Source: Myeloma – Hematology Advisor
Early relapse after initial therapy, defined as 18 months (ER18), was strongly prognostic for early progression and higher risk among patients with multiple myeloma (MM), according to the results of an analysis of data from the National Longitudinal Cohort of Hematological Diseases in China cohort. The results of the study were published in the journal Cancer.
Although early relapse has been known to be prognostic for worse outcomes among patients with MM, the timing of relapse varies between studies. The aim of this study was to define the optimal duration for prognostication.
The study evaluated data from 629 patients with newly-diagnosed MM. Of these patients, 19.4% developed ER18, who were more likely to have anemia (P <.001), thrombocytopenia (P =.004) and high-risk cytogenetics (P ≤.007).
The ER18 cohort demonstrated more aggressive biologic features and were less likely to respond to initial treatment (P <.001). The median overall survival (OS) was 28.9 months, which was significantly shorter than the xx months of patients who did not relapse within 18 months.
OS was significantly shorter in the ER18 cohort compared with patients who did not relapse within 18 months, with a median of 28.9 months compared with 85.6 months, respectively (P <.001). The risk of death was higher in the ER18 group (hazard ratio [HR], 6.342; 95% CI, 4.603-8.739; P <.001).
In a multivariate analysis, ER18 was associated with a significant risk of death (HR, 4.467; 95% CI, 3.012-6.625; P <.001), which was greater than that of ISS stage, lactate dehydrogenase level at diagnosis, thrombocytopenia, or high-risk cytogenetics (HR range, 1.598-2.071).
The study also evaluated the effect of incorporating ER18 as a complement to the R-ISS model and developed a second-state model based on the reorganization of the OS groups classified by R-ISS staging and ER18.
The concordance index of this model on adjusted OS was 0.726. The model also identified an ultra-high-risk subgroup that demonstrated a median OS of 8.9 months after first relapse. “Collectively, this study concludes that ER18 is a simple and dynamic prognostic predictor in MM,” the authors wrote in their report.
Disclosures: Some of the study authors declared affiliations with biotech, pharmaceutical, or device companies. Please see the original reference for a full list of disclosures.
Yan W, Xu J, Fan H, et al. Early relapse within 18 months (ER18) is a powerful dynamic predictor for prognosis and could revise static risk distribution in multiple myeloma. Cancer. Published online October 17, 2023. doi: 10.1002/cncr.35056