Clinical outcomes with intensive therapy for patients with primary resistant multiple myeloma

Abstract

Summary:Clinical outcomes were evaluated in 89 consecutive patients with multiple myeloma that had not responded to dexamethasone-based primary therapy, who received early intensive therapy supported by autologous stem cell transplantation. Results were compared with those of 45 comparable patients who refused or were unable to receive intensive treatment for socioeconomic reasons. Following high-dose therapy, the response rate was 69% including 16% with CR. Survival of 14 patients with CR (median 47.0 years) was significantly longer than those of 47 patients with PR (median 4.5 years) or of 28 patients who remained NR (median 2.2 years). CR occurred in 43% of patients with serum myeloma protein o1.5 gm/dl, in contrast to 7% of those with higher values, a finding similar to that observed previously for patients consolidated in PR. No prognostic factor was associated with PR and, in view of the high frequencies of PR or CR, all patients with primary resistant myeloma should be considered for early intensive therapy. The limited improvement of lifespan and disease-free survival for those in PR indicated the need for further treatment to achieve CR, the major surrogate marker for long survival.

Outcomes after auto-SCT in African Americans with multiple myeloma

“…Refractory disease at the time of auto-SCT was associated with poor PFS and a trend towards worse OS, consistent with the published literature in non-AA. 23,24 Chromosome 13 deletions were detected in 35% of the patients with available cytogenetics, comparable to earlier reports in non-AA. 25,26 Interestingly, history of palliative XRT before auto-SCT was predictive of poor PFS and OS in univariate and 27,28 At this point, the cause of the inferior outcomes in patients with a history of palliative XRT before auto-SCT is unclear.…”

Thalidomide–dexamethasone as primary therapy for advanced multiple myeloma

“…When intensification was possible, the frequency of meaningful benefit of approximately 50% was similar to that observed previously among comparable patients who received high-dose therapy [5,6].…”

“…Early intensive therapy within 1 year, supported by autologous blood stem cells, was considered for all patients using criteria described previously [5,6], and was given to 54% of patients. Eligibility required age <70 years, acceptable performance status (Zubrod/ WHO score 2), adequate cardiac and pulmonary functions, collection of>2Â10 6 CD34 + mononuclear cells/kg by apheresis, and sufficient socioeconomic resources for hospitalization and living near the treatment center for >4 weeks.…”

Benefit from autologous stem cell transplantation in primary refractory myeloma? Different outcomes in progressive versus stable disease

“…14,15 However, there is a paucity of published evidence to support this claim. [15][16][17][18][19][20] Furthermore, two different conditions should be distinguished among myeloma patients in whom primary therapy fails: (i) refractory myeloma, with progressive disease while on therapy and (ii) stable disease, in which the M-protein size does not change significantly and there is no clinical progression. 21 These two different categories have not been analyzed separately in previous studies.…”