P-126: The prognostic impact of the UK Myeloma Research Alliance Risk Profile in untreated patients with multiple myeloma who received melphalan, prednisolone, and bortezomib: an ad hoc analysis of JCOG1105

• Published in: Clinical lymphoma, myeloma and leukemia myeloma and leukemia, 2021-10, Vol.21, p.S103-S104
• Main Authors: Suzuki, Tomotaka, Maruyama, Dai, Machida, Ryunosuke, Kataoka, Tomoko, Fukushima, Noriyasu, Takayama, Nobuyuki, Ohba, Rie, Omachi, Ken, Imaizumi, Yoshitaka, Tokunaga, Masahito, Katsuya, Hiroo, Yoshida, Isao, Sunami, Kazutaka, Kurosawa, Mitsutoshi, Kubota, Nobuko, Morimoto, Hiroaki, Kobayashi, Miki, Yamamoto, Kazuhito, Kameoka, Yoshihiro, Kagami, Yoshitoyo, Tabayashi, Takayuki, Maruta, Masaki, Kobayashi, Tsutomu, Iida, Shinsuke, Nagai, Hirokazu
• Format: Article
• Language: English
• ISSN: 2152-2650; 2152-2669
• DOI: 10.1016/S2152-2650(21)02253-9

The UK Myeloma Research Alliance Risk Profile (MRP) (Lancet Haematol 2019) was developed as a prognostic score for transplant-ineligible, newly diagnosed multiple myeloma (NDMM) patients. MRP consists of widely available clinical parameters, such as WHO performance status (PS), International Staging System (ISS), age, and C-reactive protein (CRP) level. However, as MRP was developed in clinical trials in which immunomodulatory drugs were used as induction regimens, its applicability to patients who were treated with bortezomib (BOR)-based regimens remains elusive. We conducted an exploratory analysis to assess the utility of MRP using data from JCOG1105, a randomized phase II trial in which two modified MPBs (melphalan, prednisolone, and BOR) were compared (Br J Haematol 2021). Furthermore, the clinical factors associated with poor outcomes among patients included in JCOG1105 were evaluated. The data of 88 transplant-ineligible patients with NDMM enrolled in JCOG1105 between July 2013 and April 2016 were analyzed. Progression-free survival (PFS) and overall survival (OS) in each MRP risk were estimated using the Kaplan-Meier method and compared using the log-rank test. Clinical parameters associated with poor prognosis were evaluated in univariable and multivariable Cox regression analyses. The baseline characteristics of the 88 patients were as follows: a median age of 72 (range, 65–79) years, 20 (23%) had PS ≥2, 13 (15%) with LDH > upper normal limit (UNL), and median CRP level of 1 mg/L (range, 0–140). Forty-six (52%) and 16 (18%) patients had ISS II and III disease, respectively. MRP was evaluated in 87 patients (excluding one patient with missing data on CRP levels) and was classified as low (n=51), medium (n=16), and high risk (n=20). With a median follow-up of 47.3 (range, 10.4-71.1) months, the 3-year PFS and OS of all 88 patients were 20.5% (95% confidence interval [CI]: 13–29%) and 81.8% (95% CI: 72–88%), respectively. In patients with MRP low, medium, and high risk, the outcomes were as follows: a 3-year PFS of 26%, 19%, and 10% and a 3-year OS of 84%, 69%, and 85%, respectively. A higher MRP risk was not significantly associated with a poorer PFS and OS. In multivariable analysis, LDH > UNL (Hazard Ratio [HR]: 4.73, 95% CI: 1.71–13.13) and β2MG ≥ 3.5 mg/dL (HR: 2.86, 95% CI: 1.20–6.81) were significantly associated with poor OS. PS ≥2 was not associated with poor OS (HR: 0.85, 95% CI: 0.33–2.23). Higher MRP risk scores were not significantly as