Impact of risk stratification on outcome among patients with multiple myeloma receiving initial therapy with lenalidomide and dexamethasone

Prashant Kapoor, Shaji K Kumar, Rafael Fonseca, Martha Lacy, Thomas Elmer Witzig, Suzanne R. Hayman, Angela Dispenzieri, Francis Buadi, Peter Leif Bergsagel, Morie Gertz, Robert J. Dalton, Joseph R Mikhael, David M Dingli, Craig B. Reeder, John A. Lust, Stephen J Russell, Vivek Roy, Steven R. Zeldenrust, Alexander Keith Stewart, Robert A. KylePhilip R. Greipp, S Vincent Rajkumar

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Abstract

The outcome of patients with multiple myeloma is dictated primarily by cytogenetic abnormalities and proliferative capacity of plasma cells. We studied the outcome after initial therapy with lenalidomide-dexamethasone among 100 newly diagnosed patients, risk-stratified by genetic abnormalities and plasma cell labeling index. A total of 16% had high-risk multiple myeloma, defined by the presence of hypodiploidy, del(13q) by metaphase cytogenetics, del(17p), IgH translocations [t(4;14), or t(14;16)] or plasma cell labeling index more than or equal to 3%. Response rates were 81% vs 89% in the high-risk and standard-risk groups, respectively. The median progression-free survival was shorter in the high-risk group (18.5 vs 36.5 months, P < .001), but overall survival was comparable. Because of unavailability of all tests for every patient, we separately analyzed 55 stringently classified patients, and the results were similar. In conclusion, high-risk patients achieve less durable responses with lenalidomide-dexamethasone compared with standard-risk patients; no significant differences in overall survival are apparent so far. These results need confirmation in larger, prospectively designed studies.

Original languageEnglish (US)
Pages (from-to)518-521
Number of pages4
JournalBlood
Volume114
Issue number3
DOIs
StatePublished - 2009

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Multiple Myeloma
Dexamethasone
Plasma Cells
Plasmas
Labeling
Therapeutics
Survival
Metaphase
lenalidomide
Cytogenetics
Chromosome Aberrations
Disease-Free Survival

ASJC Scopus subject areas

  • Hematology
  • Biochemistry
  • Cell Biology
  • Immunology

Cite this

Impact of risk stratification on outcome among patients with multiple myeloma receiving initial therapy with lenalidomide and dexamethasone. / Kapoor, Prashant; Kumar, Shaji K; Fonseca, Rafael; Lacy, Martha; Witzig, Thomas Elmer; Hayman, Suzanne R.; Dispenzieri, Angela; Buadi, Francis; Bergsagel, Peter Leif; Gertz, Morie; Dalton, Robert J.; Mikhael, Joseph R; Dingli, David M; Reeder, Craig B.; Lust, John A.; Russell, Stephen J; Roy, Vivek; Zeldenrust, Steven R.; Stewart, Alexander Keith; Kyle, Robert A.; Greipp, Philip R.; Rajkumar, S Vincent.

In: Blood, Vol. 114, No. 3, 2009, p. 518-521.

Research output: Contribution to journalArticle

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