Attainment of at least a very good partial response after induction treatment is an important surrogate of longer survival for multiple myeloma

Tan, Daryl; Lao, Zhentang; Loh, Yvonne; Ng, H. J.; Chuah, Charles; Wong, G C; Koh, Mickey; Linn, Yeh Ching; Lim, Lay-Cheng; Tien, Sim Leng; Lee, L H; Goh, Yeow Tee; Hwang, William Ying Khee

doi:10.1038/bmt.2010.25

Cited by 8 publications

(9 citation statements)

References 39 publications

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“…Like the previous classification of the European Study Group for Blood and Marrow Transplantation, these categories were not previously validated. 6 The VGPR category has been validated by the IFM group in several prospective studies and recently by other groups 11,18,19,38,39 ; however, the IFM studies did not use IF in patients' evaluation, and they never compared the VGPR with patients in CR strictly defined by IF. 28 As in our study, although with a lower follow-up of 29 months, in a recent European study considering elderly patients included in 3 phase 3 clinical trials treated as initial therapy with melphalanprednisone or melphalan-prednisone and thalidomide Ϯ bortezomib, only CR was related with improved PFS and OS (79% and 88% at 3 years, respectively), whereas the prognosis of the patients who achieved VGPR or PR was similar (PFS: 24% vs 23%, OS: 65% vs 57%).…”

Section: Org Frommentioning

confidence: 99%

Long-term prognostic significance of response in multiple myeloma after stem cell transplantation

Martínez‐López

Bladé

Mateos

et al. 2011

Blood

190

121

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For establishing the true effect of different response categories in patients with multiple myeloma (MM) treated with autologous stem cell transplantation, we evaluated, after a median follow-up of 153 months, 344 patients with MM who received a transplant between 1989 and 1998. Overall survival (OS) at 12 years was 35% in complete response (CR) patients, 22% in near complete response (nCR), 16% in very good partial response (VGPR), and 16% in partial response (PR) groups. Significant differences in OS and progression-free survival were found between CR and nCR groups (P = .01 and P = .002, respectively), between CR and VGPR groups (P = .0001 and P = .003), or between CR and PR groups (P = .003 and P = < 10(-5)); no differences were observed between the nCR and VGPR groups (P = .2 and P = .9) or between these groups and the PR group (P = .1 and P = .8). A landmark study found a plateau phase in OS after 11 years; 35% patients in the CR group and 11% in the nCR+VGPR+PR group are alive at 17 years; 2 cases had relapsed in the nCR+VGPR+PR group. In conclusion, MM achieving CR after autologous stem cell transplantation is a central prognostic factor. The relapse rate is low in patients with > 11 years of follow-up, possibly signifying a cure for patients in CR.

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Section: Org Frommentioning

confidence: 99%

Long-term prognostic significance of response in multiple myeloma after stem cell transplantation

Martínez‐López

Bladé

Mateos

et al. 2011

Blood

190

121

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“…(57,58) The minimum response required before proceeding to ASCT is a partial response (PR). If a PR is not achieved after four cycles of induction therapy, a further two cycles should be considered.…”

Section: Choice Of Induction Therapymentioning

confidence: 99%

The Singapore Myeloma Study Group Consensus Guidelines for the management of patients with multiple myeloma

Ooi

et al. 2017

smedj

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Multiple myeloma (MM) is an incurable plasma cell neoplasm with an incidence of 100 patients per year in Singapore. Major advances have been made in the diagnosis, risk stratifi cation and treatment of MM in the recent past. The reclassifi cation of a subset of patients with smouldering MM, based on high-risk biomarkers, and the development of the revised international staging system are among the key new developments in diagnosis and staging. The use of novel agent-based treatment has resulted in signifi cant improvements in the survival and quality of life of many patients with MM. Determining the optimal use of proteasome inhibitors, immunomodulators and, more recently, monoclonal antibodies is an area of ongoing investigation. In this guideline, we aim to provide an overview of the management of MM, incorporating the latest developments in diagnosis and treatment.

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“…Median overall survival was similar between the VGPR and PR groups, a finding that is in contrast to previous large, prospective trials involving induction therapy. [26][27][28][29][30] Of note, MartinezLopez et al 31 found no difference in survival between the VGPR and PR group after long-term follow-up in patients after stem cell transplantation. The patient population in our study was not representative of the full spectrum of myeloma patients at initial diagnosis as those with a PCLI of Ͻ 0.5% were excluded.…”

Section: Discussionmentioning

confidence: 99%

Reduction in plasma cell proliferation after initial therapy in newly diagnosed multiple myeloma measures treatment response and predicts improved survival

Larsen

Chee

Lust

et al. 2011

Blood

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Standard myeloma treatment response criteria are determined principally by changes in the monoclonal protein. Reduction in the size of the proliferative component of malignant plasma cells may be an additional metric of assessing response to therapy. We retrospectively analyzed 176 patients with newly diagnosed myeloma with a measurable plasma cell labeling index (PCLI) at diagnosis and repeat measurement 4 months after initiation of therapy. PCLI response was defined as a > 60% reduction. Baseline PCLI is an independent prognostic factor; therefore, we categorized patients into 3 groups: PCLI > 3% (high), > 1% (intermediate), and < 1% (low). Patients achieving a greater PCLI response had improved median overall survival of 54 months compared with 29 months in nonresponders (P ‫؍‬ .02). Improved median overall survival with PCLI response occurred in the high initial PCLI group (28 vs 7 months; P ‫؍‬ .003) and intermediate group (64 vs 24 months; P ‫؍‬ .002). The application of PCLI response and serum M-spike response together provided further prognostic information. On multivariate analysis, the prognostic value of PCLI response was independent of ␤ 2 -microglobulin, elevated creatinine, serum M-spike response, and baseline PCLI. We conclude that a significant reduction in plasma cell proliferation in patients with newly diagnosed myeloma is an important predictor of survival. (Blood. 2011; 118(10):2702-2707)

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Attainment of at least a very good partial response after induction treatment is an important surrogate of longer survival for multiple myeloma

Cited by 8 publications

References 39 publications

Long-term prognostic significance of response in multiple myeloma after stem cell transplantation

Long-term prognostic significance of response in multiple myeloma after stem cell transplantation

The Singapore Myeloma Study Group Consensus Guidelines for the management of patients with multiple myeloma

Reduction in plasma cell proliferation after initial therapy in newly diagnosed multiple myeloma measures treatment response and predicts improved survival

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