AI Article Synopsis

  • The study evaluates the prognostic importance of minimal residual disease (MRD) assessment in multiple myeloma patients who participated in the MRC Myeloma IX trial, focusing on outcomes after treatment.
  • Patients were assessed for MRD using multiparameter flow cytometry after induction therapy and after autologous stem-cell transplantation (ASCT), with results showing that the absence of MRD after ASCT strongly predicted better progression-free survival (PFS) and overall survival (OS).
  • Notably, while MRD assessment was effective in predicting outcomes for intensive-pathway patients, it did not show a significant predictive value in non-intensive-pathway patients, highlighting the importance of MRD status and possible benefits from maintenance therapy like thalidom

Article 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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Source
http://dx.doi.org/10.1200/JCO.2012.46.2119DOI Listing

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