1
|
Methods and role of minimal residual disease after stem cell transplantation. Bone Marrow Transplant 2018; 54:681-690. [PMID: 30116018 DOI: 10.1038/s41409-018-0307-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/28/2018] [Accepted: 06/13/2018] [Indexed: 11/08/2022]
Abstract
Relapse is the major cause of treatment failure after stem cell transplantation. Despite the fact that relapses occurred even if transplantation was performed in complete remission, it is obvious that minimal residual disease is present though not morphologically evident. Since adaptive immunotherapy by donor lymphocyte infusion or other novel cell therapies as well as less toxic drugs, which can be used after transplantation, the detection of minimal residual disease (MRD) has become a clinical important variable for outcome. Besides the increasing options to treat MRD, the most advanced technologies currently allow to detect residual malignant cells with a sensitivity of 10-5 to 10-6.Under the patronage of the European Society for Blood and Marrow Transplantation (EBMT) and the American Society for Blood and Marrow Transplantation (ASBMT) the 3rd workshop was held on 4/5 November 2016 in Hamburg/Germany, with the aim to present an up-to-date status of epidemiology and biology of relapse and to summarize the currently available options to prevent and treat post-transplant relapse. Here the current methods and role of minimal residual disease for myeloid and lymphoid malignancies are summarized.
Collapse
|
2
|
Ho C, Arcila ME. Minimal residual disease detection of myeloma using sequencing of immunoglobulin heavy chain gene VDJ regions. Semin Hematol 2018; 55:13-18. [DOI: 10.1053/j.seminhematol.2018.02.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 02/21/2018] [Indexed: 01/29/2023]
|
3
|
Abstract
Multiple myeloma (MM), a heterogeneous plasma cell dyscrasia with a variety of clinical presentations and outcomes, is undergoing a treatment renaissance. While new drug classes have been discovered, a subset of high-risk MM remains relatively refractory to treatment. Current risk stratifications models, such as Durie-Salmon and the International Staging System, estimate disease burden and prognosis. Cytogenetics and gene expression profiles can help further identify more aggressive disease. Additionally, molecular and immunophenotypic assessment of minimal residual disease (MRD) and different imaging studies can identify patients at higher risk for relapse. It is now an opportune time to develop algorithms to combine all of the currently available clinical and genomic information to begin to inform specific therapeutic intervention in individual patients or at least smaller subgroups with similarly behaving disease.
Collapse
Affiliation(s)
- Saulius Girnius
- Boston Veterans Affairs Healthcare System, Boston, MA; Boston Medical Center, Boston, MA
| | | |
Collapse
|
4
|
Martinez-Lopez J, Fernández-Redondo E, García-Sánz R, Montalbán MA, Martínez-Sánchez P, Pavia B, Mateos MV, Rosiñol L, Martín M, Ayala R, Martínez R, Blanchard MJ, Alegre A, Besalduch J, Bargay J, Hernandez MT, Sarasquete ME, Sanchez-Godoy P, Fernández M, Blade J, San Miguel JF, Lahuerta JJ. Clinical applicability and prognostic significance of molecular response assessed by fluorescent-PCR of immunoglobulin genes in multiple myeloma. Results from a GEM/PETHEMA study. Br J Haematol 2013; 163:581-9. [DOI: 10.1111/bjh.12576] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 08/14/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Joaquin Martinez-Lopez
- Servicio de Hematología & Instituto de Investigación; Hospital Universitario 12 de Octubre; Madrid Spain
| | - Elena Fernández-Redondo
- Servicio de Hematología & Instituto de Investigación; Hospital Universitario 12 de Octubre; Madrid Spain
| | - Ramón García-Sánz
- Servicio de Hematología; Hospital Clínico Universitario de Salamanca; IBSAL. IBMCC (USAL-CSIC); Salamanca Spain
| | - María Angeles Montalbán
- Servicio de Hematología & Instituto de Investigación; Hospital Universitario 12 de Octubre; Madrid Spain
| | - Pilar Martínez-Sánchez
- Servicio de Hematología & Instituto de Investigación; Hospital Universitario 12 de Octubre; Madrid Spain
| | - Bruno Pavia
- Servicio de Hematología; Hospital Clínico Universitario de Salamanca; IBSAL. IBMCC (USAL-CSIC); Salamanca Spain
| | - María Victoria Mateos
- Servicio de Hematología; Hospital Clínico Universitario de Salamanca; IBSAL. IBMCC (USAL-CSIC); Salamanca Spain
| | - Laura Rosiñol
- Servicio de Hematologia, Hospital Clinic i Provincial de Barcelona, IDIBAPS; Barcelona Spain
| | - Marisa Martín
- Servicio de Hematología & Instituto de Investigación; Hospital Universitario 12 de Octubre; Madrid Spain
| | - Rosa Ayala
- Servicio de Hematología & Instituto de Investigación; Hospital Universitario 12 de Octubre; Madrid Spain
| | - Rafael Martínez
- Servicio de Hematología; Hospital Clínico Universitario San Carlos; Madrid Spain
