Early response to therapy and survival in multiple myeloma.
Whether the response to chemotherapy is a prognosticator in multiple myeloma (MM) is still not known. Therefore, the relationship between survival and the rate of monoclonal protein (M-protein) decrement during the first cycles of therapy was prospectively assessed in 262 patients with newly diagnosed MM that were included in a phase III trial (HOVON-16). M-proteins were collected monthly during melphalan-prednisone therapy (MP: melphalan 0.25 mg/kg, prednisone 1.0 mg/kg orally for 5 d every 4 weeks). Patients with light chain disease (n = 18), immunoglobulin M (IgM)-MM (n = 1) and no immunotyping (n = 1) were excluded. Of the 242 patients studied, 75% had IgG M-protein and 25% IgA; MM stages: I: 1%, II: 35% and III: 64%. The median M-protein decrease after the first cycle of MP was 21% for IgG and 27% for IgA, and declined to < 5% after four cycles. An obvious survival advantage was seen for patients who had an M-protein decrease of at least 30% after the first MP cycle, which became significant when an M-protein decrease of 40% or more was reached. As established prognostic parameters (Salmon & Durie stage, serum creatinine, and haemoglobin) also remained prognostically significant, we concluded that early response to MP predicts for survival in MM.
Schaar
C G
CG
Department of Haematology, Leiden University Medical Centre, Leiden, The Netherlands. c.schaar@gelre.nl
Kluin-Nelemans
J C
JC
le Cessie
S
S
Franck
P F H
PF
te Marvelde
M C
MC
Wijermans
P W
PW
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007070:Immunoglobulin A / Q000378:metabolism; D007074:Immunoglobulin G / Q000378:metabolism; D008297:Male; D008558:Melphalan / Q000008:administration & dosage; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000378:metabolism; D009194:Myeloma Proteins / Q000378:metabolism; D011241:Prednisone / Q000008:administration & dosage; D011446:Prospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
D007070:Immunoglobulin A; D007074:Immunoglobulin G; D009194:Myeloma Proteins; C085016:multiple myeloma M-proteins; D008558:Melphalan; D011241:Prednisone