New study redefines high risk criteria for multiple myeloma

Researchers have found that with new treatments for multiple myeloma, a serious type of blood cancer, clinicians should use different criteria for identifying patients with poor odds of survival. The study is published by Wiley online in CANCER, a peer-reviewed journal of the American Cancer Society.

Functional high-risk (FHR) multiple myeloma, which affects a subset of patients with blood cancer, is commonly defined as a multiple myeloma that progresses within 18 months of starting treatment, and it comes with a survival prognosis of less than 2 years after progression. Recently, however, the use of a 4-part treatment regimen-including anti-CD38 antibodies, proteasome inhibitors, immunomodulatory agents, and dexamethasone-followed by autologous stem cell transplantation, has helped to slow the cancer’s progression.

To update the definition of FHR multiple myeloma in the current era of combination therapy, investigators from the University of Alabama at Birmingham and the CoMMiT consortium analyzed information on 310 patients with newly diagnosed multiple myeloma who received this therapy and were followed for a median of 3.5 years.

Survival analyses indicated that cancer progression within 36 months of the onset of combination therapy identified patients whose survival was likely under 2 years from the time of progression. Adding another treatment called T-cell redirecting therapy helped slow progression. This “FHR36” patient population, corresponding to 16.4% of all treated patients, should be prioritized as candidates for early use of T-cell redirecting therapy and for clinical trials of medications with novel mechanisms of action.

The findings will help physicians choose therapies for this important minority of patients who have disease progression in the first 3 years of diagnosis and identify an important population in greater need for treatment innovations to be addressed in the next generation of clinical trials.”

Luciano J. Costa, MD, PhD, senior author, University of Alabama at Birmingham