Revised International Staging System Is Predictive and Prognostic for Early Relapse (<24 months) after Autologous Transplantation for Newly Diagnosed Multiple Myeloma

Sathish Gopalakrishnan, Anita D'Souza, Emma Scott, Raphael Fraser, Omar Davila, Nina Shah, Robert Peter Gale, Rammurti Kamble, Miguel Angel Diaz, Hillard M. Lazarus, Bipin N. Savani, Gerhard C. Hildebrandt, Melhem Solh, Cesar O. Freytes, Cindy Lee, Robert A. Kyle, Saad Z. Usmani, Siddhartha Ganguly, Amer Assal, Jesus Berdeja & 14 others Abraham S. Kanate, Binod Dhakal, Kenneth Meehan, Tamila Kindwall-Keller, Ayman Saad, Frederick Locke, Sachiko Seo, Taiga Nishihori, Usama Gergis, Cristina Gasparetto, Tomer Mark, Yago Nieto, Shaji Kumar, Parameswaran Hari

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

The revised International Staging System (R-ISS) combines ISS with genetic markers and lactate dehydrogenase and can prognosticate newly diagnosed multiple myeloma (MM). Early relapse (<24 months) after upfront autologous hematopoietic cell transplantation (AHCT) strongly predicts inferior overall survival (OS). We examined the ability of R-ISS in predicting early relapse and its independent prognostic effect on postrelapse survival after an early relapse. Using the Center for International Blood and Marrow Transplant Research database we identified MM patients receiving first AHCT within 18 months after diagnosis with available R-ISS stage at diagnosis (n = 628). Relative risks of relapse/progression, progression-free survival (PFS), and OS were calculated with the R-ISS group as a predictor in multivariate analysis. Among early relapsers, postrelapse survival was tested to identify factors affecting postrelapse OS. The cumulative incidence of early relapse was 23%, 39%, and 50% for R-ISS I, R-ISS II, and R-ISS III, respectively (P <.001). Shorter PFS and OS were seen with higher stage R-ISS. R-ISS was independently predictive for inferior postrelapse OS among early relapsers, as was the presence of ≥3 comorbidities and the use of ≥2 induction chemotherapy lines. R-ISS stage at diagnosis predicts early post-AHCT relapse and independently affects postrelapse survival among early relapsers.

Original languageEnglish (US)
JournalBiology of Blood and Marrow Transplantation
DOIs
StateAccepted/In press - Jan 1 2019

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Autologous Transplantation
Multiple Myeloma
Recurrence
Survival
Cell Transplantation
Disease-Free Survival
Induction Chemotherapy
Genetic Markers
L-Lactate Dehydrogenase
Comorbidity
Multivariate Analysis
Bone Marrow
Databases
Transplants
Incidence
Research

Keywords

  • Myeloma stage
  • Postrelapse survival
  • Transplant

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

Revised International Staging System Is Predictive and Prognostic for Early Relapse (<24 months) after Autologous Transplantation for Newly Diagnosed Multiple Myeloma. / Gopalakrishnan, Sathish; D'Souza, Anita; Scott, Emma; Fraser, Raphael; Davila, Omar; Shah, Nina; Gale, Robert Peter; Kamble, Rammurti; Diaz, Miguel Angel; Lazarus, Hillard M.; Savani, Bipin N.; Hildebrandt, Gerhard C.; Solh, Melhem; Freytes, Cesar O.; Lee, Cindy; Kyle, Robert A.; Usmani, Saad Z.; Ganguly, Siddhartha; Assal, Amer; Berdeja, Jesus; Kanate, Abraham S.; Dhakal, Binod; Meehan, Kenneth; Kindwall-Keller, Tamila; Saad, Ayman; Locke, Frederick; Seo, Sachiko; Nishihori, Taiga; Gergis, Usama; Gasparetto, Cristina; Mark, Tomer; Nieto, Yago; Kumar, Shaji; Hari, Parameswaran.

In: Biology of Blood and Marrow Transplantation, 01.01.2019.

