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DETECTING EARLY RELAPSE IN MULTIPLE MYELOMA (MM) AFTER ASCT: USEFULNESS OF IMMUNEASSAYS.
Author(s):
Marcio Andrade-Campos
,
Marcio Andrade-Campos
Affiliations:
Translational Research Unit - Hematology,IIS-Aragon. CIBERER.,Zaragoza,Spain
Ilda Murillo Flores
,
Ilda Murillo Flores
Affiliations:
Hematology,Miguel Servet University Hospital,Zaragoza,Spain
Ernesto Colorado Ledesma
,
Ernesto Colorado Ledesma
Affiliations:
Hematology,Miguel Servet University Hospital,Zaragoza,Spain
Pilar Giraldo
Pilar Giraldo
Affiliations:
Translational Research Unit,IIS-Aragon. CIBERER. IISCIII,Zaragoza,Spain
(Abstract release date: 05/18/17) EHA Library. Andrade-Campos M. 05/18/17; 182703; PB1989
Dr. Marcio Andrade-Campos
Dr. Marcio Andrade-Campos
Contributions
PDF Abstract
Abstract

Abstract: PB1989

Type: Publication Only

Background
The Free Light chain immunoassay (FLC) (Bindingsite, Birmingham, UK) is part of the mandatory response assessment for MM, the role of the Heavy/Light Chain immunoassay (HLC), is under investigation. Also relapses in MM patients are frequent, autologous stem cell transplantation (ASCT) is the standard consolidation therapy and there is an interest to detect early relapses and optimize therapy. We hypothesized that the combination of these techniques could permit to detect early biological (non-symptomatic) relapses (EBR) in this setting.

Aims
To analyze the usefulness of HLC and FLC to detect EBR in MM after ASCT.

Methods

A retrospective study was performed following these criteria: all patients diagnosed of secretory MM, in our center, and treated (including ASCT), between May 2011-August 2015; the protocol for follow-up included FLC, HLC, serum and urine electrophoresis (SPE, UPE) with immunofixation (IFX), pre-ASCT, after 12 weeks and every 3 months later (minimum follow-up: 6 months). EBR was defined as 25% on M-protein increase (any amount for patients on CR/SR) and/or ≥20mg/dl FLC increase, and/or 25% involved HLC increase with abnormal ratios. For urine, an increase >500mg/24 hrs of involved free-chain protein.

Results

Fifty-five patients were registered. Median follow-up 47 months. MF ratio: 29/26, mean age 59.5 y (33-71). Immunoglobulin subtype: IgG-Kappa: 41.8% (23), IgG-Lambda: 23.6% (13), IgA-Kappa: 16.4% (9), IgA-Lambda: 7.3% (4), Bence-Jones-Kappa: 3.6% (2), Bence-Jones-Lambda: 7.3% (4). Durie-Salmon Stage: IA: 13.5% (7), II-A: 32.7% (17), III-A: 44.2% (23), III-B: 9.6% (5), missing-data 3 case. All patients received Bortezomib based therapy and MEL200 as ASCT conditioning. Status pre-ASCT: minimal response: 12%, Partial Response (PR): 50.0%, very-good-PR (VGPR): 28.0%, complete response (CR): 6% and string response (SR): 4.0%. After ASCT, evaluation reveals that 13.0% achieved SR, 13.0% CR, 30.4% VGPR and 39.1% PR. During follow-up, 34/50 (68%) patients who achieved at least PR after ASCT, had a clinical relapse/progress, median PFS 41 months (31.5-50.5). EBR were detected in 28 patients, of them 22/34 (64.7%) clinically relapsed patients at median time 8.0 (2-22) months before symptomatic relapse. The EBR were detected by FLCr (36.7%), HLCr (22.7%), FLC+SPE (4.5%), FLC+IFX (9.1%), FLC+HLC+SPE (13.6%), FLC+HLC+SPE+UPE (13.6%).

Conclusion
Both FLC and HLC are useful tools to detect EBR in more than 50% of patients in our cohort ahead other techniques.

Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical

Keyword(s): Relapse

Abstract: PB1989

Type: Publication Only

Background
The Free Light chain immunoassay (FLC) (Bindingsite, Birmingham, UK) is part of the mandatory response assessment for MM, the role of the Heavy/Light Chain immunoassay (HLC), is under investigation. Also relapses in MM patients are frequent, autologous stem cell transplantation (ASCT) is the standard consolidation therapy and there is an interest to detect early relapses and optimize therapy. We hypothesized that the combination of these techniques could permit to detect early biological (non-symptomatic) relapses (EBR) in this setting.

Aims
To analyze the usefulness of HLC and FLC to detect EBR in MM after ASCT.

Methods

A retrospective study was performed following these criteria: all patients diagnosed of secretory MM, in our center, and treated (including ASCT), between May 2011-August 2015; the protocol for follow-up included FLC, HLC, serum and urine electrophoresis (SPE, UPE) with immunofixation (IFX), pre-ASCT, after 12 weeks and every 3 months later (minimum follow-up: 6 months). EBR was defined as 25% on M-protein increase (any amount for patients on CR/SR) and/or ≥20mg/dl FLC increase, and/or 25% involved HLC increase with abnormal ratios. For urine, an increase >500mg/24 hrs of involved free-chain protein.

Results

Fifty-five patients were registered. Median follow-up 47 months. MF ratio: 29/26, mean age 59.5 y (33-71). Immunoglobulin subtype: IgG-Kappa: 41.8% (23), IgG-Lambda: 23.6% (13), IgA-Kappa: 16.4% (9), IgA-Lambda: 7.3% (4), Bence-Jones-Kappa: 3.6% (2), Bence-Jones-Lambda: 7.3% (4). Durie-Salmon Stage: IA: 13.5% (7), II-A: 32.7% (17), III-A: 44.2% (23), III-B: 9.6% (5), missing-data 3 case. All patients received Bortezomib based therapy and MEL200 as ASCT conditioning. Status pre-ASCT: minimal response: 12%, Partial Response (PR): 50.0%, very-good-PR (VGPR): 28.0%, complete response (CR): 6% and string response (SR): 4.0%. After ASCT, evaluation reveals that 13.0% achieved SR, 13.0% CR, 30.4% VGPR and 39.1% PR. During follow-up, 34/50 (68%) patients who achieved at least PR after ASCT, had a clinical relapse/progress, median PFS 41 months (31.5-50.5). EBR were detected in 28 patients, of them 22/34 (64.7%) clinically relapsed patients at median time 8.0 (2-22) months before symptomatic relapse. The EBR were detected by FLCr (36.7%), HLCr (22.7%), FLC+SPE (4.5%), FLC+IFX (9.1%), FLC+HLC+SPE (13.6%), FLC+HLC+SPE+UPE (13.6%).

Conclusion
Both FLC and HLC are useful tools to detect EBR in more than 50% of patients in our cohort ahead other techniques.

Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical

Keyword(s): Relapse

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