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Assessment of tumoral plasma cells in apheresis products for autologous stem cell transplantation in multiple myeloma

Bone Marrow Transplantation volume 51, pages 1143–1145 (2016)Cite this article

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The use of high-dose therapy (HDT) has improved the outcome of younger patients with multiple myeloma (MM).1 Further advance in this procedure was achieved in the 1990s when mobilized PBSC were proposed to perform autologous stem cell transplantation (ASCT) instead of bone marrow,2, 3 inducing faster hematopoietic recovery. However, both types of grafts contain plasma cells (PC) and, potentially, tumor PC (tPC), thus being liable to induce relapse after ASCT. Several techniques have been used to detect these remaining PC, such as PCR,4 M-protein detection4 or flow cytometry.5 In the late 1990s, following the induction regimen based on VCR, doxorubicin and dexamethasone (VAD regimen), the levels of residual PC have been shown to be around 1.5 × 105/kg, even reaching 109 per transplant according to Lemoli et al.6 This tumor cell contamination has also been described as a prognostic factor for outcome in some series.5

In recent years, the outcome of MM patients has further improved with the incorporation of novel agents such as proteasome inhibitors (PI) and immunomodulatory drugs (IMiDs).7 Standard regimens prior to ASCT have been modified over the last decade, and triplet combinations including one PI+one IMiD+dexamethasone are considered to be the best options to induce high response rates before HDT.8 However, little is known of the efficacy of these new combinations in efficiently reducing the number of residual tPC contaminating the graft of PBSC. It is expected that these tumor cell numbers will be very low, and recent techniques of multiparameter flow cytometry can be applied to their detection. Indeed, such methods are used for the assessment of minimal residual disease (MRD), after treatment and ASCT.9, 10

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References

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Authors and Affiliations

  1. Hematology Biology, Nantes University Hospital, Nantes, France

    S Wuillème, N Robillard, H Migné & M C Béné

  2. Clinical Hematology, Nantes University Hospital, Nantes, France

    A Lok, C Touzeau & P Moreau

  3. Cell Therapy, Etablissement Français du Sang, Nantes, France

    P Dupuis, V Stocco & A Dusquesne

  4. Clinical Hematology, Regional Hospital of Vendée, La Roche sur Yon, France

    M Tiab

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  1. S Wuillème
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  2. A Lok
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Correspondence to S Wuillème.

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Wuillème, S., Lok, A., Robillard, N. et al. Assessment of tumoral plasma cells in apheresis products for autologous stem cell transplantation in multiple myeloma. Bone Marrow Transplant 51, 1143–1145 (2016). https://doi.org/10.1038/bmt.2016.74

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