Prognostic Value of Serum Paraprotein Response Kinetics in Patients With Newly Diagnosed Multiple Myeloma.

Autor: Tamariz-Amador LE; Clínica Universidad de Navarra, CCUN, Centro de Investigación Médica Aplicada (CIMA), IDISNA, CIBERONC, Pamplona, Spain. Electronic address: ltamariz@unav.es., Rodríguez-Otero P; Clínica Universidad de Navarra, CCUN, Centro de Investigación Médica Aplicada (CIMA), IDISNA, CIBERONC, Pamplona, Spain. Electronic address: paurodriguez@unav.es., Jiménez-Ubieto A; Hospital 12 de Octubre, Madrid, Spain., Rosiñol L; Hospital Clínic de Barcelona, IDIBAPS, Barcelona, Spain., Oriol A; Institut Català d'Oncologia i Institut Josep Carreras, Badalona, Spain., Ríos R; Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain., Sureda A; Institut Català d'Oncologia - Hospital Duran i Reynals, IDIBELL, Universitat de Barcelona, Barcelona, Spain., Blanchard MJ; Hospital Ramón y Cajal, Madrid, Spain., Hernández MT; Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain., Cabañas Perianes V; Hospital Virgen de la Arrixaca, Murcial, Spain., Jarque I; Hospital La Fe, Valencia, Spain., Bargay J; Hospital Son Llatzer, Palma de Mallorca, Spain., Gironella M; Hospital Vall d'Hebron, Barcelona, Spain., De Arriba F; Hospital Universitario Morales Meseguer, IMIB-Arrixaca, Universidad de Murcia, Murcia, Spain., Palomera L; Hospital Clínico Lozano Blesa, Zaragoza, Spain., Gonzalez-Montes Y; Hospital Josep Trueta, Girona, Spain., Martí JM; Hospital Mutua de Terrassa, Terrassa, Spain., Krsnik I; Hospital Puerta del Hierro, Madrid, Spain., Arguiñano JM; Hospital Universitario de Navarra, Pamplona, Spain., González ME; Hospital de Cabueñes, Gijón, Spain., Casado LF; Hospital Virgen de la Salud, Toledo, Spain., González-Rodriguez AP; Hospital Universitario Central de Asturias, Oviedo, Spain., López-Anglada L; Hospital Clínic de Barcelona, IDIBAPS, Barcelona, Spain., Puig N; Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain., Cedena MT; Hospital 12 de Octubre, Madrid, Spain., Paiva B; Clínica Universidad de Navarra, CCUN, Centro de Investigación Médica Aplicada (CIMA), IDISNA, CIBERONC, Pamplona, Spain., Mateos MV; Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain., San-Miguel J; Clínica Universidad de Navarra, CCUN, Centro de Investigación Médica Aplicada (CIMA), IDISNA, CIBERONC, Pamplona, Spain., Lahuerta JJ; Hospital 12 de Octubre, Madrid, Spain., Bladé J; Hospital Clínic de Barcelona, IDIBAPS, Barcelona, Spain., Trocóniz IF; Facultad de Farmacia y Nutrición, Universidad de Navarra, Pamplona, Spain.
Jazyk: angličtina
Zdroj: Clinical lymphoma, myeloma & leukemia [Clin Lymphoma Myeloma Leuk] 2022 Sep; Vol. 22 (9), pp. e844-e852. Date of Electronic Publication: 2022 May 05.
DOI: 10.1016/j.clml.2022.04.024
Abstrakt: Introduction: Response kinetics is a well-established prognostic marker in acute lymphoblastic leukemia. The situation is not clear in multiple myeloma (MM) despite having a biomarker for response monitoring (monoclonal component [MC]).
Materials and Methods: We developed a mathematical model to assess the prognostic value of serum MC response kinetics during 6 induction cycles, in 373 NDMM transplanted patients treated in the GEM2012Menos65 clinical trial. The model calculated a "resistance" parameter that reflects the stagnation in the response after an initial descent.
Results: Two patient subgroups were defined based on low and high resistance, that respectively captured sensitive and refractory kinetics, with progression-free survival (PFS) at 5 years of 72% and 59% (HR 0.64, 95% CI 0.44-0.93; P = .02). Resistance significantly correlated with depth of response measured after consolidation (80.9% CR and 68.4% minimal residual disease negativity in patients with sensitive vs. 31% and 20% in those with refractory kinetics). Furthermore, it modulated the impact of reaching CR after consolidation; thus, within CR patients those with refractory kinetics had significantly shorter PFS than those with sensitive kinetics (median 54 months vs. NR; P = .02). Minimal residual disease negativity abrogated this effect. Our study also questions the benefit of rapid responders compared to late responders (5-year PFS 59.7% vs. 76.5%, respectively [P < .002]). Of note, 85% of patients considered as late responders were classified as having sensitive kinetics.
Conclusion: This semi-mechanistic modeling of M-component kinetics could be of great value to identify patients at risk of early treatment failure, who may benefit from early rescue intervention strategies.
(Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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