الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Remarkable progress in the understanding of the pathogenesis of multiple myeloma has led to evolving definitions of the disease and its prognosis; more stringent criteria for response; and advances in the treatment protocols integrating ASCT and novel agents. This has resulted in increased depth and frequency of targeted response. Although CR rates are greater, relapse rates are still high, indicating that persistent disease may not be picked up by current approaches.
Methods have been developed to detect minimal residual disease with greater sensitivity, multiparameter flow cytometry (MFC), which is applicable to a great proportion of patients, and is a relatively rapid and inexpensive technique. Unfortunately, flowcytometry assessment is not routinely performed in the current clinical practice for multiple myeloma.
The aim of the study was to detect the prognostic value of MRD monitoring by ASO RQ-PCR in adult multiple myeloma patients undergoing stem cell transplant after induction of remission and proceeding to maintenance therapy, in order to determine efficacy of treatment, monitor remission status of the patient and predict impending relapse.
Our study included 30 patients, for which all a bone marrow aspiration was performed for minimal residual disease assessment using ASO RQ-PCR prior to their autologous stem cell transplant (after induction therapy) and was repeated after transplant. We later assessed their remission status 2 years post-transplant.
Our study showed that the regimen used for induction, whether bortezomib based or non-Bortezomib based, the type of therapy received did not significantly affect MRD status. Negative MRD after receiving bortezomib based regimens was 66.7% of our patients. While only 37.5% of patients who had received a non-bortezomib regimens were MRD negative before transplant. There was no statistically significant relation between the type of therapy received and the remission status of our patients. This was also maintained post-transplant, there was no statistically significant difference between patients receiving bortezomib-based regimens who achieved an MRD negative status (70%) and those receiving non-bortezomib based regimens that had negative MRD (30%).
Our patients were divided into two groups based on their PCR status 3–6 months post ASCT, i.e., MRD less than 0.01% (the MRD negative group) or MRD >0.01% (MRD positive group). We included 30 MM patients, MRD could be assessed in 23 patients (76.6%) and in 10 (43.4%) of the 23 patients with CR⁄nCR after SCT, the PCR transcript was negative 3–6 months after autologous transplantation. All IFE positive patients had MRD (>0.01%). One patient was IFE negative but remained categorized within the MRD high group. Our study found that achieving a CR was not an independent risk factor, which implies that using qPCR to directly estimate the burden of myeloma cells may be a more accurate technique to assess the response than measuring Para protein.