A novel, 3-tiered scoring system for patients with multiple myeloma (MM) undergoing upfront autologous hematopoietic stem cell transplantation (HSCT) appears predictive of both progression-free survival (PFS) and overall survival (OS), according study results published in the British Journal of Haematology.

Despite novel therapeutic options for patients with MM, autologous HSCT and high-dose therapy remain the preferred treatments. While the International Staging System (ISS) and the revised-ISS are widely used prognostic tools for patients in this disease setting, they have several limitations, including not being specific to HSCT-eligible patients.

Therefore, a prognostic system that focuses not only on disease-specific characteristics, but patient characteristics is needed. For this study, researchers used “data from the Center for Blood and Marrow Transplant Research registry to identify disease-, patient-, and transplantation-specific variables to develop a risk stratification tool that could be used to predict outcomes in patients undergoing [HSCT] for MM.”

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Overall, 1246 and 1255 patients were included in a training and validation set, respectively. In the training and validation sets, the median ages were 58 and 59 years, respectively; 41% of patients in both sets were women, 75% and 78% of patients had had 1 prior line of chemotherapy, and 55% and 56% had a Karnofsky performance status score of at least 90, respectively. Complete data were not available for all patients in the validation set, leaving 774 patients in the validation analysis.

A 10-point, 3-tiered system was developed, based on the calculated hazard ratios (HRs) of high-risk cytogenetics (HR, 1.68; 4 points), pre-existing bone marrow plasma cells of at least 10% (HR, 1.68; 4 points), and albumin levels at diagnosis of less than 3.5 g/dL (HR, 1.31; 2 points). Standard-risk cytogenetics added 1 point.

In low- (0-3 points) vs high-risk (9-10 points) patients, 3-year PFS rates were 58% vs 31%, respectively (P <.001). The 3-year OS rates in low-, intermediate (4-8 points), and high-risk patients were 88%, 81%, and 64%, respectively (P <.001).

“Most importantly, the scoring system may be used to identify high-risk populations where post-[autologous HSCT] consolidation and maintenance may be of benefit and could be incorporated in future clinical trials to identify these patients,” the authors concluded.

Disclosures: Some authors have declared affiliations with or received funding from the pharmaceutical industry. Please refer to the original study for a full list of disclosures.


Dhakal B, D’Souza A, Callander N, et al. Novel prognostic scoring system for autologous hematopoietic cell transplantation in multiple myeloma. Br J Haematol. Published online October 23, 2020. doi:10.1111/bjh.16987