CR Represents an Early Index of Potential Long Survival in Multiple Myeloma

Overview

Journal Bone Marrow Transplant

Specialty General Surgery

Date 2009 Jul 28

PMID 19633690

Citations 22

Authors

M Wang

K Delasalle

L Feng

S Thomas

S Giralt

M Qazilbash

B Handy

J J Lee

R Alexanian

Affiliations

Soon will be listed here.

Abstract

To assess the impact of CR on survival in multiple myeloma. Retrospective evaluation of response and survival among 758 consecutive patients with multiple myeloma treated at a single center, of whom 395 patients received intensive therapy supported by autologous stem cells within the first year. Survival times were calculated after 1 and 2 years from the start of chemotherapy. On the basis of the response status after a 2-year landmark, the subsequent median survival was 9.7 years for patients with CR, 4.4 years for those with PR and 2.7 years for patients with NR (P<0.001). Longer survival was attributed in part to intensive therapy that converted the myeloma of 67% of patients with NR to PR or CR, and induced CR in 26% of patients with PR. Intensive therapy did not prolong survival for patients with CR after primary therapy. For patients with multiple myeloma, Cox regression analyses showed that CR was the dominant prognostic factor for long survival, followed by stage I disease, PR and intensive treatment as independent factors. A cure fraction of 2% was identified for nine patients who have remained in CR >10 years.

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References

Barlogie B, Anaissie E, Haessler J, Van Rhee F, Pineda-Roman M, Hollmig K . Complete remission sustained 3 years from treatment initiation is a powerful surrogate for extended survival in multiple myeloma. Cancer. 2008; 113(2):355-9. DOI: 10.1002/cncr.23546. View

ANDERSON J, Cain K, Gelber R . Analysis of survival by tumor response. J Clin Oncol. 1983; 1(11):710-9. DOI: 10.1200/JCO.1983.1.11.710. View

Dingli D, Pacheco J, Nowakowski G, Kumar S, Dispenzieri A, Hayman S . Relationship between depth of response and outcome in multiple myeloma. J Clin Oncol. 2007; 25(31):4933-7. DOI: 10.1200/JCO.2007.11.7879. View

Attal M, Harousseau J, Facon T, Guilhot F, Doyen C, Fuzibet J . Single versus double autologous stem-cell transplantation for multiple myeloma. N Engl J Med. 2003; 349(26):2495-502. DOI: 10.1056/NEJMoa032290. View

Kumar S, Lacy M, Dispenzieri A, Rajkumar S, Fonseca R, Geyer S . High-dose therapy and autologous stem cell transplantation for multiple myeloma poorly responsive to initial therapy. Bone Marrow Transplant. 2004; 34(2):161-7. DOI: 10.1038/sj.bmt.1704545. View

Vesole D, Crowley J, Catchatourian R, Stiff P, Johnson D, Cromer J . High-dose melphalan with autotransplantation for refractory multiple myeloma: results of a Southwest Oncology Group phase II trial. J Clin Oncol. 1999; 17(7):2173-9. DOI: 10.1200/JCO.1999.17.7.2173. View

Alexanian R, Weber D, Giralt S, Dimopoulos M, Delasalle K, Smith T . Impact of complete remission with intensive therapy in patients with responsive multiple myeloma. Bone Marrow Transplant. 2001; 27(10):1037-43. DOI: 10.1038/sj.bmt.1703035. View

Desikan R, Barlogie B, Sawyer J, Ayers D, Tricot G, Badros A . Results of high-dose therapy for 1000 patients with multiple myeloma: durable complete remissions and superior survival in the absence of chromosome 13 abnormalities. Blood. 2000; 95(12):4008-10. View

Child J, Morgan G, Davies F, Owen R, Bell S, Hawkins K . High-dose chemotherapy with hematopoietic stem-cell rescue for multiple myeloma. N Engl J Med. 2003; 348(19):1875-83. DOI: 10.1056/NEJMoa022340. View

10.

Weber D, Rankin K, Gavino M, Delasalle K, Alexanian R . Thalidomide alone or with dexamethasone for previously untreated multiple myeloma. J Clin Oncol. 2002; 21(1):16-9. DOI: 10.1200/JCO.2003.03.139. View

11.

Alexanian R, Dimopoulos M, Delasalle K, Barlogie B . Primary dexamethasone treatment of multiple myeloma. Blood. 1992; 80(4):887-90. View

12.

Blade J, Samson D, Reece D, Apperley J, Bjorkstrand B, Gahrton G . Criteria for evaluating disease response and progression in patients with multiple myeloma treated by high-dose therapy and haemopoietic stem cell transplantation. Myeloma Subcommittee of the EBMT. European Group for Blood and Marrow Transplant. Br J Haematol. 1998; 102(5):1115-23. DOI: 10.1046/j.1365-2141.1998.00930.x. View

13.

Kim J, Kim K, Cheong J, Min Y, Suh C, Kim H . Complete remission status before autologous stem cell transplantation is an important prognostic factor in patients with multiple myeloma undergoing upfront single autologous transplantation. Biol Blood Marrow Transplant. 2009; 15(4):463-70. DOI: 10.1016/j.bbmt.2008.12.512. View

14.

Attal M, Harousseau J, Stoppa A, Sotto J, Fuzibet J, Rossi J . A prospective, randomized trial of autologous bone marrow transplantation and chemotherapy in multiple myeloma. Intergroupe Français du Myélome. N Engl J Med. 1996; 335(2):91-7. DOI: 10.1056/NEJM199607113350204. View

15.

Greipp P, San Miguel J, Durie B, Crowley J, Barlogie B, Blade J . International staging system for multiple myeloma. J Clin Oncol. 2005; 23(15):3412-20. DOI: 10.1200/JCO.2005.04.242. View

16.

Fermand J, Katsahian S, Divine M, Leblond V, Dreyfus F, Macro M . High-dose therapy and autologous blood stem-cell transplantation compared with conventional treatment in myeloma patients aged 55 to 65 years: long-term results of a randomized control trial from the Group Myelome-Autogreffe. J Clin Oncol. 2005; 23(36):9227-33. DOI: 10.1200/JCO.2005.03.0551. View

17.

Durie B, Jacobson J, Barlogie B, Crowley J . Magnitude of response with myeloma frontline therapy does not predict outcome: importance of time to progression in southwest oncology group chemotherapy trials. J Clin Oncol. 2004; 22(10):1857-63. DOI: 10.1200/JCO.2004.05.111. View

18.

Barlogie B, Tricot G, van Rhee F, Angtuaco E, Walker R, Epstein J . Long-term outcome results of the first tandem autotransplant trial for multiple myeloma. Br J Haematol. 2006; 135(2):158-64. DOI: 10.1111/j.1365-2141.2006.06271.x. View

19.

Mantel N . Evaluation of survival data and two new rank order statistics arising in its consideration. Cancer Chemother Rep. 1966; 50(3):163-70. View

20.

Singhal S, Powles R, Sirohi B, Treleaven J, Kulkarni S, Mehta J . Response to induction chemotherapy is not essential to obtain survival benefit from high-dose melphalan and autotransplantation in myeloma. Bone Marrow Transplant. 2002; 30(10):673-9. DOI: 10.1038/sj.bmt.1703717. View