Detalle Publicación

A multiparameter flow cytometry immunophenotypic algorithm for the identification of newly diagnosed symptomatic myeloma with an MGUS-like signature and long-term disease control

Autores: Paiva, Bruno; Vidriales, M. B.; Rosinol, L.; Martinez-Lopez, J.; Mateos, M. V.; Ocio, E. M.; Montalban, M. A.; Cordon, L.; Gutierrez, N. C.; Corchete, L.; Oriol, A.; Terol, M. J.; Echeveste, M. A.; De Paz, R.; de Arriba, F.; Palomera, L.; de la Rubia, J.; Díaz-Mediavilla, J.; Granell, M.; Gorosquieta, A.; Alegre, A.; Orfao, A.; Lahuerta, J. J.; Blade, J.; San Miguel Izquierdo, Jesús; GEM Grp Espanol MM PETHEMA Program
Título de la revista: LEUKEMIA
ISSN: 1476-5551
Volumen: 27
Número: 10
Páginas: 2056 - 2061
Fecha de publicación: 2013
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.