Risk stratification by detection of clonal circulating plasma cells (CPCs) by multi-parametric flow cytometry (MFC) in light chain amyloidosis (AL).

Authors

Surbhi Sidana

Surbhi Sidana

Mayo Clinic, Rochester, MN

Surbhi Sidana , Nidhi Tandon , Angela Dispenzieri , Morie A. Gertz , Francis Buadi , Martha Lacy , David Dingli , Amie L. Fonder , Suzanne R. Hayman , Miriam A. Hobbs , Yi Lisa Hwa , Prashant Kapoor , Robert A. Kyle , Nelson Leung , Ronald S. Go , John Anthony Lust , Stephen J. Russell , S. Vincent Rajkumar , Shaji Kumar , Wilson I. Gonsalves

Organizations

Mayo Clinic, Rochester, MN, Division of Hematology, Mayo Clinic, Rochester, MN

Research Funding

Other

Background: Presence of CPCs by six color MFC is associated with worse outcomes in multiple myeloma (MM). Using a slide based immunofluorescence assay, CPCs are associated with worse prognosis in AL, but outcomes with MFC are not known. Methods: We retrospectively analyzed 154 patients (pts) from Jan 2008 – Dec 2015 with AL who had CPCs analyzed by MFC at diagnosis. Results: CPCs were present in 42% pts (n = 64, median = 88 per 150,000 events, range 6-17844). Table 1 lists baseline characteristics, treatment and response. In univariate analysis, bone marrow (BM) plasma cells > 15% (p<0.0001), dFLC > 60 mg/dL (p=0.02) and presence of active MM (p=0.0004) were associated with detectable CPCs. In multivariate (MV) model, only BM plasma cells > 15% predicted for presence of CPCs (p=0.02). There was no difference in hematologic or organ response in the 2 groups. Median follow up was 43 months (m). Pts with detectable CPCs had worse survival than those without detectable CPCs (90 m vs. 98 m, p=0.0004). In MV analysis model with Mayo Stage and detectable CPCs, presence of CPCs at diagnosis was independently associated with poor survival (CPCs p= 0.02, Mayo Stage p < 0.0001). Conclusions: Presence of detectable CPCs is an independent adverse prognostic factor for survival in AL. Comparatively fewer pts with detectable CPCs underwent early ASCT, which may reflect a more aggressive disease presentation.

CPCs Present
N=64
CPCs Absent
N=90
P value
Median age63 years62 years0.8
Cardiac involvement61%
n=39
56%
n=50
0.5
Renal involvement58%
n=36
62%
n=56
0.6
Liver involvement8%
n=59
11%
n=10
0.48
Mayo Stage..0.13
126% (n=16)43% (n=38)
228% (n=17)24% (n=21)
315% (n=9)16% (n=14)
431% (n=19)18% (n=16)
Median dFLC (mg/dL)41160.037
Median BM plasma cells15%10%<0.0001
Active MM30%
n=19
8%
n=7
0.0004
Treatment..
ASCT based51%(n=31)72% (n=63)
Bortezomib based17% (n=10)22% (n=19)
Alkylator/IMiD30% (n=18)6% (n=5)
None4% (n=2)-
Early ASCT54%
n=32
75%
n=65
0.01
Response
>PR85% (n=28, N=31)88% (n=58, N=66)0.68
>VGPR64% (n=21)65% (n=43)0.88
Cardiac response47% (n=9, N=19)57% (n=10, N=25)0.49
Median time to cardiac response (m)8.890.98
Renal response79% (n=19, N=24)74% (n=36, N=49)0.59

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Abstract Details

Meeting

2017 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Hematologic Malignancies—Plasma Cell Dyscrasia

Track

Hematologic Malignancies—Plasma Cell Dyscrasia

Sub Track

Plasma Cell Disorders

Citation

J Clin Oncol 35, 2017 (suppl; abstr 8047)

DOI

10.1200/JCO.2017.35.15_suppl.8047

Abstract #

8047

Poster Bd #

373

Abstract Disclosures

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