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

Nidhi Tandon, Surbhi Sidana, S. Vincent Rajkumar, Morie A. Gertz, Francis K. Buadi, Martha Q. Lacy, Prashant Kapoor, Wilson I. Gonsalves, Angela Dispenzieri, Taxiarchis V. Kourelis, Rahma Warsame, David 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

Research output: Contribution to journalArticle

3 Scopus citations

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 5 .6; OS, 78 vs 96 months, P 5 .1) and 4 cycles (PFS, 31 vs 29 months; OS, 89 vs 91 months, P 5 .9), although both were improved, with $VGPR as best response (PFS, 33 vs 22 months, P, .001; OS, 102 vs 77 months, P 5 .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

ASJC Scopus subject areas

  • Hematology

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