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Blood, 15 April 2006, Vol. 107, No. 8, pp. 3384-3388.
Prepublished online as a Blood First Edition Paper on December 8, 2005; DOI 10.1182/blood-2005-08-3398.
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Submitted August 22, 2005
Accepted November 16, 2005
Flow cytometric detection of circulating myeloma cells pretransplant in patients with multiple myeloma: a simple risk stratification system
David Dingli, Grzegorz S Nowakowski, Angela Dispenzieri, Martha Q Lacy, Suzanne R Hayman, S V Rajkumar, Philip R Greipp, Mark R Litzow, Dennis A Gastineau, Thomas E Witzig, and Morie A Gertz*
Division of Hematology, Mayo Clinic College of Medicine, Rochester, MN, USA
* Corresponding author; email: gertz.morie{at}mayo.edu.
Detection of circulating myeloma cells (CMC) by flow cytometry in patients with multiple myeloma (MM) indicates active disease. We hypothesized that detection of CMC at the time of stem cell collection prior autologous stem cell transplantation (ASCT) identifies patients at high risk of rapid progression.
A cohort of patients undergoing ASCT was identified. CMC were determined by gating on CD38+/CD45- cells using flow cytometry. The impact of CMC on overall survival (OS) and time to progression (TTP) were evaluated in univariate and multivariate analyses.
Of 246 patients undergoing ASCT, 95 had CMC. Complete response (CR) rates post transplant were 32% and 36% for patients with and without CMC (p=0.50). OS were 33.2 and 58.6 months (p=0.01) while TTP were 14.1 and 22 months respectively (p=0.001). On multivariate analysis, CMC remained independent of cytogenetics and disease status at time of transplant (p=0.03). CMC and cytogenetics were combined in a new scoring system. Patients with neither, one or both parameters had median, OS of 55, 48 and 21.5 months and median TTP of 22, 15.4 and 6.5 months respectively (p<0.0001).
CMC at the time of ASCT is an independent prognostic factor and in combination with cytogenetics provides a powerful scoring system that stratifies patients and guides management.
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