| | | | - Adrian Alegre
- Servicio de Hematología; Hospital Universitario La Princesa; Madrid Spain
| | | | - Joan Bargay
- Hospital Son Llatzer; Palma de Mallorca Spain
| | | | - María Eugenia Sarasquete
- Servicio de Hematología; Hospital Clínico Universitario de Salamanca; IBSAL. IBMCC (USAL-CSIC); Salamanca Spain
| | | | - Manuela Fernández
- Servicio de Hematología & Instituto de Investigación; Hospital Universitario 12 de Octubre; Madrid Spain
| | - Joan Blade
- Servicio de Hematologia, Hospital Clinic i Provincial de Barcelona, IDIBAPS; Barcelona Spain
| | - Jesús F. San Miguel
- Servicio de Hematología; Hospital Clínico Universitario de Salamanca; IBSAL. IBMCC (USAL-CSIC); Salamanca Spain
| | - Juan Jose Lahuerta
- Servicio de Hematología & Instituto de Investigación; Hospital Universitario 12 de Octubre; Madrid Spain
| | | |
Collapse
|
5
|
Korthals M, Sehnke N, Kronenwett R, Schroeder T, Strapatsas T, Kobbe G, Haas R, Fenk R. Molecular Monitoring of Minimal Residual Disease in the Peripheral Blood of Patients with Multiple Myeloma. Biol Blood Marrow Transplant 2013; 19:1109-15. [DOI: 10.1016/j.bbmt.2013.04.025] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Accepted: 04/26/2013] [Indexed: 10/26/2022]
|
6
|
In non-transplant patients with multiple myeloma, the pre-treatment level of clonotypic cells predicts event-free survival. Mol Cancer 2012; 11:78. [PMID: 23083101 PMCID: PMC3522007 DOI: 10.1186/1476-4598-11-78] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Accepted: 10/17/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In multiple myeloma (MM), the immunoglobulin heavy chain VDJ gene rearrangement is a unique clonotypic signature that identifies all members of the myeloma clone independent of morphology or phenotype. Each clonotypic MM cell has only one genomic copy of the rearranged IgH VDJ. METHODS Pre-treatment bone marrow aspirates from myeloma patients at diagnosis or in relapse were evaluated for the number of clonotypic cells using real time quantitative PCR (RPCR). RPCR measured the level of clonal cells, termed VDJ%, in 139 diagnosis and relapse BM aspirates from MM patients. RESULTS Patients with a VDJ% below the median had a significantly longer event free survival (EFS) then those with a VDJ% higher than the median (p=0.0077, HR=0.57). Further, although the VDJ% from non-transplant patients predicted EFS (p=0.0093), VDJ% failed to predict outcome after autologous stem cell transplant (p=0.53). CONCLUSIONS Our results suggest that for non-transplant patients, the tumor burden before treatment, perhaps reflecting cancer stem cell progeny/output, is an indirect measure that may indicate the number of MM cancer stem cells and hence event free survival.
Collapse
|
7
|
Hart AJ, Jagasia MH, Kim AS, Mosse CA, Savani BN, Kassim A. Minimal residual disease in myeloma: are we there yet? Biol Blood Marrow Transplant 2012; 18:1790-9. [PMID: 22626785 DOI: 10.1016/j.bbmt.2012.05.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 05/03/2012] [Indexed: 12/20/2022]
Abstract
Measurement of minimal residual disease is routine in diseases such as chronic myelogenous leukemia, precursor B cell acute lymphoblastic leukemia, and acute promyelocytic leukemia because it provides important prognostic information. However, the role of minimal residual disease testing has not been widely adopted in multiple myeloma (MM), with other parameters such as the International Staging System (ISS) and cytogenetic analysis primarily guiding therapy and determination of prognosis. Until recently, achieving a complete response (CR), as defined by the International Myeloma Working Group (IMWG) criteria, was rare in patients with MM. The use of novel agents with or without autologous peripheral blood stem cell transplantation (auto-PBSCT) has significantly increased CR rates, thus increasing overall survival (OS) rates. The majority of patients with MM have persistent levels of residual disease that are below the sensitivity of bone marrow (BM) morphology, protein electrophoresis with immunofixation, and light chain quantitation even after attaining CR and will eventually relapse. Measurement of minimal residual disease by more sensitive methods, and the use of these methods as a tool for predicting patient outcomes and guiding therapeutic decisions, has thus become more relevant. Methods available for monitoring minimal residual disease in MM include PCR and multiparameter flow cytometry (MFC), both of which have been shown to be valuable in other hematologic malignancies; however, neither has become a standard of care in MM. Here, we review current evidence for using minimal residual disease measurement for risk assessment in MM as well as incorporating pretreatment factors and posttreatment minimal residual disease monitoring as a prognostic tool for therapeutic decisions, and we outline challenges to developing uniform criteria for minimal residual disease monitoring.
