Abstract
The quantification of submicroscopic minimal residual disease (MRD) after therapy proved to have independent prognostic significance in many mature B-cell malignancies. With the advent of routine benchtop cytometers capable of simultaneously analyzing ≥4 colors and with improved standardization, flow cytometry has become the method of choice for MRD assessments in some lymphoma entities. Herein we describe general aspects of flow cytometric standardization. Chronic lymphocytic leukemia and multiple myeloma (MM) are used as examples to explain the technical standardization of flow cytometry for MRD detection according to EuroFlow strategies. MRD data acquisition and detailed analysis using a newly developed approach (so-called next generation flow, NGF) in MM is a particular focus of this chapter.
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References
Fischer K, Bahlo J, Fink AM et al (2016) Long-term remissions after FCR chemoimmunotherapy in previously untreated patients with CLL: updated results of the CLL8 trial. Blood 127:208–215
Hermine O, Hoster E, Walewski J et al (2016) Addition of high-dose cytarabine to immunochemotherapy before autologous stem-cell transplantation in patients aged 65 years or younger with mantle cell lymphoma (MCL Younger): a randomised, open-label, phase 3 trial of the European Mantle Cell Lymphoma Network. Lancet 388:565–575
European Medicines Agency Committee for Medicinal Products for Human Use (2016) Appendix 4 to the guideline on the evaluation of anticancer medicinal products in man. http://www.ema.europa.eu/docs/en_GB/document_library/Scientific_guideline/2016/02/WC500201945.pdf, Accessed 15 Mar 2018
Fink AM, Bottcher S, Ritgen M et al (2013) Prediction of poor outcome in CLL patients following first-line treatment with fludarabine, cyclophosphamide and rituximab. Leukemia 27:1949–1952
Cramer P, von Tresckow J, Bahlo J et al (2018) CLL2-BXX Phase II trials: sequential, targeted treatment for eradication of minimal residual disease in chronic lymphocytic leukemia. Future Oncol (London, England) 14:499–513
Bottcher S, Ritgen M, Buske S et al (2008) Minimal residual disease detection in mantle cell lymphoma: methods and significance of four-color flow cytometry compared to consensus IGH-polymerase chain reaction at initial staging and for follow-up examinations. Haematologica 93:551–559
Bottcher S, Ritgen M, Pott C et al (2004) Comparative analysis of minimal residual disease detection using four-color flow cytometry, consensus IgH-PCR, and quantitative IgH PCR in CLL after allogeneic and autologous stem cell transplantation. Leukemia 18:1637–1645
van der Velden VH, Cazzaniga G, Schrauder A et al (2007) Analysis of minimal residual disease by Ig/TCR gene rearrangements: guidelines for interpretation of real-time quantitative PCR data. Leukemia 21:604–611
Puig N, Sarasquete ME, Balanzategui A et al (2014) Critical evaluation of ASO RQ-PCR for minimal residual disease evaluation in multiple myeloma. A comparative analysis with flow cytometry. Leukemia 28:391–397
Rawstron AC, Orfao A, Beksac M et al (2008) Report of the European Myeloma Network on multiparametric flow cytometry in multiple myeloma and related disorders. Haematologica 93:431–438
Rawstron AC, Villamor N, Ritgen M et al (2007) International standardized approach for flow cytometric residual disease monitoring in chronic lymphocytic leukaemia. Leukemia 21:956–964
Rawstron AC, de Tute R, Jack AS et al (2006) Flow cytometric protein expression profiling as a systematic approach for developing disease-specific assays: identification of a chronic lymphocytic leukaemia-specific assay for use in rituximab-containing regimens. Leukemia 20:2102–2110
Mateo G, Montalban MA, Vidriales MB et al (2008) Prognostic value of immunophenotyping in multiple myeloma: a study by the PETHEMA/GEM cooperative study groups on patients uniformly treated with high-dose therapy. J Clin Oncol 26:2737–2744
