Absolute lymphocyte count as a prognostic marker in newly diagnosed multiple myeloma patients treated in the era of novel agents

Abstract

combination of these techniques could permit to detect early biological (non-symptomatic) relapses (EBR) in this setting. Aims: To analyze the usefulness of HLC and FLC to detect EBR in MM after ASCT. Patient and Methods: A retrospective study was performed following these criteria: all patients diagnosed of secretory MM, in our center, and treated (including ASCT), between May 2011August 2014; the protocol for follow-up included FLC, HLC, serum and urine electrophoresis (SPE, UPE) with immunofixation (IFX), pre-ASCT, after 12 weeks and every 3 months later (minimum follow-up: 6 months). EBR was defined as 25% on M-protein increase (any amount for patients on CR/SR) and/or 20mg/dl FLC increase, and/or 25% involved HLC increase with abnormal ratios. For urine, an increase >500mg/24 hrs of involved free-chain protein. Results: Fifty-five patients were registered. Median followup 21 months. MF ratio: 29/26, mean age 59.5 y (33-71). Immunoglobulin subtype: IgG-Kappa: 41.8% (23), IgG-Lambda: 23.6% (13), IgA-Kappa: 16.4% (9), IgA-Lambda: 7.3% (4), BenceJones-Kappa: 3.6% (2), Bence-Jones-Lambda: 7.3% (4). DurieSalmon Stage: IA: 13.5% (7), II-A: 32.7% (17), III-A: 44.2% (23), III-B: 9.6% (5), missing-data 3 case. All patients received Bortezomib based therapy and MEL200 as ASCT conditioning. Status pre-ASCT: minimal response: 12%, Partial Response (PR): 50.0%, very-good-PR (VGPR): 28.0%, complete response (CR): 6% and string response (SR): 4.0%. After ASCT, evaluation reveals that 13.0% achieved SR, 13.0% CR, 30.4% VGPR and 39.1% PR. During follow-up, 27/50 (54.0%) patients who achieved at least PR after ASCT, had a clinical relapse/progress, median PFS 24 months (19.8-28.1). EBR were detected in 19/27 relapsed patients at median time 7 (2-19) months before symptomatic relapse. The EBR were detected by FLCr (31.6%), HLCr (21.0%), FLC+SPE (10.5%), FLC+IFX (5.2%), FLC+HLC+SPE (15.8%), FLC+HLC+SPE+UPE (15.8%). Conclusion: Both FLC and HLC are useful tools to detect EBR in more than 50% of patients in our cohort ahead other techniques. PO-043 Absolute lymphocyte count as a prognostic marker in newly diagnosed multiple myeloma patients treated in the era of novel agents C. Suriu, L. Akria, D. Azoulay, E. Shaul, A. Braester Hematology Institute, Galilee Medical Center, Nahariya, Israel; Faculty of Medicine in Galilee, Bar-Ilan University, Israel Introduction: The survival of multiple myeloma (MM) patients has improved significantly in the last decade, attributed especially to the use of novel therapeutic agents. Several studies suggest a prognostic significance in the absolute lymphocyte count (ALC) as a surrogate marker of the immune status (Hilmi E. et.al, BJH 2008). Also, increased peripheral blood absolute monocyte count (AMC) and decreased lymphocyte monocyte ratio (LMR) have been reported to be poor prognostic factors in both malignant lymphoproliferative disorders and solid tumors (Berardi S. et.al, Journal of Oncology 2013). Objective: To evaluate the prognostic impact of the ALC, AMC and LMR in our cohort of patients, treated in the era of novel agents. Methods: We retrospectively reviewed the medical records of 62 patients treated at Galilee Medical Center, Israel. AMC and ALC were obtained at diagnosis from routine complete blood count.Overall survival (OS) was measured from the time of diagnosis to the date of death or last follow-up. Univariate and Multivariate Survival analysis was performed using Cox Regression Model and Kaplan-Meier method with Log Rank (Mantel-Cox) test. Results: 62 newly diagnosed MM patients were evaluated. The median age was 69 years (range: 46-88 years); 35 (56.5%) patients were male. 51 patients (82%) were treated with novel agents at diagnosis. The median follow-up for the entire cohort after the diagnosis was 28.2 months (range 0.5-98.8 months). At the time of writing, 41 (66.1%) patients were living. The optimal cut-off for the ALC and AMC, and the LMR was set at 1600/mL, 450/mL and 4 respectively (median value). Univariate analysis of overall survival (OS) showed that age 1600/mL (p1⁄40.066) . The AMC and LMR had no significance on survival in our patients. On multivariate analysis only age (p<0.001) and ALC (p1⁄40.032) showed statistical significance on OS. In subgroup analysis the ALC showed statistical survival significance (p1⁄40.05) only for the group of patients not treated with novel agents. Conclusion: In our cohort of patients, only a high ALC level at diagnosis was significant in the survival of the multiple myeloma patients. This survival benefit is no longer seen in those patients treated with novel agents. 15th International Myeloma Workshop, September 23-26, 2015 e105