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Increased Bone Marrow Plasma-Cell Percentage Predicts Outcomes in Newly Diagnosed Multiple Myeloma Patients
Abdullah S Al Saleh1, Harsh V Parmar2, Alissa Visram2
1Division of Hematology, Department of Internal Medicine, Mayo Clinic Rochester, Rochester, MN; Department of Oncology, Division of Hematology, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
Background:
Previous reports have suggested that a higher bone marrow plasma-cell percentage (BMPC%) is associated with worse outcomes. However, it is unknown whether BMPC% is an independent predictor because genetic information was not available at that time. Currently the impact of BMPC% at diagnosis of multiple myeloma (MM) is not well described.
Patients And Methods:
We evaluated the prognostic impact of BMPC% ≥ 60% versus < 60% in 1426 newly diagnosed MM patients. All patients had an estimation of their BMPC% at diagnosis, and the highest percentage was used. Progression-free survival (PFS) and overall survival (OS) analyses were performed by the Kaplan-Meier method. Univariate and multivariate analyses for PFS and OS using the Cox proportional hazards model were performed for age, Revised International Staging System (R-ISS) score, creatinine level, and BMPC%.
Results:
BMPC% ≥ 60% was found in 562 patients (39%), and the median PFS was shorter for these patients compared to BMPC% < 60% (22.6 vs. 32.1 months; P < .0001). Also, for OS, the median was shorter for the higher BMPC% group (53.4 vs. 75.4 months; P < .0001). On the multivariate analysis for PFS, age ≥ 65 years (hazard ratio [HR], 1.46; P < .0001), R-ISS (1-2 vs. 3) (HR, 0.49; P < .0001), and BMPC% ≥ 60% (HR, 1.23; P = .015) were predictive. On the multivariate analysis for OS, age ≥ 65 years (HR, 2.23; P < .001), R-ISS (1-2 vs. 3) (HR, 0.41; P < .0001), and BMPC% ≥ 60% (HR, 1.24; P = .02) were also predictive.
Conclusion:
BMPC% ≥ 60% at diagnosis is predictive for PFS and OS, even in a multivariate analysis that included known prognostic factors for MM.
Insights
A higher bone marrow plasma-cell percentage (BMPC%) of 60% or more at diagnosis is linked to worse outcomes in multiple myeloma (MM). This finding holds true even when considering other known prognostic factors for MM patients.
Area of Science:
- Hematology
- Oncology
- Cancer Research
Background:
- Previous studies suggested a link between higher bone marrow plasma-cell percentage (BMPC%) and poorer outcomes in multiple myeloma (MM).
- The independent predictive value of BMPC% was previously unclear due to a lack of genetic data.
- The prognostic significance of BMPC% at the time of MM diagnosis requires further elucidation.
Purpose of the Study:
- To investigate the prognostic impact of a bone marrow plasma-cell percentage (BMPC%) of 60% or higher versus less than 60% in newly diagnosed multiple myeloma (MM) patients.
- To determine if BMPC% is an independent predictor of progression-free survival (PFS) and overall survival (OS) in MM.
Main Methods:
- Evaluation of 1426 newly diagnosed MM patients.
- Assessment of bone marrow plasma-cell percentage (BMPC%) at diagnosis.
- Progression-free survival (PFS) and overall survival (OS) analyses using Kaplan-Meier and Cox proportional hazards models, incorporating age, R-ISS score, creatinine, and BMPC%.
Main Results:
- Patients with BMPC% ≥ 60% (39%) had significantly shorter median PFS (22.6 vs. 32.1 months) and OS (53.4 vs. 75.4 months) compared to those with BMPC% < 60%.
- Multivariate analysis identified age ≥ 65 years, R-ISS score, and BMPC% ≥ 60% as independent predictors for PFS.
- Age ≥ 65 years, R-ISS score, and BMPC% ≥ 60% were also significant independent predictors for OS.
Conclusions:
- A bone marrow plasma-cell percentage (BMPC%) of 60% or higher at diagnosis is a significant independent predictor of both progression-free survival (PFS) and overall survival (OS) in multiple myeloma (MM).
- This finding is robust even after adjusting for established prognostic factors in MM.
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