Predictors of Poorer Outcomes Identified in Standard Risk Multiple Myeloma
Gene profiling expression should be used to identify subsets of patients with standard risk multiple myeloma.
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.
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).
- 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.