Contributions
Type: Publication Only
Background
Bone marrow trephine samples are routinely assessed from patients following autologous stem cell transplantation (SCT) for Multiple Myeloma (MM) 100 days after the procedure
Aims
The aim of this study is to assess the clinical value of the day 100 trephine biopsy and to see if it offers additional information when compared to serological markers.
Methods
We analysed the pre-transplant and day 100 (d100) post-transplant bone marrow trephines for a series of consecutive patients (n=64) who underwent autologous stem cell transplant between June 2013 to August 2014. Only patients who had adequate pre- and post-transplant trephine biopsies taken were included in the study (n=46). Pre-transplant state was categorised as either complete response (CR) or as partial response (VGPR/PR groups) as defined by the International Myeloma Working Group (Uniform Response Criteria for MM). At d100 the bone marrow trephine results and corresponding serum paraprotein and light chain values were analysed. The concordance between these sets of results was determined
Results
Prior to transplant, 34 patients were in VGPR/PR and 12 in CR. Overall, the bone marrow trephines showed no change in 34/46 patients. There was an improvement in 11/46, while poor regeneration was noted in 1/46.
In all patients with CR (n=12), there was no change in the d100 trephine results. However, paraprotein became detectable in 7/12. 5/12 remained in CR.
In the VGPR/PR patients (n=34), d100 trephine showed no change in 22/34, 11/34 showed an improvement, 1/34 showed poor regeneration. Out of the 11 that showed improvement, 4/11 showed concordant improvement in the serum markers (paraprotein and/or light chain levels), 1/11 showed worsening of serum markers, 5/11 showed no change and 1/11 had no d100 serum markers available.
In the VGPR/PR group, 2/34 had progressive disease according to serum markers; of these, one had no change in the trephine while the other showed improvement. 10/34 showed improvement in the serum markers; of these, 4/10 showed concordant improvement in the trephine samples. 21/34 showed no change in serum markers, of which 15/21 showed no change in the trephine, 5/21 showed improvement, 1/21 had poor regeneration. There were no d100 serum markers available for one patient.
Overall, no progression was seen in all d100 trephines compared to pre-transplant sample, while progression was seen in 9/46 serum markers at d100 compared to the pre-transplant levels
Summary
Data from this study demonstrates that based on the bone marrow trephine results in isolation, patients who had received SCT for MM did not require a change to clinical management. There was no progression noted in any d100 trephine biopsy sample, although 9/46 patients showed progression in serum markers. Although this study is too early to assess any longer-term predicative value of d100 marrow assessment, we would propose routine day 100 bone marrow trephine biopsies for MM patient’s post autologous SCT contributes little additional clinical value and could be omitted with little risk to the patient. It may be more appropriate to follow up such patients using serum paraprotein and/or light chain levels alone.
Keyword(s): Autologous hematopoietic stem cell transplantation, Multiple myeloma
Type: Publication Only
Background
Bone marrow trephine samples are routinely assessed from patients following autologous stem cell transplantation (SCT) for Multiple Myeloma (MM) 100 days after the procedure
Aims
The aim of this study is to assess the clinical value of the day 100 trephine biopsy and to see if it offers additional information when compared to serological markers.
Methods
We analysed the pre-transplant and day 100 (d100) post-transplant bone marrow trephines for a series of consecutive patients (n=64) who underwent autologous stem cell transplant between June 2013 to August 2014. Only patients who had adequate pre- and post-transplant trephine biopsies taken were included in the study (n=46). Pre-transplant state was categorised as either complete response (CR) or as partial response (VGPR/PR groups) as defined by the International Myeloma Working Group (Uniform Response Criteria for MM). At d100 the bone marrow trephine results and corresponding serum paraprotein and light chain values were analysed. The concordance between these sets of results was determined
Results
Prior to transplant, 34 patients were in VGPR/PR and 12 in CR. Overall, the bone marrow trephines showed no change in 34/46 patients. There was an improvement in 11/46, while poor regeneration was noted in 1/46.
In all patients with CR (n=12), there was no change in the d100 trephine results. However, paraprotein became detectable in 7/12. 5/12 remained in CR.
In the VGPR/PR patients (n=34), d100 trephine showed no change in 22/34, 11/34 showed an improvement, 1/34 showed poor regeneration. Out of the 11 that showed improvement, 4/11 showed concordant improvement in the serum markers (paraprotein and/or light chain levels), 1/11 showed worsening of serum markers, 5/11 showed no change and 1/11 had no d100 serum markers available.
In the VGPR/PR group, 2/34 had progressive disease according to serum markers; of these, one had no change in the trephine while the other showed improvement. 10/34 showed improvement in the serum markers; of these, 4/10 showed concordant improvement in the trephine samples. 21/34 showed no change in serum markers, of which 15/21 showed no change in the trephine, 5/21 showed improvement, 1/21 had poor regeneration. There were no d100 serum markers available for one patient.
Overall, no progression was seen in all d100 trephines compared to pre-transplant sample, while progression was seen in 9/46 serum markers at d100 compared to the pre-transplant levels
Summary
Data from this study demonstrates that based on the bone marrow trephine results in isolation, patients who had received SCT for MM did not require a change to clinical management. There was no progression noted in any d100 trephine biopsy sample, although 9/46 patients showed progression in serum markers. Although this study is too early to assess any longer-term predicative value of d100 marrow assessment, we would propose routine day 100 bone marrow trephine biopsies for MM patient’s post autologous SCT contributes little additional clinical value and could be omitted with little risk to the patient. It may be more appropriate to follow up such patients using serum paraprotein and/or light chain levels alone.
Keyword(s): Autologous hematopoietic stem cell transplantation, Multiple myeloma