Biological Sciences Division
Published September 10, 2023 | Version v1
Journal article Open

Polyclonal immunoglobulin recovery in patients with newly diagnosed myeloma receiving maintenance therapy after autologous haematopoietic stem cell transplantation with either carfilzomib, lenalidomide and dexamethasone or lenalidomide alone: Subanalysis of the randomized phase 3 ATLAS trial

Creators

  • 1. University of Chicago
  • 2. Poznań University of Medical Sciences
  • 3. Wrocław Medical University
  • 4. Institute of Hematology and Blood Transfusion
  • 5. Medical University of Łódź
  • 6. Nicolaus Copernicus University in Toruń Ludwik Rydygier Collegium Medicum in Bydgoszcz
  • 7. Medical University of Gdańsk
  • 8. Maria Sklodowska- Curie National Research Institute of Oncology
  • 9. Medical University of Lublin
  • 10. Memorial Sloan-Kettering Cancer Center

Description

Previous studies suggest that postautologous stem cell transplant (ASCT) recovery of polyclonal immunoglobulin from immunoparesis in patients with multiple myeloma is a positive prognostic marker. We performed a longitudinal analysis of polyclonal immunoglobulin concentrations and unique B-cell sequences in patients enrolled in the phase 3 ATLAS trial that randomized 180 subjects to either carfilzomib, lenalidomide, dexamethasone (KRd) or lenalidomide (R) maintenance. In the KRd arm, standard-risk patients with minimal residual disease negativity after six cycles de-escalated to R alone after cycle 8. One year from the initiation of maintenance at least partial recovery of polyclonal immunoglobulin was observed in more patients on the R arm (58/66, p < 0.001) and in those who de-escalated from KRd to R (27/38, p < 0.001) compared to the KRd arm (9/36). In patients who switched from KRd to R, the concentrations of uninvolved immunoglobulin and the number of B-cell unique sequences increased over time, approaching values observed in the R arm. There were no differences in progression-free survival between the patients with at least partial immunoglobulin recovery and the remaining population. Our analysis indicates that patients receiving continuous therapy after ASCT experience prolonged immunoparesis, limiting prognostic significance of polyclonal immunoglobulin recovery in this setting.

Data availability

The data that support the findings of this study are available on request from the corresponding author.

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Additional details

Identifiers

DOI
10.1111/bjh.19097
Other
oai:uchicago.tind.io:7973

Funding

Amgen
Celgene (Bristol Myers Squibb)

UChicago Information

Division(s)
Biological Sciences Division
Department(s)
Medicine