for Clinical Haematology, Nottingham University Hospital, Nottingham, United Kingdom
| | - Kamaraj Karunanithi
- University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom
| | - Jindriska Lindsay
- East Kent Hospitals University NHS Foundation Trust, Canterbury, United Kingdom
| | - Alberto Rocci
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - John A. Snowden
- Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Matthew W. Jenner
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Gordon Cook
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
- Section of Experimental Haematology, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, United Kingdom
| | - Nigel H. Russell
- Centre for Clinical Haematology, Nottingham University Hospital, Nottingham, United Kingdom
| | - Mark T. Drayson
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Walter M. Gregory
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Martin F. Kaiser
- The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - Roger G. Owen
- Haematological Malignancy Diagnostic Service, St James’s University Hospital, Leeds, United Kingdom
| | - Faith E. Davies
- Perlmutter Cancer Center, NYU Langone Health, New York, New York, United States of America
| | - Gareth J. Morgan
- Perlmutter Cancer Center, NYU Langone Health, New York, New York, United States of America
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Rawstron AC, de Tute RM, Haughton J, Owen RG. Measuring disease levels in myeloma using flow cytometry in combination with other laboratory techniques: Lessons from the past 20 years at the Leeds Haematological Malignancy Diagnostic Service. Cytometry B Clin Cytom 2015; 90:54-60. [PMID: 26147493 DOI: 10.1002/cyto.b.21271] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 06/20/2015] [Accepted: 06/29/2015] [Indexed: 11/09/2022]
Abstract
People with myeloma who obtain a good response to treatment have a better survival if sensitive molecular or flow-cytometric techniques show no detectable minimal residual disease (MRD). The application of MRD techniques to clinical trials is now considered to be increasingly important because treatment approaches are sufficiently effective that using survival outcomes is slowing down the identification of the best new treatments. The articles in this issue consider the laboratory requirements for harmonization of MRD analysis by flow cytometry but there are practical considerations that are also important in implementing a myeloma MRD assay in the cytometry laboratory. In particular, it is important to consider when to request, and how best to utilize, a bone marrow aspirate sample because the procedure is invasive and the cells obtained are valuable for a number of different investigations. This brief article considers some experience obtained over two decades of implementing a service for MRD detection, initially as a scientific bolt-on to clinical trials through to a routine clinical diagnostic assay.
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Affiliation(s)
- Andy C Rawstron
- HMDS, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Ruth M de Tute
- HMDS, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - J Haughton
- HMDS, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Roger G Owen
- HMDS, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
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de Tute RM, Rawstron AC, Gregory WM, Child JA, Davies FE, Bell SE, Cook G, Szubert AJ, Drayson MT, Jackson GH, Morgan GJ, Owen RG. Minimal residual disease following autologous stem cell transplant in myeloma: impact on outcome is independent of induction regimen. Haematologica 2015; 101:e69-71. [PMID: 26471484 DOI: 10.3324/haematol.2015.128215] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
| | | | | | | | - Faith E Davies
- Institute of Cancer Research, London, UK University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Sue E Bell
- Clinical Trials Research Unit, University of Leeds, UK
| | | | | | | | | | - Gareth J Morgan
