Distinct trajectory of measurable residual disease in t(11;14) myeloma treated with quadruplet therapy
Abstract
Abstract Quadruplet (QUAD) induction and autologous stem cell transplantation (ASCT) leads to high rates of measurable residual disease (MRD) negativity with improved outcomes in multiple myeloma (MM). The t(11;14) confers unique biology and different kinetics of treatment response. We analyzed MRD trajectories of patients treated with QUAD/ASCT and MRD-adapted post-ASCT management. Of the 302 patients assessed, 47 (16%) had t(11;14)+ MM. Median follow-up was 45.8 months. MRD negativity at <10−5 level (MRD <10−5) for t(11;14)+ vs t(11;14)− MM was 9% vs 31%, 36% vs 59%, and 53% vs 75% after induction, after ASCT, and any time on treatment, respectively. The rates of sustained MRD negativity <10−5 (S-MRD <10−5) were 38% vs 46%. Median time to MRD <10−5 was 13.6 vs 7.7 months for t(11;14)+ vs t(11;14)− MM, respectively. Progression-free survival (PFS) was superior for patients with t(11;14)+ MM, with 4-year PFS rates of 90% vs 72%. In multivariable analysis, S-MRD <10−5 were associated with reduced risk of progression or death, with no progression seen in those with t(11;14)+ MM who achieved S-MRD <10−5. In the setting of QUAD/ASCT therapy and MRD-adapted post-ASCT management, t(11;14)+ newly diagnosed MM is associated with improved prognosis despite slow conversion to MRD negativity.
Article Details
Authors (13)
Susan Bal
University of Alabama at Birmingham, Birmingham, Alabama, United States
Gayathri Ravi
1Division of Hematology and Oncology, Department of Medicine, The University of Alabama at Birmingham School of Medicine, Birmingham, AL
Binod Dhakal
2Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
Natalie S. Callander
3Division of Hematology, Medical Oncology and Palliative Care, Department of Medicine, University of Wisconsin, Madison, WI
Eva Medvedova
Knight Cancer Institute, Oregon Health and Science University, Portland
Bhagirathbhai R. Dholaria
5Division of Hematology Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
Smith Giri
1Division of Hematology and Oncology, Department of Medicine, The University of Alabama at Birmingham School of Medicine, Birmingham, AL
Kelly N. Godby
1Division of Hematology and Oncology, Department of Medicine, The University of Alabama at Birmingham School of Medicine, Birmingham, AL
Rebecca W. Silbermann
2Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
Fady M. Mikhail
6Department of Genetics, The University of Alabama at Birmingham School of Medicine, Birmingham, AL
Forest Huls
7Department of Pathology, The University of Alabama at Birmingham School of Medicine, Birmingham, AL
Vishnu Reddy
7Department of Pathology, The University of Alabama at Birmingham School of Medicine, Birmingham, AL
Luciano J. Costa
Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham