{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T05:44:25Z","timestamp":1790660665478,"version":"4.1.0"},"reference-count":31,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2025,7,23]],"date-time":"2025-07-23T00:00:00Z","timestamp":1753228800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Introduction: Despite the approval of novel agents that have significantly improved long-term survival rates for multiple myeloma (MM) patients undergoing autologous stem cell transplant (ASCT), most patients eventually relapse. The failure to achieve or maintain bone marrow (BM) minimal residual disease (MRD) negativity is a recognised adverse prognostic factor for progression-free survival (PFS) and overall survival (OS). Contamination of stem cell apheresis by clonal plasma cells may also affect prognosis, though data remain limited. Methods: We conducted a prospective, single-centre observational study including 100 newly diagnosed MM patients eligible for ASCT and treated with bortezomib-based triplet induction. MRD was assessed both on BM and apheresis samples using multiparameter flow cytometry (MFC-MRD) with a sensitivity of 10\u22125. Results: Clonal plasma cells were detected in 22 apheresis samples (aMRD+), all of which were associated with BM MRD positivity. Patients with aMRD+ had inferior pre-ASCT responses (\u2265VGPR: 10% vs. 63%, p = 0.005) and worse post-ASCT BM MRD negativity rates (4% vs. 49%, p = 0.048). After a median follow-up of 52.4 months, aMRD+ was associated with shorter progression-free survival (median 38.5 vs. not reached, p = 0.007) and overall survival (median 60 months vs. not reached, p = 0.003). Conclusions: Contamination of the apheresis product is associated with persistent BM disease and poorer outcomes. Combined MRD assessment in both bone marrow and apheresis may improve risk stratification in MM patients undergoing ASCT.<\/jats:p>","DOI":"10.3390\/cancers17152439","type":"journal-article","created":{"date-parts":[[2025,7,23]],"date-time":"2025-07-23T10:49:17Z","timestamp":1753267757000},"page":"2439","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Combined Minimal Residual Disease Evaluation in Bone Marrow and Apheresis Samples in Multiple Myeloma Patients Undergoing Autologous Stem Cell Transplantation Improves Outcome Prediction"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7301-5559","authenticated-orcid":false,"given":"Irene","family":"Attucci","sequence":"first","affiliation":[{"name":"Haematology Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benedetta","family":"Peruzzi","sequence":"additional","affiliation":[{"name":"Flow Cytometry and Immunology Diagnostic Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Nozzoli","sequence":"additional","affiliation":[{"name":"Cell Therapy and Transfusion Medicine Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serena","family":"Guerrieri","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofia","family":"Pilerci","sequence":"additional","affiliation":[{"name":"Haematology Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy"},{"name":"USL Toscana Nord Ovest, Versilia Hospital, Via Aurelia n. 335, 55041 Lido di Camaiore, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riccardo","family":"Boncompagni","sequence":"additional","affiliation":[{"name":"Cell Therapy and Transfusion Medicine Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serena","family":"Urbani","sequence":"additional","affiliation":[{"name":"Cell Therapy and Transfusion Medicine Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Orazzini","sequence":"additional","affiliation":[{"name":"Flow Cytometry and Immunology Diagnostic Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy"},{"name":"Immunohematology and Transfusion Medicine Unit, S. Stefano Hospital, Via Suor Niccolina Infermiera 20\/22, 59100 Prato, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Bencini","sequence":"additional","affiliation":[{"name":"Flow Cytometry and Immunology Diagnostic Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4690-9960","authenticated-orcid":false,"given":"Manuela","family":"Capone","sequence":"additional","affiliation":[{"name":"Flow Cytometry and Immunology Diagnostic Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy"},{"name":"Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Messeri","sequence":"additional","affiliation":[{"name":"Haematology Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Caporale","sequence":"additional","affiliation":[{"name":"Flow Cytometry and Immunology Diagnostic Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8798-7589","authenticated-orcid":false,"given":"Francesco","family":"Annunziato","sequence":"additional","affiliation":[{"name":"Flow Cytometry and Immunology Diagnostic Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy"},{"name":"Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5755-0730","authenticated-orcid":false,"given":"Alessandro M.","family":"Vannucchi","sequence":"additional","affiliation":[{"name":"Haematology Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabetta","family":"Antonioli","sequence":"additional","affiliation":[{"name":"Haematology Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1001\/jama.2022.0003","article-title":"Diagnosis and Management of Multiple Myeloma","volume":"327","author":"Cowan","year":"2022","journal-title":"JAMA"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"iv52","DOI":"10.1093\/annonc\/mdx096","article-title":"Multiple myeloma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up","volume":"28","author":"Moreau","year":"2017","journal-title":"Ann. 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