Early relapse after autologous transplant for myeloma is associated with poor survival regardless of cytogenetic risk

Multiple Myeloma (MM) management and survival have dramatically improved in the last decade, notably with triple combinations including one immunomodulatory drug (IMiD) and one proteasome inhibitor (PI) for induction treatment, and high dose therapy (HDT) plus autologous stem cell transplantation (ACST) in younger patients. However, while some patients experience long remission and even cure for rare cases, prognosis is still poor for high-risk MM patients. Early relapse (ER) after treatment has been recognized as an independent risk factor of resistance to rescue treatments and shorter overall survival (OS). Heterogeneity in treatment response duration may be influenced by several patient or disease related features such as frailty, age, comorbidity, clinical stage and cytogenetic abnormalities. Among the highrisk chromosomal changes described in MM, those established and on which there is general consensus are del(17p) and t(4;14). These abnormalities impact negatively both, progression free survival (PFS) and OS, and affect respectively around 8% and 15% of newly diagnosed multiple myeloma (NDMM) patients. Given the current availability of particularly effective salvage therapies, we wondered if an ER after first line intensive treatment is still associated with poor OS in both high-risk and standard-risk patients. To address this issue, we retrospectively analyzed clinical and cytogenetic data of a large and homogeneous cohort of NDMM patients treated by intensive chemotherapy followed by ACST, and consolidation. The Toulouse Ethics Committee approved the study and written informed consent was obtained for all patients included. Clinical data were obtained from 2,627 patients followed >18 months or having relapsed, and for whom diagnosis of MM was established between April 1, 2004 and August 17, 2018. Patients who had primary refractory disease were not included. All patients received an intensive approach with either a doubletbased induction (38%) including PI or a triplet-based (62%) including a PI and an IMiD, followed by ASCT and consolidation by same regimen as induction. Twelve percent of the cohort also received an IMiD-based mainte-