Predictive Risk Factors for Outcome After Transplantation for Myeloma
Posted: Monday, September 17, 2018
High-risk disease and minimal residual disease–positive status after autologous hematopoietic stem cell transplant (ASCT) remain risk factors associated with a worse outcome in newly diagnosed patients with multiple myeloma, despite intensive therapy with bortezomib induction, ASCT, and maintenance therapy, found a study published in Leukemia & Lymphoma. Bei Hu, MD, of The University of Texas MD Anderson Cancer Center, Houston, and colleagues reported that both risk factors are significantly associated with an increased risk of disease progression or death.
“These patients may benefit from aggressive post-transplant maintenance, which could result in achieving a deeper response,” stated the researchers.
The study enrolled 165 patients with newly diagnosed symptomatic myeloma, including 55 with high-risk disease and 110 with standard-risk disease. All patients were treated with bortezomib-based induction therapy followed by upfront ASCT with a melphalan-containing regimen, and the median length of maintenance therapy was 28.7 months.
Patients with high-risk disease had a significantly worse median progression-free survival than did the standard-risk group (25.1 months vs. 43.3 months, P = .015), and overall survival was 56.3 months versus 88.9 months, respectively. An evaluation of individual chromosomal abnormalities revealed that patients with del 17p had significantly worse survival than did individuals with standard-risk disease.
Achieving minimal residual disease–negative status appeared to improve outcomes, with a trend toward longer overall survival, even for patients with high-risk disease. Those with no residual disease detected at 3 months post-transplant had a significantly better progression-free survival than did patients with minimal residual disease–positive status (45.6 months vs. 21.5 months).