
Improving Multiple Myeloma Prognostication: The Impact of Urine-Free Response Criteria
This study explores the impact of omitting 24-hour urine assessments from International Myeloma Working Group (IMWG) response criteria in multiple myeloma (MM), focusing on its effect on treatment response and prognostication. Secondary analysis of Phase 3 trial data (BMT CTN 0702) indicates minimal change (<1%) in response categorization and no significant impact on progression-free survival (PFS) prediction across different response levels. Implementing urine-free criteria could simplify clinical trials, reduce patient discomfort, and lower operational costs without affecting PFS outcomes, except in specific cases like AL amyloidosis.
Key Points:
- Adopting urine-free response criteria in multiple myeloma minimally affects patient responses (<1% change).
- Omission of 24-hour urine assessments does not impact progression-free survival predictions.
- Study underscores infrequent use of 24-hour urine assessments outside of clinical trials.
- Urine-free criteria simplify study logistics and reduce patient discomfort.
- Results support removing 24-hour urine assessments from future IMWG criteria updates.
- 636 patients from BMT CTN 0702 trial were evaluated; 84% were evaluable.
- LC-only disease noted in 18.9% of patients.
- Traditional and urine-free IMWG response rates compared: CR (29.4% vs 29.7%), VGPR (37.0% vs 36.6%), PR (30.7% for both), SD (3.0% for both).
- Median progression-free survival: CR (63.0 months), VGPR (49.6 months), PR (44.9 months), SD (34.4 months).
Authors:
Rahul Banerjee, MD, FACP; Amber R. Fritz, PhD; Othman S. Akhtar, MD; Ciara Louise Freeman, PhD, MSc, FRCPC, MRCP; Andrew J. Cowan, MD; Nina Shah, MD; Heather J. Landau, MD; Shaji Kumar, MD; Dan T. Vogl, MD, MS; Yvonne A. Efebera, MD; Philip L. McCarthy, MD; David H. Vesole, MD, PhD; Adam Mendizabal, PhD; Amrita Y. Krishnan, MD, FACP; George Somlo, MD; Edward A. Stadtmauer, MD; Marcelo C. Pasquini, MD, MS