An early post-transplant relapse prediction score in multiple myeloma: a large cohort study from the chronic malignancies working party of EBMT.
Meral Beksac
(1)
,
Simona Iacobelli
(2)
,
Linda Koster
(3)
,
Jan Cornelissen
(4)
,
Laimonas Griskevicius
(5)
,
Neil K. Rabin
(6)
,
Anne Marie Stoppa
(7)
,
Ellen Meijer
(8)
,
Jean-Baptiste Mear
(9)
,
Sacha Zeerleder
(10)
,
Jiri Mayer
(11)
,
Roland Fenk
(12)
,
Nathalie Fegueux
(13)
,
Patrice Chevallier
(14)
,
Eva Konirova
(15)
,
John A. Snowden
(16)
,
Monika Engelhardt
(17)
,
Kim Orchard
(18)
,
Cyrille Hulin
(19)
,
Nicolaas Schaap
(20)
,
Claudia Sossa
(21)
,
Ahmet Elmaagacli
(22)
,
Donal P. Mclornan
(23)
,
Patrick J. Hayden
(24)
,
Stefan Schönland
(25)
,
Ibrahim Yakoub-Agha
(26)
1
Ankara University School of Medicine [Turkey]
2 Università degli Studi di Roma Tor Vergata [Roma, Italia] = University of Rome Tor Vergata [Rome, Italy] = Université de Rome Tor Vergata [Rome, Italie]
3 LUMC - Leiden University Medical Center
4 Erasmus MC - Erasmus University Medical Center [Rotterdam]
5 Vilnius University [Vilnius]
6 UCL - University College of London [London]
7 IPC - Institut Paoli-Calmettes
8 VU University Medical Center [Amsterdam]
9 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Pontchaillou]
10 UNIBE - Universität Bern = University of Bern = Université de Berne
11 University Hospital Brno
12 Heinrich Heine Universität Düsseldorf = Heinrich Heine University [Düsseldorf]
13 CHU - Hôpital Lapeyronie [Montpellier]
14 CHU Nantes - Centre Hospitalier Universitaire de Nantes = Nantes University Hospital
15 UK - Univerzita Karlova [Praha, Česká republika] = Charles University [Prague, Czech Republic]
16 Sheffield Children's NHS Foundation Trust
17 Uniklinik - Universitäts Klinikum Freiburg = University Medical Center Freiburg
18 University Hospital Southampton NHS Foundation Trust
19 CHU Bordeaux
20 Radboud University Medical Center [Nijmegen]
21 UNAB - Universidad Autónoma de Bucaramanga
22 AKH - Asklepios Klinikum Harburg [Hamburg, Germany]
23 QUB - Queen's University [Belfast]
24 Trinity College Dublin
25 University of Heidelberg, Medical Faculty
26 LIRIC - Lille Inflammation Research International Center - U 995
2 Università degli Studi di Roma Tor Vergata [Roma, Italia] = University of Rome Tor Vergata [Rome, Italy] = Université de Rome Tor Vergata [Rome, Italie]
3 LUMC - Leiden University Medical Center
4 Erasmus MC - Erasmus University Medical Center [Rotterdam]
5 Vilnius University [Vilnius]
6 UCL - University College of London [London]
7 IPC - Institut Paoli-Calmettes
8 VU University Medical Center [Amsterdam]
9 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Pontchaillou]
10 UNIBE - Universität Bern = University of Bern = Université de Berne
11 University Hospital Brno
12 Heinrich Heine Universität Düsseldorf = Heinrich Heine University [Düsseldorf]
13 CHU - Hôpital Lapeyronie [Montpellier]
14 CHU Nantes - Centre Hospitalier Universitaire de Nantes = Nantes University Hospital
15 UK - Univerzita Karlova [Praha, Česká republika] = Charles University [Prague, Czech Republic]
16 Sheffield Children's NHS Foundation Trust
17 Uniklinik - Universitäts Klinikum Freiburg = University Medical Center Freiburg
18 University Hospital Southampton NHS Foundation Trust
19 CHU Bordeaux
20 Radboud University Medical Center [Nijmegen]
21 UNAB - Universidad Autónoma de Bucaramanga
22 AKH - Asklepios Klinikum Harburg [Hamburg, Germany]
23 QUB - Queen's University [Belfast]
24 Trinity College Dublin
25 University of Heidelberg, Medical Faculty
26 LIRIC - Lille Inflammation Research International Center - U 995
Résumé
Early relapse (ER) following Autologous Hematopoietic Cell Transplantation (AHCT) confers a poor prognosis. We therefore developed a novel scoring system to predict ER. A total of 14,367 AHCT-1 patients were transplanted between 2014 and 2019, and were conditioned with Melphalan 200 mg/m2 (Mel200) (n = 7228; 2014–2017) (training cohort); Mel200 (n = 5616; 2018–2019) or Mel140 (n = 1523; 2018–2019) (validation cohorts). PFS-12 and the Cumulative Incidence of Relapse at 12 months were 84.1% and 14.7% (training Mel200), 87.2% and 11.6% (validation Mel200), and 80.3% and 16.9% (validation Mel140), respectively. The points in the risk score were: 0, 1,2 for ISS stages I, II, and III; Disease status: 0 (CR/VGPR); 1 (PR); 2 (SD/MR); 4 (Relapse/Progression); and 1 for Karnofsky ≤ 70. The distribution of scores: 0 (24%), 1 (33.9%), 2 (29.6 %), 3 (9.5%), and ≥4 (2.7%). The score separated PFS-12, with the lowest risk group (n = 1752) having a PFS-12 of 91.7% and the highest risk group (n = 195) 57.1%. This also applied in cytogenetically high-risk patients. If the pre-score baseline risks are 15% (standard risk) and 25% (high-risk), a score of ≥4 confers calculated risks of 38% and 54%, respectively. This novel EBMT ER score, therefore, allows for the identification of five discrete prognostic groups.