Contributions
Abstract: PB1664
Type: Publication Only
Session title: Myeloma and other monoclonal gammopathies - Clinical
Background
Multiple myeloma (MM) is considered a disease of elderlies with only 15% of cases occurring in patients (pts) ≤55 years (ys) old. Despite the improvements on response and survival rates after treatment with the novel agents combinations, the disease still remains incurable. Focusing on younger pts, although they succeed better outcomes, a considerable number of them (25-35%) succumb to MM, within 5 years after diagnosis. Therefore, even in the novel agents era, an efficient treatment approach for young and fit pts remains a goal to be fulfilled.
Aims
In this retrospective study we evaluated the overall survival (OS) and the potentially related risk factors, in newly diagnosed MM pts aged ≤55 years. We also designed a scoring system with predictive value on their long-term outcome.
Methods
We reviewed the medical records of 122 pts who were treated in our center from 2010-2020 and received either combinations with 2 (n=21) or 3 (n=91) agents of Velcade, Cyclophosphamide, Thalidomide, Lenalidomide and Dexamethasone, or other regimens (n=10), and had also adequate data regarding their age, disease stage (according to ISS), response to the treatment (according to the latest IMWG criteria) and long-term outcome. Pts diagnosed with amyloidosis or smoldering MM were excluded from the study. Student’s t-test, Kaplan-Meir and Cox regression methods, were used for the statistical analysis.
Results
Based on the whole cohort’s median age (55 ys, range, 38-80), we divided our pts in two groups: those of ≤55 ys (group A, n=63) and those of >55ys (group B, n: 59). Cytogenetic analysis was feasible in 75 (60%) and only 7/75 pts found to have high risk features. No significant differences were noticed between the two groups in terms of disease stage, cytogenetic abnormalities and response rates after induction remission treatment. Autologous stem cell transplantation (ASCT) was performed in 69 pts [51 (81%) from group A and 18 (30%) from group B, p< .001]. After a median follow up of 28 months, the 10-year OS was better for group A (75% vs 50%) and the median OS was not reached in group A vs 6,5 ys in group B (p: 0,01). With regard to younger pts, we observed that approximately 25% died within 5 years after MM diagnosis, even if combinations of novel agents plus ASCT (either as induction or as salvage treatment) had been used. Three factors adversely affected the outcome of group A pts: advanced stage, less than VGPR achievement after induction treatment and presence of extramedullary disease at diagnosis. Based on these 3 factors we created an easily applicable scoring system. Due to the insufficient number of pts with chromosomal analysis, the cytogenetic abnormalities were not incorporated in the scoring system. Pts with 0-1 factors had significantly better prolonged OS rates as compared to those with 2-3 factors (82% vs. 55% p=0.02). Also, in multivariate analysis, our proposed scoring system was found to be independent risk factor for prolonged survival.
Conclusion
The heterogeneity in the outcomes among the MM pts, denotes that the “one size fits all” approach, probably is not efficient enough at least for selected young pts with adverse disease features. Currently, the plethora of the available novel treatment agents, highlights the unmet need to establish appropriate criteria for personalized and more efficient treatment approaches for MM pts, especially for the younger ones. In this study, using an easily applicable scoring system, we were able to identify pts ≤55 ys who might need more intensive treatment approaches aiming at prolonged survival rates.
Keyword(s): High risk, Multiple myeloma, Treatment
Abstract: PB1664
Type: Publication Only
Session title: Myeloma and other monoclonal gammopathies - Clinical
Background
Multiple myeloma (MM) is considered a disease of elderlies with only 15% of cases occurring in patients (pts) ≤55 years (ys) old. Despite the improvements on response and survival rates after treatment with the novel agents combinations, the disease still remains incurable. Focusing on younger pts, although they succeed better outcomes, a considerable number of them (25-35%) succumb to MM, within 5 years after diagnosis. Therefore, even in the novel agents era, an efficient treatment approach for young and fit pts remains a goal to be fulfilled.
Aims
In this retrospective study we evaluated the overall survival (OS) and the potentially related risk factors, in newly diagnosed MM pts aged ≤55 years. We also designed a scoring system with predictive value on their long-term outcome.
Methods
We reviewed the medical records of 122 pts who were treated in our center from 2010-2020 and received either combinations with 2 (n=21) or 3 (n=91) agents of Velcade, Cyclophosphamide, Thalidomide, Lenalidomide and Dexamethasone, or other regimens (n=10), and had also adequate data regarding their age, disease stage (according to ISS), response to the treatment (according to the latest IMWG criteria) and long-term outcome. Pts diagnosed with amyloidosis or smoldering MM were excluded from the study. Student’s t-test, Kaplan-Meir and Cox regression methods, were used for the statistical analysis.
Results
Based on the whole cohort’s median age (55 ys, range, 38-80), we divided our pts in two groups: those of ≤55 ys (group A, n=63) and those of >55ys (group B, n: 59). Cytogenetic analysis was feasible in 75 (60%) and only 7/75 pts found to have high risk features. No significant differences were noticed between the two groups in terms of disease stage, cytogenetic abnormalities and response rates after induction remission treatment. Autologous stem cell transplantation (ASCT) was performed in 69 pts [51 (81%) from group A and 18 (30%) from group B, p< .001]. After a median follow up of 28 months, the 10-year OS was better for group A (75% vs 50%) and the median OS was not reached in group A vs 6,5 ys in group B (p: 0,01). With regard to younger pts, we observed that approximately 25% died within 5 years after MM diagnosis, even if combinations of novel agents plus ASCT (either as induction or as salvage treatment) had been used. Three factors adversely affected the outcome of group A pts: advanced stage, less than VGPR achievement after induction treatment and presence of extramedullary disease at diagnosis. Based on these 3 factors we created an easily applicable scoring system. Due to the insufficient number of pts with chromosomal analysis, the cytogenetic abnormalities were not incorporated in the scoring system. Pts with 0-1 factors had significantly better prolonged OS rates as compared to those with 2-3 factors (82% vs. 55% p=0.02). Also, in multivariate analysis, our proposed scoring system was found to be independent risk factor for prolonged survival.
Conclusion
The heterogeneity in the outcomes among the MM pts, denotes that the “one size fits all” approach, probably is not efficient enough at least for selected young pts with adverse disease features. Currently, the plethora of the available novel treatment agents, highlights the unmet need to establish appropriate criteria for personalized and more efficient treatment approaches for MM pts, especially for the younger ones. In this study, using an easily applicable scoring system, we were able to identify pts ≤55 ys who might need more intensive treatment approaches aiming at prolonged survival rates.
Keyword(s): High risk, Multiple myeloma, Treatment