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Novel prognostic scoring system for autologous hematopoietic cell transplantation in multiple myeloma
Author(s) -
Dhakal Binod,
D’Souza Anita,
Callander Natalie,
Chhabra Saurabh,
Fraser Raphael,
Davila Omar,
Anderson Kenneth,
Assal Amer,
Badawy Sherif M.,
Berdeja Jesus,
Cerny Jan,
Comenzo Raymond,
Chakraborty Rajshekhar,
Peter Gale Robert,
Kamble Rammurti,
KharfanDabaja Mohamed A.,
Krem Maxwell,
Ganguly Siddhartha,
Janakiram Murali,
Kansagra Ankit,
Munker Reinhold,
Murthy Hemant,
Patel Sagar,
Kumar Shaji,
Shah Nina,
Qazilbash Muzaffar,
Hari Parameswaran
Publication year - 2020
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.16987
Subject(s) - medicine , hazard ratio , multiple myeloma , oncology , cytogenetics , proportional hazards model , transplantation , hematopoietic stem cell transplantation , autologous stem cell transplantation , bone marrow , gastroenterology , confidence interval , biology , chromosome , biochemistry , gene
We studied 2,528 patients with upfront autologous haematopoietic cell transplantation (AHCT) for multiple myeloma (MM) from 2008–2017 to develop a prognostic model to predict outcomes. High‐risk cytogenetics included t(4;14), t(14;16), t(14;20), del13q on karyotype, del17p, +1q or 1pdel. A Cox model identified factors prognostic of progression/relapse in a training subset ( n = 1,246). A weighted score using these factors was assigned to a validation cohort ( n = 774). Presence of high‐risk cytogenetics [hazard ratio, (HR) 1·68 (1·3–2·17)] and pre‐AHCT bone marrow plasma cells (BMPCs) ≥10% [1·68 (1·33–2·12)] were assigned 4 points each; albumin at diagnosis <3·5 g/dl [1·31 (1·07–1·61)] 2; standard risk cytogenetics 1, and no cytogenetics abnormality, BMPCs <10% at AHCT and albumin ≥3·5 g/dl at diagnosis 0 points each. A three‐category system with low risk (0–3), intermediate risk (4–8) and high risk (9–10) showed 3‐year progression‐free survival in the low vs. intermediate vs. high risk of 58% (95% CI: 52–63) vs. 49% (95% CI: 43–56) vs. 31% (95% CI: 12–51), P < 0.001 respectively, and 3‐year OS in low vs. intermediate vs. high risk of 88% (95% CI: 84–91) vs. 81% (95% CI: 76–86) vs. 64% (95% CI: 39–80); P < 0·001. Our prognostic scoring system can identify MM patients at risk for early relapse after AHCT.