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Shaji K. Kumar, MD

Prashant Kapoor, MD, FACP


Survival Outcomes After Biochemical and Clinical Progression of Relapsed Myeloma

By: Vanessa A. Carter, BS
Posted: Wednesday, May 18, 2022

Shaji K. Kumar, MD, of the Mayo Clinic, Rochester, Minnesota, and colleagues performed a retrospective study of patients who experienced relapse of multiple myeloma to elucidate how biochemical and clinical disease progression patterns might affect survival outcomes. Published in Blood Advances, their results concluded that individuals who exhibited clinical disease progression at relapse appeared to demonstrate poorer survival than those who relapsed only with biochemical features (increasing monoclonal protein).

“Approximately half of clinical progression presented while on active treatment, which suggests that even patients monitored closely may develop CRAB [hypercalcemia, renal insufficiency, anemia, and new bone disease] features at relapse,” mentioned the investigators. “Patients with deeper response to first-line treatment are less likely to develop clinical progression, once again highlighting the need for deep responses for front-line therapy, especially in those with high-risk features at baseline.”

The investigators retrospectively reviewed data on 1,347 patients with relapsed multiple myeloma who were followed at the Mayo Clinic. Participants were stratified to clinical or biochemical disease progression via CRAB criteria or an increase in serum or urine monoclonal protein leading to initiation of a new line of therapy, respectively.

Many cases of disease progression were classified as biochemical (60.4%). Among those with clinical disease progression, new or evolving bone disease (80.9%) was the most prevalent symptom at relapse, followed by anemia (38.0%) and renal failure (12.7%). It was noted that patients with biochemical disease progression had a significantly longer median time from second-line therapy to the next treatment when compared with those experiencing clinical disease progression (P < .001).

Furthermore, individuals who had biochemical versus clinical disease progression also had a longer median overall survival from first relapse by more than twofold (59.4 vs. 26.2 months, P < .001). Of note, a plasma cell labeling index of at least 2% (P = .04), male sex (P = .04), and the presence of extramedullary disease at diagnosis (P = .03) were all associated with a higher risk of clinical disease progression. In contrast, very good partial remission or better seemed to correlate with a decreased risk of clinical disease progression (P = .02).

Disclosure: For full disclosures of the study authors, visit

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