Do Cytogenetics Predict Likelihood to Attain Minimal Residual Disease (MRD) Post Autologous Stem Cell Transplantation (SCT) in Multiple Myeloma (MM)?

Do Cytogenetics Predict Likelihood to Attain Minimal Residual Disease (MRD) Post Autologous Stem Cell Transplantation (SCT) in Multiple Myeloma (MM)?

S394 Abstracts / Biol Blood Marrow Transplant 25 (2019) S290 S442 (p=0.68), TNC cell dose (p=0.82), CD34 cell dose (p=0.66), and graft volume (p=0.9...

228KB Sizes 0 Downloads 37 Views

S394

Abstracts / Biol Blood Marrow Transplant 25 (2019) S290 S442

(p=0.68), TNC cell dose (p=0.82), CD34 cell dose (p=0.66), and graft volume (p=0.91). Patients with ES had a higher rate of steady state mobilization which approached significance (94.1% vs 74.3%, p=0.053). Logistic regression analysis confirmed diagnosis of amyloidosis as the primary risk factor for ES (OR of 7.62, p=0.0002). ES had no impact on OS (p=0.91, fig 1) or PFS (p=0.79, fig 2). 1-year survival rate was 98.1% in patients without ES and 94.1% in patients with ES whereas 1year PFS rates were 87.1% and 78.1% respectively according to Kaplan Meier estimates. ES remains common in a contemporary cohort of ASCT recipients. Use of plerixafor, which has been increasingly common, did not impact incidence. Primary diagnosis of amyloidosis was the most important risk factor. While one mortality was attributed to ES, ES had no impact on OS or PFS in the overall cohort.

Figure 2. Progression free survival is similar in patients with or without engraftment syndrome.

596 Do Cytogenetics Predict Likelihood to Attain Minimal Residual Disease (MRD) Post Autologous Stem Cell Transplantation (SCT) in Multiple Myeloma (MM)? Tania Jain MBBS1,2, Carlo Guerrero MD3,4, Heidi Kosiorek MS5, Richard Butterfield6, Luke Mountjoy DO7, Craig Reeder MD6, P. Leif Bergsagel MS6, Jeremy T. Larsen MD8, Keith Stewart MB ChB, MBA9, Rafael Fonseca MD10. 1 Division of Hematology, Memorial Sloan Kettering, New York, NY; 2 Equal contribution, New York, NY; 3 Maricopa Integrated Health System, Phoenix, AZ; 4 Equal contribution, Phoenix, AZ; 5 Division of Health Sciences Research, Mayo Clinic Arizona, Scottsdale, AZ; 6 Mayo Clinic, Scottsdale, AZ; 7 Division of Hematology and Medical Oncology, Mayo Clinic Arizona, Phoenix, AZ; 8 Mayo Clinic, Phoenix, AZ; 9 Hematology Oncology, Mayo Clinic, Scottsdale, AZ; 10 Mayo Clinic Cancer Center, Phoenix, AZ Background: Determination of high risk via genetics plays a significant role in prognosis of disease outcomes in MM. More recently, MRD is emerging as an important prognostic marker and will potentially be used as a surrogate marker in clinical trials. So far, there is limited data on the association between cytogenetics in MM and MRD status. We conducted this study with the hypothesis that cytogenetics in MM would be predictive of MRD status after treatment with high dose chemotherapy and SCT.

Methods: Patients who underwent SCT for MM and had MRD data available (tested at day +100 post SCT) were included in the study. Clinical data was obtained via retrospective chart review. Cytogenetic risk (CyR) were classified into high [-17p, t (4;14), t(14;16), 1q gain, t(14;20)] and standard risk [all others including trisomies, t(11;14), t(6;14)], based on the updated mSMART criteria. Disease and SCT related characteristics were compared by MRD status. Comparisons were performed using the chi-squared test for categorical variables and Wilcoxon rank sum test for continuous variables. Results: A total 144 patients were identified. Median age at diagnosis was 60 years (range, 37-76 years) and at SCT was 62 years (range, 38 78 years). Eighty-eight (61%) were men. CyR was standard risk in 103 (72%) and high risk in 41 (28%) patients. Flow cytometry (FC) was used in 78 (54%) patients while next generation sequencing (NGS) (Clonoseq, Adaptive Biotechnology) in 66 (46%) for MRD detection. In the 66 patients who had both test results available, NGS report was used for this analysis. Amongst these patients, MRD results were discordant in 37 out of 66 (56%) patients (i.e. FC was negative but NGS was positive). This is expected due to difference in sensitivities of the two methods (i.e. 10¡4 to 2 £ 10¡5 for FC and 10¡6 for NGS). In the comparison of patients who had high risk vs standard risk cytogenetics, rates of MRD negativity were not statistically significantly different (MRD negative in high risk 37% vs standard risk 32%, p = 0.6) (Figure 1). Several other disease and SCT related characteristics were examined for association with MRD negativity (M-spike levels, presence of extramedullary disease at diagnosis, type of light chain/ heavy chain involvement with MM, prior treatments, use of novel agents, number of lines of induction prior to SCT, disease response at SCT, cell dose and conditioning regimen). Of these, response at SCT was the only variable that was statistically significantly associated with MRD negative results in univariate analysis (Figure 1). Conclusions: In our study, no association was seen between cytogenetic risk at baseline to achievement of MRD negative status post SCT. This is unexpected and possibly related to the small sample size. This clinical question, however, remains to be of significant clinical utility and should be explored in a larger database.

Figure 1. Association of CyR with MRD.

597 Does Cell of Origin Classification Impact Outcomes in Diffuse Large B-Cell Lymphoma after Autologous Stem Cell Transplant Neeraj Saini MD1, Rima M. Saliba PhD1, Romil D. Patel MD1, Mustafa Nooruldeen Abdulrazzaq MD2, Chitra M. Hosing MD1, Amin M. Alousi MD1, Paolo Anderlini MD1, Uday R. Popat MD1, Muzaffar H. Qazilbash MD1, EJ J. Shpall MD1, Partow Kebriaei MD1, Loretta J. Nastoupil MD3, Jason R. Westin MD, MS3, Gabriela Rondon MD1, Borje S. Andersson MD, PhD1, Richard E. Champlin MD1, Tariq R. Muzzafar MD2, Yago Nieto MD, PhD1, Sairah Ahmed MD1. 1 Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center,