EVALUATION OF CURRENT CLINICAL MODELS FOR RISK OF PROGRESSION FROM SMOLDERING MULTIPLE MYELOMA TO MULTIPLE MYELOMA IN 287 PATIENTS FOLLOWED IN THE CZECH REPUBLIC
Author(s): ,
Vera Sandecka
Affiliations:
Department of Internal Medicine, Hematology and Oncology,University Hospital,Brno,Czech Republic;Czech Myeloma Group,Brno,Czech Republic
,
Roman Hajek
Affiliations:
Department of Haematooncology,University Hospital and the Faculty of Medicine University of Ostrava,Ostrava,Czech Republic;Department of Pathological Physiology, Faculty of Medicine, Masaryk University,Babak Myeloma Group,Brno,Czech Republic;Department of
,
Zdenek Adam
Affiliations:
Department of Internal Medicine, Hematology and Oncology,University Hospital Brno, Czech Republic,Brno,Czech Republic;Czech Myeloma Group,Brno,Czech Republic
,
Ivan Spicka
Affiliations:
Department of Internal Medicine,University Hospital,Prague,Czech Republic;Czech Myeloma Group,Prague,Czech Republic
,
Vlastimil Scudla
Affiliations:
Department of Hemato-oncology,University Hospital Olomouc and Faculty of Medicine and Dentistry of Palacky University,Olomouc,Czech Republic;Czech Myeloma Group,Olomouc,Czech Republic
,
Evžen Gregora
Affiliations:
Department of Clinical Hematology,University Hospital Kralovske Vinohrady,Prague,Czech Republic;Czech Myeloma Group,Prague,Czech Republic
,
Jakub Radocha
Affiliations:
4th Department of Medicine - Hematology,University Hospital,Hradec Kralove,Czech Republic;Czech Myeloma Group,Hradec Kralove,Czech Republic
,
Lucie Brozova
Affiliations:
Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University,Brno,Czech Republic
,
Jaroslav Jarkovsky
Affiliations:
Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University,Brno,Czech Republic
,
Lucie Rihova
Affiliations:
Department of Clinical Hematology,University Hospital,Brno,Czech Republic;Czech Myeloma Group,Brno,Czech Republic
,
Aneta Mikulasova
Affiliations:
Department of Clinical Hematology,University Hospital,Brno,Czech Republic;Department of Experimental Biology,Faculty of Science, Masaryk University,Brno,Czech Republic
,
David Starostka
Affiliations:
Department of Clinical Hematology,Hospital,Havirov,Czech Republic;Czech Myeloma Group,Havirov,Czech Republic
,
Lenka Walterova
Affiliations:
Department of Clinical Hematology,Hospital,Liberec,Czech Republic;Czech Myeloma Group,Liberec,Czech Republic
,
Dagmar Adamova
Affiliations:
Department of Hematology and Transfusion,Hospital,Opava,Czech Republic;Czech Myeloma Group,Opava,Czech Republic
,
Petr Kessler
Affiliations:
Department of Hematology and Transfusion Medicine,Hospital,Pelhrimov,Czech Republic;Czech Myeloma Group,Pelhrimov,Czech Republic
,
Martin Brejcha
Affiliations:
Department of Clinical Hematology,Hospital,Novy Jicin,Czech Republic;Czech Myeloma Group,Novy Jicin,Czech Republic
,
Ivan Vonke
Affiliations:
Department of Clinical Hematology,Hospital,Ceske Budejovice,Czech Republic
,
Jana Obernauerova
Affiliations:
Department of Hematology and Transfusion,Hospital,Mlada Boleslav,Czech Republic;Czech Myeloma Group,Mlada Boleslav,Czech Republic
,
Kamila Valentova
Affiliations:
Department of Clinical Hematology,Thomayer Hospital,Prague,Czech Republic
,
Ludek Pour
Affiliations:
Department of Internal Medicine, Hematology and Oncology,University Hospital,Brno,Czech Republic;Czech Myeloma Group,Brno,Czech Republic
,
Jiri Minarik
Affiliations:
Department of Hemato-oncology,University Hospital Olomouc and Faculty of Medicine and Dentistry of Palacky University,Olomouc,Czech Republic;Czech Myeloma Group,Olomouc,Czech Republic
,
Jan Straub
Affiliations:
Department of Clinical Hematology,University Hospital Kralovske Vinohrady,Prague,Czech Republic;Czech Myeloma Group,Prague,Czech Republic
,
Jaromir Gumulec
Affiliations:
Department of Haematooncology,University Hospital Ostrava and the Faculty of Medicine, University of Ostrava,Ostrava,Czech Republic;Czech Myeloma Group,Ostrava,Czech Republic
Vladimir Maisnar
Affiliations:
4th Department of Medicine - Hematology,University Hospital,Hradec Kralove,Czech Republic;Czech Myeloma Group,Hradec Kralove,Czech Republic
EHA Library. Hajek R. Jun 13, 2015; 100798; P657
Prof. Roman Hajek
Prof. Roman Hajek
Contributions
Abstract
Abstract: P657