Collapse
Affiliation(s)
- Andrew J Hart
- Department of Medicine, Division of Hematology/Oncology, Section of Hematology and Stem Cell Transplant, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | | | | | | |
Collapse
|
8
|
Kröger N, Badbaran A, Lioznov M, Schwarz S, Zeschke S, Hildebrand Y, Ayuk F, Atanackovic D, Schilling G, Zabelina T, Bacher U, Klyuchnikov E, Shimoni A, Nagler A, Corradini P, Fehse B, Zander A. Post-transplant immunotherapy with donor-lymphocyte infusion and novel agents to upgrade partial into complete and molecular remission in allografted patients with multiple myeloma. Exp Hematol 2009; 37:791-8. [PMID: 19487069 DOI: 10.1016/j.exphem.2009.03.008] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2009] [Revised: 03/24/2009] [Accepted: 03/26/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To investigate post-transplant immunotherapy with escalating donor-lymphocyte infusions (DLI) and novel agents (thalidomide, bortezomib, and lenalidomide) to target complete remission (CR). MATERIALS AND METHODS Thirty-two patients with multiple myeloma who achieved only partial remission after allogeneic stem cell transplantation were treated with DLI. If no CR was achieved, one of the novel agents was added to target CR. RESULTS CR defined either by European Group for Blood and Marrow Transplantation criteria, flow cytometry, or molecular methods as assessed by patient-specific immunoglobulin H-polymerase chain reaction or plasma cell chimerism polymerase chain reaction was accomplished in 59%, 63%, and 50% of patients, respectively. Achievement of CR resulted in improved 5-year progressive-free and overall survival, according to European Group for Blood and Marrow Transplantation criteria (53% vs 35%; p=0.03 and 90% vs 62%; p=0.06), flow cytometry (74% vs 15%; p=0.001 and 100% vs 52%; p=0.1), or molecular methods (84% vs 38%; p=0.001 and 100% vs 71%; p=0.03). CONCLUSIONS Our finding demonstrates the clinical relevance of posttransplantation therapies to upgrade remission, and of remission's depth for long-term survival in myeloma patients.
Collapse
Affiliation(s)
- Nicolaus Kröger
- Department for Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Martínez-Sánchez P, Montejano L, Sarasquete ME, García-Sanz R, Fernández-Redondo E, Ayala R, Montalbán MA, Martínez R, García Laraña J, Alegre A, Hernández B, Lahuerta JJ, Martínez-López J. Evaluation of minimal residual disease in multiple myeloma patients by fluorescent-polymerase chain reaction: the prognostic impact of achieving molecular response. Br J Haematol 2008; 142:766-74. [DOI: 10.1111/j.1365-2141.2008.07263.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
10
|
Bench AJ, Erber WN, Follows GA, Scott MA. Molecular genetic analysis of haematological malignancies II: mature lymphoid neoplasms. Int J Lab Hematol 2007; 29:229-60. [PMID: 17617076 DOI: 10.1111/j.1751-553x.2007.00876.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Molecular genetic techniques have become an integral part of the diagnostic assessment for many lymphomas and other chronic lymphoid neoplasms. The demonstration of a clonal immunoglobulin or T cell receptor gene rearrangement offers a useful diagnostic tool in cases where the diagnosis is equivocal. Molecular genetic detection of other genomic rearrangements may not only assist with the diagnosis but can also provide important prognostic information. Many of these rearrangements can act as molecular markers for the detection of low levels of residual disease. In this review, we discuss the applications of molecular genetic analysis to the chronic lymphoid malignancies. The review concentrates on those disorders for which molecular genetic analysis can offer diagnostic and/or prognostic information.
Collapse
MESH Headings
- Burkitt Lymphoma/genetics
- Gene Rearrangement
- Humans
- Immunoglobulin G/genetics
- Leukemia, Hairy Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Prolymphocytic/genetics
- Leukemia-Lymphoma, Adult T-Cell/genetics
- Lymphoma, B-Cell/genetics
- Lymphoma, Follicular/genetics
- Lymphoma, Mantle-Cell/genetics
- Lymphoma, Non-Hodgkin/genetics
- Lymphoma, T-Cell/genetics
- Molecular Diagnostic Techniques
- Receptors, Antigen, T-Cell/genetics
Collapse
Affiliation(s)
- A J Bench
- Haemato-Oncology Diagnostic Service, Department of Haematology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
| | | | | | | |
Collapse
|
11
|
Zhao X, Huang Q, Slovak M, Weiss L. Comparison of Ancillary Studies in the Detection of Residual Disease in Plasma Cell Myeloma in Bone Marrow. Am J Clin Pathol 2006. [DOI: 10.1309/b2p9xeh44cy9lpuk] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
12
|
Current Awareness in Hematological Oncology. Hematol Oncol 2005. [DOI: 10.1002/hon.730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|