- Institute of Cancer Research, London, UK University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Rawstron AC, Child JA, de Tute RM, Davies FE, Gregory WM, Bell SE, Szubert AJ, Navarro Coy N, Drayson MT, Feyler S, Ross FM, Cook G, Jackson GH, Morgan GJ, Owen RG. Reply to M. Roschewski et al. J Clin Oncol 2014; 32:476-7. [PMID: 24419132 DOI: 10.1200/jco.2013.53.0980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Rawstron AC, Child JA, de Tute RM, Davies FE, Gregory WM, Bell SE, Szubert AJ, Navarro-Coy N, Drayson MT, Feyler S, Ross FM, Cook G, Jackson GH, Morgan GJ, Owen RG. Minimal Residual Disease Assessed by Multiparameter Flow Cytometry in Multiple Myeloma: Impact on Outcome in the Medical Research Council Myeloma IX Study. J Clin Oncol 2013; 31:2540-7. [DOI: 10.1200/jco.2012.46.2119] [Citation(s) in RCA: 325] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Purpose To investigate the prognostic value of minimal residual disease (MRD) assessment in patients with multiple myeloma treated in the MRC (Medical Research Council) Myeloma IX trial. Patients and Methods Multiparameter flow cytometry (MFC) was used to assess MRD after induction therapy (n = 378) and at day 100 after autologous stem-cell transplantation (ASCT; n = 397) in intensive-pathway patients and at the end of induction therapy in non–intensive-pathway patients (n = 245). Results In intensive-pathway patients, absence of MRD at day 100 after ASCT was highly predictive of a favorable outcome (PFS, P < .001; OS, P = .0183). This outcome advantage was demonstrable in patients with favorable and adverse cytogenetics (PFS, P = .014 and P < .001, respectively) and in patients achieving immunofixation-negative complete response (CR; PFS, P = .0068). The effect of maintenance thalidomide was assessed, with the shortest PFS demonstrable in those MRD-positive patients who did not receive maintenance and longest in those who were MRD negative and did receive thalidomide (P < .001). Further analysis demonstrated that 28% of MRD-positive patients who received maintenance thalidomide became MRD negative. MRD assessment after induction therapy in the non–intensive-pathway patients did not seem to be predictive of outcome (PFS, P = .1). Conclusion MRD assessment by MFC was predictive of overall outcome in patients with myeloma undergoing ASCT. This predictive value was seen in patients achieving conventional CR as well as patients with favorable and adverse cytogenetics. The effects of maintenance strategies can also be evaluated, and our data suggest that maintenance thalidomide can eradicate MRD in some patients.
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Affiliation(s)
- Andy C. Rawstron
- Andy C. Rawstron, Ruth M. de Tute, Gordon Cook, and Roger G. Owen, St James's University Hospital; J. Anthony Child, Walter M. Gregory, Sue E. Bell, Alexander J. Szubert, and Nuria Navarro-Coy, University of Leeds, Leeds; Faith E. Davies and Gareth J. Morgan, Institute of Cancer Research, London; Mark T. Drayson, University of Birmingham, Birmingham; Sylvia Feyler, Calderdale and Huddersfield National Health Service Trust, Huddersfield; Fiona M. Ross, Wessex Regional Genetics Laboratory, Salisbury; and
| | - J. Anthony Child
- Andy C. Rawstron, Ruth M. de Tute, Gordon Cook, and Roger G. Owen, St James's University Hospital; J. Anthony Child, Walter M. Gregory, Sue E. Bell, Alexander J. Szubert, and Nuria Navarro-Coy, University of Leeds, Leeds; Faith E. Davies and Gareth J. Morgan, Institute of Cancer Research, London; Mark T. Drayson, University of Birmingham, Birmingham; Sylvia Feyler, Calderdale and Huddersfield National Health Service Trust, Huddersfield; Fiona M. Ross, Wessex Regional Genetics Laboratory, Salisbury; and
| | - Ruth M. de Tute
- Andy C. Rawstron, Ruth M. de Tute, Gordon Cook, and Roger G. Owen, St James's University Hospital; J. Anthony Child, Walter M. Gregory, Sue E. Bell, Alexander J. Szubert, and Nuria Navarro-Coy, University of Leeds, Leeds; Faith E. Davies and Gareth J. Morgan, Institute of Cancer Research, London; Mark T. Drayson, University of Birmingham, Birmingham; Sylvia Feyler, Calderdale and Huddersfield National Health Service Trust, Huddersfield; Fiona M. Ross, Wessex Regional Genetics Laboratory, Salisbury; and
