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Prepublished online as a Blood First Edition Paper on June 7, 2002; DOI 10.1182/blood-2001-12-0297.
Submitted December 21, 2001
Accepted May 21, 2002
Fow cytometric disease monitoring in multiple myeloma: the relationship between normal and neoplastic plasma cells predicts outcome post-transplantation
Andy C Rawstron*, Faith E Davies, Ranjit K DasGupta, A J Ashcroft, Russell D Patmore, Mark T Drayson, Roger G Owen, Andrew S Jack, J A Child, and Gareth J Morgan
Academic Unit of Haematology and Oncology, University of Leeds, Leeds, United Kingdom
Department of Haematology, Hull Royal Infirmary, Hull, United Kingdom
Department of Immunology, University of Birmingham, Birmingham, United Kingdom
* Corresponding author; email: andy.rawstron{at}hmds.org.uk.
Conventional monitoring strategies for myeloma are not sufficiently sensitive to identify patients likely to benefit from further therapy immediately post-transplant. We have used a sensitive flow cytometry assay that quantitates normal and neoplastic plasma cells to monitor the bone marrow of 45 patients undergoing high dose chemotherapy. Neoplastic plasma cells were detectable at 3 months post-transplant in 42% of patients. Once detected, neoplastic cell levels increased steadily until clinical progression: these patients had a significantly shorter PFS (median 20 months) than those with no detectable disease (median >35 months, P=0.003). Neoplastic plasma cells were detectable in 27% (9/33) of immunofixation-negative complete remission patients. These patients had a significantly shorter PFS than immunofixation-negative patients with no detectable neoplastic plasma cells (P=0.04). Normal plasma cells were present in 89% of patients immediately post-transplant, but were not sustained in most cases. Patients with only normal phenotype plasma cells present at three months post-transplant and also at second assessment had a low risk of disease progression. Patients with neoplastic plasma cells present at three months post transplant, or with only normal plasma cells present at first assessment and only neoplastic plasma cells at second assessment had a significantly higher risk of early disease progression (P<0.0001) with a five year survival of 54% for the high-risk group, compared to 100% in the low-risk group (P=0.036). Analysis of normal and neoplastic plasma cell levels is more sensitive than immunofixation, and can identify which patients may benefit from additional treatment strategies at an early stage post-transplant.
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