Skip to main content

A New Risk Stratification Tool to Estimate Survival in Patients with Multiple Myeloma After First Relapse

Conference Correspondent - Conference Correspondent, ASH 2016 - Multiple Myeloma

Risk stratification tools in multiple myeloma are used to define risk after first relapse in clinical trials and standard practice. Although these tools can help clinicians to define survival expectations and treatment decisions, there are additional variables that may need to be considered to understand drivers of disease progression and ensure that treatment strategies are aligned with patient risk. This European study assessed predictors of overall survival (OS) and developed a new Risk Stratification Tool (RST) to predict OS at time of treatment decision after first relapse (TTD1). The Partitioning for Survival method, which stratified data based on distinct survival expectations, was run to define 4 distinct groups of patients.

The RST consists of 4 dimensions and 12 questions based on the strongest predictors of survival at TTD1. Dimensions include the following: (1) patient factors (age and Eastern Cooperative Oncology Group [ECOG] performance status); (2) existing stratification factors (R-ISS [Revised International Staging System] at diagnosis and ISS at TTD1); (3) disease factors (calcium level, number of bone lesions, extramedullary disease, thrombocyte count, clonal cells in bone marrow aspiration cytology, and lactate dehydrogenase); and (4) treatment history (refractory to prior therapy and time to next treatment). Subsequently, the researchers assessed each group based on distribution of frailty-driven measures (age and ECOG) and aggressiveness of the disease (all other parameters) to determine which parameters contribute most to risk stratification.

A survival analysis showed strong differentiation in survival expectations between the 4 groups when viewing the Kaplan-Meier curves; median OS after first relapse was significantly different for all groups and the confidence intervals did not overlap (group 1, 57.2 months; group 2, 28.8 months; group 3, 13.4 months; group 4, 4.7 months). When evaluating the drivers of risk, researchers found that the differences for the risk groups were greater for mean aggressiveness scores than for mean frailty scores, underscoring the considerable impact of disease severity on outcomes.

Study authors concluded that RST has shown promising results; however, further validation is required using other real-world and clinical trials data. This approach may represent a new method for systematically assessing patient risk to improve the selection of treatments based on improved understanding of patient profiles.

Hajek R, et al. ASH 2016. Abstract 2417.

Related Items
Omadacycline for Acute Bacterial Skin and Skin Structure Infections: Integrated Analysis of Randomized Clinical Trials
December 2018 Vol 11, No 9 published on December 27, 2018 in Conference Correspondent
Improved Quality of Life in Adults with Acute Bacterial Skin and Skin Structure Infections with Omadacycline or Linezolid Therapy
December 2018 Vol 11, No 9 published on December 27, 2018 in Conference Correspondent
Omadacycline In Vitro Activity Against a Molecularly Characterized Collection of Clinical Isolates with Known Tetracycline Resistance Mechanisms
December 2018 Vol 11, No 9 published on December 27, 2018 in Conference Correspondent
Integrated Safety Summary of Omadacycline, A Novel Aminomethylcycline Antibiotic
December 2018 Vol 11, No 9 published on December 27, 2018 in Conference Correspondent
Improvements in Remission and Low Disease Activity Achieved with Ongoing Sarilumab Treatment in Patients with RA
Conference Correspondent published on November 9, 2017 in ACR 2017, Conference Correspondent
Last modified: August 30, 2021