“Evaluation of CTCs in PB outperformed quantification of BM PCs. The detection of ≥ 0.01% CTCs could be a new risk factor in novel multiple myeloma staging systems for patients with transplant-eligible MM.”
Multiple Myeloma staging- that is to say, determining the stage or how advanced newly diagnosed multiple myeloma patients are, is essential to determine the patient’s prognosis and therapy plan.
For example:
As we all know, catching cancer, any cancer, early when the amount of cancer is reduced means a higher possibility of cure or longer overall survival.
I found the study below to be a bit confusing and difficult to follow with all the acronyoms used. Before I get into the nitty-gritty of the study’s details, I will break down some key terms as I understand them.
- circulating tumor cells (CTC)
- peripheral blood (PB)
- bone marrow (BM)
- plasma cells (PC)
- newly diagnosed multiple myeloma (NDMM)
According to the study linked and excerpted below, the presence of circulating tumor cells in newly diagnosed MM patients “outperformed” or determined more about the prognosis of the MM patient than bone marrow plasma cells.
Keep in mind that-
Staging of the NDMM patient is the first and most important step in determining the prognosis and therapy plan for all NDMM patients.
A bone marrow biopsy is one of the usual diagnostic tests we all undergo in order to determine the percentage of plasma cells IN the bone marrow. The challenge with this test is that PCs vary throughout the BM of each patient.
The study below refers to this as “patchy bone marrow infiltration.” The study also cites extra medullary disease as being problematic to MM staging.
Determining the percentage of CTC tells the NDMM patient more about the stage of multiple myeloma in the patients bone marrow than does a bone marrow biopsy, according to the study. To quote the study below:
“Increasing logarithmic percentages of CTCs were associated with inferior progression-free survival (PFS).”
The greater the percentage of CTC of MM in your peripheral blood, the worse prognosis you have. Discuss your therapy plan with your oncologist, of course, but this determination my influence your therapy plan.
Have you been diagnosed with MM? What are your symptoms? CRAB involvement? Scroll down the page, post a question or a comment and I will reply to you ASAP.
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David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
Recommended Reading:
“Patients with multiple myeloma (MM) may show patchy bone marrow (BM) infiltration and extramedullary disease. Notwithstanding, quantification of plasma cells (PCs) continues to be performed in BM since the clinical translation of circulating tumor cells (CTCs) remains undefined.
CTCs were measured in peripheral blood (PB) of 374 patients with newly diagnosed MM…
Treatment included bortezomib, lenalidomide, and dexamethasone induction followed by autologous transplant, consolidation, and maintenance.
Next-generation flow cytometry was used to evaluate circulating tumor cells (CTCs) in PB at diagnosis and measurable residual disease (MRD) in BM throughout treatment.
RESULTS- CTCs were detected in 92% (344 of 374) of patients with newly diagnosed MM. The correlation between the percentages of CTCs and BM PCs was modest.
Increasing logarithmic percentages of CTCs were associated with inferior progression-free survival (PFS). A cutoff of 0.01% CTCs showed an independent prognostic value in multivariable PFS analysis including the
- International Staging System,
- lactate dehydrogenase levels,
- and cytogenetics.
The combination of the four prognostic factors significantly improved risk stratification.
Outcomes according to the percentage of CTCs and depth of response to treatment showed that patients with undetectable CTCs had exceptional PFS regardless of complete remission and MRD status.
In all other cases with detectable CTCs, only achieving MRD negativity (and not complete remission) demonstrated a statistically significant increase in PFS.
CONCLUSION- Evaluation of CTCs in PB outperformed quantification of BM PCs. The detection of ≥ 0.01% CTCs could be a new risk factor in novel staging systems for patients with transplant-eligible MM.
