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
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
No (%)
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
ThaDD-V (36%)
EDA-V (40%)
RD (16%)
RESPONSE TO THERAPY
ACCORDING TO FLCr
Median (range)
65 (31-82)
ThaDD (8%)
31 (36)
60 (69)
FLCr
0.03-32
p
Response FLCr <0.03 or >32 FLCr 0.03-32
No (%)
No (%) No (%)
56 (64)
31 (36)
CR
8.3 (0-14200)
42 (48)
8 (9)
24 (54)
 VGPR
 PR
0.028
13 (29.5)13 (29.5)
0.468
20 (45.5)
5 (12)
20 (47.5)
20 (45.5%)
24 (57)
28 (62)
0.542
28 (62)
3.6 (0.2-21.5)
42 (52)
3.6 (2.4-4.5)
OS
36 (46)
68 (78)
19 (22)
28 (32)
51 (59)
38 (44)
FLCr 0.03-32
median = NR
p= 0.030
FLCr< 0.03 or >32
UNIVARIATE ANALYSIS FOR PFS
median = 17 months
Age > 65 (HR=1.5; p=0.433)
PFS
ISS stage 2-3 (HR=1.7; p= 0.078)
eFLCr (HR=2.0; p= 0.020)
FLCr 0.03-32
median = 22 months
Unfavorable FISH (HR=1.3; p= 0.345)
First remission < 12 months (HR=1.6; p=0.083)
p= 0.019
MULTIVARIATE ANALYSIS FOR PFS
FLCr< 0.03 or >32
median = 10 months
eFLCr: HR= 1.9 (95%CI= 1.2-3.4); p= 0.030)
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