Novel prognostic scoring system for autologous hematopoietic cell transplantation in multiple myeloma.
Binod DhakalAnita D'SouzaNatalie CallanderSaurabh ChhabraRaphael FraserOmar DavilaKenneth AndersonAmer AssalSherif M BadawyJesus BerdejaJan CernyRaymond L ComenzoRajshekhar ChakrabortyRobert Peter GaleRammurti KambleMohamed A Kharfan-DabajaMaxwell KremSiddhartha GangulyMurali JanakiramAnkit KansagraReinhold MunkerHemant MurthySagar S PatelShaji K KumarNina ShahMuzaffar QazilbashParameswaran HariPublished in: British journal of haematology (2020)
We studied 2,528 patients with upfront autologous haematopoietic cell transplantation (AHCT) for multiple myeloma (MM) from 2008-2017 to develop a prognostic model to predict outcomes. High-risk cytogenetics included t(4;14), t(14;16), t(14;20), del13q on karyotype, del17p, +1q or 1pdel. A Cox model identified factors prognostic of progression/relapse in a training subset (n = 1,246). A weighted score using these factors was assigned to a validation cohort (n = 774). Presence of high-risk cytogenetics [hazard ratio, (HR) 1·68 (1·3-2·17)] and pre-AHCT bone marrow plasma cells (BMPCs) ≥10% [1·68 (1·33-2·12)] were assigned 4 points each; albumin at diagnosis <3·5 g/dl [1·31 (1·07-1·61)] 2; standard risk cytogenetics 1, and no cytogenetics abnormality, BMPCs <10% at AHCT and albumin ≥3·5 g/dl at diagnosis 0 points each. A three-category system with low risk (0-3), intermediate risk (4-8) and high risk (9-10) showed 3-year progression-free survival in the low vs. intermediate vs. high risk of 58% (95% CI: 52-63) vs. 49% (95% CI: 43-56) vs. 31% (95% CI: 12-51), P < 0.001 respectively, and 3-year OS in low vs. intermediate vs. high risk of 88% (95% CI: 84-91) vs. 81% (95% CI: 76-86) vs. 64% (95% CI: 39-80); P < 0·001. Our prognostic scoring system can identify MM patients at risk for early relapse after AHCT.
Keyphrases
- free survival
- bone marrow
- multiple myeloma
- cell therapy
- end stage renal disease
- magnetic resonance
- ejection fraction
- chronic kidney disease
- induced apoptosis
- single cell
- type diabetes
- stem cells
- metabolic syndrome
- magnetic resonance imaging
- computed tomography
- prognostic factors
- adipose tissue
- signaling pathway
- peritoneal dialysis
- platelet rich plasma
- cell death
- pi k akt