• Esftathios Kastritis, Ioannis V Kostopoulos, Foteini Theodorakakou, Despina Fotiou, Maria Gavriatopoulou, Magdalini Migkou, Maria Irini Tselegkidi, Maria Roussou, Alexandra Papathoma, Evangelos Eleutherakis-Papaioakovou, Ioanna Dialoupi, Nikolaos Kanellias, Argyrios Ntalianis, Pantelis Rousakis, Ioannis P Trougakos, Ourania Tsitsilonis, Charikleia Gakiopoulou, Evangelos Terpos, and Meletios A Dimopoulos.
• Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
• Amyloid. 2021 Mar 1; 28 (1): 19-23.

AbstractThe treatment of AL amyloidosis aims to eradicate the plasma cell clone and eliminate toxic free light chain production. Only in a minority of patients the plasma cell clone is completely eradicated; residual light chain production may still exist while clonal relapse may occur. We used sensitive next-generation flow cytometry (NGF) to detect minimal residual disease (MRD) in AL amyloidosis patients at complete haematologic response. MRD evaluation was feasible in 51 of 52 (98%) tested patients and at a median sensitivity of 2.3 × 10-6 MRD was undetectable in 23 (45%). An organ response occurred in 86% of MRDneg vs 77% in MRDpos; renal response in 15/17(88%) of MRDneg vs in 14/16(87.5%) of MRDpos and cardiac response in 10/10(100%) of MRDneg vs 11/15(73%) of MRDpos patients. After a median follow-up of 24 months post MRD testing, no MRDneg patient had a haematologic relapse vs 6/28(21%) MRDpos (p = .029). Pooling haematologic and organ progressions, 9 (32%) MRDpos patients had disease progression vs only 1 (4%) MRDneg patient (p = .026). In conclusion, MRD detection using NGF has profound clinical implications, so that AL patients with undetectable MRD have a very high probability of organ response and a very low probability of haematologic relapse.

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