Outcomes from early relapse in multiple myeloma

This paper studied the effect of early relapse on survival in patients with multiple myeloma. Patients who had an early relapse had a worse overall survival than patients who did not have an early relapse. 

Despite advances in treatment, many patients with multiple myeloma will experience a relapse (have a return of disease). With each relapse, multiple myeloma becomes harder to treat. Several reports have suggested that an early relapse affects overall survival (time from treatment until death from any cause). Early relapse refers to a relapse or worsening disease within 1 year after autologous stem cell therapy (procedure where stem cells are transferred). 

This study examined the effects of early relapse on overall survival. 257 patients with multiple myeloma who had undergone one autologous stem cell transplantation were analyzed. Of the 257 patients, 13.6% had an early relapse.  

100 days after autologous stem cell transplant, 80.5% of those without an early relapse and 51.4% of those with an early relapse had at least a very good partial response to treatment. 25.7% of those with an early relapse had a complete or near complete response to treatment. Meanwhile, 35.6% of patients without an early relapse had a complete or near complete response to treatment.

At the time of the analysis of results, 84.6% of patients without an early relapse were alive. 25.7% of patients who had an early relapse were alive. Overall, 43.8% of the patients developed worsening disease. Patients without an early relapse developed worsening disease after an average 25.5 months. Patients with an early relapse developed worsening disease after an average 7.7 months.

For patients who had an early relapse, the average overall survival was 17.8 months. The average overall survival for patients without early relapse was not reached during the study.  The overall survival for patients with high-risk multiple myeloma based on genetic analysis was 43 months.

When various factors were considered, the presence of early relapse and high-risk multiple myeloma by genetic analysis was found to be factors that could predict overall survival. 

The authors concluded that an early relapse is an important predictor of overall survival in multiple myeloma. The authors suggested that novel therapies are needed for patients with high-risk features.