Open AccessMultiple myeloma: Maintenance therapy after autologous hematopoietic stem cell transplantation, depending on minimal residual disease
Author(s) -
M. V. Solovyev,
Larisa Mendeleeva,
O S Pokrovskaya,
Maria V. Nareyko,
M V Firsova,
Irina Galtseva,
Yulia Davydova,
Nikolay Kapranov,
Л А Кузьмина,
Э Г Гемджян,
Savchenko Vg
Publication year - 2017
Publication title -
terapevtičeskij arhiv
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.181
H-Index - 14
eISSN - 2309-5342
pISSN - 0040-3660
DOI - 10.17116/terarkh201789725-31
Subject(s) - medicine , minimal residual disease , multiple myeloma , bortezomib , maintenance therapy , hematopoietic stem cell transplantation , surgery , confidence interval , transplantation , odds ratio , bone marrow , oncology , gastroenterology , chemotherapy
Aim. To determine the efficiency of maintenance therapy with bortezomib in patients with multiple myeloma (MM) who have achieved complete remission (CR) after autologous hematopoietic stem cell (auto-HSCT), depending on the presence of minimal residual disease (MRD). Subjects and methods. In January 2014 to February 2016, fifty-two MM patients (19 men and 33 women) aged 24 to 66 years (median 54 years), who had achieved CR after auto-HSCT, were randomized to perform maintenance therapy with bortezomib during a year. On day 100 after auto-HSCT, all the patients underwent immunophenotyping of bone marrow plasma cells by 6-color flow cytometry to detect MRD. Relapse-free survival (RFS) was chosen as a criterion for evaluating the efficiency of maintenance therapy. Results. After auto-HSCT, MRD-negative patients had a statistically significantly higher 2-year RFS rate than MRD-positive patients: 52.9% (95% confidence interval (CI), 35.5 to 70.5%) versus 37.2% (95% CI, 25.4 to 49.3%) (p=0.05). The presence of MRD statistically significantly increased the risk of relapse (odds ratio 1.7; 95% CI, 1.2 to 3.4; p=0.05). Two-year cumulative risk of relapse (using the Kaplan-Meier) after auto-HSCT did not statistically significantly differ in MRD-negative patients receiving (n=15) and not receiving (n=10) maintenance therapy with bortezomib (p=0.58). After completion of maintenance treatment, 42% of the MRD-positive patients achieved a negative status. In the MRD-positive patients who had received maintenance therapy, the average time to recurrence was 5 months longer than that in the naïve patients: 17.3 versus 12.3 months. Conclusion. The MRD status determined in MM patients who have achieved CR after auto-HSCT is an important factor for deciding on the use of maintenance therapy.