| Autor: |
Bruno Paiva, Jesus F. San-Miguel, Aldo M. Roccaro, Hervé Avet-Loiseau, Hartmut Goldschmidt, Alberto Orfao, Juan Flores-Montero, Maria-Victoria Mateos, Noemi Puig, Pablo Rios, Maria Sarasa, Luis Palomera, José-Ángel Hernández-Rivas, Javier de la Rubia, Albert Oriol, Maialen Sirvent, Valentin Cabañas, Adrian Alegre, Maria Casanova, Antoni Garcia-Guiñon, Heinz Ludwig, Felipe De Arriba, Clara Gomez, Helena Vitoria, Catarina Geraldes, Artur Paiva, Rebeca Iglesias, Fernando Solano, Joaquin Martinez-Lopez, Roman Hájek, Enrique M. Ocio, Maria-Elena Cabezudo, Joan Bargay, Felipe Prosper, Luis-Esteban Tamariz-Amador, Aitziber Lopez, Juan-Jose Garces, Cirino Botta, Camilla Guerrero, Esperanza Martín-Sánchez, Catarina Maia, Cristina Perez, Cristina Moreno, Sara Rodriguez, Alessandra Tucci, Viviana Giustini, Marco Chiarini, Antonio Sacco, Francois Vergez, Jill Corre, Anna Luise Grab, Elias K. Mai, Niels Weinhold, Marc Raab, Tomáš Jelínek, Albert Perez-Montaña, Evangelos Terpos, David Žihala, Rosalinda Termini |
| Rok vydání: |
2023 |
| DOI: |
10.1158/1078-0432.c.6532880 |
| Popis: |
Purpose:Early intervention in smoldering multiple myeloma (SMM) requires optimal risk stratification to avoid under- and overtreatment. We hypothesized that replacing bone marrow (BM) plasma cells (PC) for circulating tumor cells (CTC), and adding immune biomarkers in peripheral blood (PB) for the identification of patients at risk of progression due to lost immune surveillance, could improve the International Myeloma Working Group 20/2/20 model.Experimental Design:We report the outcomes of 150 patients with SMM enrolled in the iMMunocell study, in which serial assessment of tumor and immune cells in PB was performed every 6 months for a period of 3 years since enrollment.Results:Patients with >0.015% versus ≤0.015% CTCs at baseline had a median time-to-progression of 17 months versus not reached (HR, 4.9; P 20% BM PCs had no prognostic value in a multivariate analysis that included serum free light-chain ratio >20, >2 g/dL M-protein, and >0.015% CTCs. The 20/2/20 and 20/2/0.015 models yielded similar risk stratification (C-index of 0.76 and 0.78). The combination of the 20/2/0.015 model with an immune risk score based on the percentages of SLAN+ and SLAN− nonclassical monocytes, CD69+HLADR+ cytotoxic NK cells, and CD4+CXCR3+ stem central memory T cells, allowed patient’ stratification into low, intermediate-low, intermediate-high, and high-risk disease with 0%, 20%, 39%, and 73% rates of progression at 2 years.Conclusions:This study showed that CTCs outperform BM PCs for assessing tumor burden. Additional analysis in larger series are needed to define a consensus cutoff of CTCs for minimally invasive stratification of SMM. |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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