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

Bone Marrow Transplantation volume 48, pages 419–424 (2013)Cite this article

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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.

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Authors and Affiliations

  1. Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    D Zamarin, S Giralt, H Landau, N Lendvai, A Lesokhin, D Chung, G Koehne, D Chimento & H Hassoun

  2. Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, New York, NY, USA

    S M Devlin & E Riedel

  3. Department of Medical Oncology Branch, NCI, National Institutes of Health, Bethesda, MD, USA

    M Bhutani

  4. Department of Internal Medicine, St. Luke’s-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, Memorial Sloan Kettering Cancer Center and Weil Cornell Medical School, New York, NY, USA

    D Babu

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  1. D Zamarin
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Correspondence to H Hassoun.

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Additional information

Prior presentation of data: American Society of Hematology (ASH) Meeting 2011, Abstract 38460; San Diego, CA, USA.

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Zamarin, D., Giralt, S., Landau, H. et al. Patterns of relapse and progression in multiple myeloma patients after auto-SCT: implications for patients’ monitoring after transplantation. Bone Marrow Transplant 48, 419–424 (2013). https://doi.org/10.1038/bmt.2012.151

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