Pb2140: evaluation of early relapse in multiple myeloma (mm) patients

Topic: 14. Myeloma and other monoclonal gammopathies - Clinical Background: Besides the tremendous evolution in myeloma treatment, the detection of patients with a rapid relapse remains an unmet need. Early relapsed myeloma patients’ simplified score was suggested by researchers1, but recent validation study was not successful 2. Aims: Our purpose was to separate, in a large cohort of MM patients, those with an early relapse after first line treatment. Our study included patients treated with conventional chemotherapy and the ones treated with novel agents at first line. Methods: Thirty-hundred and thirty-four MM patients at diagnosis were included in our study with median age 69 years old, 43 % women and 57 % men. Clinical and laboratory data were retrieved from medical records after patients’ informed consent. Ig type was IgG in 63%, IgA in 20%, Light Chain in 14% and other types in 3%. 22% of the patients were stratified as ISS1, 28% were ISS 2 and 50% were ISS3. 47% of patients received novel agents treatment. S-ERMM score was calculated using the below parameters; BMPCs > 60% (3 points), albumin ≤ 3.5 or ≥ 5.0 (3 points), del(17p) (3 points), t(4;14) (5 points),LDH > ULN (5 points) and presence of lambda light chain (2 points). Patients were classified as low (≤ 5), intermediate (6 – 10) or high risk (≥ 11). BMINF>60% was observed in 61% of patients, abnormal LDH in 21%, abnormal albumin in 38%, abnormal t(4;14) and del17p in 12%. Our research has the limitations of being retrospective, not using data from clinical trials, and not using FISH translocation testing until it was widely recommended by international risk stratification recommendations for myeloma. Although analysis of patients with all predictor variables was done, a significant percentage of patients lacked FISH studies, necessitating the modification of the model. Statistical analysis was performed using SPSS v28 and p-value under was considered statistically significant. Results: Sixty percent of the whole cohort experienced an early relapse at 18 months and 73% at 24 months. A lower percentage of patients receiving a novel agent was observed at 18months (28%) and at 24 months (33%); the difference was statistically significant on both timepoints (p<0.001) showing the high efficacy of these agents. Based on S-ERRM score in all patients, 65% were low risk, 29% were intermediate and 6% high risk. When studied separately; the corresponding percentages were respectively, low risk 60%, intermediate risk 32% and high risk 8% in patients receiving novel agents Vs 71% low risk, 26% intermediate risk and 3% high risk in conventional chemotherapy patients’ group. respectively. Application of the risk stratification score successfully categorized our patients at 18 months (p=0.002) and at 24 months (p=0.004). Separate analysis of patients receiving conventional chemotherapy Vs newer agents, showed statistically significant difference only in the conventional chemotherapy group at 18 months (p=0.000) and 24 months (p=0.001). We also tested the impact of abnormal karyotype which was not statistically significant on early relapse. Summary/Conclusion: Treatment with novel agents overcome the adverse prognosis evaluated into scoring system regarding the early relapse and further studies are needed. References 1. Zaccaria GM, et al. Newly Diagnosed Multiple Myeloma in a Pooled Dataset of 2,190 Patients. Clin Cancer Res. 2021 Jul 1;27(13):3695-3703. doi: 10.1158/1078-0432.CCR-21-0134. Epub 2021 Apr 29. 2. Slade M, et al. Evaluation of the Simplified Score to Predict Early Relapse in Multiple Myeloma (S-ERMM) in the MMRF CoMMpass study. Leuk Res. 2023 Feb 11;127:107037. doi: 10.1016/j.leukres.2023.107037. Keywords: Prognosis, Relapse, Multiple myeloma