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 language | English (US) |
|---|---|
| Journal | Leukemia |
| DOIs | |
| State | Accepted/In press - Jan 1 2018 |
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ASJC Scopus subject areas
- Hematology
- Oncology
- Cancer Research
Cite this
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 journal › Article
}
TY - JOUR
T1 - Relapse after complete response in newly diagnosed multiple myeloma
T2 - implications of duration of response and patterns of relapse
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
PY - 2018/1/1
Y1 - 2018/1/1
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.
UR - http://www.scopus.com/inward/record.url?scp=85055058026&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85055058026&partnerID=8YFLogxK
U2 - 10.1038/s41375-018-0271-1
DO - 10.1038/s41375-018-0271-1
M3 - Article
C2 - 30323358
AN - SCOPUS:85055058026
JO - Leukemia
JF - Leukemia
SN - 0887-6924
ER -