Bottcher S, Stilgenbauer S, Busch R et al (2009) Standardized MRD flow and ASO IGH RQ-PCR for MRD quantification in CLL patients after rituximab-containing immunochemotherapy: a comparative analysis. Leukemia 23:2007–2017
Paiva B, Cedena MT, Puig N et al (2016) Minimal residual disease monitoring and immune profiling in multiple myeloma in elderly patients. Blood 127:3165–3174
Rawstron AC, Fazi C, Agathangelidis A et al (2016) A complementary role of multiparameter flow cytometry and high-throughput sequencing for minimal residual disease detection in chronic lymphocytic leukemia: an European Research Initiative on CLL study. Leukemia 30:929–936
Flores-Montero J, Sanoja-Flores L, Paiva B et al (2017) Next Generation Flow for highly sensitive and standardized detection of minimal residual disease in multiple myeloma. Leukemia 31:2094–2103
Goede V, Fischer K, Busch R et al (2014) Obinutuzumab plus chlorambucil in patients with CLL and coexisting conditions. N Engl J Med 370:1101–1110
Hallek M, Fischer K, Fingerle-Rowson G et al (2010) Addition of rituximab to fludarabine and cyclophosphamide in patients with chronic lymphocytic leukaemia: a randomised, open-label, phase 3 trial. Lancet 376:1164–1174
Stilgenbauer S, Leblond V, Foa R et al (2018) Obinutuzumab plus bendamustine in previously untreated patients with CLL: a subgroup analysis of the GREEN study. Leukemia 32:1778–1786
Roberts AW, Davids MS, Pagel JM et al (2016) Targeting BCL2 with Venetoclax in relapsed chronic lymphocytic leukemia. N Engl J Med 374:311–322
Seymour JF, Ma S, Brander DM et al (2017) Venetoclax plus rituximab in relapsed or refractory chronic lymphocytic leukaemia: a phase 1b study. Lancet Oncol 18:230–240
Stilgenbauer S, Eichhorst B, Schetelig J et al (2016) Venetoclax in relapsed or refractory chronic lymphocytic leukaemia with 17p deletion: a multicentre, open-label, phase 2 study. Lancet Oncol 17:768–778
Byrd JC, Brown JR, O’Brien S et al (2014) Ibrutinib versus ofatumumab in previously treated chronic lymphoid leukemia. N Engl J Med 371:213–223
Furman RR, Sharman JP, Coutre SE et al (2014) Idelalisib and rituximab in relapsed chronic lymphocytic leukemia. N Engl J Med 370:997–1007
Ahn IE, Farooqui MZH, Tian X et al (2018) Depth and durability of response to ibrutinib in CLL: 5-year follow-up of a phase II study. Blood 131:2357–2366
Burger JA, Tedeschi A, Barr PM et al (2015) Ibrutinib as initial therapy for patients with chronic lymphocytic leukemia. N Engl J Med 373:2425–2437
Fischer K, Al-Sawaf O, Fink AM et al (2017) Venetoclax and obinutuzumab in chronic lymphocytic leukemia. Blood 129:2702–2705
Moreno C, Villamor N, Colomer D et al (2006) Clinical significance of minimal residual disease, as assessed by different techniques, after stem cell transplantation for chronic lymphocytic leukemia. Blood 107:4563–4569
Bottcher S, Ritgen M, Fischer K et al (2012) Minimal residual disease quantification is an independent predictor of progression free and overall survival in chronic lymphocytic leukemia. A multivariate analysis from the randomized GCLLSG CLL8 trial. J Clin Oncol 30:980–988
Fischer K, Cramer P, Busch R et al (2012) Bendamustine in combination with rituximab for previously untreated patients with chronic lymphocytic leukemia: a multicenter phase II trial of the German Chronic Lymphocytic Leukemia Study Group. J Clin Oncol 30:3209–3216
Pettitt AR, Jackson R, Carruthers S et al (2012) Alemtuzumab in combination with methylprednisolone is a highly effective induction regimen for patients with chronic lymphocytic leukemia and deletion of TP53: final results of the national cancer research institute CLL206 trial. J Clin Oncol 30:1647–1655
Bouvet E, Borel C, Oberic L et al (2013) Impact of dose intensity on outcome of fludarabine, cyclophosphamide, and rituximab regimen given in the first-line therapy for chronic lymphocytic leukemia. Haematologica 98:65–70
Santacruz R, Villamor N, Aymerich M et al (2014) The prognostic impact of minimal residual disease in patients with chronic lymphocytic leukemia requiring first-line therapy. Haematologica 99:873–880
