Effect of complete response on outcome following autologous stem cell transplantation for myeloma

Abstract

Summary:We studied the effect of complete response (CR) among 126 consecutive patients who underwent stem cell transplantation (SCT) for myeloma. The CR rate with SCT was 33%. Median overall survival (OS) from diagnosis of myeloma was 56 months. OS following SCT was 22 months. Progression-free survival (PFS) was 12 months. OS was not different between patients who achieved CR and those who did not, median survival 25 vs 24 months, P = 0.5. Corresponding median times for PFS were 15 and 11 months, P = 0.2. The plasma cell labeling index (PCLI) was high (у1%) in 36% (high risk group) and was associated with poor OS and PFS (P Ͻ 0.001). Achieving CR did not influence OS or PFS in either the high or the low risk group. In contrast, OS and PFS were significantly influenced by high PCLI both in patients who achieved CR and those who did not. OS was poor (Ͻ30 months) in high risk patients regardless of CR status and in low risk patients who did not achieve CR, compared to low risk patients achieving CR (57 months), making them candidates for novel posttransplant treatment options. Outcome following SCT is dependent more on biological variables such as the PCLI than on CR status. Bone Marrow Transplantation (2000) 26, 979-983. Keywords: multiple myeloma; complete response; prognosis; transplantation Multiple myeloma is a clonal plasma cell proliferative disorder that is characterized by the presence of a monoclonal (M) protein in the serum or urine, lytic bony lesions, renal failure, anemia and hypercalcemia. It accounts for 1% of all cancers, and 10% of all hematologic malignancies.1,2 In 2000, approximately 13 700 new cases of myeloma will be diagnosed and over 11 000 will die of the disease in the United States.2 Therapy for myeloma is not curative. The overall response rate with standard melphalan and prednisone therapy is approximately 50% and the complete response (CR) rate is less than 10%.3,4 Combination chemotherapy leads to superior response rates (60-70%), but is without survival benefit.3,5,6 High-dose therapy followed by autologous blood cell transplantation results in response rates exceeding 75-90%, 4,5 and CR rates in the range of 20-40%. 7,8 A French randomized trial has demonstrated improved survival with autologous marrow transplantation compared to conventional chemotherapy, with 5 year survival rates of 52% and 12%, respectively.

Autologous stem cell transplantation in multiple myeloma: improved survival in nonsecretory multiple myeloma but lack of influence of age, status at transplant, previous treatment and conditioning regimen. A single-centre experience in 127 patients

“…There has been some evidence that achieving CR after ASCT does not result in prolonged PFS, 33 particularly in patients relapsing after, or who are refractory to standard chemotherapy. 34 However, our data confirm the results of several other studies showing that achieving CR has an important influence on PFS and that this subset of patients may derive the greatest benefit from the procedure. 10,35 Advanced age has been shown to be a poor prognostic factor in several trials using conventional chemotherapy [5][6][7] or ASCT.…”

Prognostic factors for survival after autologous transplantation: a single centre experience in 133 multiple myeloma patients

“…Some authors also believe that better responses after transplant are associated with improved survival. 10,20,21 In contrast, Rajkumar et al 33 reported that the outcome following ASCT depends more on biological variables, such as plasma cell labelling index rather than on the CR status.…”

Impact of pretransplant therapy in patients with newly diagnosed myeloma undergoing autologous SCT

“…Achievement of a complete response is one of the strongest predictors of TTP after ASCT. 31,32 While long-term results with the new regimens such as Len-Dex appear to result in CR rates comparable to that of ASCT, the CR rates after four cycles of treatment, where a majority of patients go on to receive high-dose therapy is under 10% and far below the CR rates seen with transplant. 11 So it is quite conceivable that initial demonstrating the median overall survival from diagnosis among the groups of patients receiving different initial therapies for their disease.…”