Gayathri Ravi, M.D.A new study led by researchers at the University of Alabama at Birmingham has found that patients with multiple myeloma whose disease returns within three years of receiving current intensive standard treatment should be considered functional high-risk, expanding the previous definition of 18 months.
Published online in CANCER, a peer-reviewed journal of the American Cancer Society, the findings suggest that a revised definition could help doctors identify vulnerable patients earlier, improve the design of clinical trials and guide treatment decisions for patients whose cancer returns despite aggressive therapy.
Doctors have traditionally considered multiple myeloma “functional high risk” when the cancer returns within 18 months of starting treatment. The study analyzed outcomes from 310 patients with newly diagnosed multiple myeloma who received modern four-drug induction therapy followed by autologous stem cell transplantation. Even after receiving these highly effective treatments, about 16 percent of patients experienced disease progression within three years. Researchers found that these patients had substantially shorter remissions and survival after subsequent treatment than did patients whose disease remained under control longer.
In a study of 310 multiple myeloma patients treated with today’s most intensive standard therapies, researchers found that cancer returning within three years, rather than the historical 18-month benchmark, best identifies patients with particularly poor outcomes, while newer T-cell–based immunotherapies showed encouraging benefits for these high-risk patients.
“We identify that, with modern therapy, myeloma relapsing within 36 months (vs. prior definition of 18 months) can be considered as having functional high-risk disease,” said Gayathri Ravi, M.D., assistant professor in the UAB Division of Hematology and Oncology. “These patients should be prioritized for treatments engaging the patient’s immune system with chimeric antigen receptor-T cell [CAR-T] therapy or bispecific antibodies, resulting in improved responses and durable cancer control.”
Researchers also found encouraging results for patients whose disease relapsed after initial treatment. Patients who received T-cell redirecting therapies, a newer form of immunotherapy that helps the body’s immune cells recognize and attack cancer, experienced substantially better outcomes than those receiving other treatments.
In the study, those who received T-cell redirecting therapies after relapse achieved a 91 percent response rate, compared with 47 percent among patients receiving other treatments. One year later, 80 percent remained free from disease progression, versus 23 percent of patients who did not receive a T-cell redirecting therapy. Overall survival at one year was also higher among patients treated with these therapies, at 90 percent compared with 73 percent.
The findings suggest that T-cell redirecting therapies may offer an important new option for patients whose disease returns early despite frontline treatment. Researchers say future clinical trials should incorporate the three-year benchmark when identifying high-risk patients and continue evaluating earlier use of these therapies to improve outcomes for this difficult-to-treat population.