Strati P, Keating MJ, O’Brien SM et al (2014) Eradication of bone marrow minimal residual disease may prompt early treatment discontinuation in CLL. Blood 123:3727–3732
Ritgen M, Langerak A, Goede V et al (2016) Quantitative MRD is prognostic for progression free & overall survival in elderly patients receiving chlorambucil alone or with obinutuzumab/rituximab: a prospective analysis of the GCLLSG CLL11 study. Haematologica 101:149–150 [abstract]
Howard DR, Munir T, McParland L et al (2017) Results of the randomized phase IIB ARCTIC trial of low-dose rituximab in previously untreated CLL. Leukemia 31:2416–2425
Kwok M, Rawstron AC, Varghese A et al (2016) Minimal residual disease is an independent predictor for 10-year survival in CLL. Blood 128:2770–2773
Munir T, Howard DR, McParland L et al (2017) Results of the randomized phase IIB ADMIRE trial of FCR with or without mitoxantrone in previously untreated CLL. Leukemia 31:2085–2093
Feugier P, Aurran T, Mahe B et al (2018) Long-term follow-up of the CLL2007FMP trial evaluating fludarabine and cyclophosphamide in combination with either rituximab or alemtuzumab in previously untreated patients with chronic lymphocytic leukemia. Haematologica 103:e304–e306
Seymour JF, Kipps TJ, Eichhorst B et al (2018) Venetoclax-rituximab in relapsed or refractory chronic lymphocytic leukemia. N Engl J Med 378:1107–1120
Hallek M, Cheson BD, Catovsky D et al (2018) Guidelines for diagnosis, indications for treatment, response assessment and supportive management of chronic lymphocytic leukemia. Blood 131:2745–2760
Rawstron AC, Bottcher S, Letestu R et al (2013) Improving efficiency and sensitivity: European Research Initiative in CLL (ERIC) update on the international harmonised approach for flow cytometric residual disease monitoring in CLL. Leukemia 27:142–149
Logan AC, Zhang B, Narasimhan B et al (2013) Minimal residual disease quantification using consensus primers and high-throughput IGH sequencing predicts post-transplant relapse in chronic lymphocytic leukemia. Leukemia 27:1659–1665
Roussel M, Lauwers-Cances V, Robillard N et al (2014) Front-line transplantation program with lenalidomide, bortezomib, and dexamethasone combination as induction and consolidation followed by lenalidomide maintenance in patients with multiple myeloma: a phase II study by the Intergroupe Francophone du Myelome. J Clin Oncol 32:2712–2717
San Miguel JF, Schlag R, Khuageva NK et al (2008) Bortezomib plus melphalan and prednisone for initial treatment of multiple myeloma. N Engl J Med 359:906–917
Stewart AK, Rajkumar SV, Dimopoulos MA et al (2015) Carfilzomib, lenalidomide, and dexamethasone for relapsed multiple myeloma. N Engl J Med 372:142–152
Moreau P, Masszi T, Grzasko N et al (2016) Oral ixazomib, lenalidomide, and dexamethasone for multiple myeloma. N Engl J Med 374:1621–1634
Dimopoulos MA, Oriol A, Nahi H et al (2016) Daratumumab, lenalidomide, and dexamethasone for multiple myeloma. N Engl J Med 375:1319–1331
Mateos MV, Dimopoulos MA, Cavo M et al (2018) Daratumumab plus bortezomib, melphalan, and prednisone for untreated myeloma. N Engl J Med 378:518–528
Palumbo A, Chanan-Khan A, Weisel K et al (2016) Daratumumab, bortezomib, and dexamethasone for multiple myeloma. N Engl J Med 375:754–766
Lonial S, Dimopoulos M, Palumbo A et al (2015) Elotuzumab therapy for relapsed or refractory multiple myeloma. N Engl J Med 373:621–631
Chari A, Suvannasankha A, Fay JW et al (2017) Daratumumab plus pomalidomide and dexamethasone in relapsed and/or refractory multiple myeloma. Blood 130:974–981
San Miguel J, Weisel K, Moreau P et al (2013) Pomalidomide plus low-dose dexamethasone versus high-dose dexamethasone alone for patients with relapsed and refractory multiple myeloma (MM-003): a randomised, open-label, phase 3 trial. Lancet Oncol 14:1055–1066
Paiva B, Vidriales MB, Cervero J et al (2008) Multiparameter flow cytometric remission is the most relevant prognostic factor for multiple myeloma patients who undergo autologous stem cell transplantation. Blood 112:4017–4023
