Complete response in myeloma extends survival without, but not with history of prior monoclonal gammopathy of undetermined significance or smouldering disease.
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.
Pineda-Roman
Mauricio
M
Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
Bolejack
Vanessa
V
Arzoumanian
Varant
V
Anaissie
Elias
E
van Rhee
Frits
F
Zangari
Maurizio
M
Walker
Ron
R
Hollmig
Klaus
K
Shaughnessy
John D
JD
Epstein
Joshua
J
Krishna
Somashekar
S
Crowley
John
J
Barlogie
Bart
B
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
D000963:Antimetabolites; D013792:Thalidomide