[Mark11]

Sustained Molecular Responses for Younger High Risk Patients

by Mark11 on Thu Jul 02, 2015 11:01 am

I have mentioned this study here previously. The full study is now available so I thought I would put up the link. This small study is mainly for younger patients with high risk features del(17p13) and/or t(4;14). Patients did a tandem auto-allo early in disease course. Study used molecular methods for MRD testing.

Figure 4 at the bottom was particularly interesting to me. I am in a sustained molecular CR as defined by this study and found a few things interesting in looking at the 16 that achieved a sustained molecular response.. Note this is the group that did the best and not all had high risk cytogenetics. Many patients did not achieve a molecular CR and did not fare nearly as well.

Only one of the 16 patients was in CR after induction and only one more achieved CR after auto. In my opinion this clearly shows the power of immunotherapy for myeloma patients. The donor immune system with a lower dose of melphalan plus fludarabine and ATG (polyclonal antibody) was able to take 13 patients in PR and 1 with progressive disease into a sustained molecular response (4 consecutive MRD negative tests). Note some patients needed DLI's (additional infusions of donor cells) to achieve sustained molecular CR.

Only 2 of the 16 sustained MCR patients have ever relapsed. Not surprising since remissions gained from immunotherapy can be very durable. One at 3.5 years and one at 7 years. One died of chronic GVHD. Another important note in my opinion. 9 patients that never relapsed do not have GVHD. More than half of the patients appear to have a durable response with no GVHD. Of the 3 that have been in remission longer than 10 years note that 2 do not have GVHD. That can be attributed to using ATG-F as part of the conditioning. I used ATG-F and I have no chronic GVHD at this time.

http://www.bbmt.org/article/S1083-8791(12)00424-7/fulltext

Makes me wonder what kind of cure rates there would be for younger myeloma patients that got to an MRD negative CR after induction / auto and than did a t cell depleted or partially t cell depleted allogeneic transplant to avoid GVHD and live with good quality of life. I was CR but MRD positive prior to my allo.

Immunotherapy is a powerful tool for blood cancer patients.