Journal
BLOOD
Volume 112, Issue 10, Pages 4017-4023Publisher
AMER SOC HEMATOLOGY
DOI: 10.1182/blood-2008-05-159624
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Funding
- Cooperative Research Thematic Network [RD06/0020/0006]
- MM Jevitt
- SL firm
- Instituto de Salud Carlos III/Subdireccion General de Investigacion Sanitaria, Madrid, Spain [PI060339, 02/0905, 01/0089/01-02]
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Minimal residual disease (MRD) assessment is standard in many hematologic malignancies but is considered investigational in multiple myeloma (MM). We report a prospective analysis of the prognostic importance of MRD detection by multiparameter flow cytometry (MFC) in 295 newly diagnosed MM patients uniformly treated in the GEM2000 protocol VBMCP/VBAD induction plus autologous stem cell transplantation [ASCT]). MRD status by MFC was determined at day 100 after ASCT. Progression-free survival (PFS; median 71 vs 37 months, P < .001) and overall survival (OS; median not reached vs 89 months, P = .002) were longer in patients who were MRD negative versus MRD positive at day 100 after ASCT. Similar prognostic differentiation was seen in 147 patients who achieved immunofixation-negative complete response after ASCT. Moreover, MRD- immunofixation-negative (IFx(-)) patients and MRD- IFx(+) patients had significantly longer PFS than MRD+ IFx(-) patients. Multivariate analysis identified MRD status by MFC at day 100 after ASCT as the most important independent prognostic factor for PFS (HR = 3.64, P = .002) and OS (HR = 2.02, P = .02). Our findings demonstrate the clinical importance of MRD evaluation by MFC, and illustrate the need for further refinement of MM response criteria. This trial is registered at http://clinicaltrials.gov under identifier NCT00560053. (Blood. 2008; 112: 4017-4023)
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