Scoring System for Predicting Risk of Relapse in Patients with Multiple Myeloma within Two Years after Stem Cell Transplantation

Novel drugs induction therapy followed with autologous stem cell transplantation (ASCT) is the first-line treatment for patients with multiple myeloma who suitable for ASCT, prolonging overall survival (OS) to approximately 7 years. However, some patients relapse within two years after transplantation and their prognosis is extremely poor. Identifying patients at high risk of early relapse might help clinicians propose alternative therapeutic strategies that improve outcomes. We retrospectively analyzed 641 multiple myeloma patients from 6 centers in China who received Bortezomib induction therapy followed by ASCT between June 1, 2006 and June 30, 2014. 181 patients (28.2%) progressed within two years after ASCT. Comparison of patients who progressed early [time to progression (TTP) < 2 year] and patients who did not (TTP ≥ 2 year) showed that those TTP < 2 yr had higher corrected calcium and lactate dehydrogenase (LDH) and more be in stage III of the International Staging System (ISS). 17p- was present in a significantly higher proportion of patients with TTP < 2 yr (P < 0.0001). Binary logistic regression identified the following four independent risk factors for TTP < 2 yr: ISS Ⅱ/Ⅲ, LDH > 240 U/L, presence of 17p- and HBsAg positivity. And these four independent risk factors were assigned scores using the regression coefficient β to predict relapse or progression within two years after ASCT, where LDH > 240 U/L was given a score of 2.0; 17p-, a score of 3.9; ISS II/III, a score of 3.8; and HBsAg positive, a score of 1.9. Based on total scores, patients were classified into three risk groups: the low-risk group (score < 4): 6.9% relapsed within two years of ASCT; the medium-risk group (score 4-8): 45.8% relapsed within two years; and the high-risk group (score > 8): 89.3% relapsed within two years. Based on this scoring system, TTP was analyzed for the 641 patients. TTP was not achieved in the low-risk group, while 25.6 months in the medium-risk group and 16.5 months in the high-risk group (Figure 1). The differences among the groups were significant. It is a useful scoring system for predicting risk of relapse within two years after ASCT in patients with multiple myeloma.

Figure 1

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Figure 1

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