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An early post-transplant relapse prediction score in multiple myeloma: a large cohort study from the chronic malignancies working party of EBMT


A Correction to this article was published on 14 June 2023

This article has been updated


Early relapse (ER) following Autologous Hematopoietic Cell Transplantation (AHCT) confers a poor prognosis. We therefore developed a novel scoring system to predict ER. A total of 14,367 AHCT-1 patients were transplanted between 2014 and 2019, and were conditioned with Melphalan 200 mg/m2 (Mel200) (n = 7228; 2014–2017) (training cohort); Mel200 (n = 5616; 2018–2019) or Mel140 (n = 1523; 2018–2019) (validation cohorts). PFS-12 and the Cumulative Incidence of Relapse at 12 months were 84.1% and 14.7% (training Mel200), 87.2% and 11.6% (validation Mel200), and 80.3% and 16.9% (validation Mel140), respectively. The points in the risk score were: 0, 1,2 for ISS stages I, II, and III; Disease status: 0 (CR/VGPR); 1 (PR); 2 (SD/MR); 4 (Relapse/Progression); and 1 for Karnofsky ≤ 70. The distribution of scores: 0 (24%), 1 (33.9%), 2 (29.6 %), 3 (9.5%), and ≥4 (2.7%). The score separated PFS-12, with the lowest risk group (n = 1752) having a PFS-12 of 91.7% and the highest risk group (n = 195) 57.1%. This also applied in cytogenetically high-risk patients. If the pre-score baseline risks are 15% (standard risk) and 25% (high-risk), a score of ≥4 confers calculated risks of 38% and 54%, respectively. This novel EBMT ER score, therefore, allows for the identification of five discrete prognostic groups.

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Fig. 1: 12-month PFS by score in the 3 cohorts.
Fig. 2: 12-month PFS by score for patients with high-risk cytogenetics in the three cohorts.
Fig. 3: Impact of early relapse score on long-term survival parameters.

Data availability

The EBMT database is not open to general access per EBMT regulations.

Change history


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The study has been performed within the EBMT database utilizing EBMT resources. SI has performed the statistical analysis that led to this novel ER risk-calculating model.

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Authors and Affiliations



MB planned the study and wrote the manuscript, LK prepared the study-specific EBMT database which was presented to SI who performed the statistical analysis and modeled the early relapse score; SI, PH, and IYA contributed to the manuscript preparation; all authors contributed to data enrollment and revised manuscript.

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Correspondence to Meral Beksac.

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The authors declare no competing interests.

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The original online version of this article was revised: The affiliations for Dr Claudia Sossa were incomplete and has now been corrected.

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Beksac, M., Iacobelli, S., Koster, L. et al. An early post-transplant relapse prediction score in multiple myeloma: a large cohort study from the chronic malignancies working party of EBMT. Bone Marrow Transplant 58, 916–923 (2023).

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