Rawstron, A. C., Child, J. A., de Tute, R. M., Davies, F. E., Gregory, W. M., Bell, S. E., Szubert, A. J., Navarro-Coy, N., Drayson, M. T., Feyler, S., Ross, F. M., Cook, G., Jackson, G. H., Morgan, G. J., Owen, R. G. (2013) Minimal Residual Disease Assessed by Multiparameter Flow Cytometry in Multiple Myeloma: Impact on Outcome in the Medical Research Council Myeloma IX Study. JOURNAL OF CLINICAL ONCOLOGY, 31 (20). pp. 2540-2547. ISSN 0732-183X

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Abstract

Purpose To investigate the prognostic value of minimal residual disease (MRD) assessment in patients with multiple myeloma treated in the MRC (Medical Research Council) Myeloma IX trial. Patients and Methods Multiparameter flow cytometry (MFC) was used to assess MRD after induction therapy (n = 378) and at day 100 after autologous stem-cell transplantation (ASCT; n = 397) in intensive-pathway patients and at the end of induction therapy in non-intensive-pathway patients (n = 245). Results In intensive-pathway patients, absence of MRD at day 100 after ASCT was highly predictive of a favorable outcome (PFS, P < .001; OS, P = .0183). This outcome advantage was demonstrable in patients with favorable and adverse cytogenetics (PFS, P = .014 and P < .001, respectively) and in patients achieving immunofixation-negative complete response (CR; PFS, P = .0068). The effect of maintenance thalidomide was assessed, with the shortest PFS demonstrable in those MRD-positive patients who did not receive maintenance and longest in those who were MRD negative and did receive thalidomide (P < .001). Further analysis demonstrated that 28% of MRD-positive patients who received maintenance thalidomide became MRD negative. MRD assessment after induction therapy in the non-intensive-pathway patients did not seem to be predictive of outcome (PFS, P = .1). Conclusion MRD assessment by MFC was predictive of overall outcome in patients with myeloma undergoing ASCT. This predictive value was seen in patients achieving conventional CR as well as patients with favorable and adverse cytogenetics. The effects of maintenance strategies can also be evaluated, and our data suggest that maintenance thalidomide can eradicate MRD in some patients. (C) 2013 by American Society of Clinical Oncology

Item Type:	Article
Authors (ICR Faculty only):	Davies, Faith
All Authors:	Rawstron, A. C., Child, J. A., de Tute, R. M., Davies, F. E., Gregory, W. M., Bell, S. E., Szubert, A. J., Navarro-Coy, N., Drayson, M. T., Feyler, S., Ross, F. M., Cook, G., Jackson, G. H., Morgan, G. J., Owen, R. G.
Additional Information:	ISI Document Delivery No.: 301NA Times Cited: 6 Cited Reference Count: 38 Rawstron, Andy C. Child, J. Anthony de Tute, Ruth M. Davies, Faith E. Gregory, Walter M. Bell, Sue E. Szubert, Alexander J. Navarro-Coy, Nuria Drayson, Mark T. Feyler, Sylvia Ross, Fiona M. Cook, Gordon Jackson, Graham H. Morgan, Gareth J. Owen, Roger G. Celgene Research Funding: Gordon Cook, Celgene Amer soc clinical oncology Alexandria
Uncontrolled Keywords:	stem-cell transplantation marrow plasma-cells polymerase-chain-reaction complete response autologous transplantation randomized-trial therapy progression chemotherapy thalidomide
Research teams:	Closed research groups > Myeloma Targeted Treatment
Depositing User:	Users 11 not found.
Date Deposited:	27 Feb 2014 12:22
Last Modified:	13 Nov 2015 15:06
URI:	http://publications.icr.ac.uk/id/eprint/13054

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