Background

Patients(pts) who undergo autologous stem cell transplant (ASCT) for multiple myeloma (MM) are routinely assessed at Day-100 using serum monoclonal protein (M-spike), free light chains(FLC), and urine studies. Limited data are available to assess the prognostic value of an increasing M-spike or FLC from immediately before ASCT to Day-100 post-ASCT. We evaluated this in our cohort of patients.

Methods

We retrospectively reviewed 1070 pts with MM at Mayo Clinic, Rochester, who had their first ASCT between 2000 and 2016. We stratified pts according to a rise in M-spike by at least >0.1g/dl from immediately before ASCT to Day-100 post-ASCT (cohort 1) compared to those who did not (cohort 2). We also stratified pts according to a rise in involved FLC by at least >5mg/dl (cohort 3) compared to those who did not (cohort 4). Survival analysis for progression free survival (PFS) and overall survival (OS) was performed using the Kaplan Meier method.

Results

46 pts were found to have a rise in M-spike by at least >0.1g/dl between pre-ASCT and Day-100 (cohort 1) and 825 pts were found to have a declining or <=0.1g/dl increase in M-spike (cohort 2). 25 pts were found to have an increase in involved FLC by at least >5mg/dl (cohort 3) and 1045 pts were found to have a decrease or a < = 5mg/dl increase in involved FLC (cohort 4). The median PFS was significantly shorter in cohort 1 compared to cohort 2 (median PFS of 10 months vs. 27 months, respectively P<0.0001). Cohort 1 patients also had an inferior OS, compared to cohort 2 (median OS of 34 months vs. 79 months, respectively, P<0.0001). Similarly the median PFS and OS were found to be inferior in cohort 3 compared to cohort 4 (median PFS of 4 months and 28 months, respectively p<0.0001 and median OS of 11 months and 82 months, respectively, p<0.0001)

Conclusions

An increase of M-spike by at least >0.1 g/dl and involved FLC by at least >5mg/dl from pre-ASCT to Day-100 is predictive of inferior PFS and OS in pts with MM. These patients would benefit from closer surveillance post Day-100.

中文翻译：

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自体干细胞移植后多发性骨髓瘤患者血清单克隆蛋白和游离轻链上升的意义。

背景

在第100天使用血清单克隆蛋白（M-spike），游离轻链（FLC）和尿液研究常规评估接受自体干细胞移植（ASCT）的多发性骨髓瘤（MM）患者。有限的数据可用于评估从ASCT之前到ASCT后100天的M峰或FLC升高的预后价值。我们在我们的患者队列中对此进行了评估。

方法

我们回顾了罗彻斯特Mayo诊所的MM的1070分，该患者在2000年至2016年间进行了首次ASCT。我们根据从ASCT之前到第100天的M-spike上升至少0.1g / dl来分层。 ASCT后（组1）与未做过CTCT的组（组2）相比。我们还根据参与的FLC至少增加了> 5mg / dl（组3），而不进行分析的组（组4），对pts进行了分层。使用Kaplan Meier方法进行无进展生存期（PFS）和总生存期（OS）的生存期分析。

结果

在ASCT前和第100天（队列1）之间，发现46磅的M-spike升高至少> 0.1g / dl，并且发现825磅的M-spike下降或<= 0.1g / dl M尖峰（同类群组2）。发现25点的参与性FLC升高至少> 5mg / dl（组3），发现1045点的参与性FLC降低或≤5mg / dl（组4）。与队列2相比，队列1中的PFS显着缩短（中位PFS为10个月对27个月，分别为P <0.0001）。与队列2相比，队列1的患者的OS也较差（中位OS分别为34个月和79个月，P <0.0001）。同样地，第3组的中位PFS和OS也比第4组低（中位PFS分别为4个月和28个月，p <0.0001，中位OS​​为11个月和82个月，

结论

从ASCT前到第100天，M峰增加至少> 0.1 g / dl，并且涉及FLC至少增加> 5mg / dl，预示着MM患者的PFS和OS较差。这些患者将在100天后接受更密切的监视。