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Mass spectrometry vs immunofixation for treatment monitoring in multiple myeloma

Autores: Puig, N.; Contreras, M. T.; Agullo, C.; Martinez-Lopez, J.; Oriol, A.; Blanchard, M. J.; Rios, R.; Martin, J.; Inigo, M. B.; Sureda, A.; Hernandez, M. T.; de la Rubia, J.; Gonzalez-Calle, V.; Krsnik, I.; Cabanas, V.; Palomera, L.; Moraleda, J. M.; Bargay, J.; Cedena, M. T.; Paiva, Bruno; Rosinol, L.; Blade, J.; San Miguel Izquierdo, Jesús; Lahuerta, J. J.; Mateos, M. V. (Autor de correspondencia)
Título de la revista: BLOOD ADVANCES
ISSN: 2473-9529
Volumen: 6
Número: 11
Páginas: 3234 - 3239
Fecha de publicación: 2022
Monitoring of the monoclonal protein (M-protein) by electrophoresis and/or immunofixation (IFE) has long been used to assess treatment response in multiple myeloma (MM). However, with the use of highly effective therapies, the M-protein becomes frequently undetectable, and more sensitive methods had to be explored. We applied IFE and mass spectrometry (EXENT&FLC-MS) in serum samples from newly diagnosed MM patients enrolled in the PETHEMA/GEM2012MENOS65 obtained at baseline (n = 223), and after induction (n = 183), autologous stem cell transplantation (n = 173), and consolidation (n = 173). At baseline, the isotypes identified with both methods fully matched in 82.1% of samples; in the rest but 2 cases, EXENT&FLC-MS provided additional information to IFE with regards to the M-protein(s). Overall, the results of EXENT&FLC-MS and IFE were concordant in >80% of cases, being most discordances due to EXENT&FLC-MS+ but IFE- cases. After consolidation, IFE was not able to discriminate 2 cohorts with different median progression-free survival (PFS), but EXENT&FLC-MS did so; furthermore, among IFE- patients, EXENT&FLC-MS identified 2 groups with significantly different median PFS (P = .0008). In conclusion, compared with IFE, EXENT&FLC-MS is more sensitive to detect the M-protein of patients with MM, both at baseline and during treatment, and provides a more accurate prediction of patients' outcome. This trial was registered at as #NCT01916252.