Double-hit newly diagnosed multiple myeloma patients with minimal residual disease positivity have a poor prognosis compared to patients with minimal residual disease negativity, according to the results of a recent cohort study.
Autologous stem cell transplantation (ASCT) is one of the novel therapeutic approaches that are beneficial for newly diagnosed multiple myeloma (NDMM) patients. The treatment prognosis is determined by the high-risk cytogenetic abnormalities (HRCAs) present in the NDMM patients, with minimal residual disease (MRD) after initial therapy being a powerful prognostic indicator.
The current study reviewed the importance of double-hit genetics—the presence of two or more HRCAs— in the prognosis of NDMM patients subjected to ASCT. The findings are published in the journal BMC Cancer.
Baseline Characteristics
The study analysis included a total of 168 NDMM patients who underwent ASCT. The median age of the patients was 55 (26–67) years, and 51% of the patients were female. Approximately 42%, 42%, and 16% of the NDMM patients had 0, 1, and ≥ 2 HRCAs, respectively. Double-hit NDMM was present in 26 patients, and 31% of these patients experienced disease progression within a period of 18 months, which was significantly greater compared to those with 0 HRCA and 1 HRCA.
Number of HRCAs and NDMM Prognosis
NMDD patients with double-hit genetics had significantly shorter progression-free survival compared to patients with 1 HRCA or 0 HRCA.
Treatment Response in Double-Hit NDMM Patients
Of the patients with double-hit genetics, 54% were administered proteasome inhibitors, 35% were administered proteasome inhibitors/immunomodulatory drugs, and 11% received combination therapy with proteasome inhibitors, immunomodulatory drugs, and CD38 antibodies. In approximately 54% of patients with double-hit NDMM, MRD-negative therapeutic response was observed within three months in seven, five, and two patients who received combination therapy with proteasome inhibitors, immunomodulatory drugs, and CD38 antibodies, respectively.
NDMM Prognosis Based on Double-Hit Genetics and MRD After ASCT
The overall survival was comparable between patients with double-hit NDMM and MRD negativity and patients with non-double-hit genetics and MRD negativity. On the contrary, the poorest prognosis was associated with double-hit NDMM in patients with MRD positivity.
Source:
Yi, T., Jin, S., Yang, D., Pan, M., Ouyang, W., Liu, Y., Wang, Y., Zhang, W., & Mi, J. (2024). Real-world advantage and challenge of post-autologous stem cell transplantation MRD negativity in high-risk patients with double-hit multiple myeloma. BMC Cancer, 24(1). https://doi.org/10.1186/s12885-024-12077-0
