Blood Journal
Leading the way in experimental and clinical research in hematology

Brief report
High-risk cytogenetics and persistent minimal residual disease by multiparameter flow cytometry predict unsustained complete response after autologous stem cell transplantation in multiple myeloma

  1. Bruno Paiva1,2,
  2. Norma C. Gutiérrez1,2,
  3. Laura Rosiñol3,
  4. María-Belén Vídriales1,2,
  5. María-Ángeles Montalbán4,
  6. Joaquín Martínez-López4,
  7. María-Victoria Mateos1,2,
  8. María-Teresa Cibeira3,
  9. Lourdes Cordón5,
  10. Albert Oriol6,
  11. María-José Terol7,
  12. María-Asunción Echeveste8,
  13. Raquel de Paz9,
  14. Felipe de Arriba10,
  15. Luis Palomera11,
  16. Javier de la Rubia5,
  17. Joaquín Díaz-Mediavilla12,
  18. Anna Sureda13,
  19. Ana Gorosquieta14,
  20. Adrian Alegre15,
  21. Alejandro Martin16,
  22. Miguel T. Hernández17,
  23. Juan-José Lahuerta4,
  24. Joan Bladé3, and
  25. Jesús F. San Miguel1,2 on behalf of the PETHEMA/GEM (Programa para el Estudio de la Terapéutica en Hemopatías Malignas/Grupo Español de Mieloma) Cooperative Study Groups
  1. 1Hospital Universitario de Salamanca, Salamanca, Spain;
  2. 2Centro de Investigación del Cáncer (Instituto de Biología Molecular y Celular del Cancer Universidad de Salamanca-Consejo Superior de Investigaciones Cientificas), Salamanca, Spain;
  3. 3Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain;
  4. 4Hospital 12 de Octubre, Madrid, Spain;
  5. 5Hospital Universitario de la Fe, Valencia, Spain;
  6. 6Hospital Universitari Germans Trias i Pujol, Badalona, Spain;
  7. 7Hospital Clínico de Valencia, Valencia, Spain;
  8. 8Hospital de Donostia, San Sebastian, Spain;
  9. 9Hospital Universitario La Paz, Madrid, Spain;
  10. 10Hospital Morales Meseguer, Murcia, Spain;
  11. 11Hospital Lozano Blesa, Zaragoza, Spain;
  12. 12Hospital Clinico San Carlos, Madrid, Spain;
  13. 13Hospital de la Santa Creu i Sant Pau, Barcelona, Spain;
  14. 14Hospital Universitario Navarra, Pamplona, Spain;
  15. 15Hospital Universitario La Princesa, Madrid, Spain;
  16. 16Hospital Virgen de la Concha, Zamora, Spain; and
  17. 17Hospital Universitario Canarias, Tenerife, Spain


The achievement of complete response (CR) after high-dose therapy/autologous stem cell transplantation (HDT/ASCT) is a surrogate for prolonged survival in multiple myeloma; however, patients who lose their CR status within 1 year of HDT/ASCT (unsustained CR) have poor prognosis. Thus, the identification of these patients is highly relevant. Here, we investigate which prognostic markers can predict unsustained CR in a series of 241 patients in CR at day +100 after HDT/ASCT who were enrolled in the Spanish GEM2000 (n = 140) and GEM2005 < 65y (n = 101) trials. Twenty-nine (12%) of the 241 patients showed unsustained CR and a dismal outcome (median overall survival 39 months). The presence of baseline high-risk cytogenetics by FISH (hazard ratio 17.3; P = .002) and persistent minimal residual disease by multiparameter flow cytometry at day +100 after HDT/ASCT (hazard ratio 8.0; P = .005) were the only independent factors that predicted unsustained CR. Thus, these 2 parameters may help to identify patients in CR at risk of early progression after HDT/ASCT in whom novel treatments should be investigated.

  • Submitted July 26, 2011.
  • Accepted November 18, 2011.
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