clinical, genomic and imaging predictor of myeloma ...web.tccf.org.tw/media/slide/3166.pdf ·...
TRANSCRIPT
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Clinical, genomic and imaging predictor of myeloma progression from asymptomatic monoclonal gammopathies
CR簡聖軒VS劉俊煌教授
(Blood. 2014;123(1):78-85)
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MGUSAsymptomatic
MM
Symptomatic
MM
Extra
medullary
Clonal cells
PC > 10%
End organ damage
BM independent
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AMM
Serum M-protein ≥3.0 g/dLand / or
Marrow plasma cells ≥10% (clonal)
+No related organ or tissue
impairment
MGUS
Serum M-protein
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Observe !
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PC > 10 %, M> 3g/dL
PC > 10 %, M< 3g/dL
PC < 10 %, M< 3g/dL
N Engl J Med 2007;356:2582-90
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51 gene Up regulation
19 gene down regulation
EFS OS
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Prospective observation trail : SWOG S0120
MGUS, SMM, solitary plasmacytoma
Hemogram, serum/urinary M protein, SEP, IEP, B2M, free light chain, metaphase karyotyping, MRI
At 3,6 and 12 months at first year, then every 6-12 months
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Collected to isolate CD 138+ plasma cell with immunomagnetic bead selection
Monitored by flow cytomerty for > 85%
Affymetrix U133 plus 2.0 microarrays, generate risk score based on a validated 70-gene model (GEP-70)
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GEP -70score
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Age ≧65
Low level of uninvolved Ig
Urine M > 0 g/dL
Serum M ≧3 g/dL
B2M > 3 mg /L
Albumin< 4 g/dL
Hb 25 mg/dL
Elevated ratio of involved/uninvolved SFLC > 10
Plasma > 20% in BM
GEP-70 risk score > -0.26
GEP-70 PI > -2.73
MRI focal lesion > 1
Univariate analysis
GEP poly-PC > 11.6
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Addition of GEP improved cumulative R2
by approximately 11 %
11%
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Risk factor: SFLC >25 mg/dlM spike > 3g/dLGEP70 risk >-0.26
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Risk factor: M spike > 3g/dLBM PC > 20 % Age ≧65
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Risk factor: SFLC >25 mg/dlM spike > 3g/dLGEP70 risk >-0.26
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Higher polytypic-PC risk score predicts reduced risk of
progression
Multivariate analysis
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Follow up time ?
VS
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First prospective clinical trial
Mode for risk identification
Genomic and clinical based
Monitor and intervention
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M
M
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