title: Complete response in myeloma extends survival without, but not with history of prior monoclonal gammopathy of undetermined significance or smouldering disease.
abstract: Complete response (CR) is still considered an important surrogate marker for outcome in multiple myeloma (MM). Long-term survival after transplantation, however, has been observed in a substantial proportion of patients who never achieved CR. The tandem transplant trial, Total Therapy 2, enrolled 668 patients, who were randomised up-front to thalidomide (THAL) or no THAL; 56 patients were identified as having had, for at least 6 months prior to initiation of therapy, monoclonal gammopathy of undetermined significance (MGUS, n = 21), smouldering MM (SMM, n = 22) or solitary plasmacytoma of bone (SPC, n = 13). The clinical characteristics and outcomes of patients with such 'evolved' MM (E-MM) and of those with 'unknown' prior history (U-MM) were compared. Fewer patients with MGUS/SMM-E-MM had anaemia or renal failure; CR was lower (22% vs. 48%) but 4-year estimates of event-free survival (54% vs. 56% with U-MM) and overall survival (65% vs. 70% with U-MM) were similar to those with SPC-E-MM or U-MM. In the latter group, achieving CR was associated with prolonged survival. In comparison with U-MM, E-MM evolved from MGUS/SMM was associated with lower CR rate without adversely affecting survival. In contrast, CR was an independent favourable feature for survival in U-MM.
authors.affiliation: Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Pineda-Roman
authors.forename: Vanessa
authors.initials: V
authors.lastname: Bolejack
authors.forename: Varant
authors.initials: V
authors.lastname: Arzoumanian
authors.forename: Elias
authors.initials: E
authors.lastname: Anaissie
authors.forename: Frits
authors.initials: F
authors.lastname: van Rhee
authors.forename: Maurizio
authors.initials: M
authors.lastname: Zangari
authors.forename: Ron
authors.initials: R
authors.lastname: Walker
authors.forename: Klaus
authors.initials: K
authors.lastname: Hollmig
authors.forename: John D
authors.initials: JD
authors.lastname: Shaughnessy
authors.forename: Joshua
authors.initials: J
authors.lastname: Epstein
authors.forename: Somashekar
authors.initials: S
authors.lastname: Krishna
authors.forename: John
authors.initials: J
authors.lastname: Crowley
authors.forename: Bart
authors.initials: B
authors.lastname: Barlogie
mesh_terms: D000368:Aged; D000963:Antimetabolites / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008998:Monoclonal Gammopathy of Undetermined Significance / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D009101:Multiple Myeloma / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D036102:Peripheral Blood Stem Cell Transplantation; D010954:Plasmacytoma / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D016016:Proportional Hazards Models; D012074:Remission Induction; D016019:Survival Analysis; D013792:Thalidomide / Q000627:therapeutic use*; D014182:Transplantation, Autologous
chemical_list: D000963:Antimetabolites; D013792:Thalidomide