P-378: A retrospective study of serum indicators in functional high-risk multiple myeloma patients undertaking proteasome inhibitors treatments

Introduction: Multiple myeloma (MM) ranks as the second most prevalent hematological malignancy, predominantly affecting the elderly population. The concept of functional high-risk (FHR) has recently emerged, specifically for patients who exhibit disease progression within 12 months of initiating therapy. Studies have shown that individuals classified as FHR have a median overall survival (OS) of only 20.2 months.



MM patients who are resistant to PIs have a poor prognosis, particularly when accompanied by renal insufficiency. In this study, we aimed to discuss the effects of RI on FHR status in MM patients, and seek the determining factors among biochemical parameters. We explored the clinical indices related to FHR and sought prognostic roles in transplant-eligible MM patients.

Methods: 216 patients were included and divided into two groups according to the FHR status. PFS and OS were estimated by using the Kaplan-Meier method and were compared by using a log-rank test. Logistic regression analysis was used to assess the association of baseline characteristics at MM diagnosis with FHR status. P< .05 was considered statistically significant.

Results: This study included a total of 760 newly diagnosed MM patients. A total of 216 patients undergoing PI-dexamethasone based therapy were included in the study, with follow-up data available. An equal distribution of gender was observed, with a male-female ratio of 1.0. Over a median follow-up period of 21 months, 59 (27.3%) patients deceased while 157 (72.7%) remained alive. The median survival time was 91 months.



While patients treated with triplet chemotherapy exhibited improved progression-free survival (PFS) and OS compared to those receiving PI-dexamethasone regimens, no significant differences were observed in PFS and OS within the first 12 months. The results of the univariate logistic regression analysis revealed that treatment options did not have a significant impact on FHR status (p=0.116). Additionally, there were no significant differences in baseline data between the FHR and functional standard-risk (FSR) groups.



Patients with amplification of 1q21 or deletion of 17p13 had significantly shorter PFS and OS. Moreover, our analysis revealed that renal function did not significantly impact PFS or OS in transplant recipients, despite the observed improvements in outcomes for MM patients with RI. Furthermore, transplant-eligible MM patients with elevated AST levels ( >40U/L) tended to experience poorer outcomes. In the context of transplant therapy, a marginal elevation in AST levels did not appear to have a significant impact on PFS and OS. Subsequently, our objective was to assess the prognostic significance of abnormal AST levels.

Conclusions: Our investigation revealed a notable disparity in biochemical parameters between patients with FHR and FSR MM. Patients with varying levels of Scr and AST exhibited divergent clinical outcomes. Consequently, in the era of PIs, transplant therapies remain efficacious for MM patients.