Early relapse following initial therapy for multiple myeloma predicts poor outcomes in the era of novel agents

N. Majithia, S Vincent Rajkumar, Martha Lacy, F. K. Buadi, Angela Dispenzieri, Morie Gertz, S. R. Hayman, David M Dingli, Prashant Kapoor, L. Hwa, J. A. Lust, Stephen J Russell, R. S. Go, R. A. Kyle, Shaji K Kumar

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Abstract

Outcomes for patients with multiple myeloma (MM) have improved in recent years owing to use of novel agents and high-dose therapy followed by autologous stem cell transplant (ASCT). We analyzed the outcomes of 511 consecutive patients treated with novel therapies at our institution between 2006 and 2014 to determine the impact of relapse within 12 months of initiating treatment. A total of 82 patients (16.0%) experienced early relapse, with median time to relapse of 8.0 months (95% confidence interval (CI); 6.3, 8.9). Median overall survival (OS) was significantly worse for this group at 21.0 months (95% CI; 16.3, 27.2) vs not reached (NR) (95% CI; 96.3, NR) for those with late relapse (P<0.001). Survival outcomes remained poor among early relapse patients irrespective of depth of response to initial therapy. In multivariate analysis, low albumin and high-risk cytogenetics predicted early relapse. Outcomes of early relapse from early ASCT were also considered; median OS from ASCT for those relapsing within 12 months was 23.1 months (95% CI; 15.7, 32.4) vs 122.2 months (95% CI; 111.5, 122.2) for the remaining patients (P<0.001). Early relapse remains a marker of poor prognosis in the current era, and such patients should be targeted for clinical trials.Leukemia advance online publication, 7 June 2016; doi:10.1038/leu.2016.147.

Original languageEnglish (US)
JournalLeukemia
DOIs
StateAccepted/In press - Jun 7 2016

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Multiple Myeloma
Recurrence
Confidence Intervals
Stem Cells
Therapeutics
Transplants
Survival
Cytogenetics
Publications
Albumins
Leukemia
Multivariate Analysis
Clinical Trials

ASJC Scopus subject areas

  • Hematology
  • Cancer Research
  • Anesthesiology and Pain Medicine

Cite this

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title = "Early relapse following initial therapy for multiple myeloma predicts poor outcomes in the era of novel agents",
abstract = "Outcomes for patients with multiple myeloma (MM) have improved in recent years owing to use of novel agents and high-dose therapy followed by autologous stem cell transplant (ASCT). We analyzed the outcomes of 511 consecutive patients treated with novel therapies at our institution between 2006 and 2014 to determine the impact of relapse within 12 months of initiating treatment. A total of 82 patients (16.0{\%}) experienced early relapse, with median time to relapse of 8.0 months (95{\%} confidence interval (CI); 6.3, 8.9). Median overall survival (OS) was significantly worse for this group at 21.0 months (95{\%} CI; 16.3, 27.2) vs not reached (NR) (95{\%} CI; 96.3, NR) for those with late relapse (P<0.001). Survival outcomes remained poor among early relapse patients irrespective of depth of response to initial therapy. In multivariate analysis, low albumin and high-risk cytogenetics predicted early relapse. Outcomes of early relapse from early ASCT were also considered; median OS from ASCT for those relapsing within 12 months was 23.1 months (95{\%} CI; 15.7, 32.4) vs 122.2 months (95{\%} CI; 111.5, 122.2) for the remaining patients (P<0.001). Early relapse remains a marker of poor prognosis in the current era, and such patients should be targeted for clinical trials.Leukemia advance online publication, 7 June 2016; doi:10.1038/leu.2016.147.",
author = "N. Majithia and Rajkumar, {S Vincent} and Martha Lacy and Buadi, {F. K.} and Angela Dispenzieri and Morie Gertz and Hayman, {S. R.} and Dingli, {David M} and Prashant Kapoor and L. Hwa and Lust, {J. A.} and Russell, {Stephen J} and Go, {R. S.} and Kyle, {R. A.} and Kumar, {Shaji K}",
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T1 - Early relapse following initial therapy for multiple myeloma predicts poor outcomes in the era of novel agents

AU - Majithia, N.

AU - Rajkumar, S Vincent

AU - Lacy, Martha

AU - Buadi, F. K.

AU - Dispenzieri, Angela

AU - Gertz, Morie

AU - Hayman, S. R.

AU - Dingli, David M

AU - Kapoor, Prashant

AU - Hwa, L.

AU - Lust, J. A.

AU - Russell, Stephen J

AU - Go, R. S.

AU - Kyle, R. A.

AU - Kumar, Shaji K

PY - 2016/6/7

Y1 - 2016/6/7

N2 - Outcomes for patients with multiple myeloma (MM) have improved in recent years owing to use of novel agents and high-dose therapy followed by autologous stem cell transplant (ASCT). We analyzed the outcomes of 511 consecutive patients treated with novel therapies at our institution between 2006 and 2014 to determine the impact of relapse within 12 months of initiating treatment. A total of 82 patients (16.0%) experienced early relapse, with median time to relapse of 8.0 months (95% confidence interval (CI); 6.3, 8.9). Median overall survival (OS) was significantly worse for this group at 21.0 months (95% CI; 16.3, 27.2) vs not reached (NR) (95% CI; 96.3, NR) for those with late relapse (P<0.001). Survival outcomes remained poor among early relapse patients irrespective of depth of response to initial therapy. In multivariate analysis, low albumin and high-risk cytogenetics predicted early relapse. Outcomes of early relapse from early ASCT were also considered; median OS from ASCT for those relapsing within 12 months was 23.1 months (95% CI; 15.7, 32.4) vs 122.2 months (95% CI; 111.5, 122.2) for the remaining patients (P<0.001). Early relapse remains a marker of poor prognosis in the current era, and such patients should be targeted for clinical trials.Leukemia advance online publication, 7 June 2016; doi:10.1038/leu.2016.147.

AB - Outcomes for patients with multiple myeloma (MM) have improved in recent years owing to use of novel agents and high-dose therapy followed by autologous stem cell transplant (ASCT). We analyzed the outcomes of 511 consecutive patients treated with novel therapies at our institution between 2006 and 2014 to determine the impact of relapse within 12 months of initiating treatment. A total of 82 patients (16.0%) experienced early relapse, with median time to relapse of 8.0 months (95% confidence interval (CI); 6.3, 8.9). Median overall survival (OS) was significantly worse for this group at 21.0 months (95% CI; 16.3, 27.2) vs not reached (NR) (95% CI; 96.3, NR) for those with late relapse (P<0.001). Survival outcomes remained poor among early relapse patients irrespective of depth of response to initial therapy. In multivariate analysis, low albumin and high-risk cytogenetics predicted early relapse. Outcomes of early relapse from early ASCT were also considered; median OS from ASCT for those relapsing within 12 months was 23.1 months (95% CI; 15.7, 32.4) vs 122.2 months (95% CI; 111.5, 122.2) for the remaining patients (P<0.001). Early relapse remains a marker of poor prognosis in the current era, and such patients should be targeted for clinical trials.Leukemia advance online publication, 7 June 2016; doi:10.1038/leu.2016.147.

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