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Dual assessment with multiparameter flow cytometry and 18F-FDG PET/CT scan provides enhanced prediction of measurable residual disease after autologous haemopoietic stem cell transplant in myeloma—a prospective study

Bone Marrow Transplantation volume 58, pages 1045–1047 (2023)Cite this article

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Measurable residual disease (MRD) is a surrogate endpoint for progression-free survival (PFS) in Multiple myeloma (MM) and meta analysis have confirmed that bone marrow (BM) MRD negativity is associated with superior PFS both in transplant and non transplant setting [1]. BM next generation multiparametric flow cytometry (MFC) and next generation sequencing (NGS) are currently being employed to assess MRD and have been included in the International Myeloma Working Group (IMWG) criteria for defining MRD negative state [2]. 18F-FDG PET/CT scan with its ability to distinguish between metabolically active and inactive disease has helped to evaluate the extramedullary disease component which is present in up to 20% of patients [3, 4]. We hypothesized that a combined assessment of MRD with BM flow and PET/CT scan may be more predictive and prospectively evaluated both on day + 100 post ASCT. In addition, we also assessed the clinical and laboratory predictors of of flow MRD status and the risk factors influencing time to progression after transplant.

Between April, 2016 and November, 2019, 160 consecutive MM patients underwent first ASCT post novel agent based induction. Responses to induction and transplant were assessed using the IMWG consensus criteria. [2]. Post ASCT patients received maintenance therapy with lenalidomide 10 mg daily for 21 days every month for ≥2 years. The BM flow MRD was performed on 138 patients using previously described protocol (supplementary File: Protocol) with an overall sensitivity of 10−6. Whole body 18F-FDG PET/CT after ASCT was done in 131 patients and the FDG uptake in the target lesions was quantified according to the 5-point Deauville scale [5]. Four patients were PET negative at diagnosis as well as on day + 100 evaluation. The median interval from diagnosis to transplant was 12.1 months. The median follow up of the cohort is 39 months (range: 11 to 63.9 months).

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Fig. 1: Overall and progression free survival according to BM Flow  and PET scan MRD status.

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Acknowledgements

We wish to thank all the patients and their families for having participated in the study. We are also grateful to the resident doctors, laboratory and nursing staff, scientists and faculty of the departments of Medical Oncology, Laboratory Oncology Unit and Nuclear Medicine.

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Authors and Affiliations

  1. Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, 110029, India

    Anjali Mookerjee, Atul Sharma & Lalit Kumar

  2. Lab Oncology, All India Institute of Medical Sciences, New Delhi, 110029, India

    Ritu Gupta

  3. Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India

    Rakesh Kumar

  4. Bio-Statistics, All India Institute of Medical Sciences, New Delhi, 110029, India

    Ravindra Mohan Pandey

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  1. Anjali Mookerjee
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Contributions

AM: designing and performed the experiments, collating data, manuscript writing. RG: review of flow cytometry experiments/data, discussion. RK: review of PET scan data. AS: patients clinical management RMP Statistical analysis. LK: conceptualization, experiments design, treatment and monitoring, manuscript writing and editing.

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Correspondence to Lalit Kumar.

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Mookerjee, A., Gupta, R., Kumar, R. et al. Dual assessment with multiparameter flow cytometry and 18F-FDG PET/CT scan provides enhanced prediction of measurable residual disease after autologous haemopoietic stem cell transplant in myeloma—a prospective study. Bone Marrow Transplant 58, 1045–1047 (2023). https://doi.org/10.1038/s41409-023-02017-0

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