A novel early relapse scoring system for multiple myeloma (MM) identified discrete prognostic groups, according to a large cohort study from the European Society for Blood and Marrow Transplantation (EBMT).
Meral Beksac, MD, of Ankara University in Turkey and colleagues conducted the study to develop a “more widely applicable” scoring system for early relapse due to the “poor prognosis” of patients with MM who have an early relapse after autologous hemopoietic stem cell transplantation (AHSCT).
They developed a novel scoring system to predict early relapse by evaluating a training cohort and two validation cohorts. The training cohort included 7,228 patients who underwent AHSCT and received conditioning with melphalan 200 mg/m2 between 2014 and 2017. One of the validation cohorts included 5,616 patients who underwent AHSCT and received conditioning with melphalan 200 mg/m2 between 2018 and 2019. The second validation cohort included 1,523 patients who underwent AHSCT and received conditioning with melphalan 140 mg/m2 between 2018 and 2019.
The main endpoint of the study was progression-free survival (PFS) artificially censored at 12 months (PFS-12), which “essentially corresponds to one minus the cumulative incidence of [early relapse], ie, disease progression,” Dr. Beksac and colleagues wrote.
In the training cohort, the PFS-12 rate was 84.1% and the cumulative incidence of relapse at 12 months was 14.7%. In the validation cohort that received melphalan 200 mg/m2, the PFS-12 rate was 87.2% and the cumulative incidence of relapse at 12 months was 11.6%. In the validation cohort that received melphalan 140 mg/m2, the PFS-12 rate was 80.3% and the cumulative incidence of relapse at 12 months was 16.9%.
The researchers assigned points to multiple factors to develop a risk score. An International Staging System (ISS) stage I disease classification was assigned a score of zero points, while ISS stages II and III were assigned one and two points, respectively. In terms of disease status, a complete response or very good partial response was assigned zero points, while a partial response was assigned one point, stable disease was assigned two points, and relapse or progression was assigned four points. A Karnofsky performance status of ≤70 was assigned a weight of one point.
Around one-quarter (24%) of patients had a total score of zero, while 33.9% had a score of one point, 29.6% had a score of two, 9.5% had a score of three, and 2.7% had a score of four or higher.
The score separated groups by PFS-12 rates. The group with the lowest risk (n=1,752) had a PFS-12 rate of 91.7%, while the group with the highest risk (n=195) had a PFS-12 rate of 57.1%. This also applied to patients with high-risk cytogenetics, according to the study’s authors.
“In conclusion, this novel validated EBMT early relapse score is based on universally available parameters applied to real-world myeloma patients,” Dr. Beksac and colleagues concluded. “This score robustly allocates patients to five discrete risk groups, regardless of the dose of melphalan used in conditioning, their cytogenetic profile and whether or not they proceeded to a tandem [HSCT]. Finally, the risk score predicts both [early relapse] and long-term survival.”
Beksac M, Iacobelli S, Koster L, et al. An early post-transplant relapse prediction score in multiple myeloma: a large cohort study from the chronic malignancies working party of EBMT. Bone Marrow Transplant. 2023:1-8. doi:10.1038/s41409-023-01999-1