The role of complete response in multiple myeloma

Abstract

In multiple myeloma (MM), the impact of complete response (CR) could be shown only after introduction of high-dose therapy plus autologous stem cell transplantation (ASCT). In the context of ASCT, achieving CR (negative immunofixation and normal bone marrow) or at least very good partial response is associated with longer progression-free survival and in most studies longer survival. With novel agents, high CR rates are achieved and this prognostic impact of CR is being shown as well, both in relapsed and in newly diagnosed MM. However the benefit of CR achievement depends on the type of treatment and is not identical for all patients. In elderly patients, treatments inducing more CR may be more toxic. Although CR achievement is necessary in patients with poor-risk disease, it might not be as critical for long survival in more indolent MM. CR achievement is not the only objective of treatment because it is possible to further improve the depth of response and the outcome by continuing treatment after CR achievement. Finally, there are several levels of CR and in the future it will be necessary to confirm the prognostic impact of immunophenotypic or molecular CR or of CR defined by imaging procedures. (Blood. 2009;114: 3139-3146)

Long‐term survival with cyclophosphamide, bortezomib and dexamethasone induction therapy in patients with newly diagnosed multiple myeloma

“…High dose melphalan and stem cell transplantation (SCT) has improved responses and lengthened survival (Harousseau et al, 2009). Advances in science have ushered in new classes of drugs including immunomodulatory agents (IMiDs) and proteasome inhibitors (PIs).…”

Bortezomib plus dexamethasone induction followed by autologous stem cell transplantation in multiple myeloma: A study from India

“…These response rates were similar to observed in previous studies with the VD regimen 9,10 but are higher than those obtained in studies with conventional chemotherapy. [4][5][6][7][8]13 Superiority of novel agents-based induction therapy both in terms of mobilization of stem cells and response rates to ASCT has been established. 1 Other studies showed that better pre-transplantation remission status implies better posttransplant CR rate.…”

Bortezomib, Dexamethasone, and High-Dose Melphalan as Conditioning for Stem Cell Transplantation in Young Japanese Multiple Myeloma Patients: A Pilot Study

“…It seems that achieving CR is crucial for a long-lasting response and prolonged survival [7]. Patients who achieve immunofixation-negative CR after ASCT have significantly longer event-free survival and overall survival than those who remain in partial remission (PR) [5].…”

“…Conventional chemotherapy rarely achieves a major response, so high-dose chemotherapy with autologous stem cell transplantation (ASCT) is the standard treatment for MM patients under 65 years old [3,4]. After ASCT, a number of patients achieve prolonged progression-free survival [3][4][5][6][7][8]. Among several conditioning regimens, high-dose melphalan (HDM; 200 mg/m 2 ) is the recommended standard regimen for use before ASCT, because of its efficiency and acceptable toxicity [9].…”