Changing trends in prognostic factors for patients with multiple myeloma after autologous stem cell transplantation during the immunomodulator drug/proteasome inhibitor era

Abstract

We evaluated the clinical significance of prognostic factors including the International Staging System (ISS) and modified European Group for Blood and Marrow Transplantation response criteria in 1650 Japanese patients with multiple myeloma (MM) who underwent upfront single autologous stem cell transplantation (ASCT). We categorized patients into two treatment cohorts: pre-novel agent era (1995–2006) and novel agent era (2008–2011). The combined percentage of pre-ASCT complete response and very good partial response cases (463 of 988, 47%) significantly increased during the novel agent era compared with the pre-novel agent era (164 of 527, 31%; P < 0.0001). The 2-year overall survival (OS) rate of 87% during the novel agent era was a significant improvement relative to that of 82% during the pre-novel agent era (P = 0.019). Although significant differences in OS were found among ISS stages during the pre-novel agent era, no significant difference was observed between ISS I and II (P = 0.107) during the novel agent era. The factors independently associated with a superior OS were female gender (P = 0.002), a good performance status (P = 0.024), lower ISS (P < 0.001), pre-ASCT response at least partial response (P < 0.001) and ASCT during the novel agent era (P = 0.017). These results indicate that the response rate and OS were significantly improved, and the ISS could not clearly stratify the prognoses of Japanese patients with MM who underwent upfront single ASCT during the novel agent era.

Early relapse post autologous transplant is a stronger predictor of survival compared with pretreatment patient factors in the novel agent era: analysis of the Singapore Multiple Myeloma Working Group

“…This population may have inherent biologic characteristics that do not respond well to a single autologous transplant. Lastly, our observations that the old ISS may be less robust in the novel agent era (only associated with PFS/early relapse but not OS) parallel findings by prior studies, 16 and support the use of the revised ISS, which includes adverse cytogenetics, for risk stratification. 17 However, the prognostic impact of adverse cytogentics (17p13 deletion, t(14;16) or t(4;14)) needs to be clarified further.…”

Pretreatment Lymphopenia, Poor Performance Status, and Early Courses of Therapy Are Risk Factors for Severe Bacterial Infection in Patients with Multiple Myeloma during Treatment with Bortezomib-based Regimens

“…Poor performance status has been reported as a poor prognostic factor for survival ( 1 , 24 ), which increases treatment-related toxicity and/or the risk of infection in MM ( 25 ). Because the bortezomib-based treatment for patients with poor performance status is usually performed in the inpatient setting, these patients can be easily exposed to a variety of nosocomial infections.…”

Clinical Implications of t(11;14) in Patients with Multiple Myeloma Undergoing Autologous Stem Cell Transplantation

“…Patient responses to therapy were assessed on the basis of the IMWG criteria [7,8]. Primary outcomes were progression-free survival (PFS) and overall survival (OS) [7].…”

“…The study cohort included 1432 Japanese patients (811 males and 621 females), with a median age of 58 years (range, 18 to 73 years) who underwent upfront single ASCT in Japan between March 2001 and December 2011 after treatment with 200 mg/m 2 melphalan for newly diagnosed symptomatic MM [8]. After reviewing the registry data, information on 110 patients with MM harboring t (11;14), t (4;14), and/or del 17p detected by G-banding and/or FISH were extracted and investigated using detailed questionnaires.…”