Minimally Invasive Assessment of Peripheral Residual Disease During Maintenance or Observation in Transplant-Eligible Patients With Multiple Myeloma

医学 多发性骨髓瘤 内科学 微小残留病 临床终点 肿瘤科 临床试验 骨髓 代理终结点 疾病 外科
作者
Marta Lasa,Laura Notarfranchi,Cristina Agulló,C. González,Sérgio Luís de Castro Júnior,Jose J. Pérez,Leire Burgos,Camilla Guerrero,Marı́a José Calasanz,Juan Flores‐Montero,Albert Oriol,Joan Bargay,Rafael Ríos,Valentín Cabañas,C Cabrera,Rafael Martínez-Martínez,Cristina Encinas,Felipe de Arriba,Miguel‐Teodoro Hernández,Luis Palomera,Alberto Órfão,Joaquín Martínez‐López,Josep‐María Ribera,Jesús F. San Miguel,Juan José Lahuerta,Laura Rosiñol,Joan Bargay,María‐Teresa Cedena,Noemí Puig,Bruno Paiva,María Casanova,Carmen Couto,Estrella Carrillo,Esther González,Ana Pilar González-Rodríguez,Antònia Sampol,Arturo Suarez,Jaime Sanz,María Teresa Restrepo Calle,Luís Felipe Casado,Dunia de Miguel,Ángela Ibáñez,Jorge Labrador,Aranzazu Garcı́a,Fernando Escalante,Carlos Iván Aguilar Gaibor,Lourdes Escoda,Anna Sureda,Cristina Motlló,Yolanda González,Enric Monreal,Juan A. Soler,Miquel Granell,Maria-Elena Cabezudo,Josep M. Martí,Antonio García,Mercedes Gironella,Ana M. S. de Dios,José Ángel Méndez,Marta Sonia González,Maria Najera,Francisco Javier Peñalver,Pilar Bravo,José‐Ángel Hernández‐Rivas,Luděk Pour,Rosa Barrio,Ana López de la Guía,Adrián Alegre,Isabel Krsnik,Elena Ruíz,María‐Jesús Blanchard,Belén Íñigo,Eugenio Giménez,Rosalía Riaza,Elena Prieto,Marta Romera,José M. Moraleda,Felipe Prósper,José María Arguiñano,María Pilar González-Conde Puente,Xabier Gutiérrez,Isabel Krsnik,Pedro Rivas,Isidro Jarque,Ángel Martín Fernández,Amparo Santamaría,Carmen Martínez
出处
期刊:Journal of Clinical Oncology [American Society of Clinical Oncology]
标识
DOI:10.1200/jco.24.00635
摘要

Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported. In multiple myeloma (MM), measurable residual disease (MRD) is assessed in bone marrow (BM). However, less invasive evaluation of peripheral residual disease (PRD) in blood could be advantageous and less cumbersome. We investigated the prognostic value of PRD monitoring after 24 cycles of maintenance in 138 transplant-eligible patients with MM enrolled in the GEM2012MENOS65/GEM2014MAIN clinical trials. PRD was assessed using next-generation flow (NGF) and mass spectrometry (MS). Positive PRD by NGF in 16/138 (11.5%) patients was associated with a 13-fold increased risk of progression and/or death; median progression-free survival (PFS) and overall survival (OS) were 2.5 and 47 months, respectively. Considering patients' MRD status in BM as the reference, PRD detection using NGF showed positive and negative predictive values of 100% and 73%, respectively. Presence of PRD helped identifying patients at risk of imminent progression among those with positive MRD in BM. Patients with undetectable PRD according to both NGF and MS showed 2-year PFS and OS rates of 97% and 100%, respectively. In multivariate analyses including the Revised International Staging System and the complete remission status, only MRD in BM and PRD by NGF showed independent prognostic value for PFS. This study supports the use of less invasive PRD monitoring during maintenance or observation in transplant-eligible patients with MM.
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