Impact of minimal residual negativity using next generation flow cytometry on outcomes in light chain amyloidosis

Surbhi Sidana, Eli Muchtar, M. Hasib Sidiqi, Dragan Jevremovic, Angela Dispenzieri, Wilson Gonsalves, Francis Buadi, Martha Q. Lacy, Suzanne R. Hayman, Taxiarchis Kourelis, Prashant Kapoor, Ronald S. Go, Rahma Warsame, Nelson Leung, S. Vincent Rajkumar, Robert A. Kyle, Morie A. Gertz, Shaji K. Kumar

Research output: Contribution to journalArticlepeer-review

22 Scopus citations

Abstract

We evaluated bone marrow minimal residual disease (MRD) negativity in 44 patients with light chain (AL) amyloidosis using next generation flow cytometry (sensitivity ≥1 × 10−5; median events analyzed: 8.7 million, range: 4.8 to 9.7 million). All patients underwent MRD testing in 2 years from start of therapy (median: 7 months). The overall MRD negative rate was 64% (n = 28). The MRD-negative rate after one-line of therapy was 71% (20/28). And, MRD negative rates were higher with stem-cell transplant as first-line therapy (86%, 18/21) vs chemotherapy alone as first-line treatment (29%, 2/7), P =.005. The MRD negative rate amongst patients in complete response was 75% (15/20), and in very good partial response, 50% (11/22). There were two patients in partial response/rising light chains (with renal dysfunction) who were MRD negative. There were no differences in baseline characteristics of MRD negative vs MRD positive patients, except younger age amongst MRD-negative patients. Patients with MRD negativity were more likely to have achieved cardiac response at the time of MRD assessment, 67% (8/12) vs 22% (2/7), P =.04. Renal response rates were similar in both groups. Progression free survival was assessed in the 42 patients achieving CR or VGPR. After median follow-up of 14 months, the estimated 1-year progression free survival in MRD negative vs MRD positive patients was 100% (26 patients, 0 events) vs 64% (16 patients, five events), P =.006, respectively. MRD assessment should be explored as a surrogate endpoint in clinical trials and MRD risk-adapted trials may help optimize treatment in AL amyloidosis.

Original languageEnglish (US)
Pages (from-to)497-502
Number of pages6
JournalAmerican journal of hematology
Volume95
Issue number5
DOIs
StatePublished - May 1 2020

ASJC Scopus subject areas

  • Hematology

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