Session: 653. Multiple Myeloma: Clinical and Epidemiological: Poster I
Hematology Disease Topics & Pathways:
B Cell lymphoma, Plasma Cell Disorders, Genomics, Diseases, Lymphoid Malignancies, Biological Processes, Technology and Procedures, Measurable Residual Disease , Molecular testing
Methods: We isolated cfRNA from the peripheral blood of 80 patients with MM (N=53), MGUS (N=18), WM (N=9), normal individuals (N=430), and individuals with CHIP (N=502). The cfRNA was sequenced using a 1500-gene targeted RNA next generation sequencing (NGS) panel that included all immunoglobulin heavy chain (IgH), Kappa (IgK), and Lambda (IgL) genes, and all T-cell receptors alpha (TRA), beta (TRB), and gamma (TRG) genes. Sequencing was performed using the Illumina NovaSeq 6000 instrument. More than 80 million reads and a percentage of spliced reads above 20% were required for acceptable evaluation.
Results: Based on testing 430 normal control, a cut-off point for determining clonality was established at a clonotype ratio of tenfold above the next highest clonotype. Using this stringent criterion, 44 (9%) of the 502 patients with CHIP showed evidence of clonality in peripheral blood, likely reflecting undiagnosed MGUS or monoclonal B-cell lymphocytosis (MBL). Of the 80 tested patients suspected of MM, MGUS, or WM, 35 (44%) showed clonality in either heavy chain or light chain or both. Of these, 6 patients showed clonality in light chain only without demonstratable clonality in heavy chain. B-cell clonality was detected in 7 cases (8%) clinically referred as WM, 23 cases (43%) referred as MM, and 5 cases referred as MGUS (28%). Sixty-four patients showed mutations in the tested cfRNA that are typically seen in lymphoid neoplasms including MYD88, KRAS, and NRAS. Of the 80 cases, 16 (20%) showed either no mutations at all or mutations consistent with CHIP. However, 14 of these 16 cases (88%) showed B-cell clonality. The overall confirmation of the presence of either clonal B-cell abnormality or mutations associated with MM or WM (MYD88) was 98% in this patient population. None of the 80 tested cases showed evidence of clonality in T-cell receptors.
Conclusions: In the absence of prior tissue-based information on clonotype, liquid biopsy testing of cfRNA by combining B-cell clonality evaluation and mutation detection is reliable in evaluating patients suspected of having MGUS, MM, or WM. This approach may replace the need for bone marrow biopsy as a screening test. The sensitivity of such an approach is increased significantly when the clonotype and mutations are known (tumor-informed) (data not presented), which can be used for minimal residual monitoring. Further studies are needed to confirm the clinical utility of this approach in monitoring minimal residual disease.
Disclosures: Biran: Sanofi: Honoraria, Speakers Bureau; AbbVie: Consultancy; Amgen: Research Funding; Janssen: Consultancy, Honoraria, Research Funding, Speakers Bureau; Pfizer: Consultancy, Honoraria; Karyopharm: Research Funding; Bristol Myers Squibb: Consultancy, Honoraria, Research Funding, Speakers Bureau. Vesole: Takeda: Speakers Bureau; Amgen: Speakers Bureau; BMS: Speakers Bureau; Karyopharm: Speakers Bureau; Janssen: Speakers Bureau; Sanofi: Speakers Bureau. Parmar: Sanofi: Membership on an entity's Board of Directors or advisory committees; Cellectar Biosciences: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Data Safety Monitoring/Advisory Board, Research Funding. Siegel: Roche: Honoraria; BMS: Honoraria; Sebia: Honoraria; Envision Pharma: Honoraria; Merck: Honoraria; COTA: Current holder of stock options in a privately-held company; Prothena: Honoraria; Pfizer: Honoraria; K36 Therapeutics: Honoraria; Sanofi: Honoraria; Envision Pharma: Honoraria.
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