You are evaluating a 47-year-old man with revised international staging system stage III myeloma who recently underwent an autologous stem cell transplant after receiving 6 cycles of carfilzomib, lenalidomide, and dexamethasone for newly diagnosed disease. Fluorescence in situ hybridization testing at initial presentation also revealed t(4;14). On day 100 evaluation after transplant, he has achieved a stringent complete response. Two-tube, 8-color advanced flow cytometry with a sensitivity of 10−5 shows no minimal residual disease. Whole-body positron emission tomography/computed tomography scan shows resolution of all fluorodeoxyglucose avid uptake seen at diagnosis. The patient asks you how these test results impact his prognosis and whether this overcomes his baseline high risk from t(4;14)?

References

References
1.
Nandakumar
B
,
Binder
M
,
Dispenzieri
A
, et al
.
Continued improvement in survival in multiple myeloma (MM) including high-risk patients
.
J Clin Oncol
.
2019
;
37
(
15 suppl
):
8039
.
2.
Munshi
NC
,
Avet-Loiseau
H
,
Rawstron
AC
, et al
.
Association of minimal residual disease with superior survival outcomes in patients with multiple myeloma: a meta-analysis
.
JAMA Oncol
.
2017
;
3
(
1
):
28
-
35
.
3.
Kumar
S
,
Paiva
B
,
Anderson
KC
, et al
.
International Myeloma Working Group consensus criteria for response and minimal residual disease assessment in multiple myeloma
.
Lancet Oncol
.
2016
;
17
(
8
):
e328
-
e346
.
4.
Perrot
A
,
Lauwers-Cances
V
,
Corre
J
, et al
.
Minimal residual disease negativity using deep sequencing is a major prognostic factor in multiple myeloma
.
Blood
.
2018
;
132
(
23
):
2456
-
2464
.
5.
Rawstron
AC
,
Child
JA
,
de Tute
RM
, et al
.
Minimal residual disease assessed by multiparameter flow cytometry in multiple myeloma: impact on outcome in the Medical Research Council Myeloma IX Study
.
J Clin Oncol
.
2013
;
31
(
20
):
2540
-
2547
.
6.
Li
H
,
Li
F
,
Zhou
X
, et al
.
Achieving minimal residual disease-negative by multiparameter flow cytometry may ameliorate a poor prognosis in MM patients with high-risk cytogenetics: a retrospective single-center analysis
.
Ann Hematol
.
2019
;
98
(
5
):
1185
-
1195
.
7.
Paiva
B
,
Cedena
MT
,
Puig
N
, et al
;
Grupo Español de Mieloma/Programa para el Estudio de la Terapéutica en Hemopatías Malignas (GEM/PETHEMA) Cooperative Study Groups
.
Minimal residual disease monitoring and immune profiling in multiple myeloma in elderly patients
.
Blood
.
2016
;
127
(
25
):
3165
-
3174
.
8.
Hu
B
,
Thall
P
,
Milton
DR
, et al
.
High-risk myeloma and minimal residual disease postautologous-HSCT predict worse outcomes
.
Leuk Lymphoma
.
2019
;
60
(
2
):
442
-
452
.
9.
Chakraborty
R
,
Muchtar
E
,
Kumar
SK
, et al
.
Impact of post-transplant response and minimal residual disease on survival in myeloma with high-risk cytogenetics
.
Biol Blood Marrow Transplant
.
2017
;
23
(
4
):
598
-
605
.
10.
Lahuerta
J-J
,
Paiva
B
,
Vidriales
M-B
, et al
;
GEM (Grupo Español de Mieloma)/PETHEMA (Programa para el Estudio de la Terapéutica en Hemopatías Malignas) Cooperative Study Group
.
Depth of response in multiple myeloma: a pooled analysis of three PETHEMA/GEM clinical trials
.
J Clin Oncol
.
2017
;
35
(
25
):
2900
-
2910
.
11.
Goicoechea
I
,
Puig
N
,
Cedena
MT
, et al
.
Clinical significance and transcriptional profiling of persistent minimal residual disease (MRD) in multiple myeloma (MM) patients with standard-risk (SR) and high-risk (HR) cytogenetics
.
Blood
.
2018
;
132
(
suppl 1
):
112
.
12.
Paiva
B
,
Gutiérrez
NC
,
Rosiñol
L
, et al
;
PETHEMA/GEM (Programa para el Estudio de la Terapéutica en Hemopatías Malignas/Grupo Español de Mieloma) Cooperative Study Groups
.
High-risk cytogenetics and persistent minimal residual disease by multiparameter flow cytometry predict unsustained complete response after autologous stem cell transplantation in multiple myeloma
.
Blood
.
2012
;
119
(
3
):
687
-
691
.
13.
Kunacheewa
C
,
Patel
KK
,
Lee
HC
, et al
.
Correlation of minimal residual disease negativity (MRD-) with prognosis in high-risk myeloma (HRM)
.
J Clin Oncol
.
2019
;
37
(
15 suppl
):
8024
.
14.
Hahn
TE
,
Wallace
PK
,
Fraser
R
, et al
.
Minimal residual disease (MRD) assessment before and after autologous hematopoietic cell transplantation (AutoHCT) and maintenance for multiple myeloma (MM): results of the Prognostic Immunophenotyping for Myeloma Response (PRIMeR) study
.
Biol Blood Marrow Transplant
.
2019
;
25
(
3
):
S4
-
S6
.
15.
Alonso
R
,
Cedena
MT
,
Gómez-Grande
A
, et al
.
Imaging and bone marrow assessments improve minimal residual disease prediction in multiple myeloma
.
Am J Hematol
.
2019
;
94
(
8
):
853
-
861
.
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