Time to progression predicts outcome of myeloma patients that can be influenced by autologous hematopoietic stem cell transplantation

Currently, there is limited understanding regarding the prognostic significance of time to progression (TTP) after first remission in multiple myeloma (MM). We conducted a retrospective analysis of clinical data from 209 MM patients who experienced disease progression after very good partial remission (VGPR) or complete remission (CR) with first-line therapy. These patients were categorized into subgroups based on TTP. Our findings revealed that patients in G2 group (TTP ≤ 12 months) exhibited shorter median progression-free survival (PFS) and overall survival (OS) compared to those in G3 group (TTP ≤ 24 months) (13.17 vs 16.10 months, P   24 months) (16.10 vs 47.7 months, P  < 0.001; 96.10 vs 121.73 months, P  < 0.001). Besides, G1 group exhibited a shorter median OS compared to G5 group (6 months < TTP ≤ 12 months) (33.63 vs 79.60 months, P  = 0.022). However, no significant difference in OS was observed between patients in G6 (12 months < TTP ≤ 24 months) and G4 group. Furthermore, for patients who experienced progression within 12 or 24 months after VGPR/CR, undergoing autologous hematopoietic stem cell transplantation (ASCT) after progression conferred a median OS advantage over receiving novel agent-based chemotherapy or conventional chemotherapy. Multivariable analysis confirmed that TTP after VGPR/CR was an independent predictor for OS in MM patients. In conclusion, MM patients who experience earlier disease progression within 12 months after VGPR/CR have a worse prognosis, and post-progression ASCT can improve their survival outcomes. Trial registration: 2022(科) CL112, November, 2022, retrospectively registered.