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Rasche L, Alapat D, Kumar M, Gershner G, McDonald J, Wardell CP, Samant R, Van Hemert R, Epstein J, Williams AF, Thanendrarajan S, Schinke C, Bauer M, Ashby C, Tytarenko RG, van Rhee F, Walker BA, Zangari M, Barlogie B, Davies FE, Morgan GJ, Weinhold N. Combination of flow cytometry and functional imaging for monitoring of residual disease in myeloma. Leukemia 2018; 33:1713-1722. [PMID: 30573775 PMCID: PMC6586541 DOI: 10.1038/s41375-018-0329-0] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [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: 08/02/2018] [Revised: 09/24/2018] [Accepted: 10/10/2018] [Indexed: 02/08/2023]
Abstract
The iliac crest is the sampling site for minimal residual disease (MRD) monitoring in multiple myeloma (MM). However, the disease distribution is often heterogeneous, and imaging can be used to complement MRD detection at a single site. We have investigated patients in complete remission (CR) during first-line or salvage therapy for whom MRD flow cytometry and the two imaging modalities positron emission tomography (PET) and diffusion-weighted magnetic resonance imaging (DW-MRI) were performed at the onset of CR. Residual focal lesions (FLs), detectable in 24% of first-line patients, were associated with short progression-free survival (PFS), with DW-MRI detecting disease in more patients. In some patients, FLs were only PET positive, indicating that the two approaches are complementary. Combining MRD and imaging improved prediction of outcome, with double-negative and double-positive features defining groups with excellent and dismal PFS, respectively. FLs were a rare event (12%) in first-line MRD-negative CR patients. In contrast, patients achieving an MRD-negative CR during salvage therapy frequently had FLs (50%). Multi-region sequencing and imaging in an MRD-negative patient showed persistence of spatially separated clones. In conclusion, we show that DW-MRI is a promising tool for monitoring residual disease that complements PET and should be combined with MRD.
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Affiliation(s)
- L Rasche
- Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, AR, USA.,Department of Internal Medicine 2, University Hospital of Würzburg, Würzburg, Germany
| | - D Alapat
- Pathology Department, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - M Kumar
- Radiology Department, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - G Gershner
- Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - J McDonald
- Radiology Department, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - C P Wardell
- Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - R Samant
- Radiology Department, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - R Van Hemert
- Radiology Department, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - J Epstein
- Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - A F Williams
- Pathology Department, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - S Thanendrarajan
- Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - C Schinke
- Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - M Bauer
- Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - C Ashby
- Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - R G Tytarenko
- Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - F van Rhee
- Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - B A Walker
- Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - M Zangari
- Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - B Barlogie
- Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - F E Davies
- Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - G J Morgan
- Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - N Weinhold
- Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
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2
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Chavan SS, He J, Tytarenko R, Deshpande S, Patel P, Bailey M, Stein CK, Stephens O, Weinhold N, Petty N, Steward D, Rasche L, Bauer M, Ashby C, Peterson E, Ali S, Ross J, Miller VA, Stephens P, Thanendrarajan S, Schinke C, Zangari M, van Rhee F, Barlogie B, Mughal TI, Davies FE, Morgan GJ, Walker BA. Bi-allelic inactivation is more prevalent at relapse in multiple myeloma, identifying RB1 as an independent prognostic marker. Blood Cancer J 2017; 7:e535. [PMID: 28234347 PMCID: PMC5386330 DOI: 10.1038/bcj.2017.12] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [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: 12/27/2016] [Accepted: 01/13/2017] [Indexed: 12/21/2022] Open
Abstract
The purpose of this study is to identify prognostic markers and treatment targets using a clinically certified sequencing panel in multiple myeloma. We performed targeted sequencing of 578 individuals with plasma cell neoplasms using the FoundationOne Heme panel and identified clinically relevant abnormalities and novel prognostic markers. Mutational burden was associated with maf and proliferation gene expression groups, and a high-mutational burden was associated with a poor prognosis. We identified homozygous deletions that were present in multiple myeloma within key genes, including CDKN2C, RB1, TRAF3, BIRC3 and TP53, and that bi-allelic inactivation was significantly enriched at relapse. Alterations in CDKN2C, TP53, RB1 and the t(4;14) were associated with poor prognosis. Alterations in RB1 were predominantly homozygous deletions and were associated with relapse and a poor prognosis which was independent of other genetic markers, including t(4;14), after multivariate analysis. Bi-allelic inactivation of key tumor suppressor genes in myeloma was enriched at relapse, especially in RB1, CDKN2C and TP53 where they have prognostic significance.
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Affiliation(s)
- S S Chavan
- The Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - J He
- Foundation Medicine Inc., Cambridge, MA, USA
| | - R Tytarenko
- The Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - S Deshpande
- The Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - P Patel
- The Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - M Bailey
- Foundation Medicine Inc., Cambridge, MA, USA
| | - C K Stein
- The Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - O Stephens
- The Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - N Weinhold
- The Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - N Petty
- The Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - D Steward
- The Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - L Rasche
- The Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - M Bauer
- The Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - C Ashby
- The Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - E Peterson
- The Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - S Ali
- Foundation Medicine Inc., Cambridge, MA, USA
| | - J Ross
- Foundation Medicine Inc., Cambridge, MA, USA.,Albany Medical College, Albany, NY, USA
| | - V A Miller
- Foundation Medicine Inc., Cambridge, MA, USA
| | - P Stephens
- Foundation Medicine Inc., Cambridge, MA, USA
| | - S Thanendrarajan
- The Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - C Schinke
- The Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - M Zangari
- The Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - F van Rhee
- The Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - B Barlogie
- The Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA.,Icahn School of Medicine at Mt. Sinai, New York, NY, USA
| | - T I Mughal
- Foundation Medicine Inc., Cambridge, MA, USA.,Tufts University Medical Center, Boston, MA, USA
| | - F E Davies
- The Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - G J Morgan
- The Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - B A Walker
- The Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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3
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Jethava Y, Mitchell A, Zangari M, Waheed S, Schinke C, Thanendrarajan S, Sawyer J, Alapat D, Tian E, Stein C, Khan R, Heuck CJ, Petty N, Avery D, Steward D, Smith R, Bailey C, Epstein J, Yaccoby S, Hoering A, Crowley J, Morgan G, Barlogie B, van Rhee F. Dose-dense and less dose-intense total therapy 5 for gene expression profiling-defined high-risk multiple myeloma. Blood Cancer J 2016; 6:e471. [PMID: 27635734 PMCID: PMC5056975 DOI: 10.1038/bcj.2016.85] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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