Predicting early relapse in transplant-eligible MM patients using baseline prognostic features and MRD negativity
Dr Francesca Gay - University of Torino, Torino, Italy
The study is again on the same FORTE study that evaluated carfilzomib-based treatment up front, KRd plus transplant versus KRd without transplant or carfilzomib, cyclophosphamide, dexamethasone plus transplant in newly diagnosed patients. We analysed the factors that were related to the risk of early relapse, so relapse within 18 months from diagnosis. We did this because we know that early relapse and generally duration of remission after first line is a strong prognostic factor with patients having a short duration of remission also having a short overall survival. So it is of interest to try to understand what are the factors that impact on the risk of early relapse.
We put together baseline features and a dynamic factor that is MRD achievement with treatment. We showed that the risk of early relapse is higher in patients who had specific baseline features that we included in a score that we call the simplified early relapse multiple myeloma score. This score includes the evaluation of the LDH level, the deletion 17p, the translocation (4;14), the albumen levels, the presence of bone marrow plasma cells higher than 60% and the lambda light chain. Also we showed that patients who had circulating tumour cells higher than 0.13% have a higher risk of early relapse.
On the other hand, a lower risk of early relapse was for those patients who received KRd plus transplant and for those patients who get minimal residual disease negativity. So in this comprehensive evaluation there are several factors that need to be kept in mind if we evaluate the risk of early relapse of a patient.
Was the age of the patients a factor?
Patients analysed in this study were at a median age of 57/58 years. Age was not a factor that impacted on the risk of early relapse.
We did an analysis similar, a colleague of mine presented a poster a couple of days ago and he showed that in a big population of patients with 1,600 patients these that I listed, the LDH, the deletion 17p, the translocation (4;14), the bone marrow plasma cells percentage, the albumen levels and the lambda light chain, were factors that predicted the risk of early relapse. There was no impact of age on that.
What is the potential clinical impact?
We need to understand very well what could be these patients that will relapse early to treatment despite responding because we need to plan different therapies for these patients because once they relapse their survival is really bad, unfortunately. So the attempt in the future should be to understand which are these patients and how to treat well these patients to overcome the risk of early relapse.