Research output: Contribution to journalArticle

Gopalakrishnan, S, D'Souza, A, Scott, E, Fraser, R, Davila, O, Shah, N, Gale, RP, Kamble, R, Diaz, MA, Lazarus, HM, Savani, BN, Hildebrandt, GC, Solh, M, Freytes, CO, Lee, C, Kyle, RA, Usmani, SZ, Ganguly, S, Assal, A, Berdeja, J, Kanate, AS, Dhakal, B, Meehan, K, Kindwall-Keller, T, Saad, A, Locke, F, Seo, S, Nishihori, T, Gergis, U, Gasparetto, C, Mark, T, Nieto, Y, Kumar, S & Hari, P 2019, 'Revised International Staging System Is Predictive and Prognostic for Early Relapse (<24 months) after Autologous Transplantation for Newly Diagnosed Multiple Myeloma', Biology of Blood and Marrow Transplantation. https://doi.org/10.1016/j.bbmt.2018.12.141
Gopalakrishnan, Sathish ; D'Souza, Anita ; Scott, Emma ; Fraser, Raphael ; Davila, Omar ; Shah, Nina ; Gale, Robert Peter ; Kamble, Rammurti ; Diaz, Miguel Angel ; Lazarus, Hillard M. ; Savani, Bipin N. ; Hildebrandt, Gerhard C. ; Solh, Melhem ; Freytes, Cesar O. ; Lee, Cindy ; Kyle, Robert A. ; Usmani, Saad Z. ; Ganguly, Siddhartha ; Assal, Amer ; Berdeja, Jesus ; Kanate, Abraham S. ; Dhakal, Binod ; Meehan, Kenneth ; Kindwall-Keller, Tamila ; Saad, Ayman ; Locke, Frederick ; Seo, Sachiko ; Nishihori, Taiga ; Gergis, Usama ; Gasparetto, Cristina ; Mark, Tomer ; Nieto, Yago ; Kumar, Shaji ; Hari, Parameswaran. / Revised International Staging System Is Predictive and Prognostic for Early Relapse (<24 months) after Autologous Transplantation for Newly Diagnosed Multiple Myeloma. In: Biology of Blood and Marrow Transplantation. 2019.
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T1 - Revised International Staging System Is Predictive and Prognostic for Early Relapse (<24 months) after Autologous Transplantation for Newly Diagnosed Multiple Myeloma

AU - Gopalakrishnan, Sathish

AU - D'Souza, Anita

AU - Scott, Emma

AU - Fraser, Raphael

AU - Davila, Omar

AU - Shah, Nina

AU - Gale, Robert Peter

AU - Kamble, Rammurti

AU - Diaz, Miguel Angel

AU - Lazarus, Hillard M.

AU - Savani, Bipin N.

AU - Hildebrandt, Gerhard C.

AU - Solh, Melhem

AU - Freytes, Cesar O.

AU - Lee, Cindy

AU - Kyle, Robert A.

AU - Usmani, Saad Z.

AU - Ganguly, Siddhartha

AU - Assal, Amer

AU - Berdeja, Jesus

AU - Kanate, Abraham S.

AU - Dhakal, Binod

AU - Meehan, Kenneth

AU - Kindwall-Keller, Tamila

AU - Saad, Ayman

AU - Locke, Frederick

AU - Seo, Sachiko

AU - Nishihori, Taiga

AU - Gergis, Usama

AU - Gasparetto, Cristina

AU - Mark, Tomer

AU - Nieto, Yago

AU - Kumar, Shaji

AU - Hari, Parameswaran

PY - 2019/1/1

Y1 - 2019/1/1

N2 - The revised International Staging System (R-ISS) combines ISS with genetic markers and lactate dehydrogenase and can prognosticate newly diagnosed multiple myeloma (MM). Early relapse (<24 months) after upfront autologous hematopoietic cell transplantation (AHCT) strongly predicts inferior overall survival (OS). We examined the ability of R-ISS in predicting early relapse and its independent prognostic effect on postrelapse survival after an early relapse. Using the Center for International Blood and Marrow Transplant Research database we identified MM patients receiving first AHCT within 18 months after diagnosis with available R-ISS stage at diagnosis (n = 628). Relative risks of relapse/progression, progression-free survival (PFS), and OS were calculated with the R-ISS group as a predictor in multivariate analysis. Among early relapsers, postrelapse survival was tested to identify factors affecting postrelapse OS. The cumulative incidence of early relapse was 23%, 39%, and 50% for R-ISS I, R-ISS II, and R-ISS III, respectively (P <.001). Shorter PFS and OS were seen with higher stage R-ISS. R-ISS was independently predictive for inferior postrelapse OS among early relapsers, as was the presence of ≥3 comorbidities and the use of ≥2 induction chemotherapy lines. R-ISS stage at diagnosis predicts early post-AHCT relapse and independently affects postrelapse survival among early relapsers.

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