Three Biomarkers Can Predict Long-Term Disease Control in Elderly Patients With MM

While there have been advances in multiple myeloma (MM) treatments that have led to improved outcomes, elderly patients with MM continue to have poorer outcomes. Spanish researchers have identified 3 biomarkers, including minimal residual disease (MRD) negativity, that can help define those elderly patients with MM who are likely to achieve long-term disease control. The study was published in Blood Cancer Journal.

The researchers noted that disease control at 5 years is a desirable end point for elderly patients with MM, “since patients that are free from relapse beyond 5 years could eventually die for reasons other than progressive disease.” However, biomarkers for predicting disease control at 5 years are not defined, the authors added.

They analyzed 435 newly diagnosed transplant-ineligible patients with MM. The population was taken from 2 Spanish studies, GEM05MAS65 and GEM2010MAS65, which had a total of 498 patients. In the post-hoc study, 18.6% (n = 81) were alive and had no disease progression after 5 years of treatment initiation. The remaining patients progressed during those first 5 years. Among the 81 patients who were deemed long-term disease-free survivors, 60.8% were alive at 10 years compared with 11.8% of the remaining population.

International Staging System (ISS) stage 1, Revised ISS 1, hemoglobin greater than or equal to 12 g/dL, normal lactate dehydrogenase levels, and the absence of high-risk cytogenetic abnormalities were significantly associated with long-term progression-free survival (PFS). The PFS group also had higher proportion of complete remissions (58.0% vs 33.3%, P = .001) and MRD-negative cases (41.9% vs 9.9%, P <.001).

The presence of a monoclonal gammopathy of unknown significance (MGUS)—like signature defined by automated multiparameter flow cytometry. Overall, the combination of normal hemoglobin, an MGUS-like signature, and MRD negativity can be used to define which elderly patients with MM are likely to achieve long-term disease control, the authors concluded.

“…our results show that the presence of a MGUS-like signature in the [bone marrow] at diagnoses is the most powerful predictor for long-term disease-free survival, becoming an important prognostic biomarker,” they wrote.

Reference

Rodriguez-Otero P, Mateos MC, Martinez-López J, et al. Predicting long-term disease control in transplant-ineligible patients with multiple myeloma: impact of an MGUS-like signature. Blood Cancer J. 2019;9(4):36. doi: 10.1038/s41408-019-0176-x.