Revised International Staging System Is Predictive and Prognostic for Early Relapse (<24 months) after Autologous Transplantation for Newly Diagnosed Multiple Myeloma

Abstract

A B S T R A C TThe revised International Staging System (R-ISS) combines ISS with genetic markers and lactate dehydrogenase and can prognosticate newly diagnosed multiple myeloma (MM). Early relapse (<24 months) after upfront autologous hematopoietic cell transplantation (AHCT) strongly predicts inferior overall survival (OS). We examined the ability of R-ISS in predicting early relapse and its independent prognostic effect on postrelapse survival after an journal homepage: www.bbmt.org early relapse. Using the Center for International Blood and Marrow Transplant Research database we identified MM patients receiving first AHCT within 18 months after diagnosis with available R-ISS stage at diagnosis (n = 628). Relative risks of relapse/progression, progression-free survival (PFS), and OS were calculated with the R-ISS group as a predictor in multivariate analysis. Among early relapsers, postrelapse survival was tested to identify factors affecting postrelapse OS. The cumulative incidence of early relapse was 23%, 39%, and 50% for R-ISS I, R-ISS II, and R-ISS III, respectively (P < .001). Shorter PFS and OS were seen with higher stage R-ISS. R-ISS was independently predictive for inferior postrelapse OS among early relapsers, as was the presence of 3 comorbidities and the use of 2 induction chemotherapy lines. R-ISS stage at diagnosis predicts early post-AHCT relapse and independently affects postrelapse survival among early relapsers.

Early relapse after autologous transplant for myeloma is associated with poor survival regardless of cytogenetic risk

“…For instance t(4;14) has been shown to induce a chemotherapy sensitive disease, characterized by a high OR rate, but patients achieved short PFS after transplantation. 12 Very recently, revised-ISS has been shown to be predictive and prognostic for relapse within 24 months after ASCT, 13 confirming that some initial characteristics are associated with higher probablity to experiment short PFS. But importantly, we observed that not all patients with ER were included in high-risk cytogenetic group, since 12.5% of standard-risk patients experienced an ER ( vs. 25.4% of high-risk cytogenetic group, see Table 1 ).…”

Novel prognostic scoring system for autologous hematopoietic cell transplantation in multiple myeloma

“…Next, we compared the CIBMTR scoring system with the R‐ISS system in a second validation cohort of patients undergoing upfront AHCT with available R‐ISS at diagnosis ( n = 488), previously reported by the CIBMTR 9 . The 3‐year PFS was 59% (95% CI: 52–64) in low risk group compared to 68% (95% CI: 59–75) in R‐ISS I (Figure S1A,B).…”

Correlations Between Apparent Diffusion Coefficient Values of WB-DWI&nbsp;and Clinical Parameters in Multiple Myeloma

“…[21,22] Moreover, the RISS staging system can predict the prognosis of patients with MM. [23] Beksac et al [24] found that patients with ISS stage I had a signi cantly better prognosis than stage and patients. Soekojo et al [25] reported that when compared with the RISS, there was a high level of concordance in high-risk patients identi ed using FISH analysis with an independent cohort of 375 patients.…”