| | - Faith E. Davies
- Andy C. Rawstron, Ruth M. de Tute, Gordon Cook, and Roger G. Owen, St James's University Hospital; J. Anthony Child, Walter M. Gregory, Sue E. Bell, Alexander J. Szubert, and Nuria Navarro-Coy, University of Leeds, Leeds; Faith E. Davies and Gareth J. Morgan, Institute of Cancer Research, London; Mark T. Drayson, University of Birmingham, Birmingham; Sylvia Feyler, Calderdale and Huddersfield National Health Service Trust, Huddersfield; Fiona M. Ross, Wessex Regional Genetics Laboratory, Salisbury; and
| | - Walter M. Gregory
- Andy C. Rawstron, Ruth M. de Tute, Gordon Cook, and Roger G. Owen, St James's University Hospital; J. Anthony Child, Walter M. Gregory, Sue E. Bell, Alexander J. Szubert, and Nuria Navarro-Coy, University of Leeds, Leeds; Faith E. Davies and Gareth J. Morgan, Institute of Cancer Research, London; Mark T. Drayson, University of Birmingham, Birmingham; Sylvia Feyler, Calderdale and Huddersfield National Health Service Trust, Huddersfield; Fiona M. Ross, Wessex Regional Genetics Laboratory, Salisbury; and
| | - Sue E. Bell
- Andy C. Rawstron, Ruth M. de Tute, Gordon Cook, and Roger G. Owen, St James's University Hospital; J. Anthony Child, Walter M. Gregory, Sue E. Bell, Alexander J. Szubert, and Nuria Navarro-Coy, University of Leeds, Leeds; Faith E. Davies and Gareth J. Morgan, Institute of Cancer Research, London; Mark T. Drayson, University of Birmingham, Birmingham; Sylvia Feyler, Calderdale and Huddersfield National Health Service Trust, Huddersfield; Fiona M. Ross, Wessex Regional Genetics Laboratory, Salisbury; and
| | - Alexander J. Szubert
- Andy C. Rawstron, Ruth M. de Tute, Gordon Cook, and Roger G. Owen, St James's University Hospital; J. Anthony Child, Walter M. Gregory, Sue E. Bell, Alexander J. Szubert, and Nuria Navarro-Coy, University of Leeds, Leeds; Faith E. Davies and Gareth J. Morgan, Institute of Cancer Research, London; Mark T. Drayson, University of Birmingham, Birmingham; Sylvia Feyler, Calderdale and Huddersfield National Health Service Trust, Huddersfield; Fiona M. Ross, Wessex Regional Genetics Laboratory, Salisbury; and
| | - Nuria Navarro-Coy
- Andy C. Rawstron, Ruth M. de Tute, Gordon Cook, and Roger G. Owen, St James's University Hospital; J. Anthony Child, Walter M. Gregory, Sue E. Bell, Alexander J. Szubert, and Nuria Navarro-Coy, University of Leeds, Leeds; Faith E. Davies and Gareth J. Morgan, Institute of Cancer Research, London; Mark T. Drayson, University of Birmingham, Birmingham; Sylvia Feyler, Calderdale and Huddersfield National Health Service Trust, Huddersfield; Fiona M. Ross, Wessex Regional Genetics Laboratory, Salisbury; and
| | - Mark T. Drayson
- Andy C. Rawstron, Ruth M. de Tute, Gordon Cook, and Roger G. Owen, St James's University Hospital; J. Anthony Child, Walter M. Gregory, Sue E. Bell, Alexander J. Szubert, and Nuria Navarro-Coy, University of Leeds, Leeds; Faith E. Davies and Gareth J. Morgan, Institute of Cancer Research, London; Mark T. Drayson, University of Birmingham, Birmingham; Sylvia Feyler, Calderdale and Huddersfield National Health Service Trust, Huddersfield; Fiona M. Ross, Wessex Regional Genetics Laboratory, Salisbury; and
| | - Sylvia Feyler
- Andy C. Rawstron, Ruth M. de Tute, Gordon Cook, and Roger G. Owen, St James's University Hospital; J. Anthony Child, Walter M. Gregory, Sue E. Bell, Alexander J. Szubert, and Nuria Navarro-Coy, University of Leeds, Leeds; Faith E. Davies and Gareth J. Morgan, Institute of Cancer Research, London; Mark T. Drayson, University of Birmingham, Birmingham; Sylvia Feyler, Calderdale and Huddersfield National Health Service Trust, Huddersfield; Fiona M. Ross, Wessex Regional Genetics Laboratory, Salisbury; and
| | - Fiona M. Ross
