Multiple myeloma is a cancer that begins in plasma cells, a type of white blood cell that normally helps the body fight infections.
When these cells become cancerous, they grow out of control inside the bone marrow and crowd out healthy blood cells.
This can lead to bone pain, frequent infections, anemia, kidney problems, and tiredness that affects everyday life.
In recent years, treatment for multiple myeloma has improved greatly. Many patients are living longer because doctors now combine several powerful medicines instead of relying on a single drug. Even so, not every patient benefits in the same way, and some people’s cancer returns much sooner than expected.
Doctors have long used the term functional high-risk, or FHR, to describe patients whose disease comes back quickly after treatment.
In the past, FHR usually meant the cancer returned within 18 months of starting treatment and survival after the cancer returned was less than two years. However, experts suspected this definition no longer matched today’s treatment results.
A research team from the University of Alabama at Birmingham and the CoMMiT consortium decided to take another look. Their findings were published online in the journal Cancer. The researchers wanted to know whether doctors should use a different time point to identify patients with the poorest outlook in the modern treatment era.
The team studied 310 people who had recently been diagnosed with multiple myeloma. All received an intensive four-drug treatment that included an anti-CD38 antibody, a proteasome inhibitor, an immunomodulatory medicine, and dexamethasone. Most patients also underwent an autologous stem cell transplant, in which their own stem cells were used to rebuild healthy bone marrow after high-dose treatment.
The patients were followed for a median of three and a half years. By examining when the cancer returned and how long patients survived afterwards, the researchers found that the old 18-month definition no longer identified the highest-risk group as well as before.
Instead, cancer returning within 36 months of starting modern treatment was a much better sign that a patient was likely to survive for less than two years after the disease progressed. The researchers named this updated group FHR36. About 16.4 percent of the patients fell into this category.
The study also found encouraging evidence that newer T-cell redirecting therapies may help delay cancer progression in these patients. These treatments help the immune system recognize and attack myeloma cells more effectively. Because these patients have the greatest need, the researchers believe they should be considered early for these therapies and for clinical trials testing new medicines.
Senior author Dr. Luciano J. Costa said the updated definition will help doctors choose better treatment plans and identify patients who may benefit most from innovative therapies. Better identification also allows researchers to focus future clinical trials on people with the greatest medical need.
This study does not introduce a new cure, but it changes how doctors may identify patients who need extra attention. The findings suggest that modern treatments have improved survival enough that older definitions are no longer accurate.
Although the research involved a moderate number of patients and longer follow-up will still be valuable, the results provide practical guidance for doctors and may help more high-risk patients receive advanced treatments sooner.
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