A multiparameter flow cytometry immunophenotypic algorithm for the identification of newly diagnosed symptomatic myeloma with an MGUS-like signature and long-term disease control
Por:
Paiva, B, Vidriales, MB, Rosinol, L, Martinez-Lopez, J, Mateos, MV, Ocio, EM, Montalban, MA, Cordon, L, Gutierrez, NC, Corchete, L, Oriol, A, Terol, MJ, Echeveste, MA, De Paz, R, De Arriba, F, Palomera, L, de la Rubia, J, Diaz-Mediavilla, J, Granell, M, Gorosquieta, A, Alegre, A, Orfao, A, Lahuerta, JJ, Blade, J, Miguel, JFS
Publicada:
1 oct 2013
Resumen:
Achieving complete remission (CR) in multiple myeloma (MM) translates into extended survival, but two subgroups of patients fall outside this paradigm: cases with unsustained CR, and patients that do not achieve CR but return into a monoclonal gammopathy of undetermined significance (MGUS)-like status with long-term survival. Here, we describe a novel automated flow cytometric classification focused on the analysis of the plasma-cell compartment to identify among newly diagnosed symptomatic MM patients (N = 698) cases with a baseline MGUS-like profile, by comparing them to MGUS (N = 497) patients and validating the classification model in 114 smoldering MM patients. Overall, 59 symptomatic MM patients (8%) showed an MGUS-like profile. Despite achieving similar CR rates after high-dose therapy/autologous stem cell transplantation vs other MM patients, MGUS-like cases had unprecedented longer time-to-progression (TTP) and overall survival (OS; similar to 60% at 10 years; P < 0.001). Importantly, MGUS-like MM patients failing to achieve CR showed similar TTP (P = 0.81) and OS (P = 0.24) vs cases attaining CR. This automated classification also identified MGUS patients with shorter TTP (P = 0.001, hazard ratio: 5.53) and ultra-high-risk smoldering MM (median TTP, 15 months). In summary, we have developed a biomarker that identifies a subset of symptomatic MM patients with an occult MGUS-like signature and an excellent outcome, independently of the depth of response.
Filiaciones:
Paiva, B:
Hosp Univ Salamanca, Salamanca 37007, Spain
IBMCC USAL CSIC, IBSAL, Salamanca, Spain
Vidriales, MB:
Hosp Univ Salamanca, Salamanca 37007, Spain
IBMCC USAL CSIC, IBSAL, Salamanca, Spain
Rosinol, L:
IDIBAPS, Hosp Clin, Barcelona, Spain
Martinez-Lopez, J:
Hosp 12 Octubre, E-28041 Madrid, Spain
Mateos, MV:
Hosp Univ Salamanca, Salamanca 37007, Spain
IBMCC USAL CSIC, IBSAL, Salamanca, Spain
Ocio, EM:
Hosp Univ Salamanca, Salamanca 37007, Spain
IBMCC USAL CSIC, IBSAL, Salamanca, Spain
Montalban, MA:
Hosp 12 Octubre, E-28041 Madrid, Spain
Cordon, L:
Univ Catolica Valencia San Vicente Martir, Hosp Univ la Fe, Valencia, Spain
Gutierrez, NC:
Hosp Univ Salamanca, Salamanca 37007, Spain
IBMCC USAL CSIC, IBSAL, Salamanca, Spain
Corchete, L:
Hosp Univ Salamanca, Salamanca 37007, Spain
IBMCC USAL CSIC, IBSAL, Salamanca, Spain
Oriol, A:
Hosp Badalona Germans Trias & Pujol, Badalona, Spain
Terol, MJ:
Hosp Clin Valencia, Valencia, Spain
Echeveste, MA:
Hosp Donostia, San Sebastian, Spain
De Paz, R:
Hosp Univ La Paz, Madrid, Spain
De Arriba, F:
Hosp Morales Meseguer, Murcia, Spain
Palomera, L:
Hosp Lozano Blesa, Zaragoza, Spain
de la Rubia, J:
Univ Catolica Valencia San Vicente Martir, Hosp Univ la Fe, Valencia, Spain
Diaz-Mediavilla, J:
Hosp Clin San Carlos, Madrid, Spain
Granell, M:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Gorosquieta, A:
Hosp Univ Navarra, Pamplona, Spain
Alegre, A:
Hosp Univ La Princesa, Madrid, Spain
Orfao, A:
IBMCC USAL CSIC, IBSAL, Salamanca, Spain
Univ Salamanca, Serv Gen Citometria, E-37008 Salamanca, Spain
Univ Salamanca, Dept Med, E-37008 Salamanca, Spain
Lahuerta, JJ:
Hosp 12 Octubre, E-28041 Madrid, Spain
Blade, J:
IDIBAPS, Hosp Clin, Barcelona, Spain
Miguel, JFS:
Hosp Univ Salamanca, Salamanca 37007, Spain
IBMCC USAL CSIC, IBSAL, Salamanca, Spain
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