Abstract
Duration of first remission is important for the survival of patients with multiple myeloma.
From the CoMMpass study (NCT01454297), 926 patients with newly diagnosed multiple myeloma, characterized by next-generation sequencing, were analyzed to evaluate those who experienced early progressive disease (PD; time to progression, TTP ≤18 months).
After a median follow-up of 39 months, early PD was detected in 191/926 (20.6%) patients, 228/926 (24.6%) patients had late PD (TTP >18 months), while 507/926 (54.8%) did not have PD at the current follow-up. Compared with patients with late PD, patients with early PD had a lower at least very good partial response rate (47% vs. 82%,
< 0.001) and more frequently acquired double refractoriness to immunomodulatory drugs (IMiD) and proteasome inhibitors (PI; 21% vs. 8%,
< 0.001). Patients with early PD were at higher risk of death compared with patients with late PD and no PD (HR, 3.65; 95% CI, 2.7-4.93;
< 0.001), showing a dismal median overall survival (32.8 months). In a multivariate logistic regression model, independent factors increasing the early PD risk were
mutation (OR, 3.78,
< 0.001), high lactate dehydrogenase levels (OR, 3.15,
= 0.006), λ-chain translocation (OR, 2.25,
= 0.033), and
mutation (OR, 2.15,
= 0.007). Carfilzomib-based induction (OR, 0.15,
= 0.014), autologous stem-cell transplantation (OR, 0.27,
< 0.001), and continuous therapy with PIs and IMiDs (OR, 0.34,
= 0.024) mitigated the risk of early PD.
Early PD identifies a high-risk multiple myeloma population. Further research is needed to better identify baseline features predicting early PD and the optimal treatment approaches for patients at risk.
