Tiny Residual Lesion Detection For Clinical Treatment And Prognosis Of Multiple Myeloma

【objective】Application of flow cytometry (FMC) dynamic monitoring tiny residual disease after induction therapy of multiple myeloma and explore their significance and clinical treatment andprognosis, and analyze the MRD and course of treatment, efficacy, CR rate, the relationship between the choice of treatment and prognosis of survival, to assess MRD status, judge the curative effect and predicting recurrence of disease and the clinical significance of earlyintervention, developed a set of suitable for clinicaltreatment.【methods】1. Use the method of retrospective analysis on from January2010to December2010in our hospital for treatment of44patients with multiple myeloma, follow-up end date is onMay31,2014, treatment effect and prognostic judgment, effect.10cases of14cases of men, women, divided into two groups,22cases of PD/PAD group, VAD group of22cases, PD/PAD way for the use of boron with m+dexamethasone+adriamycin (PD/PAD) treatment; VAD group using traditional treatments vincristine, adriamycin, dexamethasone treatment (VAD).2. Use four-color flow cytometry (CD38/CD138/CD19/CD45or CD38/CD138/CD56/CD45) detection in our blood research center for the treatment of44patients withmultiple myeloma primary immune phenotype and the second course, four period of treatment and3months after transplantation of MRD detection. According to the results of the MRD detection is divided into two groups, namely low MRD and high MRD in the two groups, one group standard is defined as a low MRD group (MRD <10e-3), high MRD group(MRD10e-4or higher).3. Summarize clinical data, using observation MRD SPSS19.0statistical software analysis of curative effect, the influence of the selection of treatment plan and prognosis. 【results】1. After the single factor analysis found that the blood β2microglobulin and theprognosis of patients with serum calcium concentration and the albumin is adverse prognostic factors for survival.2.. To treat patients with early immune phenotype the median value of12.6*10e-2,four courses of two period of treatment and the median value of MRD were1.5*10e-3,4,2.9*10e-treatment increase the MRD level declined obviously.3. The effect of treatment of the results showed that the4courses of effective rate was72.73%,2treatment effective rate was84.09%, while P>0.05, no statistical significance,but with the increase of treatment, patients with higher efficient compared with the previous.4. After two courses and four courses of treatment, low MRD group the number of cases of7cases respectively,17cases, high MRD cases of37cases,27cases, respectively, from the results of two groups found that four course can get low MRD more than two period of treatment, and there is statistical significance between the two groups (P <0.05).5. After two courses of induction therapy, the median OS and PFS MRD group were lower, has yet to happen, low median OS MRD group and prolong PFS than high MRD group, P=0.117(>0.05), there was no statistically significant difference. After four courses of induction therapy, low MRD OS and PFS time has not yet appeared, high MRDS OS28months, the median PFS23months time, so the low MRD patients significantly prolong survival time,(P=0.011<0.05), the difference was statistically significant.6. MRD level influence on CR rate, the results showed:(1) after two course of treatment, remission rate was71.42%, low MRD group high MRDgroup of remission rate was54.05%, P value is0.092(P>0.05), no statistical difference between two groups;(2) after four treatment, low MRD group of remission rate was76.47%, high MRD group of remission rate was40.74%, P value is0.218(P>0.05), no statistical differences in the two groups.7. MRD level and the relationship between the treatment, the result shows that:(1) two courses of PD/PAD group compared with VAD group, low MRD rate were18.18%and13.64%respectively. P=1.00(P>0.05), there was no statistically significant difference. (2) four courses of PD/PAD group compared with VAD group, low MRD rate were54.55%and22.73%respectively, P=0.03(P <0.05), the difference was statistically significant.8. Transplantation effect on MRD level and prognosis, the results showed:(1) early immune phenotype and two period of treatment and cure MRD, four treatment and3months after transplantation in patients with transplant patients with MRD detection, early results in cure in patients with immune phenotype median12.4*10e-2, two period of treatment, four period of treatment and after transplantation of the median MRD2.5*10e-3,3.8and4.0*10*10e-4-5e, it is concluded that as time increase in the number and the selection of transplant maintenance treatment, patients with MRD level decreasedobviously.(2) two period of treatment, Four cycles after transplantation, low rate of MRD respectively is11.76%.,41.17%,64.71%. P=0.008(P <0.008), the difference was statistically significant.(3) the influence of transplantation of PFS and OS, the median PFS, OS time transplantation group were not present, not in the transplantation group OS, PFS28months, respectively,23months, two groups of contrast P values were0.495,0.122, differences were notstatistically significant.9. Induction therapy scheme of PFS and the influence of the OS, the results showed that the PD/PAD set of median PFS, OS, time for VAD group OS17months, the median PFStime, two groups of contrast P values were0.006,0.000, differences were statistically significant.【The research conclusion】1. In this study, whether it be a PAD or VAD group, after four treatment course, lowMRD level, and compare the two the difference between the two groups after treatment, itis concluded that low MRD after four treatment groups significantly prolong survival time.So the MRD level can predict patients with OS and PFS, and prediction and judge thecurative effect and the assessment of disease recurrence and early intervention hasimportant clinical significance.2. The PAD group compared with VAD group, PAD group after four treatment, lowrate of MRD significantly increased, and get a longer survival time, it is concluded thatMRD than conventional prognostic indicators, such as cell morphology, the zhou protein to predict disease recurrence, more sensitive, so the MRD can be used as poor prognosisfactors affecting the prognosis of patients survival.3. The transplant to maintain compared with induction therapy, consolidationtreatment can obtain a lower rate of MRD, and transplant group of MRD place value ondraw negative significantly increased, the number of PFS and OS in patients will extend.4. The new targeted drugs boron for rice combination chemotherapy for treatment of multiplemyeloma induced, its effect is obvious, especially low MRD patient can obviously prolong the patient’sPFS and OS, is of great significance to improve the prognosis.