Significance of the pee-value: relevance of 24-hour urine studies for patients with myeloma

Abstract

International Myeloma Working Group (IMWG) response criteria require refrigerated 24-hour urine specimens for most patients. However, given that serum free light chain testing has been shown to outperform 24-hour urine immunofixation as a prognostic marker, the importance of maintaining urine testing options or requirements within each level of IMWG response criteria has not been investigated. We analyzed responses to induction therapy for all transplant-eligible patients with multiple myeloma at our institution over a 3-year period using traditional versus ‘urine-free’ IMWG response criteria (where references to urine were removed from the descriptions for every depth of response). Of 281 evaluable patients, responses changed for only 4% of patients (95% confidence interval 2–7%) using urine-free criteria. Our results call into question the continued requirement for 24-hour urine measurements as part of IMWG response assessments for all patients. Research into the prognostic performance of urine-free IMWG criteria is ongoing.

Keywords:

• Myeloma
• clinical results
• prognostication

Acknowledgements

The authors thank the patients who contributed to this work.

Disclosure statement

K.H.N., C.Y.H., and S.A. declare no competing interests. J.K. has received honoraria from Amgen and Kyprolis. A.C. has received research support from AbbVie, Bristol-Myers Squibb, CARSgen, Celgene, Caelum, Cellectis, Janssen, and Merck. A.C. has received honoraria from Sanofi. T.G.M. has consulted for GlaxoSmithKline, Juno, and Roche. T.G.M. has received research support from Amgen, Janssen, Sanofi, and Seattle Genetics. J.W. has consulted for Amgen, Celgene, Janssen, Novartis, and Takeda. S.W.W. has consulted for Amgen and Sanofi. S.W.W. has received research support from Bristol-Myers Squibb, Caelum, Genentech, Fortis, GlaxoSmithKline, and Janssen. N.S. is employed by AstraZeneca. N.S. has consulted for Amgen, Bristol-Myers Squibb, Celgene, CareDx, GlaxoSmithKline, Indapta Therapeutics, Karyopharm, Kite, and Sanofi. N.S. has received research support from Bluebird Bio, Bristol-Myers Squibb, Celgene, Janssen, Nektar, Poseida, Sutro Biopharma, and Tenebio. R.B. has consulted for Bristol Myers Squibb, Genentech/Roche, Janssen Oncology, Sanofi Pasteur, and SparkCures. R.B. has received research support from Pack Health.

Data availability statement

The data analyzed during the current study are not publicly available due to patient-identifying information but are available from the corresponding author on reasonable request.

Additional information

Funding

This work was supported by the University of California San Francisco Stephen & Nancy Grand Multiple Myeloma Translational Initiative.