title: Complete remission sustained 3 years from treatment initiation is a powerful surrogate for extended survival in multiple myeloma.
abstract: BACKGROUND
  Complete response (CR) has been considered a necessary although not sufficient early clinical endpoint for extended survival in multiple myeloma.
  
  
  METHODS
  By using Total Therapy 2 (TT2) clinical outcome data in 668 patients, whether sustained CR (SUS-CR) was potentially a superior surrogate for survival than attaining CR status per se was evaluated.
  
  
  RESULTS
  Compared with not achieving CR (NON-CR) and especially achieving and subsequently losing CR status (LOS-CR) within a 3-year landmark from treatment initiation, SUS-CR was associated with highly superior postlandmark survival (P < .0001). These results were validated in 231 untreated patients enrolled in the predecessor trial, TT1 (hazard ratio [HR] = 0.54, P = .013) and in 1103 previously treated patients on other transplant protocols (HR = 0.49; P < .001).
  
  
  CONCLUSIONS
  In all 3 trial settings the survival benefit of SUS-CR was independent of metaphase abnormalities as a dominant adverse parameter. Given its bleak prognosis despite high CR rates, SUS-CR should be evaluated as a primary trial endpoint in high-risk myeloma.
authors.affiliation: Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA. barlogiebart@uams.edu
authors.forename: Bart
authors.initials: B
authors.lastname: Barlogie
authors.forename: Elias
authors.initials: E
authors.lastname: Anaissie
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Haessler
authors.forename: Fritz
authors.initials: F
authors.lastname: van Rhee
authors.forename: Mauricio
authors.initials: M
authors.lastname: Pineda-Roman
authors.forename: Klaus
authors.initials: K
authors.lastname: Hollmig
authors.forename: Yazan
authors.initials: Y
authors.lastname: Alsayed
authors.forename: Joshua
authors.initials: J
authors.lastname: Epstein
authors.forename: John D
authors.initials: JD
authors.lastname: Shaughnessy
authors.forename: John
authors.initials: J
authors.lastname: Crowley
mesh_terms: D000368:Aged; D006801:Humans; D009101:Multiple Myeloma / Q000453:epidemiology / Q000628:therapy*; D012074:Remission Induction; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome