Immunomagnetic enrichment of circulating tumor cells prior to tumor Ig specific qASO-PCR enhances the sensivity of minimal residual disease detection in multiple myeloma.

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Is it possible to predict who may never need treatment for B-CLL? V. Galle, Ph. Vlummens, F. OffnerAim :Prognostic factors of B-CLL overall survival have been extensively studied. There is, however, much less known about prognostic factors that can identify, at the time of diagnosis, patients who will never develop an indication for treatment.Methods:We conducted a retrospective study of 156 unselected patients newly diagnosed with B-CLL at the University-Hospital-Ghent between 2000-2012. Demographics, lymphocyte count, RAI/Binet stage, lymphocyte doubling time, Catovsky-score, CD38, ZAP70, LDH, u03b22MG, IGHV-mutational status, cytogenetics and CLL-IPI were collected at diagnosis. We defined treatment free survival as the study endpoint. Analysis was performed using Kaplan-Meier estimate and significance was tested using the log-rank algorithm. Multivariate study was done by cox regression analysis. Reported p-values are 2-sided with a significance level of 5%.Results :Median time-to-first-treatment was 4.7 years (0-16.6 years) (figure 1). Median follow-up was 7.7 years. Ninety-nine patients (63%) needed treatment during the entire follow-up period, of whom 51 patients (33%) within 2 years and 48 patients (30%) beyond the 2 year timepoint. Fifty-seven patients (37%) did not need treatment.We saw, on univariant analysis, that elevation of B2MG or LDH, an unmutated IGHV status, del(11q) and del(17p) were able to identify patients needing treatment in more than 90% of cases. It did however proved to be more difficult to identify patients not requiring treatment. A normal u03922MG had the highest predictive value (73%), followed by the presence of a mutated-IGHV (58%), del(13q) (57%) and normal cytogenetics (52%). All the other factors such as normal LDH, ECOG 0, BINET A or RAI-0 scored less than 50%. Multivariant analysis showed that normal u03b22MG (p= 0.034, HR 3.96), low lymphocyte count (p= 0.003, HR 1.22 for each stepdown (-10 000/mcl) in lymphocyte count, starting from >40 000/mcl), mutated IGHV (p<0.001, HR 3.27) and BINET A (p=0.003, HR 2.63) have independent value, for prognosis prediction of who will not require treatment during follow-up (figure 3). Based on this data a prognostic index is currently under development. Conclusion: In daily practice, it can be very useful to predict which patient with B-CLL will never need treatment. Based on the data presented, this is possible when we combine u03b22MG, lymphocyte count, IGHV status and BINET stage. A prognostic index that integrates this information is under development. Before implementation in daily practice, such an index needs validation true prospective, population-based, observational research; we hope to commence this study in the (near) future.

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