Recovery of uninvolved heavy/light chain pair immunoparesis in newly diagnosed transplant-eligible myeloma patients complements the prognostic value of minimal residual disease detection
Lakhwani, Sunil (Hospital Universitario de Canarias (La Laguna))
Rosiñol, Laura (Hospital Clínic i Provincial de Barcelona)
Puig, Noemí (Hospital Universitario de Salamanca)
Pico-Picos, Miguel-Angel (Hospital Universitario de Canarias (La Laguna))
Medina-Gonzále, Laura (Hospital Universitario de Canarias (La Laguna))
Martínez-López, Joaquín (Hospital Universitario 12 de Octubre (Madrid))
Paiva, Bruno (Universidad de Navarra)
Cedena, Maria Teresa (Hospital Universitario 12 de Octubre (Madrid))
Oriol, Albert (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Ríos-Tamay, Rafael (Hospital Universitario Puerta de Hierro Majadahonda (Madrid))
Blanchard, María Jesús (Hospital Universitario Ramón y Cajal (Madrid))
Jarque, Isidro (Hospital Universitari i Politècnic La Fe (València))
Bargay, Joan (Hospital Universitari Son Llàtzer (Palma de Mallorca, Balears))
Moraleda, José María (Hospital Clínico Universitario Virgen de la Arrixaca (El Palmar, Múrcia))
Carrillo-Cruz, Estrella (Universidad de Sevilla)
Sureda, Anna (Institut Català d'Oncologia)
Krsnik, Isabel (Hospital Universitario Puerta de Hierro Majadahonda (Madrid))
González, Esther (Hospital Universitario de Cabueñes (Gijón))
Casado Montero, Luis Felipe (Hospital General Universitario de Toledo)
Martí, Josep M. (Hospital Universitari MútuaTerrassa (Terrassa, Catalunya))
Encinas, C. (Hospital General Universitario Gregorio Marañón)
De Arriba, Felipe (Hospital General Universitario Morales Meseguer (Múrcia))
Palomera, Luis (Hospital Clínico Universitario "Lozano Blesa" de Zaragoza)
Sampol, Antonia (Hospital Universitari Son Espases (Palma de Mallorca, Balears))
González-Monte, Yolanda (Hospital Universitari de Girona Doctor Josep Trueta)
Motlló, Cristina (Hospital Althaia. Xarxa Assistencial de Manresa)
De la Cruz, Javier (Hospital Universitario 12 de Octubre (Madrid))
Alonso, Rafael (Hospital 12 de Octubre (Madrid))
Mateos, M. V. (Hospital Universitario de Salamanca)
Bladé Creixenti, Juan (Hospital Clínic i Provincial de Barcelona)
Lahuerta, J. J. (Hospital Universitario 12 de Octubre (Madrid))
San Miguel, Jesús (Universidad de Navarra)
Hernández, Miguel Teodoro (Hospital Universitario de Canarias (La Laguna))

Data:	2024
Resum:	Immunoparesis (IP) in multiple myeloma (MM) patients can be measured by classic assessment of immunoglobulin (Ig) levels or by analysis of the uninvolved heavy/light chain pair of the same immunoglobulin (uHLC) by the Hevylite® assay. In this study we evaluate the prognostic value of recovery from IP measured by classic total Ig and uHLC assessment in newly diagnosed MM transplant-eligible (NDMM-TE) patients with intensive treatment and its association with minimal residual disease (MRD). Patients were enrolled and treated in the PETHEMA/GEM2012MENOS65 trial and continued in the PETHEMA /GEM2014MAIN trial. Total Ig (IgG, IgA and IgM) and uHLC were analyzed in a central laboratory at diagnosis, after consolidation treatment and after the first year of maintenance. MRD was analyzed by next-generation flow cytometry after consolidation (sensitivity level 2×10-6). We found no differences in progression-free survival (PFS) between patients who recovered and patients who didn't recover from IP after consolidation when examining classic total Ig and uHLC. However, after the first year of maintenance, in contrast to patients with classic IP, patients with recovery from uHLC IP had longer PFS than patients without recovery, with hazard ratio of 0. 42 (95% confidence interval [CI]: 0. 21-0. 81; P=0. 008). Multivariate analysis with Cox proportional-hazards regression models confirmed recovery from uHLC IP after the first year of maintenance as an independent prognostic factor for PFS, with an increase in C-statistic of 0. 05 (95% CI: -0. 04 to 0. 14; P<0. 001) when adding uHLC IP recovery. Moreover, we observed that MRD status and uHLC IP recovery affords complementary information for risk stratification. In conclusion, recovery from uHLC IP after 1 year of maintenance is an independent prognostic factor for PFS in NDMM-TE patients who receive intensive treatment. Immune reconstitution, measured as recovery from uHLC IP, provides complementary prognostic information to MRD assessment (clinicaltrials gov. Identifiers: NCT01916252 and NCT02406144).
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Publicat a:	Haematologica, Vol. 109 Núm. 6 (June 2024) , p. 1909-1917, ISSN 1592-8721

DOI: 10.3324/haematol.2023.284154
PMID: 38031761

9 p, 3.9 MB

El registre apareix a les col·leccions:
Articles > Articles de recerca
Articles > Articles publicats