Outcomes with early response to first-line treatment in patients with newly diagnosed multiple myeloma

Nidhi Tandon, Surbhi Sidana, S Vincent Rajkumar, Morie Gertz, Francis K. Buadi, Martha Lacy, Prashant Kapoor, Wilson Gonsalves, Angela Dispenzieri, Taxiarchis Kourelis, Rahma Warsame, David M Dingli, Amie L. Fonder, Suzanne R. Hayman, Miriam A. Hobbs, Yi Lisa Hwa, Robert A. Kyle, Nelson Leung, Ronald S. Go, John A. LustStephen J Russell, Shaji K Kumar

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1 Citation (Scopus)

Abstract

We evaluated the impact of achieving a rapid response in 840 newly diagnosed multiple myeloma patients from 2004 to 2015. Rates of very good partial response (VGPR) or better were 29% (240/840) after 2 cycles of treatment, 42% (350/840) after 4 cycles of treatment, and 66% (552/840) as best response. Early responders after 2 cycles of treatment had higher rates of light chain disease, anemia, renal failure, International Staging System (ISS) stage III disease, and high-risk cytogenetics, especially t(4;14), and were more likely to have received triplet therapy and undergo transplant. Median progression-free survival (PFS) and overall survival (OS) were not different among patients with ≥VGPR and <VGPR after 2 cycles (PFS, 28 vs 30 months, P = .6; OS, 78 vs 96 months, P = .1) and 4 cycles (PFS, 31 vs 29 months; OS, 89 vs 91 months, P = .9), although both were improved, with ≥VGPR as best response (PFS, 33 vs 22 months, P < .001; OS, 102 vs 77 months, P = .003). On multivariate analysis stratified by transplant status, achievement of ≥VGPR after 2 cycles was not associated with improved PFS (hazard ratio [95% confidence interval]; transplant cohort, 1.1 [0.7-1.6]; nontransplant cohort, 1.2 [0.8-1.7]) or OS (transplant cohort, 1.6 [0.9-2.9]; nontransplant cohort, 1.5 [1.0-2.4]). Covariates in the model included high-risk cytogenetics, ISS stage III, triplet therapy, creatinine ≥2 mg/dL, light chain disease, and age. Although patients with high-risk disease are more likely to achieve early response, a rapid achievement of a deep response by itself does not affect long-term outcomes.

Original languageEnglish (US)
Pages (from-to)744-750
Number of pages7
JournalBlood advances
Volume3
Issue number5
DOIs
StatePublished - Mar 12 2019
Externally publishedYes

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Multiple Myeloma
Disease-Free Survival
Survival
Transplants
Cytogenetics
Therapeutics
Light
Renal Insufficiency
Anemia
Creatinine
Multivariate Analysis
Confidence Intervals

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Outcomes with early response to first-line treatment in patients with newly diagnosed multiple myeloma. / Tandon, Nidhi; Sidana, Surbhi; Rajkumar, S Vincent; Gertz, Morie; Buadi, Francis K.; Lacy, Martha; Kapoor, Prashant; Gonsalves, Wilson; Dispenzieri, Angela; Kourelis, Taxiarchis; Warsame, Rahma; Dingli, David M; Fonder, Amie L.; Hayman, Suzanne R.; Hobbs, Miriam A.; Hwa, Yi Lisa; Kyle, Robert A.; Leung, Nelson; Go, Ronald S.; Lust, John A.; Russell, Stephen J; Kumar, Shaji K.

In: Blood advances, Vol. 3, No. 5, 12.03.2019, p. 744-750.

