23-10-2024 | Multiple Myeloma | Research
Immunoparesis recovery in newly diagnosed transplant ineligible multiple myeloma patients, an independent prognostic factor that complements minimal residual disease
Authors:
Sunil Lakhwani, María Victoria Mateos, Joaquín Martínez-López, Bruno Paiva, Laura Rosiñol Dachs, Rafael Martínez, Albert Oriol, Joan Bargay, Yolanda González-Montes, Mercedes Gironella, Cristina Encinas, Jesús Martín, Isidro Jarque, Miquel Granell, Eugenia Abella, Aránzazu García-Mateo, José Ángel Hernández-Rivas, Elena Ramila, Isabel Krsnik, Luis Felipe Casado Montero, Felipe De Arriba, Luis Palomera, Antonia Sampol, José María Moraleda, María Casanova, Pilar Delgado, Ana Lafuente, Elena Amutio, Aurelio López-Martínez, Albert Altés, M. Ángeles Ruíz, Adrián Alegre, Lucia Lopez-Anglada, Javier De La Cruz, Rafael Alonso Fernández, Joan Bladé Creixenti, Juan-José Lahuerta, Jesús San-Miguel, Miguel-Teodoro Hernández
Published in:
Annals of Hematology
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Abstract
Information on the prognostic value of immunoparesis (IP) recovery in multiple myeloma (MM) patients has been only generated in some observational and retrospective studies. We have evaluated the prognostic impact of IP recovery and its association with minimal residual disease (MRD) in a series of 113 newly diagnosed transplant-ineligible (NDTI) patients, that received fix duration treatment (18 cycles of VMP/lenalidomide-dexamethasone) within the PETHEMA/GEM2010MAS65 trial and who achieved CR or VGPR. Immunoglobulin levels were measured at diagnosis, at the end of treatment (after cycle 18th) and during subsequent follow up whereas MRD was analyzed only at the end of the treatment (after cycle 18th). We found that patients who had IP at diagnosis and recovered it during or after treatment had longer progression free survival (PFS) [p < 0.001; HR 0.32 (0.19–0.52)] and longer overall survival (OS) [p = 0.007; HR 0.40 (0.20–0.80)] compared to those who failed to recover it. When we analyzed IP recovery in MRD negative patients, we found that those cases with IP recovery had longer PFS [p = 0.007; HR 0.31 (0.13–0.76)] and longer OS [p = 0.012; HR 0.21 (0.06–0.80)] as compared to MRD negative patients but without IP recovery. In conclusion, IP recovery confers better prognosis in NDTI-MM patients with fixed duration treatment who achieve CR or VGPR and the prognostic value of MRD can be complemented when combined with IP recovery.