Novel risk stratification algorithm for estimating the risk of death in patients with relapsed multiple myeloma: external validation in a retrospective chart review

The prognostic utility of dynamic risk stratification at disease progression in patients with multiple myeloma

OBJECTIVES

There may be a shift in risk stratification at progression compared to that at diagnosis in patients with multiple myeloma (MM). We aimed to evaluate whether re-staging and stage migration is of prognostic impact.

METHODS

Real-world data from the National Longitudinal Cohort of Hematologic Diseases-multiple myeloma were collected; 263 consecutive patients demonstrating disease progression were finally included. Staging at diagnosis and re-staging at progression were performed using the International Staging System (ISS) and Revised International Staging System (RISS).

RESULTS

Based on ISS re-staging, the median post-progression survival (mPPS) of patients with stage I, II, and III was 44.2, 21.7, and 11.6 months, respectively (P < 0.0001). Based on RISS re-staging, the mPPS of patients with stage I, II, and III was 50.3, 22.2, and 11.4 months, respectively (P < 0.0001). The mPPS in patients with improved, maintained, and deteriorated ISS stage migration from diagnosis was 33.6, 20.9, and 16 months, respectively (P = 0.0051) and that with improved, maintained, and deteriorated RISS stage migration was 48.4, 23.1, and 13.9 months, respectively (P < 0.001). Compared to patients with maintained or improved disease stage, those with deteriorated ISS/RISS migration showed significantly higher incidence of Del(17P) at progression and worse PPS. Multivariate analyses indicated both re-staging and stage migration by ISS/RISS at progression were independent predictors for PPS.

CONCLUSIONS

We demonstrated that ISS/RISS re-staging showed superior prognostic utility over ISS/RISS staging in predicting PPS. Patients with deteriorated stage migration or maintained advanced stage at progression may need more individualized treatment.

Establishment and Validation for Predicting the Death of Multiple Myeloma among Whites

The prognosis of multiple myeloma (MM) patients was poor in white-American patients as compared to black-American patients. This study aimed to predict the death of MM patients in whites based on the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database. A total of 28,912 white MM patients were included in this study. Data were randomly divided into a training set and a test set (7 : 3). The random forest and 5-fold cross-validation were used for developing a prediction model. The performance of the model was determined by calculating the area under the curve (AUC) with 95% confidence interval (CI). MM patients in the death group had older age, higher proportion of tumor distant metastasis, bone marrow as the disease site, receiving radiotherapy, and lower proportion of receiving chemotherapy than that in the survival group (all P < 0.001). The AUC of the random forest model in the training set and testing set was 0.741 (95% CI, 0.740–0.741) and 0.703 (95% CI, 0.703–0.704), respectively. In addition, the AUC of the age-based model was 0.688 (95% CI, 0.688–0.689) in the testing set. The results of the DeLong test indicated that the random forest model had better predictive effect than the age-based model (Z = 7.023, P < 0.001). Further validation was performed based on age and marital status. The results presented that the random forest model was robust in different age and marital status. The random forest model had a good performance to predict the death risk of MM patients in whites.

Efficacy and safety profile of deep responders to carfilzomib-based therapy: a subgroup analysis from ASPIRE and ENDEAVOR

To understand the profile of best responders (complete response or better [≥CR]) to carfilzomib, we described the characteristics, progression-free survival (PFS), overall survival (OS) data, and the safety of patients who achieved ≥CR to carfilzomib-based treatment in ASPIRE and ENDEAVOR. In post hoc analyses from ASPIRE and ENDEAVOR, median PFS and OS were longer for ≥CR patients versus those who achieved a very good partial response or partial response (VGPR/PR). In the carfilzomib arm of ASPIRE, median PFS was 50.4 months for ≥CR versus 22.1 months for VGPR/PR; median OS was 67.0 versus 44.2 months, respectively. In the carfilzomib arm of ENDEAVOR, median PFS was 34.0 for ≥CR versus 20.4 months for VGPR/PR; median OS was non-estimable. Despite the longer treatment duration, fewer patients with ≥CR versus VGPR/PR experienced treatment-emergent adverse events that led to discontinuation of carfilzomib-based treatment in ASPIRE or ENDEAVOR. Low serum lactate dehydrogenase was the only factor associated with achieving ≥CR vs patients not achieving CR in ASPIRE in multivariate regression analyses. No association was found between cytogenetic risk status and reaching ≥CR. Carfilzomib treatment may lead to rapid and deep responses, irrespective of most patient characteristics.