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

Marta Lasa ¹, Laura Notarfranchi ^1,2, Cristina Agullo ³

¹Cancer Center Clinica Universidad de Navarra, Centro de Investigacion Medica Aplicada, Instituto de Investigacion Sanitaria de Navarra, CIBER-ONC CB16/12/00369 and CB16/12/00489, Pamplona, Spain.
²Department of Medicine and Surgery, University of Parma, Parma, Italy.
³Hospital Universitario de Salamanca, Instituto de Investigacion Biomedica de Salamanca, University of Salamanca, CIBER-ONC CB16/12/00233, Salamanca, Spain.
⁴Institut Català d'Oncologia and Institut Josep Carreras, Hospital Germans Trias i Pujol, Barcelona, Spain.
⁵Hospital Universitario Son Llàtzer, IdIsBa, Palma de Mallorca, Spain.
⁶Hospital Virgen de las Nieves, Granada, Spain.
⁷Hospital Virgen de la Arrixaca, Murcia, Spain.
⁸Hospital San Pedro de Alcántara, Cáceres, Spain.
⁹Hospital Universitario San Carlos, Madrid, Spain.
¹⁰Hospital General Universitario Gregorio Marañón, IiSGM, Madrid, Spain.
¹¹Hospital Morales Meseguer, IMIB-Arrixaca, Universidad de Murcia, Murcia, Spain.
¹²Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain.
¹³Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.
¹⁴Department of Medicine and Cytometry Service, Cancer Research Center (IBMCC, USAL-CSIC), University of Salamanca, CIBER-ONC CB16/12/00400, Salamanca, Spain.
¹⁵Hospital Universitario 12 de Octubre, University Complutense, CIBER-ONC CB16/12/00369, CNIO, Madrid, Spain.
¹⁶Amyloidosis and Multiple Myeloma Unit, Department of Hematology, IDIBAPS, Hospital Clinic, Barcelona, Spain.

⁰Cancer Center Clinica Universidad de Navarra, Centro de Investigacion Medica Aplicada, Instituto de Investigacion Sanitaria de Navarra, CIBER-ONC CB16/12/00369 and CB16/12/00489, Pamplona, Spain.

Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology +

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October 1, 2024

View abstract on PubMed

Summary

Peripheral residual disease (PRD) monitoring in blood, assessed by next-generation flow, offers prognostic value in multiple myeloma (MM) patients. Undetectable PRD indicates excellent survival, while detectable PRD signals increased progression risk.

Area Of Science

Hematology
Oncology
Clinical Trials

Background

Multiple myeloma (MM) management involves monitoring measurable residual disease (MRD) in bone marrow (BM).
Peripheral residual disease (PRD) assessment in blood offers a less invasive alternative for monitoring MM.
Evaluating PRD's prognostic significance post-maintenance therapy is crucial for MM patient management.

Purpose Of The Study

To investigate the prognostic value of peripheral residual disease (PRD) monitoring in transplant-eligible multiple myeloma (MM) patients.
To compare PRD assessment using next-generation flow (NGF) and mass spectrometry (MS) with bone marrow MRD.
To determine the utility of PRD in predicting progression and survival outcomes in MM.

Main Methods

Prospective analysis of 138 transplant-eligible MM patients from GEM2012MENOS65/GEM2014MAIN trials.
PRD assessment via NGF and MS after 24 cycles of maintenance therapy.
Correlation of PRD status with progression-free survival (PFS) and overall survival (OS).

Main Results

Positive PRD by NGF (11.5% of patients) was linked to a 13-fold increased risk of progression/death (median PFS 2.5 months, OS 47 months).
PRD detection by NGF demonstrated 100% positive and 73% negative predictive values relative to BM MRD.
Patients with undetectable PRD by both NGF and MS achieved high 2-year PFS (97%) and OS (100%) rates.
PRD by NGF independently predicted PFS in multivariate analysis alongside BM MRD and Revised International Staging System.

Conclusions

Less invasive PRD monitoring in blood is a valuable prognostic tool in MM.
PRD assessment aids in identifying high-risk patients among those with positive bone marrow MRD.
PRD monitoring can be effectively used during maintenance or observation phases for MM patients.

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