Format

Send to

Choose Destination
Blood. 2015 Aug 13;126(7):858-62. doi: 10.1182/blood-2015-04-638742. Epub 2015 Jun 18.

Critical analysis of the stringent complete response in multiple myeloma: contribution of sFLC and bone marrow clonality.

Author information

1
Hematology Department, Hospital Universitario 12 de Octubre, Madrid, Spain;
2
Hematology Department, Clinica Universidad de Navarra, Centro de Investigación Medica Aplicada, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain;
3
Hematology Department, Hospital Universitario de Salamanca-Instituto de Investigación Biomédica de Salamanca, Instituto de Biología Molecular y Celular del Cáncer de Salamanca-Centro de Investigación del Cáncer, Salamanca, Spain;
4
Hematology Department, Hospital Germans i Trials, Barcelona, Spain;
5
Hematology Department, Hospital Clínico de Valencia, Valencia, Spain;
6
Hematology Department, Hospital La Fe, Valencia, Spain;
7
Hematology Department, Hospital Ramon y Cajal, Madrid, Spain;
8
Hematology Department, Hospital de Donostia, San Sebastián, Spain;
9
Hematology Department, Hospital Clínico Universitario, Zaragoza, Spain;
10
Hematology Department, Hospital Morales Messeguer, Murcia, Spain;
11
Hematology Department, Servicio General de Citometría and Departamento de Medicina, Universidad de Salamanca, Salamanca, Spain; and.
12
Hematology Department, Hospital Clinic, Institut d'Investigacions Biomédiques August Pi I Sunyer, Barcelona, Spain.

Abstract

Stringent complete response (sCR) criteria are used in multiple myeloma as a deeper response category compared with CR, but prospective validation is lacking, it is not always clear how evaluation of clonality is performed, and is it not known what the relative clinical influence is of the serum free light chain ratio (sFLCr) and bone marrow (BM) clonality to define more sCR. To clarify this controversy, we focused on 94 patients that reached CR, of which 69 (73%) also fulfilled the sCR criteria. Patients with sCR displayed slightly longer time to progression (median, 62 vs 53 months, respectively; P = .31). On analyzing this contribution to the prognosis of sFLCr or clonality, it was found that the sFLCr does not identify patients in CR at distinct risk; by contrast, low-sensitive multiparametric flow cytometry (MFC) immunophenotyping (2 colors), which is equivalent to immunohistochemistry, identifies a small number of patients (5 cases) with high residual tumor burden and dismal outcome; nevertheless, using traditional 4-color MFC, persistent clonal BM disease was detectable in 36% of patients, who, compared with minimal residual disease-negative cases, had a significantly inferior outcome. These results show that the current definition of sCR should be revised.

PMID:
26089396
PMCID:
PMC4543912
DOI:
10.1182/blood-2015-04-638742
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for HighWire Icon for PubMed Central
Loading ...
Support Center