Gene profiling expression should be used to identify subsets of patients with standard risk multiple myeloma who, despite novel therapies and hematopoietic stem cell transplant (auto-HCT), have significantly shorter progression-free survival rates.1

Outcomes for patients with standard risk multiple myeloma have improved dramatically with the advent of novel treatments, with progression-free survival rates of approximately 24 to 30 months in patients not receiving maintenance therapy. There remains a subset of patients, however, who do not respond as well to therapy.

Investigators sought to determine the factors associated with shorter progression-free survival in patients with standard risk multiple myeloma. They reviewed a database of 1750 patients with multiple myeloma who underwent auto-HCT between 2002 and 2010 and identified 61 patients who had a progression-free survival rate of less than 18 months despite upfront auto-HCT.

All had diploid karyotype. Out of the 77% (47 patients) with available fluorescent in-situ hybridization analyses, 83% showed no abnormalities, 11% had monosomy/ or del (13q), 4% had monosomy 13 and t (11; 14), and 2% had trisomy 5.

All patients were treated with a melphalan-based conditioning regimen and there was a median time to auto-HCT of 10 months; 31% of patients received maintenance therapy; and 20% received lenalidomide. After auto-HCT, overall response rate was 93%. Median progression-free survival was 7.7 months and median overall survival was 59.6 months.

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Multivariate analysis for variables that showed significance on univariate analysis (P < .05) for progression-free survival determined that patients with concurrent light chain amyloidosis had poorer prognosis (HR, 4.03; 95% CI, 1.16 – 14.06; P = .02). A trend towards poorer progression-free survival was associated with patients who had > 10% bone marrow plasma cells at auto-HCT and monosomy/or del 13 q on fluorescent in situ hybridization (HR, 2.29; 95% CI, 0.85 – 6.15; P = .09; HR, 2.33; 95% CI, 0.86 – 6.31; P = .09). 

Reference

  1. Badar T, Srour S, Bashir Q, et al. Predictors of inferior clinical outcome in patients with standard risk multiple myeloma. Poster presented at: BMT Tandem Meetings 2016; February 18-22, 2016; Honolulu, HI.