EBMT 2026 | Early relapse score for identifying functionally high-risk myeloma across cytogenetic subgroups

Well, the oral presentation I’m going to be talking tomorrow morning is on the second validation of the EBMT early relapse score. In 2023, we published our report and presented the early relapse score, which identifies the functionally high-risk myeloma. And the score includes three parameters: one is related to the patient, one is to the disease, and the third is to the treatment. So ISS, performance status prior to transplant, and response to induction. So these three parameters, when combined together, they make a score which can predict the relapse risk within 12 months from transplant, or in other words, like 18 months from diagnosis, is predicting relapse in 58% of patients if they achieve score four. So the score has five tiers from zero to score four. 

And after publishing this data, we received some criticism based on the fact that these patients, well, actually, it was based on a huge number of patients, more than 7,000. They were treated before 2017. So they had received old induction regimens. The question was, in the era of more advanced induction regimens, is this score still valid? And also another caveat was the lack of analysis of cytogenetics because in that part of the study, there was half of the patients with missing cytogenetics. Now, with more recent data from 2020 to 2022, we have 8,000 patients who were analyzed, including a broader age range and all induction regimens, more recent ones, and also with a wider coverage of conditioning regimens. It is surprising to see that we still see the same frequency of high risk for early relapse, score three and four, that adds up to about 10%. And the risk of early relapse is about 42% overall. But when we divide the patients according to their cytogenetic risk, the early relapse risk goes up to 62% in high-risk patients. But with standard-risk, it goes down to 33% for score four patients. So in this way, we can say that a simple score, which does not include any molecular gene expression profiling that is not widely applicable; ISS, performance status, and response to induction prior to transplant with the use of these three parameters, you can predict early relapse and this may enable patients to change treatment or to integrate more advanced treatments such as CAR-T therapy for those who are prone to relapse and before major organ failure develops.

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