Prognostic Impact of Serum Free Light Chain Ratio Normalization in Patients with Multiple Myeloma Treated within the GMMG-MM5 Trial

Eva-Maria Klein, Diana Tichy, Hans J Salwender, Elias K Mai, Jan Duerig, Katja C Weisel, Axel Benner, Uta Bertsch, Mabast Akhavanpoor, Britta Besemer, Markus Munder, Hans-Walter Lindemann, Dirk Hose, Anja Seckinger, Steffen Luntz, Anna Jauch, Ahmet Elmaagacli, Stephan Fuhrmann, Peter Brossart, Martin GoernerHelga Bernhard, Marc S Raab, Igor W Blau, Mathias Haenel, Christof Scheid, Hartmut Goldschmidt, On Behalf Of The German-Speaking Myeloma Multicenter Group Gmmg

Onderzoeksoutput: Articlepeer review

3 Citaten (Scopus)

Samenvatting

We investigated the prognostic impact of time-dependent serum free light chain ratio (FLCr) normalization in 590 patients with secretory multiple myeloma (MM) during first-line treatment within the German-Speaking Myeloma Multicenter Group MM5 trial. Serum free light chains (sFLC) were assessed by the Freelite test at baseline, after induction, mobilization, autologous blood stem cell transplantation, consolidation and every three months during maintenance or follow up within two years after the start of maintenance. The proportion of patients with a normal or normalized FLCr increased from 3.6% at baseline to 23.2% after induction and 64.7% after consolidation. The achievement of FLCr normalization at any one time before the start of maintenance was associated with significantly prolonged progression-free survival (PFS) (p < 0.01, hazard ratio (HR) = 0.61, 95% confidence interval (95% CI) = 0.47-0.79) and overall survival (OS) (p = 0.02, HR = 0.67, 95% CI = 0.48-0.93) in multivariable time-dependent Cox regression analyses. Furthermore, reaching immune reconstitution, defined as the normalization of uninvolved immunoglobulins, before maintenance was associated with superior PFS (p = 0.04, HR = 0.77, 95% CI = 0.60-0.99) and OS (p = 0.01, HR = 0.59, 95% CI = 0.41-0.86). We conclude that FLCr normalization during therapy is an important favorable prognostic factor in MM. Therefore, we recommend serial measurements of sFLC during therapy until achieving FLCr normalization, even in patients with secretory MM.

Originele taal-2English
Artikelnummer4856
Aantal pagina's16
TijdschriftCancers
Volume13
Nummer van het tijdschrift19
DOI's
StatusPublished - okt 2021

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