多发性骨髓瘤极小残留病的动态变化及其临床意义:回顾性真实生活分析

IF 3.6 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL Clinical Medicine Pub Date : 2024-10-01 DOI:10.1016/j.clinme.2024.100252
Weiling Xu, Xinyue Liang, Shanshan Liu, Xingcheng Yi, Mengru Tian, Tingting Yue, Yingjie Zhang, Yurong Yan, Maozhuo Lan, Mengtuan Long, Nan Zhang, Jingxuan Wang, Xiaoxiao Sun, Rui Hu, Yufeng Zhu, Xintian Ma, Yue Cheng, Jiayi Xu, Yun Dai, Fengyan Jin
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引用次数: 0

摘要

背景:最小残留病灶(MRD)检测是量身定制多发性骨髓瘤(MM)治疗方案的有效方法。然而,在将其应用于日常实践之前,仍有几个主要问题需要解决,其中大部分问题源于 MRD 状态的动态性质。因此,了解 MRD 动态并提出其临床意义至关重要:我们回顾性分析了新诊断 MM(NDMM)患者的数据,这些患者在开始治疗后的多个时间点进行了基于流式细胞术的 MRD 检测。我们分析了检测不到的MRD(包括达到、持续时间和消失)对临床结果的影响:结果:在220名新确诊的MM患者中,无论基线风险因素如何,达到MRD-都会带来有利的结果(PFS和OS的P < 0.0001)。值得注意的是,MRD-持续时间≥12个月与病情进展/死亡或死亡风险降低83%(95% CI,0.09-0.34;P < 0.0001)或69%(95% CI,0.13-0.76;P = 0.0098)有关,而MRD-持续时间越长,预后越好。失去MRD-会导致较差的PFS(HR 0.01,95% CI 0-0.06,P < 0.0001)和OS(HR 0.03,95% CI 0-0.24,P = 0.0008)。大多数失去MRD-状态的患者(70%)都有高危细胞遗传学异常(HRCAs)。虽然MRD-与常规治疗反应(如≥CR或VGPR)在时间上不一致,但它比后者更能预测疾病进展或复发。最后,MRD状态的预测价值与基线风险因素(如HRCA、ISS或R-ISS分期)无关:结论:需要在治疗过程和随访中对 MRD 进行纵向评估,以监测疾病进展或复发,从而指导治疗决策。因此,目前正在进行一项前瞻性研究,以调查根据MRD状态的纵向变化进行MRD定制治疗的可行性和益处。
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Dynamics of minimal residual disease and its clinical implications in multiple myeloma: A retrospective real-life analysis.

Background: Minimal residual disease (MRD) testing is a promising approach to tailor the treatment of multiple myeloma (MM). However, several major concerns remain to be addressed before moving it into daily practice, most of which stem from the dynamic nature of the MRD status. Thus, it is crucial to understand the MRD dynamics and propose its clinical implications.

Methods: We retrospectively analysed the data of patients with newly diagnosed MM (NDMM) who had flow cytometry-based MRD tests at multiple time points after initiation of therapy. The impact of undetectable MRD (including attainment, duration and loss) on clinical outcomes was analysed.

Results: In a cohort of 220 patients with NDMM, attainment of MRD- offered favourable outcomes (P < 0.0001 for both progression-free survival (PFS) and overall survival (OS)), regardless of baseline risk factors. Notably, MRD- duration ≥12 months was associated with an 83 % (95 % confidence interval (CI), 0.09-0.34; P < 0.0001) or 69 % (95 % CI, 0.13-0.76; P = 0.0098) reduction in risk of progression/death or death, while the longer MRD- was sustained, the better the outcome was. Loss of MRD- led to poor PFS (hazard ratio (HR) 0.01, 95 % CI 0-0.06, P < 0.0001) and OS (HR 0.03, 95 % CI 0-0.24, P = 0.0008). Most patients (70 %) who lost MRD- status carried high-risk cytogenetic abnormalities (HRCAs). While MRD- was temporally inconsistent with conventional therapeutic responses (eg ≥ complete remission or very good partial response), it predicted disease progression or recurrence more robustly than the latter. Last, the predictive value of the MRD status was independent of baseline risk factors (eg high-risk cytogenetic abnormality, International Staging System (ISS) or Revised (R-)ISS staging).

Conclusions: Longitudinal assessment of MRD during the treatment course and follow-up is required for monitoring disease progression or relapse, to guide treatment decisions. Accordingly, a prospective study is currently ongoing to investigate the feasibility and benefit of the MRD-tailored therapy according to the longitudinal changes of the MRD status.

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来源期刊
Clinical Medicine
Clinical Medicine 医学-医学:内科
CiteScore
7.20
自引率
0.00%
发文量
0
审稿时长
6-12 weeks
期刊介绍: Clinical Medicine is aimed at practising physicians in the UK and overseas and has relevance to all those managing or working within the healthcare sector. Available in print and online, the journal seeks to encourage high standards of medical care by promoting good clinical practice through original research, review and comment. The journal also includes a dedicated continuing medical education (CME) section in each issue. This presents the latest advances in a chosen specialty, with self-assessment questions at the end of each topic enabling CPD accreditation to be acquired. ISSN: 1470-2118 E-ISSN: 1473-4893 Frequency: 6 issues per year
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