Minimal residual disease in patients with diffuse large B-cell lymphoma undergoing autologous stem cell transplantation.

Autor:	Merryman RW; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA., Redd RA; Department of Data Science, Dana-Farber Cancer Institute, Boston, MA., Taranto E; Department of Medicine, Brigham and Women's Hospital, Boston, MA., Ahmed G; Medical College of Wisconsin, Milwaukee, WI., Jeter E; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA., McHugh KM; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA., Brown JR; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA., Crombie JL; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA., Davids MS; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA., Fisher DC; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA., Freedman AS; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA., Jacobsen E; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA., Jacobson CA; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA., Kim AI; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA., LaCasce AS; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA., Ng SY; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA., Odejide OO; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA., Parry EM; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA., Jacene H; Department of Imaging/Radiology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA., Park H; Department of Imaging/Radiology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA., Dahi PB; Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan-Kettering Cancer Center, New York, NY., Nieto Y; Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX., Joyce RM; Department of Hematologic Malignancy, Beth Israel Deaconess Medical Center, Boston, MA., Chen YB; Bone Marrow Transplantation Program, Massachusetts General Hospital, Boston, MA., Shipp MA; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA., Herrera AF; Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA., Armand P; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA.
Jazyk:	angličtina
Zdroj:	Blood advances [Blood Adv] 2023 Sep 12; Vol. 7 (17), pp. 4748-4759.
DOI:	10.1182/bloodadvances.2022007706
Abstrakt:	Improved biomarkers are required to guide the optimal use of autologous stem cell transplantation (ASCT) in patients with relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL). We hypothesized that minimal residual disease (MRD) identified using immunoglobulin high-throughput sequencing in apheresis stem cell (ASC) samples, post-ASCT peripheral blood mononuclear cell (PBMC), and plasma samples could predict relapse. We studied 159 patients with R/R DLBCL who underwent ASCT, of whom 98 had an ASC sample and 60 had post-ASCT surveillance samples. After a median post-ASCT follow-up of 60 months, the 5-year progression-free survival (PFS) was 48%. MRD was detected in of 23/98 (23%) ASC samples and was associated with very poor PFS (5-year PFS 13% vs 53%, P < .001) and inferior overall survival (52% vs 68%, P = .05). The sensitivity and specificity of ASC MRD positivity for progression and death were 36% and 93%, respectively. Positive ASC MRD remained a significant predictor of PFS in multivariable analysis (hazard ratio [HR], 3.7; P < .001). Post-ASCT surveillance MRD testing of plasma, but not PBMC samples, reliably identified patients with an impending relapse. A positive plasma MRD result was associated with inferior PFS (HR, 3.0; P = .016) in a multivariable analysis. The median lead time from MRD detection to relapse was 62 days (range, 0-518 days). In conclusion, the detection of MRD in ASC samples is associated with a very high risk of relapse, justifying alternative treatment strategies or trials of novel consolidation options in these patients. Furthermore, post-ASCT MRD monitoring may facilitate the evaluation of the early initiation of treatment at molecular relapse. This trial has been registered at www.clinicaltrials.gov as #NCT02362997. (© 2023 by The American Society of Hematology. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0), permitting only noncommercial, nonderivative use with attribution. All other rights reserved.)
Databáze:	MEDLINE
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