Predicting long-term disease control in transplant-ineligible patients with multiple myeloma: impact of an MGUS-like signature
Paula Rodríguez-Otero, María Victoria Mateos, Joaquín Martínez-López, Miguel-Teodoro Hernández, Enrique M Ocio, Laura Rosiñol, Rafael Martínez, Ana-Isabel Teruel, Norma C Gutiérrez, Joan Bargay, Enrique Bengoechea, Yolanda González, Jaime Pérez de Oteyza, Mercedes Gironella, Jorge M Nuñez-Córdoba, Cristina Encinas, Jesús Martín, Carmen Cabrera, Luis Palomera, Felipe de Arriba, María Teresa Cedena, Noemí Puig, Albert Oriol, Bruno Paiva, Joan Bladé, Juan José Lahuerta, Jesús F San Miguel
Disease control at 5 years would be a desirable endpoint for elderly multiple myeloma (MM) patients, but biomarkers predicting this are not defined. Therefore, to gain further insights in this endpoint, a population of 498 newly diagnosed transplant-ineligible patients enrolled in two Spanish trials (GEM2005MAS65 and GEM2010MAS65), has been analyzed. Among the 435 patients included in this post-hoc study, 18.6% remained alive and progression free after 5 years of treatment initiation.
In these patients, overall survival (OS) rate at 10 years was 60.8% as compared with 11.8% for those progressing within the first 5 years. Hemoglobin (Hb) ≥ 12 g/dl (OR 2.74, p = 0.001) and MGUS-like profile (OR 4.18, p = 0.005) were the two baseline variables associated with long-term disease-free survival. Upon including depth of response (and MRD), Hb ≥ 12 g/dl (OR 2.27) and MGUS-like signature (OR 7.48) retained their predictive value along with MRD negativity (OR 5.18).
This study shows that despite the use of novel agents, the probability of disease control at 5 years is still restricted to a small fraction (18.6%) of elderly MM patients. Since this endpoint is associated with higher rates of OS, this study provides important information about diagnostic and post-treatment biomarkers helpful in predicting the likelihood of disease control at 5 years.