Abstract：
Multiple Myeloma (MM) typically originates from underlying precursor conditions, known as Monoclonal Gammopathy of Undetermined Significance (MGUS) and Smoldering Multiple Myeloma (SMM). Validated risk factors, related to the main features of the clonal plasma cells, are employed in the current prognostic models to assess long-term probabilities of progression to MM. In addition, new prognostic immunologic parameters, measuring protective MM-specific T-cell responses, could help to identify patients with shorter time-to-progression. In this report, we described a novel Multi-antigenic Myeloma-specific (MaMs) T-cell assay, based on ELISpot technology, providing simultaneous evaluation of T-cell responses towards ten different MM-associated antigens. When performed during long-term follow-up (mean 28 months) of 33 patients with either MGUS or SMM, such deca-antigenic myeloma-specific immunoassay allowed to significantly distinguish between stable vs. progressive disease (p < 0.001), independently from the Mayo Clinic risk category. Here, we report the first clinical experience showing that a wide (multi-antigen), standardized (irrespective to patients\' HLA), MM-specific T-cell assay may routinely be applied, as a promising prognostic tool, during the follow-up of MGUS/SMM patients. Larger studies are needed to improve the antigenic panel and further explore the prognostic value of MaMs test in the risk assessment of patients with monoclonal gammopathies.
摘要：
多发性骨髓瘤（MM）通常起源于潜在的前兆疾病，称为不确定意义的单克隆γ病（MGUS）和阴燃多发性骨髓瘤（SMM）。已验证的风险因素，与克隆浆细胞的主要特征有关，在当前的预后模型中用于评估进展到MM的长期概率。此外,新的预后免疫学参数，测量保护性MM特异性T细胞反应，可以帮助识别进展时间较短的患者。在这份报告中,我们描述了一种新的多抗原骨髓瘤特异性（MaMs）T细胞测定，基于ELISpot技术，提供对10种不同MM相关抗原的T细胞应答的同时评估。在对33例MGUS或SMM患者进行长期随访（平均28个月）时，这种deca抗原性骨髓瘤特异性免疫测定允许显著区分稳定与进行性疾病（p<0.001），独立于梅奥诊所风险类别。这里,我们报告的第一个临床经验表明，广泛的（多抗原），标准化(与患者的HLA无关)，可以常规应用MM特异性T细胞测定，作为一个有前途的预后工具，在MGUS/SMM患者的随访期间。需要更大规模的研究来改善抗原性小组，并进一步探讨MaMs测试在单克隆丙种球蛋白病患者风险评估中的预后价值。
