Heterogeneity in long-term outcomes for patients with Revised International Staging System stage II, newly diagnosed multiple myeloma

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

1 IUCT Oncopole - UMR 1037 - Institut Universitaire du Cancer de Toulouse - Oncopole
2 CRCT - Centre de Recherches en Cancérologie de Toulouse
3 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
4 Service Hématologie - IUCT-Oncopole [CHU Toulouse]
5 CHU Bordeaux
6 Service d'Hématologie Clinique (CHU de Dijon)
7 CHU Nantes - Centre Hospitalier Universitaire de Nantes
8 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
9 Service d'Hématologie [CHU Poitiers]
10 CHLS - Centre Hospitalier Lyon Sud [CHU - HCL]
11 Service d’Hématologie [Institut Paoli Calmettes, Marseille]
12 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
13 MOBIDIC - Microenvironment and B-cells: Immunopathology,Cell Differentiation, and Cancer
14 Hôpital Henri Mondor
15 AP-HP - Hopital Saint-Louis [AP-HP]
16 CHU Saint-Antoine [AP-HP]
17 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
18 Hôpital de Hautepierre [Strasbourg]
19 CLCC Henri Becquerel - Centre de Lutte Contre le Cancer Henri Becquerel Normandie Rouen
20 CHU Amiens-Picardie
21 Hématologie clinique [CH La Roche-sur-Yon]
22 CHCB - Centre Hospitalier de la Côte Basque
23 Centre Hospitalier Annecy-Genevois [Saint-Julien-en-Genevois]
24 Service d'Hématologie clinique et thérapie cellulaire [CHU Limoges]
25 CHRU Tours - Centre Hospitalier Régional Universitaire de Tours
26 CHRU Brest - Centre Hospitalier Régional Universitaire de Brest
27 CHU Angers - Centre Hospitalier Universitaire d'Angers
28 Service d'Hématologie [CHRU Nancy]

In the era of personalized treatment in multiple myeloma, high-risk patients must be accurately identified. The International Myeloma Working Group recommends using the Revised International Staging System (R-ISS) to pick out 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 International Staging System (ISS) stage, chromosomal abnormalities and lactate dehydrogenase level in this subgroup. Data were collected from 1,343 patients up to 65 years old with newly diagnosed myeloma, enrolled in three clinical trials implemented by the Intergroupe Francophone du Myélome. All patients were eligible for intensive treatment. Patients in R-ISS stage II but ISS stage I had 1.6 times higher risk of death than patients in R-ISS stage I (adjusted hazard ratio=1.6; 95% confidence interval: 1.1-2.2; P=0.01) and patients in R-ISS stage II but with ISS stage III had a better overall survival than patients in R-ISS stage III (adjusted hazard ratio=0.7; 95% confidence interval: 0.4-0.9, P=0.02). However, among patients classified in R-ISS II, ISS stage and chromosomal abnormalities (del[17p] and t[4;14]) were still relevant prognostic factors for death. Dividing R-ISS stage II into three subgroups: ISS I with standard-risk chromosomal abnormalities, ISS II or III with standard-risk chromosomal abnormalities and patients with high-risk chromosomal abnormalities, median overall survival times were, respectively, not reached, 112 months 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 chromosomal abnormalities and ISS. However, this does not improve predictive performance of survival models.

Domaines: Médecine humaine et pathologie

Anais Schavgoulidze, Valérie Lauwers-Cances, Aurore Perrot, Titouan Cazaubiel, Marie-Lorraine Chretien, et al.. Heterogeneity in long-term outcomes for patients with Revised International Staging System stage II, newly diagnosed multiple myeloma. Haematologica, 2023, 108 (5), pp.1374. ⟨10.3324/haematol.2021.280566⟩. ⟨hal-03801805⟩