Stem cell autograft minimal residual disease negativity and survival outcomes for multiple myeloma autotransplant
Contemporary induction regimens for newly diagnosed multiple myeloma (NDMM), particularly daratumumab-based quadruplets, achieve high rates of bone marrow (BM) minimal residual disease (MRD) negativity and improve progression-free survival (PFS) and overall survival (OS) after upfront autologous stem cell transplantation (ASCT). However, the incidence and clinical impact of stem cell autograft (AG) contamination with malignant plasma cells in the current treatment era remain undefined. We evaluated AG MRD using multiparameter flow cytometry to determine its prognostic value for ASCT outcomes. This study included 649 NDMM patients who underwent stem cell collection and upfront ASCT between 2017 and 2023. BM MRD was assessed post-induction and at day +100 post-ASCT, while AG MRD was assessed at stem cell collection. At a median follow-up of 34 months, MRD-negative AGs were associated with significantly improved PFS compared with MRD-positive AGs (3-year estimate: 81% vs. 45%, p < 0.001), with a similar trend for OS (3-year estimate: 93% vs. 76%, p < 0.001). AG MRD-negativity rates were highest with daratumumab-based quadruplets. Notably, AG MRD negativity mitigated the adverse impact of pre-collection BM MRD positivity and high-risk cytogenetics. These findings support AG MRD as a prognostic parameter for survival following ASCT in NDMM.
Authors
- Heather Jolie Landau (ORCID: https://orcid.org/0000-0002-3152-1189)
- Kylee H. Maclachlan (ORCID: https://orcid.org/0000-0001-7873-4854)
- Hamza Hashmi (ORCID: https://orcid.org/0000-0002-4129-5867)
- Saad Z. Usmani (ORCID: https://orcid.org/0000-0002-5484-8731)
- Oscar Boutros Lahoud (ORCID: https://orcid.org/0000-0002-3291-286X)
- Samantha Brown (ORCID: https://orcid.org/0000-0001-5352-974X)
- Malin L. Hultcrantz (ORCID: https://orcid.org/0000-0002-9045-6495)
- Qi Gao (ORCID: https://orcid.org/0000-0003-1054-4418)
- Gunjan L. Shah (ORCID: https://orcid.org/0000-0002-9977-0456)
- Urvi Ashok Shah (ORCID: https://orcid.org/0000-0001-8419-1091)
- Alexander M. Lesokhin (ORCID: https://orcid.org/0000-0001-9321-702X)
- Elena Maryamchik (ORCID: https://orcid.org/0000-0002-4719-4629)
- Sean M. Devlin (ORCID: https://orcid.org/0000-0002-6801-720X)
- Parastoo Bahrami Dahi (ORCID: https://orcid.org/0000-0002-0794-3226)
- Eric Matthew Jurgens (ORCID: https://orcid.org/0000-0001-8280-2581)
- David J. Chung (ORCID: https://orcid.org/0000-0003-0469-839X)
- Hani Hassoun (ORCID: https://orcid.org/0000-0002-2036-1749)
- Sham Mailankody (ORCID: https://orcid.org/0000-0002-2815-9561)
- Noriko Nishimura (ORCID: https://orcid.org/0000-0001-8720-6930)
- Neha Korde (ORCID: https://orcid.org/0000-0002-5538-4318)
- Sridevi Rajeeve (ORCID: https://orcid.org/0000-0002-3458-824X)
- Sergio A. Giralt (ORCID: https://orcid.org/0000-0003-1944-5053)
- Mohammad Alhomoud (ORCID: https://orcid.org/0000-0003-4552-0109)
- Mikhail Roshal (ORCID: https://orcid.org/0000-0002-9585-0790)
- Carlyn Rose C. Tan (ORCID: https://orcid.org/0000-0001-7922-2594)
- Maximilian Merz (ORCID: https://orcid.org/0000-0002-2805-5973)
- Ross Firestone (ORCID: https://orcid.org/0000-0002-2945-9320)
- Francesco Maura (ORCID: https://orcid.org/0000-0002-5017-1620)
- Sarah Samorodnitsky (ORCID: https://orcid.org/0000-0001-7909-0245)
- Evangelos Ntrivalas
- Michael Scordo
- Gaurav K. Gupta
- Charlotte Hughes
Institutions
- Memorial Sloan Kettering Cancer Center (US)
- Cornell University (US)
Publication Details
- Journal
- Blood Cancer Journal
- Published
- 2026-09-21
- DOI
- https://doi.org/10.1038/s41408-026-01621-9
- Primary Topic
- Multiple Myeloma Research and Treatments
- Type
- article
- Field-Weighted Citation Impact
- 0.00