Among newly diagnosed patients with multiple myeloma (MM) undergoing autologous stem cell transplantation (ASCT), graft contamination appears to predict adverse clinical outcomes, according to research published in Cancers.
MM, which accounts for about 1 in 10 of all hematologic cancers, is generally considered incurable. While patients with newly diagnosed disease are often treated in part with ASCT when eligible, there is a large amount of heterogeneity in relapse risk. Because of this heterogeneity, it is becoming increasingly important to try to determine which biological or clinical factors may predict an adverse outcome after ASCT.
Previous research has suggested that autologous grafts, which are used in ASCT, may contain aberrant plasma cells (APCs), which may relate to the relative ineffectiveness of pre-transplant therapy. For this prospective study, researchers evaluated data from patients with newly diagnosed MM undergoing ASCT to determine any relationship between APC variance and transplant outcomes.
Overall, data from 199 patients were included. Patients were assigned into a graft contamination-positive group (79 patients) and a contamination-negative group (120 patients). In the contamination-negative and -positive groups, the average ages were 55.9 and 57.3 years, respectively, and 63.8% and 54.2% of patients were male.
Analysis suggested that, in the contamination-negative vs -positive groups, 55% vs 63% of patients had bone marrow infiltration (P =.036). Patients in the contamination-negative group had, furthermore, lower serum beta 2-microglobulin levels (2.7 mg/L vs 3.3 mg/L in the contamination-positive group; P =.046).
Any-contamination and contamination levels both correlated with responses, with patients in the contamination-positive group having a post-ASCT complete response rate of 20% vs 48% in the contamination-negative group (P =.0001).
“As novel biomarkers with a strong predictive value are needed for the early recognition of those patients with a higher risk of progression, the evaluation of stem cell graft contamination with sensitive approaches may serve as a predictive factor post ASCT, which may clearly stratify patients into distinct risk categories according to their potential to progress,” the authors wrote. “In this context, tailored therapeutic decisions would be made.”
Kostopoulos IV, Eleutherakis-Papaiakovou E, Rousakis P, et al. Aberrant plasma cell contamination of peripheral blood stem cell autografts, assessed by next-generation flow cytometry, is a negative predictor for deep response post autologous transplantation in multiple myeloma; a prospective study in 199 patients. Cancers (Basel). 2021;13(16):4047. doi:10.3390/cancers13164047