Relapse after complete response in newly diagnosed multiple myeloma: implications of duration of response and patterns of relapse

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

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Achieving a complete response (CR) is associated with improved overall survival (OS) in multiple myeloma (MM), but data on duration of CR (DurCR) are limited. We evaluated 351 patients (2004–2016), achieving CR with first-line therapy. Patients with sustained DurCR ≥ 24 months (n = 177) had better OS; 150 vs. 81 months, p < 0.001. DurCR ≥ 24 months remained a significant predictor for OS (HR: 0.3, 95% CI: 0.2–0.5, p < 0.001) after adjusting for age, revised ISS stage, transplant and maintenance therapy. Landmark analysis at 24 months demonstrated similar results, OS: 150 vs. 83 months, p < 0.001. Survival benefit persisted even after loss of CR, with median OS being 89 vs. 56 months (p = 0.005), respectively. Patterns of loss of CR were heterogeneous, with biochemical relapse in 59 (25%); symptomatic relapse in 58 (24%); positive immunofixation/monoclonal protein rise not meeting relapse/progression criteria in 88 (37%) and abnormal free light chain ratio in LC MM in 34 (14%) patients. OS from start of first-line therapy was superior in patients starting second-line treatment for biochemical vs. symptomatic relapse (125 vs. 81 months, p = 0.001). This is likely attributable to underlying disease biology and prevention of end-organ damage by early treatment initiation, as benefit was independent of R-ISS stage.

Original languageEnglish (US)
JournalLeukemia
DOIs
StateAccepted/In press - Jan 1 2018

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Multiple Myeloma
Recurrence
Survival
Therapeutics
Transplants
Light
Proteins

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

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Relapse after complete response in newly diagnosed multiple myeloma : implications of duration of response and patterns of relapse. / Sidana, Surbhi; Tandon, Nidhi; Dispenzieri, Angela; Gertz, Morie; Buadi, Francis K.; Lacy, Martha; Dingli, David M; Fonder, Amie L.; Hayman, Suzanne R.; Hobbs, Miriam A.; Gonsalves, Wilson; Warsame, Rahma M.; Kourelis, Taxiarchis; Hwa, Yi Lisa; Kapoor, Prashant; Kyle, Robert A.; Leung, Nelson; Go, Ronald S.; Rajkumar, S Vincent; Kumar, Shaji K.

In: Leukemia, 01.01.2018.

Research output: Contribution to journalArticle

Sidana, Surbhi ; Tandon, Nidhi ; Dispenzieri, Angela ; Gertz, Morie ; Buadi, Francis K. ; Lacy, Martha ; Dingli, David M ; Fonder, Amie L. ; Hayman, Suzanne R. ; Hobbs, Miriam A. ; Gonsalves, Wilson ; Warsame, Rahma M. ; Kourelis, Taxiarchis ; Hwa, Yi Lisa ; Kapoor, Prashant ; Kyle, Robert A. ; Leung, Nelson ; Go, Ronald S. ; Rajkumar, S Vincent ; Kumar, Shaji K. / Relapse after complete response in newly diagnosed multiple myeloma : implications of duration of response and patterns of relapse. In: Leukemia. 2018.
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abstract = "Achieving a complete response (CR) is associated with improved overall survival (OS) in multiple myeloma (MM), but data on duration of CR (DurCR) are limited. We evaluated 351 patients (2004–2016), achieving CR with first-line therapy. Patients with sustained DurCR ≥ 24 months (n = 177) had better OS; 150 vs. 81 months, p < 0.001. DurCR ≥ 24 months remained a significant predictor for OS (HR: 0.3, 95{\%} CI: 0.2–0.5, p < 0.001) after adjusting for age, revised ISS stage, transplant and maintenance therapy. Landmark analysis at 24 months demonstrated similar results, OS: 150 vs. 83 months, p < 0.001. Survival benefit persisted even after loss of CR, with median OS being 89 vs. 56 months (p = 0.005), respectively. Patterns of loss of CR were heterogeneous, with biochemical relapse in 59 (25{\%}); symptomatic relapse in 58 (24{\%}); positive immunofixation/monoclonal protein rise not meeting relapse/progression criteria in 88 (37{\%}) and abnormal free light chain ratio in LC MM in 34 (14{\%}) patients. OS from start of first-line therapy was superior in patients starting second-line treatment for biochemical vs. symptomatic relapse (125 vs. 81 months, p = 0.001). This is likely attributable to underlying disease biology and prevention of end-organ damage by early treatment initiation, as benefit was independent of R-ISS stage.",
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AU - Sidana, Surbhi

