Implications and outcomes of MRD‐negative multiple myeloma patients with immunofixation positivity

Tschautscher, Marcella; Jevremović, Dragan; Buadi, Francis K.; Lacy, Martha Q.; Gertz, Morie A.; Dispenzieri, Angela; Kapoor, Prashant; Dingli, David; Hwa, Lisa; Fonder, Amie; Hobbs, Miriam; Hayman, Suzanne R.; Lust, John A.; Russell, Stephen J.; Leung, Nelson; Go, Ronald S.; Lin, Yi; Gonsalves, Wilson I.; Kourelis, Taxiarchis; Warsame, Rahma; Kyle, Robert A.; Rajkumar, Vincent; Kumar, Shaji

doi:10.1002/ajh.25702

Cited by 4 publications

(2 citation statements)

References 6 publications

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“…Free light chains (FLC) at month 1 were defined as below normal or normal/elevated.BM cellularity and MRD assessment by flow cytometry were collected from clinical pathology reports at months 1, 3, 6, and 12. The sensitivity of this assay is 10–5 if adequate cell number has been acquired (minimum 2 × 10 6 events) [ 8 ]. BM cellularity was defined as hypocellular or normocellular/ Not hypocellular as outlined in clinical pathology BM reports.…”

Section: Methodsmentioning

confidence: 99%

Prognostic value of early bone marrow MRD status in CAR-T therapy for myeloma

et al. 2023

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Bone marrow (BM) assessment of minimal residual disease (MRD) is prognostic for survival in multiple myeloma (MM). BM is still hypocellular at month 1 post CAR-T, thus the value of MRD negative (MRDneg) status at this timepoint is unclear. We examined the impact of month 1 BM MRD status in MM patients who received CART at Mayo Clinic between 8/2016 and 6/2021. Among 60 patients, 78% were BM-MRDneg at month 1; and 85% (40/47) of these patients also had decreased to less than normal level of both involved and uninvolved free light chain (FLC < NL). Patients who achieved CR/sCR had higher rates of month 1 BM-MRDneg and FLC < NL. The rate of sustained BM-MRDneg was 40% (19/47). Rate of conversion from MRDpos to MRDneg was 5%(1/20). At month 1, 38%(18/47) of the BM-MRDneg were hypocellular. Recovery to normal cellularity was observed in 50%(7/14) with a median time to normalization at 12 months (range: 3–Not reached). Compared to Month 1 BM-MRDpos patients, patients who were BM-MRDneg had longer PFS irrespective of BM cellularity [PFS: 2.9 months (95% CI, 1.2-NR) vs. 17.5 months (95% CI, 10.4-NR), p < 0.0001]. Month 1 BM-MRDneg and FLC below normal were associated with prolonged survival. Our data support the continued evaluation of BM early post-CART infusion as a prognostic tool.

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Section: Methodsmentioning

confidence: 99%

Prognostic value of early bone marrow MRD status in CAR-T therapy for myeloma

et al. 2023

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“…This discrepancy may be a consequence of the half-lives of monoclonal proteins and the inability to differentiate between newly produced monoclonal protein (from residual clonal plasma cells) versus previously produced monoclonal protein that has not yet been degraded in patients who are truly MRD-negative. A similar phenomenon has been described when evaluating MRD-negative patients who are IFE-positive versus those who are IFE-negative [37]. Overall, the advantages of MALDI include cost-effectiveness, automation, improved sensitivity/specificity over serum protein electrophoresis (SPEP)/serum immunofixation (SIFE), the ability to identify monoclonal antibody drugs, and the ability to more readily identify IgA monoclonal proteins that travel in the beta region on electrophoresis.…”

Section: Session 1: Molecular and Immunobiology Of Pcds From Diagnosis To Therapymentioning

confidence: 59%

Summary of the 2019 Blood and Marrow Transplant Clinical Trials Network Myeloma Intergroup Workshop on Minimal Residual Disease and Immune Profiling

Holstein

Howard²,

Avigan

et al. 2020

Biology of Blood and Marrow Transplantation

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The Blood and Marrow Transplant Clinical Trials Network (BMT CTN) Myeloma Intergroup has organized an annual workshop focused on minimal residual disease (MRD) testing and immune profiling (IP) in multiple myeloma since 2016. In 2019, the workshop took place as an American Society of Hematology (ASH) Friday Scientific Workshop titled "Immune Profiling and Minimal Residual Disease Testing in Multiple Myeloma." This workshop focused on 4 main topics: the molecular and immunologic evolution of plasma cell disorders, development of new laboratory-and imaging-based MRD assessment approaches, chimeric antigen receptor T cell therapy research, and statistical and regulatory issues associated with novel clinical endpoints. In this report, we provide a summary of the workshop and discuss future directions.

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MRD in multiple myeloma: does CR really matter?

Miguel

Avet-Loiseau

2022

Blood

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Multiple myeloma embodies the paradigm of the deepest the response the longer the survival. However, there are conflicting results between the achievement of complete remission and MRD negativity, because some patients with persistent M-protein have nonetheless undetectable MRD. We reviewed the frequency of this discordancy and the outcome of these patients. We spotlighted possible explanations and consequences of conflicting response criteria, and suggest that MRD should be assessed in patients achieving very good partial response or better in clinical trials.

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Implications and outcomes of MRD‐negative multiple myeloma patients with immunofixation positivity

Cited by 4 publications

References 6 publications

Prognostic value of early bone marrow MRD status in CAR-T therapy for myeloma

Prognostic value of early bone marrow MRD status in CAR-T therapy for myeloma

Summary of the 2019 Blood and Marrow Transplant Clinical Trials Network Myeloma Intergroup Workshop on Minimal Residual Disease and Immune Profiling

MRD in multiple myeloma: does CR really matter?

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