- Andy C. Rawstron, Ruth M. de Tute, Gordon Cook, and Roger G. Owen, St James's University Hospital; J. Anthony Child, Walter M. Gregory, Sue E. Bell, Alexander J. Szubert, and Nuria Navarro-Coy, University of Leeds, Leeds; Faith E. Davies and Gareth J. Morgan, Institute of Cancer Research, London; Mark T. Drayson, University of Birmingham, Birmingham; Sylvia Feyler, Calderdale and Huddersfield National Health Service Trust, Huddersfield; Fiona M. Ross, Wessex Regional Genetics Laboratory, Salisbury; and
| | - Gordon Cook
- Andy C. Rawstron, Ruth M. de Tute, Gordon Cook, and Roger G. Owen, St James's University Hospital; J. Anthony Child, Walter M. Gregory, Sue E. Bell, Alexander J. Szubert, and Nuria Navarro-Coy, University of Leeds, Leeds; Faith E. Davies and Gareth J. Morgan, Institute of Cancer Research, London; Mark T. Drayson, University of Birmingham, Birmingham; Sylvia Feyler, Calderdale and Huddersfield National Health Service Trust, Huddersfield; Fiona M. Ross, Wessex Regional Genetics Laboratory, Salisbury; and
| | - Graham H. Jackson
- Andy C. Rawstron, Ruth M. de Tute, Gordon Cook, and Roger G. Owen, St James's University Hospital; J. Anthony Child, Walter M. Gregory, Sue E. Bell, Alexander J. Szubert, and Nuria Navarro-Coy, University of Leeds, Leeds; Faith E. Davies and Gareth J. Morgan, Institute of Cancer Research, London; Mark T. Drayson, University of Birmingham, Birmingham; Sylvia Feyler, Calderdale and Huddersfield National Health Service Trust, Huddersfield; Fiona M. Ross, Wessex Regional Genetics Laboratory, Salisbury; and
| | - Gareth J. Morgan
- Andy C. Rawstron, Ruth M. de Tute, Gordon Cook, and Roger G. Owen, St James's University Hospital; J. Anthony Child, Walter M. Gregory, Sue E. Bell, Alexander J. Szubert, and Nuria Navarro-Coy, University of Leeds, Leeds; Faith E. Davies and Gareth J. Morgan, Institute of Cancer Research, London; Mark T. Drayson, University of Birmingham, Birmingham; Sylvia Feyler, Calderdale and Huddersfield National Health Service Trust, Huddersfield; Fiona M. Ross, Wessex Regional Genetics Laboratory, Salisbury; and
| | - Roger G. Owen
- Andy C. Rawstron, Ruth M. de Tute, Gordon Cook, and Roger G. Owen, St James's University Hospital; J. Anthony Child, Walter M. Gregory, Sue E. Bell, Alexander J. Szubert, and Nuria Navarro-Coy, University of Leeds, Leeds; Faith E. Davies and Gareth J. Morgan, Institute of Cancer Research, London; Mark T. Drayson, University of Birmingham, Birmingham; Sylvia Feyler, Calderdale and Huddersfield National Health Service Trust, Huddersfield; Fiona M. Ross, Wessex Regional Genetics Laboratory, Salisbury; and
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de Tute RM, Rawstron AC, Owen RG. Immunoglobulin M Concentration in Waldenström Macroglobulinemia: Correlation With Bone Marrow B Cells and Plasma Cells. Clinical Lymphoma Myeloma and Leukemia 2013; 13:211-3. [DOI: 10.1016/j.clml.2013.02.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Affiliation(s)
- Roger G. Owen
- HMDS Laboratory, St James’s University Hospital, Leeds
| | | | - Lee R Bond
- York Teaching Hospitals NHS Foundation Trust, York, UK.
E‐mail:
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Abstract
The last decade has seen major advances in flow cytometric immunophenotyping and this has expanded the utility of flow cytometry to investigate the antigens present on normal and neoplastic haematopoietic cells. This review summarizes how flow cytometry is used currently in the diagnosis and management of mature lymphoid malignancies. The establishment of disease-specific phenotypes allows the creation of assays which can detect neoplastic cells with high specificity and sensitivity. Certain lymphoid neoplasms are well defined immunophenotypically, while others are more heterogeneous. The availability of more sophisticated cytometers and a wider selection of antibodies in routine diagnostic laboratories will lead to the resolution of these more complex disease entities.
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Affiliation(s)
- Ruth M de Tute
- Haematological Malignancy Diagnostic Service, St James' University Hospital, Leeds, UK.
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