Universität zu Köln

Klein, Eva-Maria, Tichy, Diana, Salwender, Hans J., Mai, Elias K., Duerig, Jan, Weisel, Katja C., Benner, Axel, Bertsch, Uta, Akhavanpoor, Mabast, Besemer, Britta, Munder, Markus, Lindemann, Hans-Walter, Hose, Dirk, Seckinger, Anja, Luntz, Steffen, Jauch, Anna, Elmaagacli, Ahmet, Fuhrmann, Stephan, Brossart, Peter, Goerner, Martin, Bernhard, Helga, Raab, Marc S., Blau, Igor W., Haenel, Mathias, Scheid, Christof and Goldschmidt, Hartmut (2021). Prognostic Impact of Serum Free Light Chain Ratio Normalization in Patients with Multiple Myeloma Treated within the GMMG-MM5 Trial. Cancers, 13 (19). BASEL: MDPI. ISSN 2072-6694

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Abstract

Simple Summary For multiple myeloma (MM) patients with measurable disease, there is no recommendation to monitor serum free light chains during therapy. However, this could provide important information in terms of prognosis. We investigated the prognostic impact of serum free light chain ratio (FLCr) normalization in 590 patients with secretory MM during first-line treatment within the German-Speaking Myeloma Multicenter Group MM5 trial. We are able to show that there is an increasing percentage of patients who achieve FLCr normalization during therapy. Importantly, we demonstrate that FLCr normalization at any time before the start of maintenance is significantly associated with prolonged progression-free and overall survival in multivariable time-dependent Cox regression analyses. This suggests that FLCr normalization during therapy is an important and simple way to assess prognostic factor in MM and supports the serial measurement of serum free light chains during therapy, even in patients with secretory MM. We investigated the prognostic impact of time-dependent serum free light chain ratio (FLCr) normalization in 590 patients with secretory multiple myeloma (MM) during first-line treatment within the German-Speaking Myeloma Multicenter Group MM5 trial. Serum free light chains (sFLC) were assessed by the Freelite test at baseline, after induction, mobilization, autologous blood stem cell transplantation, consolidation and every three months during maintenance or follow up within two years after the start of maintenance. The proportion of patients with a normal or normalized FLCr increased from 3.6% at baseline to 23.2% after induction and 64.7% after consolidation. The achievement of FLCr normalization at any one time before the start of maintenance was associated with significantly prolonged progression-free survival (PFS) (p < 0.01, hazard ratio (HR) = 0.61, 95% confidence interval (95% CI) = 0.47-0.79) and overall survival (OS) (p = 0.02, HR = 0.67, 95% CI = 0.48-0.93) in multivariable time-dependent Cox regression analyses. Furthermore, reaching immune reconstitution, defined as the normalization of uninvolved immunoglobulins, before maintenance was associated with superior PFS (p = 0.04, HR = 0.77, 95% CI = 0.60-0.99) and OS (p = 0.01, HR = 0.59, 95% CI = 0.41-0.86). We conclude that FLCr normalization during therapy is an important favorable prognostic factor in MM. Therefore, we recommend serial measurements of sFLC during therapy until achieving FLCr normalization, even in patients with secretory MM.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Klein, Eva-Maria UNSPECIFIED UNSPECIFIED UNSPECIFIED Tichy, Diana UNSPECIFIED UNSPECIFIED UNSPECIFIED Salwender, Hans J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Mai, Elias K. UNSPECIFIED UNSPECIFIED UNSPECIFIED Duerig, Jan UNSPECIFIED UNSPECIFIED UNSPECIFIED Weisel, Katja C. UNSPECIFIED UNSPECIFIED UNSPECIFIED Benner, Axel UNSPECIFIED UNSPECIFIED UNSPECIFIED Bertsch, Uta UNSPECIFIED UNSPECIFIED UNSPECIFIED Akhavanpoor, Mabast UNSPECIFIED UNSPECIFIED UNSPECIFIED Besemer, Britta UNSPECIFIED UNSPECIFIED UNSPECIFIED Munder, Markus UNSPECIFIED UNSPECIFIED UNSPECIFIED Lindemann, Hans-Walter UNSPECIFIED UNSPECIFIED UNSPECIFIED Hose, Dirk UNSPECIFIED UNSPECIFIED UNSPECIFIED Seckinger, Anja UNSPECIFIED UNSPECIFIED UNSPECIFIED Luntz, Steffen UNSPECIFIED UNSPECIFIED UNSPECIFIED Jauch, Anna UNSPECIFIED UNSPECIFIED UNSPECIFIED Elmaagacli, Ahmet UNSPECIFIED UNSPECIFIED UNSPECIFIED Fuhrmann, Stephan UNSPECIFIED UNSPECIFIED UNSPECIFIED Brossart, Peter UNSPECIFIED UNSPECIFIED UNSPECIFIED Goerner, Martin UNSPECIFIED UNSPECIFIED UNSPECIFIED Bernhard, Helga UNSPECIFIED UNSPECIFIED UNSPECIFIED Raab, Marc S. UNSPECIFIED UNSPECIFIED UNSPECIFIED Blau, Igor W. UNSPECIFIED UNSPECIFIED UNSPECIFIED Haenel, Mathias UNSPECIFIED UNSPECIFIED UNSPECIFIED Scheid, Christof UNSPECIFIED UNSPECIFIED UNSPECIFIED Goldschmidt, Hartmut UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-604634
DOI:	10.3390/cancers13194856
Journal or Publication Title:	Cancers
Volume:	13
Number:	19
Date:	2021
Publisher:	MDPI
Place of Publication:	BASEL
ISSN:	2072-6694
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language STEM-CELL TRANSPLANTATION; LONG-TERM SURVIVAL; PROGRESSION; BORTEZOMIB; CRITERIA; ASSAY; IMMUNOGLOBULINS; PREDICTION; REDUCTION; DIAGNOSIS Multiple languages Oncology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/60463