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RATIONALE. METHODS. Although extreme free light chains ratio (eFLCr: < 0.03 or > 32) and ISS have been found to be prognostic factors for survival in newly diagnosed multiple myeloma (MM), their usefulness in relapsed/refractory myeloma have not been explored so far.

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RATIONALE

METHODS

Although extreme free light chains ratio (eFLCr: < 0.03 or > 32) and ISS have been found to be prognostic factors for survival in newly diagnosed multiple myeloma (MM), their usefulness in relapsed/refractory myeloma have not been explored so far.

We explored the impact of age, ISS stage, eFLCr, cytogenetics and duration of first remission on survival parameters in 87 patients with relapsed/refractory MM treated within controlled trials with regimens including:

CHARACTERISTICS OF 87 PATIENTS

RESPONSE TO THERAPY ACCORDING TO FLCr

Age

PS ≥ 2

ISS 2-3

Free light chain monoclonality

k

l

FLC ratio value

Extreme FLC ratio

Renal failure

Unfavourable cytogenetics

b2 microglobulin (mg/l)

 3.5

Albumin (g/dl)

 3.5 g/dl

Disease status

relapse

refractory

Prior chemotherapy lines > 2

Prior PSCT

First remission duration < 12 months

No (%)

31 (36)

60 (69)

56 (64)

31 (36)

42 (48)

8 (9)

24 (54)

42 (52)

36 (46)

68 (78)

19 (22)

28 (32)

51 (59)

38 (44)

Median (range)

65 (31-82)

8.3 (0-14200)

3.6 (0.2-21.5)

3.6 (2.4-4.5)

Response

CR

 VGPR

 PR

FLCr <0.03 or >32

No (%)

5 (12)

20 (47.5)

24 (57)

FLCr 0.03-32

No (%)

13 (29.5)

20 (45.5)

28 (62)

UNIVARIATE ANALYSIS FOR PFS

Age > 65 (HR=1.5; p=0.433)

ISS stage 2-3 (HR=1.7; p= 0.078)

eFLCr (HR=2.0; p= 0.020)

Unfavorable FISH (HR=1.3; p= 0.345)

First remission < 12 months (HR=1.6; p=0.083)

MULTIVARIATE ANALYSIS FOR PFS

eFLCr: HR= 1.9 (95%CI= 1.2-3.4); p= 0.030)

p= 0.030

PFS

FLCr 0.03-32

median = NR

OS

FLCr< 0.03 or >32

median = 17 months

EXTREME SERUM FREE LIGHT CHAINS RATIO IS AN INDEPENDENT PROGNOSTIC FACTOR FOR PROGRESSION IN RELAPSE/REFRACTORY MULTIPLE MYELOMA

M. Offidani1, L. Corvatta2, S. Gentili1, A. Savini1, C. Polloni1, M. Brunori2, M. Catarini2, G. Visani2, F.Alesiani2, A. Samori2, M. Ferranti2, P. Fraticelli2, B. Amoroso3, P. Leoni1

1Clinica di Ematologia Azienda Ospedaliero-Universitaria, Ospedali Riuniti Ancona; 2Marche Multiple Myeloma Network, GEMaMM, Italy and 3Scientific Director Freelite Italy, The Binding Site, Birmingham, UK

ThaDD (8%)

ThaDD-V (36%)

EDA-V (40%)

RD (16%)

FLCr 0.03-32

No (%)

13 (29.5)

20 (45.5%)

28 (62)

p

0.028

0.468

0.542

FLCr 0.03-32

median = 22 months

p= 0.019

FLCr< 0.03 or >32

median = 10 months

  • CONCLUSIONS
  • As well as patients with newly diagnosed MM, those with advanced disease can be usefully stratified according to eFLCr
  • The FLCr should be included in the work-up of patients with relapsed/refractory disease since it seems helpful in tailoring treatment