Bone marrow (BM) assessment of minimal residual disease (MRD) is prognostic for survival in multiple myeloma (MM). BM is still hypocellular at month 1 post CAR-T, thus the value of MRD negative (MRDneg) status at this timepoint is unclear. We examined the impact of month 1 BM MRD status in MM patients who received CART at Mayo Clinic between 8/2016 and 6/2021. Among 60 patients, 78% were BM-MRDneg at month 1; and 85% (40/47) of these patients also had decreased to less than normal level of both involved and uninvolved free light chain (FLC < NL). Patients who achieved CR/sCR had higher rates of month 1 BM-MRDneg and FLC < NL. The rate of sustained BM-MRDneg was 40% (19/47). Rate of conversion from MRDpos to MRDneg was 5%(1/20). At month 1, 38%(18/47) of the BM-MRDneg were hypocellular. Recovery to normal cellularity was observed in 50%(7/14) with a median time to normalization at 12 months (range: 3–Not reached). Compared to Month 1 BM-MRDpos patients, patients who were BM-MRDneg had longer PFS irrespective of BM cellularity [PFS: 2.9 months (95% CI, 1.2-NR) vs. 17.5 months (95% CI, 10.4-NR), p < 0.0001]. Month 1 BM-MRDneg and FLC below normal were associated with prolonged survival. Our data support the continued evaluation of BM early post-CART infusion as a prognostic tool.
骨髓（BM）微小残留病（MRD）评估对多发性骨髓瘤（MM）患者的生存具有预后意义。CAR-T治疗后第1个月时骨髓仍处于低细胞状态，因此该时间点MRD阴性（MRDneg）状态的价值尚不明确。我们分析了2016年8月至2021年6月在梅奥诊所接受CAR-T治疗的MM患者在第1个月的骨髓MRD状态的影响。在60例患者中，78%在第1个月达到骨髓MRD阴性；其中85%（40/47）的患者受累与非受累游离轻链（FLC<正常值）均降至正常水平以下。达到完全缓解/严格完全缓解（CR/sCR）的患者在第1个月获得骨髓MRD阴性和FLC<正常值的比例更高。持续骨髓MRD阴性率为40%（19/47），从MRD阳性转为阴性的转换率为5%（1/20）。第1个月时，38%（18/47）的骨髓MRD阴性患者存在低细胞性。50%（7/14）的患者观察到细胞数量恢复至正常水平，中位恢复时间为12个月（范围：3个月–未达到）。与第1个月骨髓MRD阳性患者相比，无论骨髓细胞数量如何，MRD阴性患者的无进展生存期更长[PFS：2.9个月（95% CI，1.2-未达到）对比17.5个月（95% CI，10.4-未达到），p<0.0001]。第1个月骨髓MRD阴性且FLC低于正常值与生存期延长相关。我们的数据支持将CAR-T输注后早期的骨髓评估作为预后工具进行持续研究。
Prognostic value of early bone marrow MRD status in CAR-T therapy for myeloma
肿瘤(癌症)患者之家