title: Complete remission rate and outcome after intensive treatment of 177 patients under 75 years of age with IgG myeloma defining a circumscribed disease entity with a new staging system.
abstract: Because the presence of IgG paraprotein in the blood is clear cut, it makes IgG myeloma a more circumscribed disease than myeloma as a whole in which to study treatment efficacy, particularly relating to complete remission (CR). Between May 1989 and December 1997, 177 consecutive patients with IgG myeloma who were <75 years old were seen, of whom 153 entered a sequential therapy (ST) programme of initial courses of C-VAMP infusional chemotherapy (IC), high-dose treatment (with or without stem cell rescue) (119 patients) and maintenance interferon (87 patients). 74/153 (48.4%) patients entered CR. Median overall survival (OS) and event-free survival (EFS) were 4.9 and 2.1 years, respectively. Multivariate analysis at presentation showed OS was significantly prolonged for beta2M <2.7 mg/l and age <median 52, whilst beta2M <2.7 mg/l and Hb >8.5 g/dl predicted for longer EFS. For CR patients, age <median 51 years, absence of Bence-Jones proteinuria (BJP), male sex and white blood cells (WBC) <7 x 109/l predicted for a longer OS. Longer length of first CR was predicted by absence of BJP at presentation (P = 0.03) and fewer than five courses of IC (P = 0.02) to attain CR. We have therefore been able to refine the use of ST in IgG myeloma, redefine CR as a 'macro' endpoint, and propose a new staging system for IgG myelomas. Analysis of 41 comparable IgA patients showed IgG to be a distinct entity.
authors.affiliation: Leukaemia and Myeloma Units, Royal Marsden NHS Trust, Sutton, Surrey.
authors.forename: B
authors.initials: B
authors.lastname: Sirohi
authors.forename: R
authors.initials: R
authors.lastname: Powles
authors.forename: J
authors.initials: J
authors.lastname: Mehta
authors.forename: N
authors.initials: N
authors.lastname: Raje
authors.forename: S
authors.initials: S
authors.lastname: Kulkarni
authors.forename: V
authors.initials: V
authors.lastname: Ramiah
authors.forename: R
authors.initials: R
authors.lastname: Saso
authors.forename: C
authors.initials: C
authors.lastname: Horton
authors.forename: N
authors.initials: N
authors.lastname: Bhagwati
authors.forename: S
authors.initials: S
authors.lastname: Singhal
authors.forename: J
authors.initials: J
authors.lastname: Treleaven
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000008:administration & dosage; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007070:Immunoglobulin A / Q000276:immunology; D007074:Immunoglobulin G / Q000276:immunology*; D007372:Interferons / Q000627:therapeutic use; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000276:immunology; D011379:Prognosis; D012008:Recurrence; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D007070:Immunoglobulin A; D007074:Immunoglobulin G; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D007372:Interferons; D008775:Methylprednisolone