ASH 2018: Early Relapse After Transplant - A New Indicator of Outcomes for Myeloma Patients?

Doctors constantly talk about "prognostic factors" in determining whether a myeloma patient is high or low risk.

 

Commonly, myeloma genetics tests like cytogenetics tests (FISH), gene expression profiling (GEP) and International Myeloma Staging Systems have all been used because higher risk genetic features have been identified. This can include features on the myeloma cells such as a deletion of 17p, a swapping (translocation) of genes like 4;14 or the addition of an extra gene copy like the 1q gain. 

 

Ceri A Bygrave, MD, FRCPath, FRCP, MPhil, Consultant Haematologist University Hospital of Wales University Hospital of Wales Heath Park Cardiff United Kingdom presented a study of 1274 myeloma patients who had received a stem cell transplant.  The title of this abstract is:

Of the 1274 patients receiving transplant, 14% relapsed within 12 months and 86% relapsed after one year.  Early relapse patients were almost twice as likely to have received three lines of treatment. (The majority of these had received lenalidomide alone or in combos). 

For patients who relapsed early, there was a direct connection with overall survival with 28% of the early relapse group having 3 year overall survival compared to 53% of the late relapse group. 

The study then followed up to review this group with early relapse after transplant. There was no difference in age, gender, or induction therapy. More of the lambda light chain patients were in the early relapse group. Interestingly, hemoglobin levels were lower in the early relapse group. At lease 31% of the patients in the early relapse group had at least one high-risk feature (such as the del17p, 4;14, 14;16 or 1q gain) and 33% had two or more high-risk genetic features (also called ultra-high-risk).  

Almost 75% of patients with the relapsed within a year of transplant had died 3 years after entering the MXI study, noting that much more work is needed for these patients.