Heterogeneity in Long Term Outcomes for R-ISS Stage II in Newly Diagnosed Multiple Myeloma Patients.

Anais Schavgoulidze (1) , Valérie Lauwers-Cances (2, 3) , Aurore Perrot (4) , Titouan Cazaubiel , Marie-Lorraine Chretien (5) , Philippe Moreau (6) , Thierry Facon (7) , Xavier Leleu (8) , Lionel Karlin (9) , Anne-Marie Stoppa (10) , Olivier Decaux (11) , Karim Belhadj (12) , Bertrand Arnulf (13, 14) , Mohamad Mohty (15, 16) , Clara M. Ariette , Cecile Fohrer-Sonntag , Pascal Lenain (17) , Jean-Pierre Marolleau (18, 19) , Mourad Tiab (20) , Carla Araujo (21) , Frederique Orsini-Piocelle (22) , Arnaud Jaccard (23) , Murielle Roussel (23) , Lotfi Benboubker (24) , Jean-Richard Eveillard (25) , Mamoun Dib (26) , Marion Divoux (27) , Michel Attal (4) , Herve Avet-Loiseau (28, 3) , Jill Corre (29)

1 CHU Purpan - Centre Hospitalier Universitaire de Purpan
2 Service Epidémiologie clinique et santé publique [CHU Toulouse]
3 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
4 Service Hématologie - IUCT-Oncopole [CHU Toulouse]
5 Service d'Hématologie Clinique (CHU de Dijon)
6 CEA Cadarache
7 CHU Lille
8 Service d'Hématologie [CHU Poitiers]
9 CHU Lyon Sud, Pierre Benite, France
10 Service d’Hématologie [Institut Paoli Calmettes, Marseille]
11 CHU Pontchaillou [Rennes]
12 Hôpital Henri Mondor
13 HIPI (UMR_S_976 / U976) - Immunologie humaine, physiopathologie & immunothérapie
14 AP-HP - Hopital Saint-Louis [AP-HP]
15 Service d'hématologie clinique et de thérapie cellulaire [CHU Saint-Antoine]
16 CRSA - Centre de Recherche Saint-Antoine
17 CLCC Henri Becquerel - Centre de Lutte Contre le Cancer Henri Becquerel Normandie Rouen
18 CHU Amiens-Picardie
19 HEMATIM - HEMATIM - Hématopoïèse et immunologie - UR UPJV 4666
20 Hématologie clinique [CH La Roche-sur-Yon]
21 Service d'hématologie (CH de la Côte Basque)
22 Centre Hospitalier Annecy-Genevois [Saint-Julien-en-Genevois]
23 Service d'Hématologie clinique et thérapie cellulaire [CHU Limoges]
24 CHRU Tours - Centre Hospitalier Régional Universitaire de Tours
25 CHRU Brest - Centre Hospitalier Régional Universitaire de Brest
26 CHU Angers - Centre Hospitalier Universitaire d'Angers
27 Service d'Hématologie [CHRU Nancy]
28 CRCT - Centre de Recherches en Cancérologie de Toulouse
29 IUCT Oncopole - UMR 1037 - Institut Universitaire du Cancer de Toulouse - Oncopole

In the era of personalized treatment in multiple myeloma, high-risk patients must be accurately defined. The International Myeloma Working Group recommends using the Revised International Staging System (R-ISS) to identify high-risk patients. The main purpose of our work was to explore the heterogeneity of outcome among R-ISS stage II patients assessing the impact of ISS, chromosomal abnormalities (CA) and LDH level in this subgroup. Data were issued from 1,343 newly diagnosed myeloma patients up to 65 years, enrolled in 3 clinical trials implemented by the Intergroupe Francophone du Myelome. All patients were eligible to an intensive treatment. Patients R-ISS stage II but ISS stage I had 1.6 times more risk of death than patients R-ISS stage I (adjusted HR 1.6; 95% CI, 1.1 to 2.2; P = .01) and patients R-ISS stage II but ISS stage III had a better overall survival than patients R-ISS stage III (adjusted HR 0.7; 95% CI, 0.4 to 0.9, P = .02). However, among patients classified in R-ISS II, ISS stage and CA (del(17p) and t(4;14)) were still relevant prognostic factors for death. Dividing R-ISS stage II into 3 subgroups: ISS I with standard risk CA, ISS II or III with standard risk CA and, high risk CA patients, median overall survivals were respectively not reached, 112 and 71 months (P < 0.001). In conclusion, stratification of patients in the R-ISS stage II group can be improved by taking into account CA and ISS. However, this does not improve predictive performance of survival models.

Domaines: Sciences du Vivant [q-bio]; Médecine humaine et pathologie

Anais Schavgoulidze, Valérie Lauwers-Cances, Aurore Perrot, Titouan Cazaubiel, Marie-Lorraine Chretien, et al.. Heterogeneity in Long Term Outcomes for R-ISS Stage II in Newly Diagnosed Multiple Myeloma Patients.. Haematologica, 2022, ⟨10.3324/haematol.2021.280566⟩. ⟨hal-03801805⟩