Serial measurements of circulating plasma cells before and after induction therapy have an independent prognostic impact in patients with multiple myeloma undergoing upfront autologous transplantation.
Serial measurements of circulating plasma cells before and after induction therapy have an independent prognostic impact in patients with multiple myeloma undergoing upfront autologous transplantation.
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DOI：
10.3324/haematol.2017.166629
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发表时间：
2017-08
期刊：
影响因子：
10.1
通讯作者：
Gertz MA
中科院分区：
文献类型：
--
作者：
Chakraborty R;Muchtar E;Kumar SK;Jevremovic D;Buadi FK;Dingli D;Dispenzieri A;Hayman SR;Hogan WJ;Kapoor P;Lacy MQ;Leung N;Gertz MA
诊断时、自体移植前和复发时循环浆细胞对多发性骨髓瘤患者的生存有负面影响。然而，在疾病过程中循环浆细胞动力学的影响尚未确定。我们分析了247例新诊断的接受早期自体移植的多发性骨髓瘤患者，他们在诊断时和移植前用6色流式细胞术对循环浆细胞进行配对评估。117例患者在两个时间点均未检测到循环浆细胞（CPC - / -）， 82例患者在诊断时有循环浆细胞，诱导后完全根除（CPC+/ -）， 48例患者在移植时有循环浆细胞，包括细胞的持久性（CPC+/+, n=45）或诱导后出现新细胞（CPC - /+, n=3）。移植后严格完全缓解率CPC - / -组为32%，CPC+/ -组为30%，CPC+/+或- /+组为12% （P=0.018）。移植后中位随访时间为58个月，3组患者的中位无进展生存期分别为30、24和14个月，5年总生存率分别为83%、70%和43%（两组比较均P<0.001）。在总生存的多变量分析中，与CPC - / -组相比，CPC+/ -组（风险比2.7,95%CI: 1.3-5.8； P=0.009）和CPC+/+或- /+组（风险比5.7,95%CI: 2.5-13.1； P<0.001）的死亡风险更高。在诱导治疗前和移植前用6色流式细胞术监测循环浆细胞可预测新诊断的骨髓瘤患者的生存，应纳入临床试验。
Circulating plasma cells at diagnosis, prior to auto-transplant and at relapse have a negative impact on survival in multiple myeloma. However, the impact of kinetics of circulating plasma cells along the course of illness has not been defined. We have analyzed 247 newly diagnosed multiple myeloma patients undergoing early auto-transplant who had paired evaluation of circulating plasma cells at diagnosis and pre-transplant by 6-color flow cytometry. A total of 117 patients had no detectable circulating plasma cells at both time points (CPC−/−), 82 had circulating plasma cells at diagnosis followed by complete eradication after induction (CPC+/−) and 48 had circulating plasma cells at transplant, including persistence of cells (CPC+/+; n=45) or emergence of new cells (CPC−/+; n=3) after induction. The rate of post-transplant stringent complete response was 32% in the CPC−/−, 30% in CPC+/− and 12% in CPC+/+ or −/+ groups (P=0.018). At a median follow up of 58 months from transplantation, the median progression-free survival in the 3 respective groups were 30, 24 and 14 months, and the 5-year overall survival rates were 83%, 70% and 43% (P<0.001 for both comparisons). On a multivariate analysis for overall survival, the risk of mortality was higher in CPC +/− (hazard ratio 2.7, 95%CI: 1.3–5.8; P=0.009) and CPC+/+ or −/+ (hazard ratio 5.7, 95%CI: 2.5–13.1; P<0.001) groups compared to the CPC−/− group. Monitoring for circulating plasma cells before induction therapy and before transplant by 6-color flow cytometry is predictive of survival in newly diagnosed myeloma and should be incorporated into clinical trials.
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影响因子：
12.8
作者：
Chakraborty R;Muchtar E;Kumar SK;Jevremovic D;Buadi FK;Dingli D;Dispenzieri A;Hayman SR;Hogan WJ;Kapoor P;Lacy MQ;Leung N;Gertz MA
通讯作者：
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