Molecular monitoring of tumour load kinetics predicts disease progression after non-myeloablative allogeneic stem cell transplantation in multiple myeloma

Background: Non-myeloablative allogeneic stem cell transplantation followed by immunomodulatory therapies is considered a potentially curative approach in the treatment of multiple myeloma and most effective in a minimal residual disease setting. Patients and methods: The aim of this study was to fi...

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Bibliographic Details
Published in:	Annals of oncology Vol. 16; no. 4; pp. 611 - 617
Main Authors:	Raab, M. S., Cremer, F. W., Breitkreutz, I. N., Gerull, S., Luft, T., Benner, A., Goerner, M., Ho, A. D., Goldschmidt, H., Moos, M.
Format:	Journal Article
Language:	English
Published:	England Oxford University Press 01-04-2005
Subjects:	Adult Disease Progression Humans IgH rearrangement Middle Aged minimal residual disease Monitoring, Immunologic - methods multiple myeloma Multiple Myeloma - immunology Multiple Myeloma - pathology Multiple Myeloma - therapy non-myeloablative allogeneic transplantation Predictive Value of Tests real-time PCR Retrospective Studies Reverse Transcriptase Polymerase Chain Reaction - methods Stem Cell Transplantation - methods Transplantation, Homologous Tumor Burden - immunology
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Summary:	Background: Non-myeloablative allogeneic stem cell transplantation followed by immunomodulatory therapies is considered a potentially curative approach in the treatment of multiple myeloma and most effective in a minimal residual disease setting. Patients and methods: The aim of this study was to find the most sensitive real-time PCR assay (TaqMan), based on the IGH rearrangement, to quantify the tumour load of 11 patients with multiple myeloma after non-myeloablative allogeneic transplantation. Patient-allele specific primers (ASO) and the TaqMan probe were derived from CDR2 and CDR3 hypervariable regions of IGH, while consensus primers were located within the FR3 and FR4/JH regions. Four different approaches of primer combinations were tested. Results: ASO-forward and -reverse primers together with the clone-specific TaqMan probe were the most sensitive approach compared with the JH (P=0.071) or the FR3 consensus primer (P <0.001). The detection limit amounted to 1/104–1/105 cells. Consecutively, 120 samples from 11 patients prior and post allogeneic transplantation were analysed. Three patients reached complete clinical remission accompanied by molecular remission. Disease progression or relapse was seen in six patients. In five, molecular progressive disease was detected prior to the clinical diagnosis of progression or relapse. Conclusion: Patient-specific real-time IGH-PCR provides the opportunity for earlier treatment intervention.
Bibliography:	Correspondence to: Dr Marc S. Raab, Department of Internal Medicine V, University of Heidelberg, INF 410, D-69120 Heidelberg, Germany. Tel: +49-6221-568072; Fax: +49-6221-565609; Email: marc.raab@med.uni-heidelberg.de istex:5FB1978DBA710D5305C6098D9C61E3C091B14487 local:mdi123 href:mdi123.pdf ark:/67375/HXZ-F7JQJ4DW-3 ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0923-7534 1569-8041
DOI:	10.1093/annonc/mdi123