Model Predicts Early Disease Progression for Patients With Multiple Myeloma

Progression-free survival (PFS) in multiple myeloma (MM) has improved in recent years, but the disease remains incurable, and some patients progress quickly despite advances in MM management. A study published in Hematology analyzed data on factors of MM progression within a year of diagnosis to form a risk prediction model for early progression in patients with newly diagnosed multiple myeloma (NDMM).

“In the past decade, due to the continuous maturation of autologous stem cell transplantation (ASCT) technology and the continuous progress of symptomatic support treatment, such as anti-rejection and anti-infection treatments after transplantation, the survival rate of MM patients has been significantly improved,” the authors wrote. Overall survival (OS) and PFS have both increased, but some patients with NDMM progress quickly, even with treatment.

The retrospective analysis aimed to produce a predictive model for early progression based on basic clinical characteristics and test indicators of patients diagnosed with MM in the Department of Hematology at The People's Hospital of Shangrao City in Jiangxi Province, China, between January 2015 and January 2020.

A total of 108 patients with NDMM were included in the study, which included univariate and multivariate logistic regression analyses to determine the factors contributing to early MM progression. Early progression was defined as disease progression within 1 year in patients with NDMM.

The independent variables assessed for the model included age, sex, clinical stage (Durie-Salmon stage, International Staging System stage), the proportion of plasma cells in bone marrow, treatment regimens, neutrophil-to-lymphocyte ratio (NLR), lactate dehydrogenase (LDH), serum corrected calcium, blood β2-microglobulin (β2-MG), serum creatinine (Scr), and hepatitis B surface antigen (HBsAg). Disease status was the sole dependent variable.

The analysis showed that a treatment regimen containing at least 2 agents reduced the risk of progression (odds ratio [OR], 0.226; 95% CI, 0.068-0.753; P < .05). An increase in LDH levels and an increase in serum corrected calcium levels were both found to be risk indicators for disease progression (OR, 3.452; 95% CI, 1.101-10.826; P < .05; and OR, 4.466; 95% CI, 1.346-14.811; P < .05, respectively).

The established prediction model is as follows:

X = −2.042 – 1.489 × treatment regimen (including at least 2 targeted drugs is 1, otherwise 0) + 1.239 × LDH level (U/L, increased is 1, normal is 0) + 1.496 × serum corrected calcium level (mmol/L, increased is 1, normal is 0)

The model’s accuracy was evaluated with a receiver operating characteristic curve analysis, which showed that the model performed well.

Although the study size was small and it was single center in nature, the findings add to current knowledge of MM risk factors. While further research is necessary to externally validate the model, it was found to be predictive and may be used as a reference for clinicians as they individualize treatment plans for their patients.

“Our prediction model shows that MM patients with high levels of LDH and high blood calcium are more likely to have early disease progression,” the authors concluded. “The use of targeted drugs can reduce the risk of early disease progression, help patients obtain better treatment effects, create opportunities for maintenance treatment, hematopoietic stem cell transplantation and CAR-T therapy, and bring longer PFS times to patients.”

Reference

Wei H, Sun Z, Ye X, Yu J, Ye Y, Wang Z. Establishment of a prediction model for disease progression within one year in newly diagnosed multiple myeloma patients. Hematology. Published online May 26, 2022. doi:10.1080/16078454.2022.2067940