Early Relapse in Transplant-Eligible MM Patients Undergoing Auto-SCT Followed By Maintenance Therapy

Introduction Autologous Stem Cell transplantation (auto-SCT), still remains as the standard therapy offered to patients with MM deemed to be eligible for this strategy. Unfortunately, even with the advent of novel and efficacious approaches such as new upfront induction regimens, consolidation and maintenance, patients will progress. Based on the above mentioned, we aimed to assess the impact of maintenance on Early Relapse and its association with predictor factors of survival. Methods All consecutive patients who underwent single auto-SCT at Tom Baker Cancer Center from 01/06 to 03/16 were evaluated. ER was defined as per recent publications (<12 months from auto-SCT). A p value of <0.05 was considered significant. Survival curves were constructed according to the Kaplan-Meier method and compared using the log rank test. Results 215 consecutive patients with MM who underwent single auto-SCT followed by maintenance therapy at our Institution over the defined period were evaluated. Clinical characteristics are shown in Table 1. At the time of analysis, 154 patients are still alive and 99 have already progressed. Among these cases, 21 patients have relapsed in <12 months (ER) from auto-SCT (20%) and 57 have relapsed within 24 months post auto-SCT. 14 out of 21 patients with ER (<12 months) and 26/57 (relapse <24 months) had HRC (high-risk cytogenetics) (66% and 45.6%, respectively, p=0.0001 compared to non-ER). Patients with <VGPR at day-100 post-ASCT exhibited a shorter PFS (25 months vs 46.8 months, p=0.006). Patients with <VGPR at day-100 post-ASCT were more likely to develop ER<12 months (31% vs 15%). (p=0.05) Median OS was shorter for the ER (<12 months) group (14 months) compared to those relapsing within12-24 months and >24 months (58 months and non-reached, respectively, p=0.0001, Fig 1) In conclusion, patients with ER after auto-SCT remain to be a challenge. Even with the advent of novel agents in the setting of maintenance, patients with ER had poor outcomes. ER for patients treated with maintenance therapy should be characterized better. ER defined as <24 months should be investigated in the setting of maintenance therapy. More biological insights on ER cases are needed to further improve survival outcomes.

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