Paiva B, Gutierrez NC, Rosinol L et al (2012) High-risk cytogenetics and persistent minimal residual disease by multiparameter flow cytometry predict unsustained complete response after autologous stem cell transplantation in multiple myeloma. Blood 119:687–691
Paiva B, Martinez-Lopez J, Vidriales MB et al (2011) Comparison of immunofixation, serum free light chain, and immunophenotyping for response evaluation and prognostication in multiple myeloma. J Clin Oncol 29:1627–1633
Martinez-Lopez J, Lahuerta JJ, Pepin F et al (2014) Prognostic value of deep sequencing method for minimal residual disease detection in multiple myeloma. Blood 123:3073–3079
Rawstron AC, Child JA, de Tute RM et al (2013) Minimal residual disease assessed by multiparameter flow cytometry in multiple myeloma: impact on outcome in the Medical Research Council Myeloma IX Study. J Clin Oncol 31:2540–2547
Lahuerta JJ, Paiva B, Vidriales MB et al (2017) Depth of response in multiple myeloma: a pooled analysis of three PETHEMA/GEM clinical trials. J Clin Oncol 35:2900–2910
Korde N, Roschewski M, Zingone A et al (2015) Treatment with carfilzomib-lenalidomide-dexamethasone with lenalidomide extension in patients with smoldering or newly diagnosed multiple myeloma. JAMA Oncol 1:746–754
Ferrero S, Ladetto M, Drandi D et al (2015) Long-term results of the GIMEMA VEL-03-096 trial in MM patients receiving VTD consolidation after ASCT: MRD kinetics’ impact on survival. Leukemia 29:689–695
Ladetto M, Pagliano G, Ferrero S et al (2010) Major tumor shrinking and persistent molecular remissions after consolidation with bortezomib, thalidomide, and dexamethasone in patients with autografted myeloma. J Clin Oncol 28:2077–2084
Ladetto M, Bruggemann M, Monitillo L et al (2014) Next-generation sequencing and real-time quantitative PCR for minimal residual disease detection in B-cell disorders. Leukemia 28:1299–1307
Martinez-Lopez J, Paiva B, Lopez-Anglada L et al (2015) Critical analysis of the stringent complete response in multiple myeloma: contribution of sFLC and bone marrow clonality. Blood 126:858–862
Arroz M, Came N, Lin P et al (2016) Consensus guidelines on plasma cell myeloma minimal residual disease analysis and reporting. Cytometry B Clin Cytom 90:31–39
Kalina T, Flores-Montero J, van der Velden VH et al (2012) EuroFlow standardization of flow cytometer instrument settings and immunophenotyping protocols. Leukemia 26:1986–2010
van Dongen JJ, Lhermitte L, Bottcher S et al (2012) EuroFlow antibody panels for standardized n-dimensional flow cytometric immunophenotyping of normal, reactive and malignant leukocytes. Leukemia 26:1908–1975
Kumar S, Paiva B, Anderson KC et al (2016) International Myeloma Working Group consensus criteria for response and minimal residual disease assessment in multiple myeloma. Lancet Oncol 17:e328–e346
Pott C, Hoster E, Delfau-Larue MH et al (2010) Molecular remission is an independent predictor of clinical outcome in patients with mantle cell lymphoma after combined immunochemotherapy: a European MCL intergroup study. Blood 115:3215–3223
Pott C, Schrader C, Gesk S et al (2006) Quantitative assessment of molecular remission after high-dose therapy with autologous stem cell transplantation predicts long-term remission in mantle cell lymphoma. Blood 107:2271–2278
Kolstad A, Laurell A, Jerkeman M et al (2014) Nordic MCL3 study: 90Y-ibritumomab-tiuxetan added to BEAM/C in non-CR patients before transplant in mantle cell lymphoma. Blood 123:2953–2959
Kolstad A, Pedersen LB, Eskelund CW et al (2017) Molecular monitoring after autologous stem cell transplantation and preemptive rituximab treatment of molecular relapse; results from the nordic mantle cell lymphoma studies (MCL2 and MCL3) with median follow-up of 8.5 years. Biol Blood Marrow Transplant 23:428–435
Armand P, Redd R, Bsat J et al (2016) A phase 2 study of Rituximab-Bendamustine and Rituximab-Cytarabine for transplant-eligible patients with mantle cell lymphoma. Br J Haematol 173:89–95
