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. 2024 Jul 4;8(7):e81.
doi: 10.1002/hem3.81. eCollection 2024 Jul.

Biological relapse in multiple myeloma: Outcome and treatment strategies in a Spanish real-world setting

Adrián Alegre  1 , Mercedes Gironella  2 , Fernando Escalante  3 , Juan M Bergua  4 , Carmen Martínez-Chamorro  5 , Aurelio López  6 , Esther González  7 , Abelardo Bárez  8 , Nieves Somolinos  9 , Ernesto P Persona  10 , Alexia S Cabrera  11 , Alfons Soler  12 , Belén I Rodríguez  13 , Joaquín M López  14 , Yolanda González  15 , Verónica C Giménez  16 , Antonia Sampol  17 , Carolina Muñoz  18 , David Vilanova  19 , Marta Durán  19 , Carlos Fernández de Larrea  20 ; Spanish Myeloma Group (GEM_PETHEMA)
Affiliations

Biological relapse in multiple myeloma: Outcome and treatment strategies in a Spanish real-world setting

Adrián Alegre et al. Hemasphere. .

Abstract

Recommendations regarding the best time to start treatment in patients with relapsed/refractory multiple myeloma (RRMM) after biological relapse/progression (BR) are unclear. This observational, prospective, multicenter registry aimed to evaluate the impact on time to progression (TTP) of treatment initiation at BR versus at symptomatic clinical relapse (ClinR) based on the Spanish routine practice in adult patients with RRMM. Patients had two or less previous treatment lines and at least one previous partial response. Baseline characteristics and treatment outcomes were recorded, and survival was analyzed. Of 225 patients, 110 were treated at BR (TxBR group) and 115 at ClinR (TxClinR group) according to the investigators' criteria. The proportion of patients with higher ECOG, previous noncomplete remission (CR), and second relapse were significantly higher in the TxBR group compared to the TxClinR group. TheTxClinR group showed improved outcomes, including TTP, compared to the TxBR group. Progression-free survival increased in the TxClinR group (56.2 months) compared to the TxBR group (32.5 months) (p = 0.0137), and median overall survival also increased (p = 0.0897). Median TTP was significantly longer in patients relapsing from a CR (50.4 months) and in their first relapse (38.7 months) compared to those relapsing from a non-CR response (32.9 months) and in their second relapse (25.2 months). Physicians seemed to start treatment earlier in RRMM patients with poor prognosis features. Previous responses to anti-MM treatment and the number of prior treatment lines were identified as prognosis factors, whereby relapse from CR and first relapse were associated with a longer time to progression.

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Conflict of interest statement

Adrián Alegre received research support from Janssen, BMS‐Celgene, Amgen, Sanofi, GSK, Grifols, Pfizer, Abbvie, and Novartis, received honoraria for speakers bureaus from BMS‐Celgene, Amgen, GSK, Janssen, and Sanofi, and participated on a Scientific Advisory Boards for Janssen, BMS‐Celgene, Amgen, Sanofi, Oncopeptides, GSK, and Takeda. Mercedes Gironella received honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from BMS and Janssen. Fernando Escalante received honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Amgen, Janssen, and Sanofi, support for attending meetings and/or travel from GSK, Janssen, BeiGene, and BMS, and participated on a Data Safety Monitoring Board or Advisory Board for Takeda, Amgen, Janssen, Sanofi, BMS, BeiGene, and GSK. Juan M. Bergua received grants or contracts from Astellas Farma, received honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from BMS, Janssen, and Jazz, and support for attending meetings and/or travel from Abbvie. Carmen Martínez‐Chamorro received honoraria for lectures, from Janssen, Abbvie, Amgen, and BMS, received support for attending meetings and/or travel from Janssen, and participated on a Data Safety Monitoring Board or Advisory Board for Janssen, BeiGene, and Abbvie. Ernesto P. Persona received honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Celgene and support for attending meetings and/or travel from Janssen. Alexia S. Cabrera participated in Advisory Boards for BMS‐Celgene, AstraZeneca, Amgen, Abbvie and received honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Janssen, Amgen, Abbvie, AstraZeneca. Alfons Soler received honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Janssen‐Cilag, Celgene‐BMS, Abbvie, Astra Zeneca, and Roche, support for attending meetings and/or travel from Celgene‐BMS, Janssen‐Cilag, Abbvie, and Amgen, Belén I. Rodríguez received honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Tropos formación, Celgene, Janssen, and Sanofi, and support for attending meetings and/or travel from Celgene and Janssen. Joaquín M. López participated in advisory boards for BMS, Janssen, Roche, Gilead, and Novartis. David Vilanova and Marta Durán are BMS employees and stockholders. Aurelio López, Esther González, Abelardo Bárez, Nieves Somolinos, Yolanda González, Verónica C. Giménez, Antonia Sampol, Carolina Muñoz, and Carlos Fernández de Larrea declare no conflicts of interest.

Figures

Figure 1
Figure 1
Study population diagram.
Figure 2
Figure 2
Time from biological relapse to progression (TTP) (A), progression‐free survival (PFS) (B), event‐free survival (EFS) (C), and overall survival (OS) (D) according to treatment group. Survival is presented as the median (95% confidence interval) (months); p‐values correspond to the Log‐Rank test for inter‐curve differences. Median overall survival in (D) could not be calculated due to the low number of events.
Figure 3
Figure 3
Time between biological relapse and progression according to previous response (A) and relapse number (B). Survival is presented as the median (95% confidence interval) (months); p‐values correspond to the Log‐Rank test for inter‐curve differences.
See this image and copyright information in PMC

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