TY - JOUR
T1 - The impact of biomarkers of malignancy (IMWG SLiM criteria) in myeloma in a real-world population
T2 - Clinical characteristics, therapy and outcomes from the Australian and New Zealand Myeloma and Related Diseases Registry (ANZ MRDR)
AU - Ho, P. Joy
AU - Moore, Elizabeth
AU - Wellard, Cameron
AU - Quach, Hang
AU - Blacklock, Hilary
AU - Harrrison, Simon J.
AU - MacDonald, Emma Jane
AU - McQuilten, Zoe K
AU - Wood, Erica M.
AU - Mollee, Peter
AU - Spencer, Andrew
N1 - Publisher Copyright:
© 2024 The Author(s). British Journal of Haematology published by British Society for Haematology and John Wiley & Sons Ltd.
PY - 2024/10
Y1 - 2024/10
N2 - A decade after International Myeloma Working Group (IMWG) biomarkers (SLiM criteria) were introduced, this real-world study examined their impact on diagnosis, therapy and outcomes in myeloma. Using the ANZ MRDR, 3489 newly diagnosed patients from 2013 to 2023, comprising 3232 diagnosed by CRAB (‘CRAB patients’, including 1758 who also satisfied ≥1 SLiM criteria) and 257 by SLiM (‘SLiM patients’) criteria were analysed. CRAB patients had higher R-ISS and lower performance status, with no difference in cytogenetic risk. SLiM patients had improved progression-free survival (PFS, 37.5 vs. 32.2 months, hazard ratio [HR] 1.31 [1.08–1.59], p = 0.003), overall survival (80.9 vs. 73.2 months, HR 1.64 [1.26–2.13], p < 0.001) and PFS2 (54.6 vs. 40.3 months, HR 1.51 [1.22–1.86], p < 0.001) compared with CRAB patients, partially explained by earlier diagnosis, with no differential impact between the plasma cell and light-chain criteria on PFS. However, 34% of CRAB patients did not manifest SLiM characteristics, raising the possibility that SLiM features are associated with different biological behaviours contributing to a better prognosis, for example, improved PFS2 in SLiM patients suggested less disease resistance at first relapse. These data support earlier initiation of therapy by SLiM. The superior survival outcomes of SLiM versus CRAB patients highlight the importance of defining these subgroups when interpreting therapeutic outcomes at induction and first relapse.
AB - A decade after International Myeloma Working Group (IMWG) biomarkers (SLiM criteria) were introduced, this real-world study examined their impact on diagnosis, therapy and outcomes in myeloma. Using the ANZ MRDR, 3489 newly diagnosed patients from 2013 to 2023, comprising 3232 diagnosed by CRAB (‘CRAB patients’, including 1758 who also satisfied ≥1 SLiM criteria) and 257 by SLiM (‘SLiM patients’) criteria were analysed. CRAB patients had higher R-ISS and lower performance status, with no difference in cytogenetic risk. SLiM patients had improved progression-free survival (PFS, 37.5 vs. 32.2 months, hazard ratio [HR] 1.31 [1.08–1.59], p = 0.003), overall survival (80.9 vs. 73.2 months, HR 1.64 [1.26–2.13], p < 0.001) and PFS2 (54.6 vs. 40.3 months, HR 1.51 [1.22–1.86], p < 0.001) compared with CRAB patients, partially explained by earlier diagnosis, with no differential impact between the plasma cell and light-chain criteria on PFS. However, 34% of CRAB patients did not manifest SLiM characteristics, raising the possibility that SLiM features are associated with different biological behaviours contributing to a better prognosis, for example, improved PFS2 in SLiM patients suggested less disease resistance at first relapse. These data support earlier initiation of therapy by SLiM. The superior survival outcomes of SLiM versus CRAB patients highlight the importance of defining these subgroups when interpreting therapeutic outcomes at induction and first relapse.
KW - diagnostic criteria
KW - multiple myeloma
KW - prognosis
UR - http://www.scopus.com/inward/record.url?scp=85197513399&partnerID=8YFLogxK
U2 - 10.1111/bjh.19624
DO - 10.1111/bjh.19624
M3 - Article
C2 - 38965706
AN - SCOPUS:85197513399
SN - 0007-1048
VL - 205
SP - 1337
EP - 1345
JO - British Journal of Haematology
JF - British Journal of Haematology
IS - 4
ER -