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Clinical Progression Outcomes ‘Inferior’ to Biochemical Progression Outcomes in Multiple Myeloma

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By Cecilia Brown - March 21, 2023

Patients with clinical progression of multiple myeloma have “inferior” outcomes after progression compared to those with biochemical progression, according to a recent study.

Sarah Goldman-Mazur, MD, PhD, of the Mayo Clinic Rochester, and colleagues conducted the study and published its results in Blood Advances.

“Almost all patients with multiple myeloma eventually relapse, either asymptomatically or with end-organ damage,” Dr. Goldman-Mazur and colleagues wrote. “However, it remains unclear whether initiating therapy at the time of biochemical progression improves the outcomes compared with initiating therapy at the clinical progression stage.”

They retrospectively assessed 1,347 patients who had relapsed multiple myeloma. Nearly two-thirds (60.4%) patients had biochemical progression, while 39.6% of patients had clinical progression.

New or evolving bone disease was the most prevalent symptom at relapse, reported in 80.9% of patients, followed by anemia (38%), and renal failure (12.7%).

The median time from second-line treatment to the next treatment was 17 months in patients with biochemical progression, while it was significantly lower at 9.6 months in patients with clinical progression (P<.001). Patients with biochemical progression had a significantly longer median overall survival from their first relapse (59.4 months) than those with clinical progression (26.2 months; P<.001).

Male sex was associated with a higher risk of clinical progression (odds ratio [OR], 1.49; 95% CI, 1.02-2.18; P=.04), as was plasma cell labeling index ≥2% (OR, 1.58; 95% CI, 1.02-2.45; P=.04), and extramedullary disease at diagnosis (OR, 1.84; 95% CI, 1.08-3.13; P=.03). However, patients with very good partial remission or better had a decreased risk of clinical progression (OR, 0.62; 95% CI, 0.43-0.91; P=.02).

“To conclude, patients with [clinical progression] have inferior postprogression outcomes compared with patients who have [biochemical progression],” Dr. Goldman-Mazur and colleagues wrote. “Patients with deeper response to first-line therapy are less likely to develop [clinical progression]. The presence of a specific CRAB (C, hypercalcemia; R, renal failure; A, anemia; B, bone disease) symptom at diagnosis predicts for the development of similar CRAB symptoms at relapse.”


Goldman-Mazur S, Visram A, Kapoor P, et al. Outcomes after biochemical or clinical progression in patients with multiple myeloma. Blood Adv. 2023;7(6):909-917. doi:10.1182/bloodadvances.2022007082


Original Source: Clinical Progression Outcomes ‘Inferior’ to Biochemical Progression Outcomes in Multiple Myeloma | Blood Cancers Today

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