Risk Assessment and Survival Prediction in Patients With Multiple Myeloma
Posted: Tuesday, October 22, 2019
The results of the GMMG-MM5 multicenter trial, published in the Journal of Hematology & Oncology, suggest that prospective assessment and target and risk reporting using published gene expression may prove to be feasible in more than 80% of patients with multiple myeloma during induction chemotherapy. Dirk Hose, MD, of the University Hospital Heidelberg, and colleagues claim that this strategy may allow for superior survival prediction.
Using data from 604 patients, the study authors prospectively performed molecular diagnostics including plasma cell purification, DNA microarrays, and interphase fluorescence in situ hybridization. Within the published gene-expression report, the authors implemented an HM metascore, which integrates gene expression–based and conventional prognostic factors into one classification. Using the HM metascore, patients were stratified into high (10%), medium (77%), and low (13%) risk.
The authors obtained bone marrow aspirates from 95% of 573 patients. Of those samples, 559 (97.6%) could be CD138-purified. Analyses such as interphase fluorescence in situ hybridization were possible in nearly all of the 559 patients and gene expression, in more than 80% of these patients.
The HM metascore categorized patients into significantly different median progression-free and median overall survival. The median progression-free survival of high-, medium-, and low-risk patients was 15 months, 39 months, and not reached, respectively (P < .001). The overall survival was 41 months for high-risk patients and not reached for medium- and low-risk patients (P < .001). The 5-year progression-free and overall survival rates were 5% and 25% for high-risk patients, 31% and 68% for medium-risk patients, and 54% and 98% for low-risk patients.
“We show for the first time that it is possible to prospectively perform and report molecular analyses in a randomized phase III multicenter trial in over 90% (interphase fluorescence in situ hybridization) and 80% (gene-expression profiling) of patients, respectively, within the first cycle of induction chemotherapy,” the investigators concluded.
Disclosure: The study authors reported no conflicts of interest.