Early achievement of measurable residual disease negativity in the treatment of multiple myeloma as predictor of outcome

Baumelou, Marion; Payssot, A.; Row, Céline; Racine, Jessica; Lafon, Ingrid; Bastie, Jean-Noel; Chevreux, Steeve; Chrétien, Marie‐Lorraine; Maynadié, Marc; Caillot, Denis; Guy, Julien

doi:10.1111/bjh.18103

Cited by 1 publication

(1 citation statement)

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“…In contrast, a single-center, retrospective analysis from Japan reported that the presence of MRD in autografts detected by next-generation sequencing (NGS) or real-time PCR predicts shorter OS and PFS after ASCT, and the lower levels of MRD in autografts are associated with longer OS and PFS [49]. In a retrospective study of patients with NDMM who underwent ASCT, those who achieved MRD negativity before ASCT had prolonged PFS compared with those who achieved MRD negativity after ASCT, suggesting that the achievement of earlier MRD negativity might be associated with a good response to induction therapy and that the incidence of MM cell contamination in the autograft might be lower in patients with MRD negativity before ASCT, leading to improved prognosis after ASCT [55]. Recently, two retrospective analyses employed next-generation flow cytometry (NGF) to reveal that MRD-negativity in autografts could predict long PFS and OS after ASCT [56,57].…”

Section: Mrd In Autografts Might Predict Clinical Outcomementioning

confidence: 99%

Treatment Strategy for Ultra-High-Risk Multiple Myelomas with Chromosomal Aberrations Considering Minimal Residual Disease Status and Bone Marrow Microenvironment

Suzuki

Yano

2023

Cancers

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Despite the development of anti-myeloma therapeutics, such as proteasome inhibitors, immunomodulatory drugs, anti-CD38 monoclonal antibodies, and autologous stem cell transplantation (ASCT), multiple myeloma remains incurable. A trial treatment combining four drugs—daratumumab, carfilzomib, lenalidomide, and dexamethasone—followed by ASCT frequently results in minimal residual disease (MRD) negativity and prevents progressive disease in patients with standard- and high-risk cytogenetics; however, it is insufficient to overcome the poor outcomes in patients with ultra-high-risk chromosomal aberration (UHRCA). In fact, MRD status in autografts can predict clinical outcomes after ASCT. Therefore, the current treatment strategy might be insufficient to overcome the negative impact of UHRCA in patients with MRD positivity after the four-drug induction therapy. High-risk myeloma cells lead to poor clinical outcomes not only by aggressive myeloma behavior but also via the generation of a poor bone marrow microenvironment. Meanwhile, the immune microenvironment effectively suppresses myeloma cells with a low frequency of high-risk cytogenetic abnormalities in early-stage myeloma compared to late-stage myeloma. Therefore, early intervention might be key to improving clinical outcomes in myeloma patients. The purpose of this review is to improve clinical outcomes in patients with UHRCA by considering MRD assessment results and improvement of the microenvironment.

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