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Multiple Myeloma, Gammopathies

Early relapse following initial therapy for multiple myeloma predicts poor outcomes in the era of novel agents

Leukemia volume 30, pages 2208–2213 (2016)Cite this article

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Abstract

Outcomes for patients with multiple myeloma (MM) have improved in recent years owing to use of novel agents and high-dose therapy followed by autologous stem cell transplant (ASCT). We analyzed the outcomes of 511 consecutive patients treated with novel therapies at our institution between 2006 and 2014 to determine the impact of relapse within 12 months of initiating treatment. A total of 82 patients (16.0%) experienced early relapse, with median time to relapse of 8.0 months (95% confidence interval (CI); 6.3, 8.9). Median overall survival (OS) was significantly worse for this group at 21.0 months (95% CI; 16.3, 27.2) vs not reached (NR) (95% CI; 96.3, NR) for those with late relapse (P<0.001). Survival outcomes remained poor among early relapse patients irrespective of depth of response to initial therapy. In multivariate analysis, low albumin and high-risk cytogenetics predicted early relapse. Outcomes of early relapse from early ASCT were also considered; median OS from ASCT for those relapsing within 12 months was 23.1 months (95% CI; 15.7, 32.4) vs 122.2 months (95% CI; 111.5, 122.2) for the remaining patients (P<0.001). Early relapse remains a marker of poor prognosis in the current era, and such patients should be targeted for clinical trials.

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Acknowledgements

This work was supported in part by the Mayo Clinic Hematological Malignancies Program, R01 CA 168762-03 (to SKK and SVR), R01 CA 107476-11 (to SKK and SVR) and R01 CA 167511-2 (to SKK).

Author contributions

NM and SKK were involved in design of concept, data collection, analysis and writing the manuscript. SVR, MQL, FKB, AD, MAG, SRH, DD, PK, LH, JAL, SJR, RSG and RAK were all involved in writing the manuscript.

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Authors and Affiliations

  1. Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA

    N Majithia

  2. Division of Hematology, Mayo Clinic, Rochester, MN, USA

    S V Rajkumar, M Q Lacy, F K Buadi, A Dispenzieri, M A Gertz, S R Hayman, D Dingli, P Kapoor, L Hwa, J A Lust, S J Russell, R S Go, R A Kyle & S K Kumar

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  1. N Majithia
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Correspondence to S K Kumar.

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Majithia, N., Rajkumar, S., Lacy, M. et al. Early relapse following initial therapy for multiple myeloma predicts poor outcomes in the era of novel agents. Leukemia 30, 2208–2213 (2016). https://doi.org/10.1038/leu.2016.147

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