Novel prognostic scoring system for autologous hematopoietic cell transplantation in multiple myeloma

Binod Dhakal*, Anita D’Souza, Natalie Callander, Saurabh Chhabra, Raphael Fraser, Omar Davila, Kenneth Anderson, Amer Assal, Sherif M. Badawy, Jesus Berdeja, Jan Cerny, Raymond Comenzo, Rajshekhar Chakraborty, Robert Peter Gale, Rammurti Kamble, Mohamed A. Kharfan-Dabaja, Maxwell Krem, Siddhartha Ganguly, Murali Janakiram, Ankit KansagraReinhold Munker, Hemant Murthy, Sagar Patel, Shaji Kumar, Nina Shah, Muzaffar Qazilbash, Parameswaran Hari

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)442-452
Number of pages11
JournalBritish Journal of Haematology
Volume191
Issue number3
DOIs
StatePublished - Nov 1 2020

Keywords

  • AHCT
  • MM
  • prognostic scoring system

ASJC Scopus subject areas

  • Hematology

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