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01.12.2012 | Research | Ausgabe 1/2012 Open Access

Molecular Cancer 1/2012

In non-transplant patients with multiple myeloma, the pre-treatment level of clonotypic cells predicts event-free survival

Molecular Cancer > Ausgabe 1/2012
Kyle J Thulien, Andrew R Belch, Tony Reiman, Linda M Pilarski
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1476-4598-11-78) contains supplementary material, which is available to authorized users.

Competing interests

The authors have no conflicts of interest and no competing interests.

Authors' contributions

KJT designed the experiments, did the work, analyzed the data and wrote the paper. TR collected patient samples, guided the analysis and edited the paper. ARB and LMP directed the work and wrote the paper. All authors read and approved the final manuscript.



In multiple myeloma (MM), the immunoglobulin heavy chain VDJ gene rearrangement is a unique clonotypic signature that identifies all members of the myeloma clone independent of morphology or phenotype. Each clonotypic MM cell has only one genomic copy of the rearranged IgH VDJ.


Pre-treatment bone marrow aspirates from myeloma patients at diagnosis or in relapse were evaluated for the number of clonotypic cells using real time quantitative PCR (RPCR). RPCR measured the level of clonal cells, termed VDJ%, in 139 diagnosis and relapse BM aspirates from MM patients.


Patients with a VDJ% below the median had a significantly longer event free survival (EFS) then those with a VDJ% higher than the median (p=0.0077, HR=0.57). Further, although the VDJ% from non-transplant patients predicted EFS (p=0.0093), VDJ% failed to predict outcome after autologous stem cell transplant (p=0.53).


Our results suggest that for non-transplant patients, the tumor burden before treatment, perhaps reflecting cancer stem cell progeny/output, is an indirect measure that may indicate the number of MM cancer stem cells and hence event free survival.
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