Abstract

Background: Multiple myeloma (MM) is an incurable hematologic malignancy, and the majority of patients eventually relapse due to persistent myeloma cells. While minimal residual disease (MRD) reflects tumor burden, the host immune system also plays a crucial role in disease control. Our study aimed to evaluate MRD, complete blood count (CBC), and immune cell profiles in MM patients treated with bortezomib/adriamycin/dexamethasone (PAD) chemotherapy followed by autologous stem cell transplantation (ASCT) to determine their prognostic value and interplay. Objectives: This study aims to identify markers indicative of a favorable prognosis in MM patients. Methods: CBC data were collected from 93 MM patients at diagnosis, prior to ASCT, and 3 months post-ASCT. Immune cell profiles were assessed via flow cytometry using fresh peripheral blood samples from a subset of 33 prior to ASCT and 3 months post-ASCT. We subsequently investigated the associations between MRD status and prognosis, the predictive value of CBC, and the longitudinal changes in immune cell profiles and their correlation with clinical outcomes. Results: An increased frequency of negative immunomodulatory cell subsets and activated T lymphocytes prior to ASCT were associated with a poor prognosis. Conversely, lower levels of exhausted T lymphocytes, alongside higher levels of functional T cells and marginal zone B cells post-ASCT, predicted a favorable prognosis. Conclusions: Our study demonstrates that pre-ASCT immune status, post-ASCT immune reconstitution, and MRD status at 3 months post-ASCT are closely associated with clinical outcomes in MM patients. These findings underscore the critical importance of regular immune monitoring in the comprehensive management of MM.

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