{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T03:21:22Z","timestamp":1785468082551,"version":"3.56.0"},"reference-count":31,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2020,7,2]],"date-time":"2020-07-02T00:00:00Z","timestamp":1593648000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"WJC is supported by NMRC Singapore Translational Research (STaR) Investigatorship. This research is partly supported by the National Research Foundation Singapore and the Singapore Ministry of Education under the Research Centers of Excellence initiative","award":["MOE2014-T3-1-006."],"award-info":[{"award-number":["MOE2014-T3-1-006."]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>The prognosis of multiple myeloma has considerably improved due to the introduction of novel agents in the upfront setting. However, the great majority of patients ultimately relapse, and choosing a salvage treatment at first relapse remains challenging. The natural history of first relapsed disease in the current era is also not well described. We retrospectively studied 300 patients with first relapsed myeloma seen between 2004 and 2019 from two institutes in Singapore. The median duration from diagnosis to first relapse was 22.7 months (1.1\u201397.0 months). Most patients received novel agent-based induction therapy, and 41.3% underwent autologous stem cell transplant. A very good partial response (VGPR) or better was achieved in 48.6%. Regarding first relapse, 50.5% were symptomatic and 19.0% received newer agent-containing regimens. Nearly a third of patients (31.7%) had a VGPR or better response. The median progression free and overall survival from first relapse was 12.0 and 44.8 months, respectively. Based on a randomized sample splitting, we first identified non-hyperdiploid karyotype at diagnosis, clinical relapse, and treatment sequence as impacting survival independently from a testing cohort, and we then further demonstrated their significance in a validation cohort. This study provides a real-world picture of first relapsed myeloma and highlights the prognostic importance of the treatment sequence.<\/jats:p>","DOI":"10.3390\/cancers12071759","type":"journal-article","created":{"date-parts":[[2020,7,2]],"date-time":"2020-07-02T05:00:08Z","timestamp":1593666008000},"page":"1759","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Natural History and Prognostic Factors at First Relapse in Multiple Myeloma"],"prefix":"10.3390","volume":"12","author":[{"given":"Chen","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Haematology-Oncology, National University Cancer Institute, National University Health System, Singapore 119074, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8376-8872","authenticated-orcid":false,"given":"Cinnie Yentia","family":"Soekojo","sequence":"additional","affiliation":[{"name":"Department of Haematology-Oncology, National University Cancer Institute, National University Health System, Singapore 119074, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjay de","family":"Mel","sequence":"additional","affiliation":[{"name":"Department of Haematology-Oncology, National University Cancer Institute, National University Health System, Singapore 119074, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7392-0655","authenticated-orcid":false,"given":"Melissa","family":"Ooi","sequence":"additional","affiliation":[{"name":"Department of Haematology-Oncology, National University Cancer Institute, National University Health System, Singapore 119074, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yunxin","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Haematology, Singapore General Hospital, Singapore 169608, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allan Zhi Kai","family":"Goh","sequence":"additional","affiliation":[{"name":"Department of Haematology, Singapore General Hospital, Singapore 169608, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chandramouli","family":"Nagarajan","sequence":"additional","affiliation":[{"name":"Department of Haematology, Singapore General Hospital, Singapore 169608, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wee Joo","family":"Chng","sequence":"additional","affiliation":[{"name":"Department of Haematology-Oncology, National University Cancer Institute, National University Health System, Singapore 119074, Singapore"},{"name":"Department of Medicine, Yong Loo Lin School of Medicine and National University of Singapore, Singapore 119228, Singapore"},{"name":"Cancer Science Institute of Singapore and National University of Singapore, Singapore 117599, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,7,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e538","DOI":"10.1016\/S1470-2045(14)70442-5","article-title":"International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma","volume":"15","author":"Rajkumar","year":"2014","journal-title":"Lancet Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1038\/leu.2013.350","article-title":"New drugs and novel mechanisms of action in multiple myeloma in 2013: A report from the International Myeloma Working Group (IMWG)","volume":"28","author":"Ocio","year":"2014","journal-title":"Leukemia"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1182\/asheducation-2017.1.508","article-title":"Management of multiple myeloma in the relapsed\/refractory patient","volume":"2017","author":"Sonneveld","year":"2017","journal-title":"Hematol. 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