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Predicting Relapse After Transplantation in Myeloma: European Group Creates Novel Score

By: Celeste L. Dixon
Posted: Tuesday, September 19, 2023

European Society for Blood and Marrow Transplantation(EBMT) researchers have described a novel score methodology based on universally available parameters to predict early relapse after autologous hematopoietic cell transplantation (AHCT) in patients with multiple myeloma. Such early relapse confers a poor prognosis, reported Meral Beksac, MD, PhD, of Ankara University, Turkey, and colleagues in the journal Bone Marrow Transplantation. They added that early identification of patients at high risk of early relapse may facilitate more effective use of immunotherapeutic approaches. Their goal was to establish a score more widely applicable to real-world practice than previous models.

The score “robustly allocates patients to five discrete [prognostic] risk groups, regardless of the dose of melphalan used in conditioning (melphalan 200 vs. melphalan 140), their cytogenetic profile, and whether or not they proceeded to a tandem AHCT,” wrote the team, the EBMT’s Chronic Malignancies Working Party. Additionally, “the risk score predicts both early relapse and long-term survival.”

To create the risk groups, the researchers used data from 14,367 patients who underwent AHCT between 2014 and 2019 and were conditioned with melphalan at 200 mg/m2 or 140 mg/m2. They assigned points as follows: 0 points for International Staging System (ISS) stage I; 1 point for ISS stage II; 2 points for ISS stage III; 0 points for complete response or very good partial response at AHCT; 1 point for partial response at AHCT; 2 points for stable disease or marginal response at AHCT; 4 points for relapse or disease progression; and 1 point for a Karnofsky score of 70 or greater.

The odds of 12-month progression-free survival in the lowest-risk group (n = 1,752) were 91.7%, versus 57.1% in the highest-risk group (n = 195). “The risk of early relapse/death increased on average by 56% for each additional point in the score,” explained the authors.

“As there is a continuum of possible treatment approaches with differing levels of intensity, we believe the ability of our score to identify five discrete groups is helpful in informing post-transplant treatment choices,” the investigators noted.

Disclosure: The study authors reported no conflicts of interest.

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