title: Predictors of inferior clinical outcome in patients with standard-risk multiple myeloma.
abstract: BACKGROUND
  Outcome of patients with standard-risk (SR) multiple myeloma (MM) has improved; however, subsets of patients do worse than expected. We sought to identify the factors associated with inferior outcome.
  
  
  METHODS
  We evaluated 51 patients with SR MM that received upfront autologous hematopoietic stem cell transplantation (auto-HCT) after induction and had a progression-free survival (PFS) of ≤18 months.
  
  
  RESULTS
  The median age of patients was 61 yr. Forty-one (80%) patients received induction with immunomodulatory drugs, proteosome inhibitors, or combination of both. The overall response rate (ORR) after auto-HCT was 96% (stringent complete response 23%, complete response 10%, very good partial response 22%, and partial response 39%). The median PFS was 7.8, and median overall survival (OS) was 56.3 months. On univariate analysis, concurrent light-chain amyloidosis (AL) was associated with inferior PFS [hematological response (HR); 2.51, 95% CI; 0.64-10.58, P = 0.03] and occurrence of soft tissue plasmacytoma was associated with a significantly shorter OS (HR: 3.05, 95% CI: 0.57-16.29, P = 0.02).
  
  
  CONCLUSIONS
  Our analysis suggests that concurrent AL and soft tissue plasmacytoma were associated with shorter PFS and OS, respectively. Heterogeneity in clinical outcome of SR MM merits better tools for prognostication, such as gene expression profiling and minimal residual disease assessment to identify high-risk patients.
authors.affiliation: Department of Stem Cell Transplantation and Cellular therapy, University of Texas MD Anderson Cancer Center, Houston, TX, USA.|Department of Leukemia, University of Texas, MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Talha
authors.initials: T
authors.lastname: Badar
authors.affiliation: Department of Stem Cell Transplantation and Cellular therapy, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Samer
authors.initials: S
authors.lastname: Srour
authors.affiliation: Department of Stem Cell Transplantation and Cellular therapy, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Qaiser
authors.initials: Q
authors.lastname: Bashir
authors.affiliation: Department of Stem Cell Transplantation and Cellular therapy, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Nina
authors.initials: N
authors.lastname: Shah
authors.affiliation: Department of Stem Cell Transplantation and Cellular therapy, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Gheath
authors.initials: G
authors.lastname: Al-Atrash
authors.affiliation: Department of Stem Cell Transplantation and Cellular therapy, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Chitra
authors.initials: C
authors.lastname: Hosing
authors.affiliation: Department of Stem Cell Transplantation and Cellular therapy, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Uday
authors.initials: U
authors.lastname: Popat
authors.affiliation: Department of Stem Cell Transplantation and Cellular therapy, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Yago
authors.initials: Y
authors.lastname: Nieto
authors.affiliation: Department of Lymphoma and Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Robert Z
authors.initials: RZ
authors.lastname: Orlowski
authors.affiliation: Department of Stem Cell Transplantation and Cellular therapy, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Champlin
authors.affiliation: Department of Stem Cell Transplantation and Cellular therapy, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Muzaffar H
authors.initials: MH
authors.lastname: Qazilbash
mesh_terms: D000328:Adult; D000368:Aged; D002869:Chromosome Aberrations; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D016130:Immunophenotyping; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D016896:Treatment Outcome
keywords: amyloidosis; autologous hematopoietic stem cell transplant; plasmacytoma; standard-risk multiple myeloma