Cheminant M, Derrieux C, Touzart A et al (2016) Minimal residual disease monitoring by 8-color flow cytometry in mantle cell lymphoma: an EU-MCL and LYSA study. Haematologica 101:336–345
Tam CS, Anderson MA, Pott C et al (2018) Ibrutinib plus venetoclax for the treatment of mantle-cell lymphoma. N Engl J Med 378:1211–1223
Ladetto M, Lobetti-Bodoni C, Mantoan B et al (2013) Persistence of minimal residual disease in bone marrow predicts outcome in follicular lymphomas treated with a rituximab-intensive program. Blood 122:3759–3766
Ladetto M, De Marco F, Benedetti F et al (2008) Prospective, multicenter randomized GITMO/IIL trial comparing intensive (R-HDS) versus conventional (CHOP-R) chemoimmunotherapy in high-risk follicular lymphoma at diagnosis: the superior disease control of R-HDS does not translate into an overall survival advantage. Blood 111:4004–4013
Galimberti S, Luminari S, Ciabatti E et al (2014) Minimal residual disease after conventional treatment significantly impacts on progression-free survival of patients with follicular lymphoma: the FIL FOLL05 trial. Clin Cancer Res 20:6398–6405
Zohren F, Bruns I, Pechtel S et al (2015) Prognostic value of circulating Bcl-2/IgH levels in patients with follicular lymphoma receiving first-line immunochemotherapy. Blood 126:1407–1414
van Oers MH, Tonnissen E, Van Glabbeke M et al (2010) BCL-2/IgH polymerase chain reaction status at the end of induction treatment is not predictive for progression-free survival in relapsed/resistant follicular lymphoma: results of a prospective randomized EORTC 20981 phase III intergroup study. J Clin Oncol 28:2246–2252
Kalina T, Flores-Montero J, Lecrevisse Q et al (2015) Quality assessment program for EuroFlow protocols: summary results of four-year (2010–2013) quality assurance rounds. Cytometry A 87:145–156
Böttcher S (2019) Minimal residual disease quantification in chronic lymphocytic leukemia: clinical significance and flow cytometric methods. Methods Mol Biol 1881:211–238. https://doi.org/10.1007/978-1-4939-8876-1_17
Böttcher S, van der Velden VHJ, Villamor N, Ritgen M, Flores-Montero J, Murua Escobar H, Kalina T, Brﺲggemann M, Grigore G, Martin-Ayuso M, Lecrevisse Q, Pedreira CE, van Dongen JJM, Orfao A (2017) Lot-to-lot stability of antibody reagents for flow cytometry. J Immunol Methods. pii: S0022-1759(17)30075-3. https://doi.org/10.1016/j.jim.2017.03.018. [Epub ahead of print]
Bomberger C, Singh-Jairam M, Rodey G et al (1998) Lymphoid reconstitution after autologous PBSC transplantation with FACS-sorted CD34+ hematopoietic progenitors. Blood 91:2588–2600
Flores-Montero J, de Tute R, Paiva B et al (2016) Immunophenotype of normal vs. myeloma plasma cells: toward antibody panel specifications for MRD detection in multiple myeloma. Cytometry B Clin Cytom 90:61–72
Bottcher S, Ritgen M, Kneba M (2013) Flow cytometric MRD detection in selected mature B-cell malignancies. Methods Mol Biol 971:149–174. https://doi.org/10.1007/978-1-62703-269-8_9
Acknowledgments
The author is grateful to E. Harbst, L. Falck, J. Hanani, D. Paape, B. Wiebeck, S. Lange, E. Koppitz, and L. Henseleit for excellent technical support with establishing the protocols and thanks the members of the EuroFlow and ERIC consortiums for long-standing collaborations. B. Wiebeck, S. Lange, PhD, R. Engelmann, PhD, and D. Paape are acknowledged for critical reading of the manuscript. Parts of this manuscript are based on a previously published chapter in Methods in Molecular Biology by the author, Matthias Ritgen, and Michael Kneba [87].
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Böttcher, S. (2019). Flow Cytometric MRD Detection in Selected Mature B-Cell Malignancies. In: Küppers, R. (eds) Lymphoma. Methods in Molecular Biology, vol 1956. Humana Press, New York, NY. https://doi.org/10.1007/978-1-4939-9151-8_8
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DOI: https://doi.org/10.1007/978-1-4939-9151-8_8
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