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 BerdejaAbraham 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

6 Scopus citations

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)
Pages (from-to)683-688
Number of pages6
JournalBiology of Blood and Marrow Transplantation
Volume25
Issue number4
DOIs
StatePublished - Apr 2019

Keywords

  • Myeloma stage
  • Postrelapse survival
  • Transplant

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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    Gopalakrishnan, S., D'Souza, A., Scott, E., Fraser, R., Davila, O., Shah, N., Gale, R. P., Kamble, R., Diaz, M. A., Lazarus, H. M., Savani, B. N., Hildebrandt, G. C., Solh, M., Freytes, C. O., Lee, C., Kyle, R. A., Usmani, S. Z., Ganguly, S., Assal, A., ... 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, 25(4), 683-688. https://doi.org/10.1016/j.bbmt.2018.12.141