High-Risk Features Impact Patient Survival in Relapsed or Refractory MM
Key Takeaways:
- The presence of focal lesions (FLs) in the appendicular skeleton was associated with shorter progression-free survival (PFS) and overall survival (OS) than the absence of FLs in patients with relapsed or refractory multiple myeloma (RRMM).
- Patients with extramedullary disease (EMD) had a significantly shorter PFS and OS than patients without EMD.
- Patients with plasma cell leukemia (PCL) had the lowest survival outcomes, with a median PFS and OS of less than 2 months.
Most research focused on the features of high-risk RRMM was conducted before the advent of T-cell therapies. Researchers assessed the impact of EMD, PCL, and FLs on survival outcomes for patients with high-risk RRMM treated with bispecific antibodies.
The study included 152 patients with RRMM who were treated with B-cell maturation antigen (BCMA)-targeting bispecific antibodies.
How High-Risk Features Affect Survival Outcomes
Out of the 152 patients, 85 had FLs within the appendicular skeleton (humeri, femora, ribs, or shoulders). These patients had a shorter PFS and OS than patients without FLs or with FLs of the spine or pelvis.
EMD was observed in 27% of patients. These patients had a significantly shorter PFS and OS than patients without EMD. Those with EMD had a median PFS of 11 months and a median OS of 17 months whereas patients without EMD had a PFS of 28 months and no median OS.
PCL occurred in 7% of patients, and this group had the poorest survival outcomes. The medians for PFS and OS were both less than 2 months.
Implications for Oncology Care
The study findings illustrate how the presence of EMD, PCL, and FLs is associated with worse survival outcomes for patients with RRMM. Therefore, they can serve as prognostic indicators and possibly influence treatment decision-making.
The authors said, “Notably, the prognostic impact of these tumor growth patterns appears to be strongly influenced by the presence of genomic [high-risk] features, underscoring the central role of chromosomal aberrations as key modifiers of clinical risk even in the era of T-cell–redirecting immunotherapies.”
Reference
Longobardi S, Oo SL, Shrestha A, et al. Influence of genomic and clinical high-risk features on outcomes after BCMA-directed bispecific antibody therapy in relapsed/refractory multiple myeloma. J Clin Oncol. 2026;44(16):7534. doi:10.1200/JCO.2026.44.16_suppl.7534
