Evaluation of EuroFlow minimal residual disease measurement and donor chimerism monitoring following tandem auto-allogeneic transplantation for multiple myeloma.
Joanne L C TanTongted P DasDavid S KlimanJenny MuirheadMalgorzata GorniakAnna KalffPatricia WalkerAndrew SpencerPublished in: Bone marrow transplantation (2020)
Prognostic factors for multiple myeloma (MM) after allogeneic haemopoietic stem cell transplantation (alloHSCT) are poorly characterised. Two potential factors include minimal residual disease (MRD) and CD3+ donor-specific chimerism. We retrospectively examined 93 consecutive patients who received upfront or deferred tandem auto-alloHSCT. Bone marrow (Euroflow) MRD was assessed pre-alloHSCT and 3-monthly post-alloHSCT. CD3+ donor chimerism was assessed at D30, D60, D90, 6 m and 12 m post-alloHSCT. There was no statistical difference between upfront and deferred transplants in progression free survival (PFS) (34 m vs. 15 m respectively, p = 0.20) and overall survival (OS) (75.5 m vs. 62.7 m respectively, p = 0.56). Patients who were MRD-positive post-alloHSCT had inferior PFS to MRD-negative patients from 6 m (6 m HR 3.32, p = 0.02; 9 m HR 4.08, p = 0.003; 12 m HR 4.47, p = 0.008). Attainment or maintenance of MRD-negativity predicted reduced relapse risk (23.5% vs. 62.5%, p = 0.04). However, there was no significant difference in OS between the MRD-negative and positive groups. Full CD3+ donor chimerism at early time points (D30 and D90) was associated with increased risk of acute GVHD (D30 p < 0.001, D90 p = 0.006) and extensive chronic GVHD (D90 p = 0.04), but not PFS or OS. These data support the use of sequential MRD evaluation post-alloHSCT to inform intervention to eradicate persistent or emergent MRD-positive disease.
Keyphrases
- stem cell transplantation
- prognostic factors
- allogeneic hematopoietic stem cell transplantation
- free survival
- bone marrow
- multiple myeloma
- high dose
- acute lymphoblastic leukemia
- end stage renal disease
- newly diagnosed
- ejection fraction
- liver failure
- low dose
- stem cells
- patient reported outcomes
- hematopoietic stem cell
- risk assessment
- peritoneal dialysis
- chronic kidney disease
- respiratory failure
- acute respiratory distress syndrome
- extracorporeal membrane oxygenation