Research output: Contribution to journalArticle

Tandon, Nidhi ; Sidana, Surbhi ; Rajkumar, S Vincent ; Gertz, Morie ; Buadi, Francis K. ; Lacy, Martha ; Kapoor, Prashant ; Gonsalves, Wilson ; Dispenzieri, Angela ; Kourelis, Taxiarchis ; Warsame, Rahma ; Dingli, David M ; Fonder, Amie L. ; Hayman, Suzanne R. ; Hobbs, Miriam A. ; Hwa, Yi Lisa ; Kyle, Robert A. ; Leung, Nelson ; Go, Ronald S. ; Lust, John A. ; Russell, Stephen J ; Kumar, Shaji K. / Outcomes with early response to first-line treatment in patients with newly diagnosed multiple myeloma. In: Blood advances. 2019 ; Vol. 3, No. 5. pp. 744-750.
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abstract = "We evaluated the impact of achieving a rapid response in 840 newly diagnosed multiple myeloma patients from 2004 to 2015. Rates of very good partial response (VGPR) or better were 29{\%} (240/840) after 2 cycles of treatment, 42{\%} (350/840) after 4 cycles of treatment, and 66{\%} (552/840) as best response. Early responders after 2 cycles of treatment had higher rates of light chain disease, anemia, renal failure, International Staging System (ISS) stage III disease, and high-risk cytogenetics, especially t(4;14), and were more likely to have received triplet therapy and undergo transplant. Median progression-free survival (PFS) and overall survival (OS) were not different among patients with ≥VGPR and <VGPR after 2 cycles (PFS, 28 vs 30 months, P = .6; OS, 78 vs 96 months, P = .1) and 4 cycles (PFS, 31 vs 29 months; OS, 89 vs 91 months, P = .9), although both were improved, with ≥VGPR as best response (PFS, 33 vs 22 months, P < .001; OS, 102 vs 77 months, P = .003). On multivariate analysis stratified by transplant status, achievement of ≥VGPR after 2 cycles was not associated with improved PFS (hazard ratio [95{\%} confidence interval]; transplant cohort, 1.1 [0.7-1.6]; nontransplant cohort, 1.2 [0.8-1.7]) or OS (transplant cohort, 1.6 [0.9-2.9]; nontransplant cohort, 1.5 [1.0-2.4]). Covariates in the model included high-risk cytogenetics, ISS stage III, triplet therapy, creatinine ≥2 mg/dL, light chain disease, and age. Although patients with high-risk disease are more likely to achieve early response, a rapid achievement of a deep response by itself does not affect long-term outcomes.",
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AU - Sidana, Surbhi

AU - Rajkumar, S Vincent

AU - Gertz, Morie

AU - Buadi, Francis K.

AU - Lacy, Martha

AU - Kapoor, Prashant

AU - Gonsalves, Wilson

AU - Dispenzieri, Angela

AU - Kourelis, Taxiarchis

AU - Warsame, Rahma

AU - Dingli, David M

AU - Fonder, Amie L.

AU - Hayman, Suzanne R.

AU - Hobbs, Miriam A.

AU - Hwa, Yi Lisa

AU - Kyle, Robert A.

AU - Leung, Nelson

AU - Go, Ronald S.

AU - Lust, John A.

AU - Russell, Stephen J

AU - Kumar, Shaji K

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N2 - We evaluated the impact of achieving a rapid response in 840 newly diagnosed multiple myeloma patients from 2004 to 2015. Rates of very good partial response (VGPR) or better were 29% (240/840) after 2 cycles of treatment, 42% (350/840) after 4 cycles of treatment, and 66% (552/840) as best response. Early responders after 2 cycles of treatment had higher rates of light chain disease, anemia, renal failure, International Staging System (ISS) stage III disease, and high-risk cytogenetics, especially t(4;14), and were more likely to have received triplet therapy and undergo transplant. Median progression-free survival (PFS) and overall survival (OS) were not different among patients with ≥VGPR and <VGPR after 2 cycles (PFS, 28 vs 30 months, P = .6; OS, 78 vs 96 months, P = .1) and 4 cycles (PFS, 31 vs 29 months; OS, 89 vs 91 months, P = .9), although both were improved, with ≥VGPR as best response (PFS, 33 vs 22 months, P < .001; OS, 102 vs 77 months, P = .003). On multivariate analysis stratified by transplant status, achievement of ≥VGPR after 2 cycles was not associated with improved PFS (hazard ratio [95% confidence interval]; transplant cohort, 1.1 [0.7-1.6]; nontransplant cohort, 1.2 [0.8-1.7]) or OS (transplant cohort, 1.6 [0.9-2.9]; nontransplant cohort, 1.5 [1.0-2.4]). Covariates in the model included high-risk cytogenetics, ISS stage III, triplet therapy, creatinine ≥2 mg/dL, light chain disease, and age. Although patients with high-risk disease are more likely to achieve early response, a rapid achievement of a deep response by itself does not affect long-term outcomes.

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