• Andy C Rawstron, Faith E Davies, Ranjit DasGupta, A John Ashcroft, Russell Patmore, Mark T Drayson, Roger G Owen, Andrew S Jack, J Anthony Child, and Gareth J Morgan.
• Academic Unit of Haematology and Oncology, Algernon Firth Building, University of Leeds, Leeds LS1 3EX, UK. andy.rawstron@hmds.org.uk
• Blood. 2002 Nov 1; 100 (9): 3095-100.

AbstractConventional monitoring strategies for myeloma are not sufficiently sensitive to identify patients likely to benefit from further therapy immediately after transplantation. We have used a sensitive flow cytometry assay that quantitates normal and neoplastic plasma cells to monitor the bone marrow of 45 patients undergoing high-dose chemotherapy. Neoplastic plasma cells were detectable at 3 months after transplantation in 42% of patients. Once detected, neoplastic cell levels increased steadily until clinical progression: these patients had a significantly shorter progression-free survival (PFS) (median, 20 months) than those with no detectable disease (median, longer than 35 months; P =.003). Neoplastic plasma cells were detectable in 27% (9 of 33) of immunofixation-negative complete-remission patients. These patients had a significantly shorter PFS than immunofixation-negative patients with no detectable neoplastic plasma cells (P =.04). Normal plasma cells were present in 89% of patients immediately after transplantation, but were not sustained in most cases. Patients with only normal phenotype plasma cells present at 3 months after transplantation and also at second assessment had a low risk of disease progression. Patients with neoplastic plasma cells present at 3 months after transplantation, or with only normal plasma cells present at first assessment and only neoplastic plasma cells at second assessment, had a significantly higher risk of early disease progression (P <.0001) with a 5-year survival of 54% for the high-risk group, compared with 100% in the low-risk group (P =.036). Analysis of normal and neoplastic plasma cell levels is more sensitive than immunofixation and can identify which patients may benefit from additional treatment strategies at an early stage after transplantation.

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