Prognostic value of deep sequencing method for minimal residual disease detection in multiple myeloma
Menée sur 133 patients atteints d'un myélome multiple, cette étude évalue l'intérêt d'une technique de séquençage appliquée à des échantillons de moelle osseuse pour estimer le niveau de maladie résiduelle et la survie des patients
We assessed the prognostic value of minimal residual disease (MRD) detection in multiple myeloma (MM) patients using a sequencing-based platform in bone marrow samples from 133 MM patients in at least very good partial response (VGPR) following front-line therapy. Deep sequencing was carried out in patients in which a high-frequency myeloma clone was identified and MRD was assessed using the IGH-VDJH, IGH-DJH and IGK assays. The results were contrasted with those of multiparametric flow cytometry (MFC) and ASO-PCR. The applicability of deep sequencing was 91%. Concordance between sequencing and MFC and ASO-PCR was 83% and 85%, respectively. Patients who were MRD- by sequencing had a significantly longer time to tumor progression (TTP) (median 80 vs. 31 months; P<0.0001) and overall survival (median not reached vs. 81 months; P=0.02), compared with patients who were MRD+. When stratifying patients by different levels of MRD, the respective TTP medians were: MRD ≥10-3 27 months, MRD 10-3 to 10-5 48 months, and MRD <10-5 80 months (P from 0.003 to 0.0001). 92% of VGPR patients were MRD+. In CR patients, the TTP remained significantly longer for MRD- compared to MRD+ patients (131 vs. 35 months; P=0.0009).
Blood , résumé, 2014