Preliminary Report of Risk-Based Approach in Korean Patients with Newly Diagnosed Multiple Myeloma.

Abstract

Purpose: The purpose of this study was to examine the impact of different approaches stratified on risk based on chromosome 13 deletion and serum beta-2 microglobulin (MG) level would lead to survival benefit in patients with newly-diagnosed multiple myeloma. Patients and Methods: At diagnosis, fresh marrow samples for FISH and serum for beta-2 MG were sent to central laboratory and reviewed. Patients who had chromosome 13 deletion and high beta-2 MG (>2.5 mg/L) were considered to have high-risk disease. Patients without chromosome 13 deletion and low beta-2 MG were classified as low-risk group. Intermediate-risk group had to have either one of these two risk factors. After VAD induction chemotherapy, autologous stem cell transplantation conditioned with MEL200 was performed in patients at high- and intermediate-risk. DECP consolidation chemotherapy was added for high-risk patients. Patients who achieved CR after VAD in low-risk did not receive any further treatment. Results: As of Jun 2004, 50 patients were registered from 10 centers. Median age was 58 (range, 39–68) years old. Chromosome 13 deletion was detected in 18 patients (36%) and beta-2 MG was elevated in 39 patients (78%). Thirteen patients were classified as high-risk, 31 patients as intermediate-risk and 6 patients as low-risk. After median follow-up of 9 months, progression-free and overall survival at 1-year were 56% and 76%, respectively. To date, no statistically significant differences in survival were observed between risk groups (figure 1). Conclusion: In this study, risk-based approach in patients with multiple myeloma appeared to be feasible. Study accrual is ongoing and updated results will be presented. Figure Figure

Recent advances in multiple myeloma: a Korean perspective

“…They began to conduct small multicenter studies, initially as a retrospective analysis testing the feasibility of ASCT [ 74 ], followed by a prospective trial [ 75 ]. A more sophisticated prospective trial of risk-adapted therapy based on FISH and serum β2-microglobulin results, in which allogeneic transplantation is included for the high-risk group, was attempted [ 76 ]. Later, the efficacies of bortezomib [ 77 ] or thalidomide [ 78 ] in patients with R/R MM were evaluated retrospectively in small numbers of patients, with the advent of novel agents in Korea.…”