Contributions
Abstract: EP1043
Type: E-Poster Presentation
Session title: Myeloma and other monoclonal gammopathies - Clinical
Background
Achievement of the complete remission (CR) represents one of the most powerful prognostic indicators in patients (pts) with multiple myeloma, along with prognostic indices as International Staging System (ISS) and recently established Revised ISS score (R-ISS).
Aims
The aim of study was to analyze prognostic significance of Response-adjusted ISS (RaISS) in transplant ineligible MM pts.
Methods
The study included 257 newly diagnosed, transplant ineligible MM, diagnosed during period 2009-2020 (129 male; 128 female, mean age 66 yrs, range 35-85 yrs). The IgG myeloma was diagnosed in 155pts (60.3%), IgA in 50 (19.5%), BJ in 43 (16.7%), IgD in 3 (1.2%) and IgM in 1pt (0.4%). According to the clinical stage (CS, Durie-Salmon), patients were distributed as follows: III 207pts (80.5%); II 38pts (14.8%); and I CS 10pts (3.9%). Renal impairment was present in 82pts (31.9%) and elevated LDH in 58pts (22.6%). Regarding ISS score, the group included: ISS1 had 55pts (21.4%), ISS2 65pts (25.3%) and 137pts (53.3%) had ISS3. According to the Revised ISS (R-ISS) score, R-ISS1 was found in 40pts (15.6%), R-ISS2 in 164pts (63.8%), while R-ISS3 was present in 53pts (20.6%). Treatment with triple thalidomide (Thal) based chemotherapy (HT) was applied in 129pts (50.2%) with standard risk features (R-ISS1), while bortezomib (Bz) based triplets were applied in 95pts (37%) with high risk features (R-ISS2 and R-ISS3). Standard HT was applied in 33pts (12.9%).
Results
Considering RaISS score, the group of pts treated with Thal-based HT, consisted of: 15pts (11.6%) with low risk (RaISS 0-1); 65pts (50.4%) with intermediate risk (RaISS 2-3); and 49pts (40.3%) with high risk (RaISS 4). There was significant difference in PFS (Log Rank 7.197; p=0.027), and, even more pronounced, in OS (log Rank 22.192; p=0.000) between low risk pts (RaISS 0-1), and intermediate or high risk pts (RaISS 2-3; RaISS 4), treated with Thal-based HT. The distribution according the RaISS score in the pts group treated with Bz-based combos was as follows: low risk - 11pts (11.6%); intermediate - risk 36pts (37.9%); high risk- 48pts (50.5%). Although there was no difference in PFS (Log Rank 3.307; p=0.191), pts of low risk, with RaISS score 0-1, had significantly longer OS (Log Rank 13.894; p=0.001) in comparison to the pts of intermediate and high risk (RaISS ≥2), treated with Bz-based triplets. There was no difference in PFS (Log Rank 0.008; p=0.930) or OS (Log Rank 0.502; p=0.479) between pts with RaISS 4, and pts with R-ISS 3 (Log Rank 0.008; p=0.930) treated with Thal-based HT. Likewise, no difference was found considering PFS (Log Rank 0.168; p=0.682) and OS (Log Rank 0.923; p=0.337) in patients treated with Bz-based triplets with RaISS 4 in comparison to the pts with R-ISS3.
Conclusion
RaISS score represents simple and powerful prognostic tool. Compared to R-ISS scoryng system, it seems that tailored treatment approach according to the R-ISS, overcomes high-risk features in patients with multiple myeloma.
Keyword(s): Myeloma, Prognosis, Treatment
Abstract: EP1043
Type: E-Poster Presentation
Session title: Myeloma and other monoclonal gammopathies - Clinical
Background
Achievement of the complete remission (CR) represents one of the most powerful prognostic indicators in patients (pts) with multiple myeloma, along with prognostic indices as International Staging System (ISS) and recently established Revised ISS score (R-ISS).
Aims
The aim of study was to analyze prognostic significance of Response-adjusted ISS (RaISS) in transplant ineligible MM pts.
Methods
The study included 257 newly diagnosed, transplant ineligible MM, diagnosed during period 2009-2020 (129 male; 128 female, mean age 66 yrs, range 35-85 yrs). The IgG myeloma was diagnosed in 155pts (60.3%), IgA in 50 (19.5%), BJ in 43 (16.7%), IgD in 3 (1.2%) and IgM in 1pt (0.4%). According to the clinical stage (CS, Durie-Salmon), patients were distributed as follows: III 207pts (80.5%); II 38pts (14.8%); and I CS 10pts (3.9%). Renal impairment was present in 82pts (31.9%) and elevated LDH in 58pts (22.6%). Regarding ISS score, the group included: ISS1 had 55pts (21.4%), ISS2 65pts (25.3%) and 137pts (53.3%) had ISS3. According to the Revised ISS (R-ISS) score, R-ISS1 was found in 40pts (15.6%), R-ISS2 in 164pts (63.8%), while R-ISS3 was present in 53pts (20.6%). Treatment with triple thalidomide (Thal) based chemotherapy (HT) was applied in 129pts (50.2%) with standard risk features (R-ISS1), while bortezomib (Bz) based triplets were applied in 95pts (37%) with high risk features (R-ISS2 and R-ISS3). Standard HT was applied in 33pts (12.9%).
Results
Considering RaISS score, the group of pts treated with Thal-based HT, consisted of: 15pts (11.6%) with low risk (RaISS 0-1); 65pts (50.4%) with intermediate risk (RaISS 2-3); and 49pts (40.3%) with high risk (RaISS 4). There was significant difference in PFS (Log Rank 7.197; p=0.027), and, even more pronounced, in OS (log Rank 22.192; p=0.000) between low risk pts (RaISS 0-1), and intermediate or high risk pts (RaISS 2-3; RaISS 4), treated with Thal-based HT. The distribution according the RaISS score in the pts group treated with Bz-based combos was as follows: low risk - 11pts (11.6%); intermediate - risk 36pts (37.9%); high risk- 48pts (50.5%). Although there was no difference in PFS (Log Rank 3.307; p=0.191), pts of low risk, with RaISS score 0-1, had significantly longer OS (Log Rank 13.894; p=0.001) in comparison to the pts of intermediate and high risk (RaISS ≥2), treated with Bz-based triplets. There was no difference in PFS (Log Rank 0.008; p=0.930) or OS (Log Rank 0.502; p=0.479) between pts with RaISS 4, and pts with R-ISS 3 (Log Rank 0.008; p=0.930) treated with Thal-based HT. Likewise, no difference was found considering PFS (Log Rank 0.168; p=0.682) and OS (Log Rank 0.923; p=0.337) in patients treated with Bz-based triplets with RaISS 4 in comparison to the pts with R-ISS3.
Conclusion
RaISS score represents simple and powerful prognostic tool. Compared to R-ISS scoryng system, it seems that tailored treatment approach according to the R-ISS, overcomes high-risk features in patients with multiple myeloma.
Keyword(s): Myeloma, Prognosis, Treatment