AU - Tandon, Nidhi

AU - Dispenzieri, Angela

AU - Gertz, Morie

AU - Buadi, Francis K.

AU - Lacy, Martha

AU - Dingli, David M

AU - Fonder, Amie L.

AU - Hayman, Suzanne R.

AU - Hobbs, Miriam A.

AU - Gonsalves, Wilson

AU - Warsame, Rahma M.

AU - Kourelis, Taxiarchis

AU - Hwa, Yi Lisa

AU - Kapoor, Prashant

AU - Kyle, Robert A.

AU - Leung, Nelson

AU - Go, Ronald S.

AU - Rajkumar, S Vincent

AU - Kumar, Shaji K

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N2 - Achieving a complete response (CR) is associated with improved overall survival (OS) in multiple myeloma (MM), but data on duration of CR (DurCR) are limited. We evaluated 351 patients (2004–2016), achieving CR with first-line therapy. Patients with sustained DurCR ≥ 24 months (n = 177) had better OS; 150 vs. 81 months, p < 0.001. DurCR ≥ 24 months remained a significant predictor for OS (HR: 0.3, 95% CI: 0.2–0.5, p < 0.001) after adjusting for age, revised ISS stage, transplant and maintenance therapy. Landmark analysis at 24 months demonstrated similar results, OS: 150 vs. 83 months, p < 0.001. Survival benefit persisted even after loss of CR, with median OS being 89 vs. 56 months (p = 0.005), respectively. Patterns of loss of CR were heterogeneous, with biochemical relapse in 59 (25%); symptomatic relapse in 58 (24%); positive immunofixation/monoclonal protein rise not meeting relapse/progression criteria in 88 (37%) and abnormal free light chain ratio in LC MM in 34 (14%) patients. OS from start of first-line therapy was superior in patients starting second-line treatment for biochemical vs. symptomatic relapse (125 vs. 81 months, p = 0.001). This is likely attributable to underlying disease biology and prevention of end-organ damage by early treatment initiation, as benefit was independent of R-ISS stage.

AB - Achieving a complete response (CR) is associated with improved overall survival (OS) in multiple myeloma (MM), but data on duration of CR (DurCR) are limited. We evaluated 351 patients (2004–2016), achieving CR with first-line therapy. Patients with sustained DurCR ≥ 24 months (n = 177) had better OS; 150 vs. 81 months, p < 0.001. DurCR ≥ 24 months remained a significant predictor for OS (HR: 0.3, 95% CI: 0.2–0.5, p < 0.001) after adjusting for age, revised ISS stage, transplant and maintenance therapy. Landmark analysis at 24 months demonstrated similar results, OS: 150 vs. 83 months, p < 0.001. Survival benefit persisted even after loss of CR, with median OS being 89 vs. 56 months (p = 0.005), respectively. Patterns of loss of CR were heterogeneous, with biochemical relapse in 59 (25%); symptomatic relapse in 58 (24%); positive immunofixation/monoclonal protein rise not meeting relapse/progression criteria in 88 (37%) and abnormal free light chain ratio in LC MM in 34 (14%) patients. OS from start of first-line therapy was superior in patients starting second-line treatment for biochemical vs. symptomatic relapse (125 vs. 81 months, p = 0.001). This is likely attributable to underlying disease biology and prevention of end-organ damage by early treatment initiation, as benefit was independent of R-ISS stage.

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