Abstract
IntroductionLight chain involvement is observed in almost every patient (pt) with newly diagnosed multiple myeloma (MM). Owing to a relatively short half-life, rapid reduction in the involved free light chain (iFLC) is of potential prognostic value.MethodsThis retrospective analysis included 92 pts with newly diagnosed MM treated with bendamustine, prednisone, and bortezomib (BPV).ResultsAfter a median number of two (range 1–5) BPV cycles, the majority of pts (n = 86; 93%) responded with either sCR (n = 21), CR (n = 1), nCR (n = 25), VGPR (n = 20), or PR (n = 19). PFS and OS at 48 months were 39% and 67%, respectively. At baseline, 79 out of 92 pts (86%) had iFLC levels above the upper standard level and an abnormal ratio of involved to uninvolved free light chain ≥ 8. In a subgroup analysis of these pts, we evaluated the prognostic importance of an early reduction of the iFLC during the first two BPV cycles. A reduction ≥ 50% of the iFLC on day 8 of the first cycle was observed in 31 of 69 pts. These pts had a significantly better median PFS of 49 months as compared to 20 months in 38 pts with a lower iFLC reduction (p = 0.002). In contrast, OS did not differ significantly with a 48 months survival of 77% vs 69% (p > 0.05).ConclusionThese results indicate that a rapid decrease in the iFLC on day 8 is an early prognostic marker for newly diagnosed MM pts undergoing BPV treatment.
Highlights
Light chain involvement is observed in almost every patient with newly diagnosed multiple myeloma (MM)
In a subgroup analysis of these patients we evaluated the prognostic importance of an early reduction of the involved free light chain (iFLC) during the first two BPV cycles (Table 4)
We found that early decline ≥ 50% in iFLC on day 8 resulted in favorable prognosis
Summary
Light chain involvement is observed in almost every patient (pt) with newly diagnosed multiple myeloma (MM). The first novel agents introduced into standard therapy were thalidomide, lenalidomide, and bortezomib These have been followed by many other new drugs (including carfilzomib, daratumumab, elotuzumab, bispecific antibodies, and CAR T cells), which have had a remarkably positive effect on the complete response (CR) rate, progressionfree survival (PFS) and overall survival (OS) of MM patients (Kumar et al 2014; Soekojo et al 2020). This has resulted in a wide range of therapeutic options, meaning that effective prognostic tools are required to select the optimal therapy
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