ROCHESTER, MN — Duration of initial disease response remains a strong prognostic factor in multiple myeloma (MM), especially for upfront autologous hematopoietic cell transplant (AHCT) recipients.
A study in the journal Leukemia hypothesized that new drug classes and combinations used before AHCT, as well as after post-AHCT relapse, might have changed the natural history of MM in this population.
A study team led by Mayo Clinic researchers and including participation from the South Texas Veterans Health Care System analyzed the Center for International Blood and Marrow Transplant Research database to track overall survival (OS) of 3,256 MM patients receiving single AHCT within 12 months after diagnosis and relapsing early post-AHCT, defined as less than 24 months.
The goal was to identify factors predictive for early vs. late relapses, defined as 24-48 months post-AHCT.
Over three periods (2001-2004, 2005-2008, 2009-2013), researchers balanced patient characteristics, except for lower proportion of Stage III, higher likelihood of one induction therapy with novel triplets and higher rates of planned post-AHCT maintenance over time.
Results indicated that the proportion of patients relapsing early was stable over time at 35-38%. Factors found to reduce risk of early relapse included lower stage, chemosensitivity, transplant after 2008 and post-AHCT maintenance. Shorter post-relapse OS was associated with early relapse, IgA MM, Karnofsky <90, Stage III, more than one line of induction and lack of maintenance.
“Post-AHCT early relapse remains a poor prognostic factor, even though outcomes have improved over time,” study authors concluded.
1Kumar SK, Dispenzieri A, Fraser R, Mingwei F, Akpek G, et. Al.
Early relapse after autologous hematopoietic cell transplantation remains a poor prognostic factor in multiple myeloma but outcomes have improved over time. Leukemia. 2017 Nov 16. doi: 10.1038/leu.2017.331. [Epub ahead of print] PubMed PMID: 29263438.
