Early relapse post autologous transplant is a stronger predictor of survival compared with pretreatment patient factors in the novel agent era: analysis of the Singapore Multiple Myeloma Working Group

Abstract

The clinical outcome of multiple myeloma is heterogeneous. Both the depth of response to induction and transplant as well as early relapse within a year are correlated with survival, but it is unclear which factor is most relevant in Southeast Asian patients with multiple myeloma. We retrospectively analyzed outcomes of 215 patients who were treated with upfront autologous transplant in Singapore between 2000 and 2014. In patients who received novel agent (NA)-based induction, achieving only partial response (PR) post-induction was associated with poorer OS (HR 1.95, P = 0.047) and PFS (HR 2.9, P o0.001), while achieving only PR post-transplant was strongly correlated with both OS (HR 3.3, P = 0.001) and PFS (HR 7.6, P o0.001), compared with patients who achieved very good partial response (VGPR) or better. Early relapse was detected in 18% of all patients, although nearly half had initially achieved VGPR or better post-transplant. Early relapse after NA-based induction led to significantly shorter OS (median 22 months vs not reached, P o0.001), and was strongly associated with OS (HR 13.7, P o 0.001). The impact of suboptimal post-transplant response and early relapse on survival may be more important than pretransplant factors, such as International Staging System or cytogenetics, and should be considered in risk stratification systems to rationalize therapy.Bone Marrow Transplantation (2016) 51, 933-937;

Early relapse after autologous transplant for myeloma is associated with poor survival regardless of cytogenetic risk

“… 1 Given the current availability of efficient salvage therapy, we wondered if an ER after intensive first line still negatively impacts survival. We demonstrate here that ER is still strongly associated with reduced survival after an intensive first line treatment, confirming three recent studies obtained with smaller cohorts, 2 , 9 , 10 and that achieving at least a very good partial response (VGPR) is associated with lower risk of ER (adjusted overall response [OR] 0.24 [range: 0.17-0.35], P <0.001). Significant progresses has been recently made for response evaluation, and high sensitivity minimal residual disease may better predict ER.…”

A new prognostic model for myeloma patients relapsing from upfront autologous transplantation based on ISS and PFS1

“…Our real‐world data echoes findings reported by other groups, indicating that early relapse is consistently associated with inferior outcomes (Jimenez‐Zepeda et al , ; Gonsalves et al , ; Majithia et al , ; Ong et al , ; Kumar et al , ). Pending validation in other patient cohorts, our risk model would be useful to stratify patients for clinical trials and may facilitate discussions with patients regarding prognosis at relapse.…”

Mass cytometry dissects T cell heterogeneity in the immune tumor microenvironment of common dysproteinemias at diagnosis and after first line therapies

“…We finally considered patients who relapsed within 12 months from their ASCT, a group thought to have inferior outcomes and associated with more aggressive disease biology 33 . In early progressors the CM4 CD4 population (Th1-like) was decreased (median 0.1% versus 0.3%, p = 0.02) as was basophil infiltration (median 0.1% versus 0.5%, p = 0.002).…”