Dear Ohio State Physicians,
I would like to know whether you and your institution have documented immunophenotypic or molecular remissions (real-time PCR) outside the transplant setting, e.g., with combinations like RVD, CVD or VTD. If so, what has been the follow-up on these patients? Thank you for your insights and time.
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Re: CR with MFC and PCR
Great question. Unfortunately this is hard outside of a clinical trial since the documentation of
a) molecular response by patient-specific primers using PCR of their bone marrow aspirate; or
b) for the presence of rare myeloma cells by multicolor flow cytometry of bone marrow aspirate
requires, you guessed it, a bone marrow aspirate, and trying to get a patient to get through all sorts of side effects from treatment, get a great response, and then try to convince them to do another bone marrow aspirate which may not change management is not an easy thing to do.
Add to all that, our center (and many other US centers that I have spoken with) has been unsuccessful in replicating the Spanish data using flow cytometry as a tool for minimal residual disease monitoring and have found no easy way to pay for PCR of marrow aspirates -- so there are numerous barriers to doing these tests routinely.
That said, this area of research and clinical investigation is a growing area. Only a very small portion of patients are in molecular remission after transplant and hence these methods of minimal residual disease monitoring are more sensitive and will allow us to improve myeloma therapies over time.
a) molecular response by patient-specific primers using PCR of their bone marrow aspirate; or
b) for the presence of rare myeloma cells by multicolor flow cytometry of bone marrow aspirate
requires, you guessed it, a bone marrow aspirate, and trying to get a patient to get through all sorts of side effects from treatment, get a great response, and then try to convince them to do another bone marrow aspirate which may not change management is not an easy thing to do.
Add to all that, our center (and many other US centers that I have spoken with) has been unsuccessful in replicating the Spanish data using flow cytometry as a tool for minimal residual disease monitoring and have found no easy way to pay for PCR of marrow aspirates -- so there are numerous barriers to doing these tests routinely.
That said, this area of research and clinical investigation is a growing area. Only a very small portion of patients are in molecular remission after transplant and hence these methods of minimal residual disease monitoring are more sensitive and will allow us to improve myeloma therapies over time.
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Dr. Craig Hofmeister - Name: Craig C. Hofmeister, M.D.
2 posts
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