Association between mutational load chance and response and clinical outcome. (A) Number of mutations (x-axis) by response groups (sCR/CR) or other responses (≤VGRP) at diagnosis and relapse for the RVD-alone (left) and RVD + HDM group (right). (B) Survival probability after first relapse from RVD + HDM treatment by mutational load. Patients with mutational load more than the median are shown in red curve and patients with low mutational load are shown in blue. (C) Survival probability after first relapse from RVD + HDM treatment by best response to initial RVD + HDM treatment. Patients with CR/sCR are shown in red and patients with other responses are shown in blue. All patients who had relapse after RVD + HDM in IFM 2009 are shown. (D) Same as in panel C but only patients in our study are shown. (E) Number of neoantigens (y-axis) detected in each group (x-axis) at diagnosis (left 2 violins) and relapse (right 2 violins). RVD-only and RVD + HMS groups compared using Wilcoxon test and patients at diagnosis and relapse from the same group compared with paired analysis. P values for each comparison are shown (top). OR, other response.