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
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 age | 63 years | 62 years | 0.8 |
Cardiac involvement | 61% n=39 | 56% n=50 | 0.5 |
Renal involvement | 58% n=36 | 62% n=56 | 0.6 |
Liver involvement | 8% n=59 | 11% n=10 | 0.48 |
Mayo Stage | . | . | 0.13 |
1 | 26% (n=16) | 43% (n=38) | |
2 | 28% (n=17) | 24% (n=21) | |
3 | 15% (n=9) | 16% (n=14) | |
4 | 31% (n=19) | 18% (n=16) | |
Median dFLC (mg/dL) | 41 | 16 | 0.037 |
Median BM plasma cells | 15% | 10% | <0.0001 |
Active MM | 30% n=19 | 8% n=7 | 0.0004 |
Treatment | . | . | |
ASCT based | 51%(n=31) | 72% (n=63) | |
Bortezomib based | 17% (n=10) | 22% (n=19) | |
Alkylator/IMiD | 30% (n=18) | 6% (n=5) | |
None | 4% (n=2) | - | |
Early ASCT | 54% n=32 | 75% n=65 | 0.01 |
Response | |||
>PR | 85% (n=28, N=31) | 88% (n=58, N=66) | 0.68 |
>VGPR | 64% (n=21) | 65% (n=43) | 0.88 |
Cardiac response | 47% (n=9, N=19) | 57% (n=10, N=25) | 0.49 |
Median time to cardiac response (m) | 8.8 | 9 | 0.98 |
Renal response | 79% (n=19, N=24) | 74% (n=36, N=49) | 0.59 |
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