Patterns of relapse and progression in multiple myeloma patients after auto-SCT: implications for patients' monitoring after transplantation

Abstract

Auto-SCT (ASCT) is widely used in first-line treatment of multiple myeloma (MM). However, most patients eventually relapse or have progression of disease (R/POD). Although precise knowledge of R/POD patterns would be important to generate evidence-based surveillance recommendations after ASCT, such data is limited in the literature, especially after introduction of the free light chain assay (FLCA). This retrospective study examined the patterns of R/POD after first-line ASCT in 273 patients, using established criteria. At the time of R/POD, only 2% of patients had no associated serological evidence of R/POD. A total of 85% had asymptomatic R/POD, first detected by serological testing, whereas 15% had symptomatic R/POD with aggressive disease, early R/POD and short survival, with poor cytogenetics and younger age identified as risk factors. Although occult skeletal lesions were found in 40% of asymptomatic patients tested following serological R/POD, yearly skeletal surveys and urine testing were poor at heralding R/POD. We found a consistent association between paraprotein types at diagnosis and R/POD, allowing informed recommendations for appropriate serological monitoring and propose a new needed criterion using FLCA for patients relapsing by FLC only. Our findings provide important evidence-based recommendations that strengthen current monitoring guidelines after first-line ASCT in MM.

Figures

Figure 1

Overall study scheme.

Figure 2. Kaplan-Meier estimates of overall survival from the time of R/POD for the symptomatic and asymptomatic groups

The survival distributions for the two groups were compared using the logrank test.

Figure 3. Association between the types of monoclonal protein present at diagnosis and R/POD

Only the patients who had complete set of serologic testing available at diagnosis and R/POD were included for the analysis. Patients were analyzed on the basis of the best response achieved after ASCT (CR or less than CR) and the type of paraprotein present at diagnosis and R/POD: FLC only, intact immunoglobulin only (Ig), and FLC with intact immunoglobulin (FLC+Ig).