INTRODUCTION: Outcome of patients with standard-risk (SR) multiple myeloma (MM) has improved; however, subsets of patients do worse than expected. We sought to identify the factors associated with inferior outcome. METHODS: We evaluated 51 patients with SR MM that received upfront autologous hematopoietic stem cell transplantation (auto-HCT) after induction and had a progression-free survival (PFS) of ≤18 months. RESULTS: The median age of patients was 61 yr. Forty-one (80%) patients received induction with immunomodulatory drugs, proteosome inhibitors, or combination of both. The overall response rate (ORR) after auto-HCT was 96% (stringent complete response 23%, complete response 10%, very good partial response 22%, and partial response 39%). The median PFS was 7.8, and median overall survival (OS) was 56.3 months. On univariate analysis, concurrent light-chain amyloidosis (AL) was associated with inferior PFS [hematological response (HR); 2.51, 95% CI; 0.64-10.58, P = 0.03] and occurrence of soft tissue plasmacytoma was associated with a significantly shorter OS (HR: 3.05, 95% CI: 0.57-16.29, P = 0.02). CONCLUSION: Our analysis suggests that concurrent AL and soft tissue plasmacytoma were associated with shorter PFS and OS, respectively. Heterogeneity in clinical outcome of SR MM merits better tools for prognostication, such as gene expression profiling and minimal residual disease assessment to identify high-risk patients.
INTRODUCTION: Outcome of patients with standard-risk (SR) multiple myeloma (MM) has improved; however, subsets of patients do worse than expected. We sought to identify the factors associated with inferior outcome. METHODS: We evaluated 51 patients with SR MM that received upfront autologous hematopoietic stem cell transplantation (auto-HCT) after induction and had a progression-free survival (PFS) of ≤18 months. RESULTS: The median age of patients was 61 yr. Forty-one (80%) patients received induction with immunomodulatory drugs, proteosome inhibitors, or combination of both. The overall response rate (ORR) after auto-HCT was 96% (stringent complete response 23%, complete response 10%, very good partial response 22%, and partial response 39%). The median PFS was 7.8, and median overall survival (OS) was 56.3 months. On univariate analysis, concurrent light-chain amyloidosis (AL) was associated with inferior PFS [hematological response (HR); 2.51, 95% CI; 0.64-10.58, P = 0.03] and occurrence of soft tissue plasmacytoma was associated with a significantly shorter OS (HR: 3.05, 95% CI: 0.57-16.29, P = 0.02). CONCLUSION: Our analysis suggests that concurrent AL and soft tissue plasmacytoma were associated with shorter PFS and OS, respectively. Heterogeneity in clinical outcome of SR MM merits better tools for prognostication, such as gene expression profiling and minimal residual disease assessment to identify high-risk patients.
Authors: Morie A Gertz; Martha Q Lacy; Angela Dispenzieri; Philip R Greipp; Mark R Litzow; Kimberly J Henderson; Scott A Van Wier; Greg J Ahmann; Rafael Fonseca Journal: Blood Date: 2005-06-23 Impact factor: 22.113
Authors: Shira Dinner; Wesley Witteles; Ronald Witteles; Anthony Lam; Sally Arai; Richard Lafayette; Tracy I George; Stanley L Schrier; Michaela Liedtke Journal: Br J Haematol Date: 2013-02-23 Impact factor: 6.998
Authors: Paul G Richardson; Pieter Sonneveld; Michael W Schuster; David Irwin; Edward A Stadtmauer; Thierry Facon; Jean-Luc Harousseau; Dina Ben-Yehuda; Sagar Lonial; Hartmut Goldschmidt; Donna Reece; Jesus F San-Miguel; Joan Bladé; Mario Boccadoro; Jamie Cavenagh; William S Dalton; Anthony L Boral; Dixie L Esseltine; Jane B Porter; David Schenkein; Kenneth C Anderson Journal: N Engl J Med Date: 2005-06-16 Impact factor: 91.245
Authors: Joan Bladé; Carlos Fernández de Larrea; Laura Rosiñol; María Teresa Cibeira; Raquel Jiménez; Ray Powles Journal: J Clin Oncol Date: 2011-09-06 Impact factor: 44.544
Authors: Paul G Richardson; Emily Blood; Constantine S Mitsiades; Sundar Jagannath; Steven R Zeldenrust; Melissa Alsina; Robert L Schlossman; S Vincent Rajkumar; K Raman Desikan; Teru Hideshima; Nikhil C Munshi; Kathleen Kelly-Colson; Deborah Doss; Mary L McKenney; Svetlana Gorelik; Diane Warren; Andrea Freeman; Rebecca Rich; Anfang Wu; Marta Olesnyckyj; Kenton Wride; William S Dalton; Jerome Zeldis; Robert Knight; Edie Weller; Kenneth C Anderson Journal: Blood Date: 2006-07-13 Impact factor: 22.113
Authors: W J Chng; A Dispenzieri; C-S Chim; R Fonseca; H Goldschmidt; S Lentzsch; N Munshi; A Palumbo; J S Miguel; P Sonneveld; M Cavo; S Usmani; B G M Durie; H Avet-Loiseau Journal: Leukemia Date: 2013-08-26 Impact factor: 11.528
Authors: Jens G Lohr; Petar Stojanov; Scott L Carter; Peter Cruz-Gordillo; Michael S Lawrence; Daniel Auclair; Carrie Sougnez; Birgit Knoechel; Joshua Gould; Gordon Saksena; Kristian Cibulskis; Aaron McKenna; Michael A Chapman; Ravid Straussman; Joan Levy; Louise M Perkins; Jonathan J Keats; Steven E Schumacher; Mara Rosenberg; Gad Getz; Todd R Golub Journal: Cancer Cell Date: 2014-01-13 Impact factor: 31.743
Authors: Joan Bladé; Meral Beksac; Jo Caers; Artur Jurczyszyn; Marie von Lilienfeld-Toal; Philippe Moreau; Leo Rasche; Laura Rosiñol; Saad Z Usmani; Elena Zamagni; Paul Richardson Journal: Blood Cancer J Date: 2022-03-21 Impact factor: 9.812