Impact of complete remission with intensive therapy in patients with responsive multiple myeloma

Abstract

Summary:Clinical outcomes were assessed in 68 consecutive patients with multiple myeloma of high or intermediate tumor mass that had responded to VAD or dexamethasone-based therapy and were consolidated with early intensive therapy and autologous stem cell transplantation. Results were compared with those of 50 comparable patients who refused or were unable to receive intensive treatment for socioeconomic reasons. Following high-dose therapy, the rate of CR increased from 6 to 37%, with median survival prolonged by 10 months. Survival of 21 patients with disease converted from PR to CR (median 8.3 years) was significantly longer than that of similarly-treated patients who remained in PR (median 5.0 years). CR of myeloma represents the major surrogate marker of long survival and the primary goal of myeloablative treatment for patients in PR. Twelve of 18 patients with rapid reduction of myeloma protein (T. Ͻ 0.5 months), and myeloma protein reduction to Ͻ1.0 g/dl after primary therapy achieved CR (67%), identifying pretransplant features favorable to intensive therapy. Among 35 patients with slower reduction or higher residual myeloma protein, CR occurred in eight patients (23%) (P Ͻ 0.01), for whom other treatments should be considered. The kinetics of response to initial therapy should be considered in selecting patients more likely to achieve CR and consequent long survival after intensive treatment. Bone Marrow Transplantation (2001) 27, 1037-1043.

Autologous stem cell transplantation followed by consolidation chemotherapy for patients with multiple myeloma

“…7 Nonetheless, it should be emphasized that attainment of CR or near CR after autotransplantation is perhaps the most important predictor of long-term survival. 7,[19][20][21] Our data do show that incremental improvement in myeloma responses is possible during or after CC (an additional eight patients entered CR and 19 patients overall had objective improvements in response), suggesting that CC may have contributed to the observed EFS and OS rates. It is also noteworthy that 18 of the 24 (75%) patients who were surviving event-free at last follow-up had received three or four consolidation treatments.…”

Graft-versus-myeloma effect following antithymocyte globulin-based reduced intensity conditioning allogeneic stem cell transplantation

“…1 High-dose chemotherapy with autologous stem cell transplantation (SCT) can result in prolonged response duration and survival. [2][3][4][5][6][7][8][9] Unfortunately, few, if any, patients with MM who receive high-dose therapy are cured. 10 On the other hand, extensive clinical and experimental data support an important role for a graft-versustumor (GVT) effect in eradicating a number of different tumor cells in patients who receive allogeneic stem cell transplantation (allo-SCT).…”

Outcomes after auto-SCT in African Americans with multiple myeloma

“…7,15-17 CR after auto-SCT is often used as a surrogate marker of survival and is frequently accepted as a study end point. [18][19][20][21][22] However, CR after auto-SCT was not predictive of improved OS or PFS in our analysis. 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.…”