Type: Poster Presentation

Presentation during EHA20: From 13.06.2015 17:15 to 13.06.2015 18:45

Location: Poster area (Hall C)

Background
Two risk stratification models predict the progression from smoldering multiple myeloma (SMM) to multiple myeloma (MM). i) the Mayo Clinic model uses percentage of bone marrow plasma cells (BMPCs) and serum monoclonal protein (M-protein) and free light chain (FLC) ratio, ii) the PETHEMA model uses immunoparesis and the percentage of abnormal PCs (aPCs) by flow cytometry.

Aims
The primary end point was to estimate the cumulative risk of MM occurring during the follow-up of our cohort. The secondary end points were: to validate known clinical models and to establish a new risk model by the Czech Myeloma Group (CMG model) with better prediction of ultra high-risk SMM group.

Methods
Data for this study were obtained from the Registry of Monoclonal Gammopathies (RMG) acquired from hematologic centers of the Czech Republic. In total, 361patients with SMM were enrolled in the RMG study from May 2007 to June 2013. In total, 79.5% (287/361) of patients were analyzed.

Results
287 SMM patients were followed with median 2.4 years. MM was developed in 51.9% (149/287) of patients. The risk of progression was 16%, 31.2%, 54.8% and 73.4%  at 1, 2, 5 and 10 years after diagnosis, respectively. The key predictors factors of progression were as follows: serum (iFLC/uFLC) ratio >30 (HR 2.4 [1.4 - 4.1], p<0.001), BMPCs  ≥15% (HR 2.1 [1.5-3.0]; p<0.001), immunoparesis (HR 2.0 [1.3-2.9]; p<0.001), M - protein concentration ≥2.3 g/dL (HR 2.00 [1.4-2.7]; p<0.001), beta2 microglobulin ≥2.0 mg/l (HR 1.8 [1.2-2.7]; p=0.001), and thrombocyte count ≤250 x 109/l (HR 1.7 [1.1-2.4]; p= 0.005). Distribution of SMM patients according to risk groups based on the Mayo Clinic model (Dispenzieri 2008) confirmed predictive power of this model based on low and intermediate- risk group, but did not confirm high-risk group. The high-risk group was represented only by 4 SMM patients.  At 2 years, no-risk group had 20.2% risk of progression compared to 23.2%, 45.4% and 25% in groups with 1, 2 or 3 risk factors, respectively (p=0.014) (Fig 1). SMM group with 1, 2 and 3 risk factors in comparison to the reference group had HR( 1.14 [0.54- 2.41]; p=0.732, HR 2.58 [1.25- 5.35]; p=0.011, HR 2.18 [0.47-10.03];p=0.317, n= 146), retrospectively. Immunoparesis and ≥ 95% aPC was used to validate the PETHEMA model (Perez-Persona 2007). The rates of progression at 2 years were 5.9%, 20% and 41.4% for groups with 0, 1 or 2 risk factors, respectively (p=0.058) (Fig 1). SMM group with 1 and 2 risk factors in comparison to the reference group had HR (1.51 [0.40-5.69]; p= 0.546, HR 3.31 [0.78-14.06]; p= 0.104, n=62), retrospectively. Based on the 3 parameters with independent predictive value in the univariate analysis (immunoparesis, serum M-protein quantity ≥2.3 g/dL and iFLC/uFLC >30) we proposed a new CMG model. The risk of progression from SMM to MM at 2 years was 18.5%, 20.9%, 41.9% and 78.7% if  0, 1, 2 or 3 risk factors are present (p<0.001) with HR of 1.4 [0.7-2.9]; p=0.28, 2.5 [1.2-5.0]; p=0.008, 6.7 [3.0-15.2]; p<0.001, n=139), respectively (Fig 1).

Summary
We confirmed the validity of previously considered clinical models by the Mayo Clinic group (except high-risk group) and the PETHEMA group. New CMG model for the risk of progression from SMM to MM was established. Better identification of ultra high-risk group with prediction of 79% risk of progression to MM within two years based on easily accessible clinical parameters is advantage. Acknowledgments: NT13492-4, NT14575-3 and by EU FP7/2007-2013; grant 278570, IGA MZ CR NT14393.

Keyword(s): Myeloma, Progression, Risk factor, Smoldering



Session topic: Multiple myeloma - Clinical 4

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