title: Influence of pre- and post-transplantation responses on outcome of patients with multiple myeloma: sequential improvement of response and achievement of complete response are associated with longer survival.
abstract: OBJECTIVE
  Complete response (CR) is considered an important goal in most hematologic malignancies. However, in multiple myeloma (MM), there is no consensus regarding whether immunofixation (IF)-negative CR, IF-positive near-CR (nCR), and partial response (PR) are associated with different survivals. We evaluated the prognostic influence on event-free survival (EFS) and overall survival (OS) of these responses pre- and post-transplantation in newly diagnosed patients with MM.
  
  
  METHODS
  We analyzed 632 patients from the prospective Grupo Español de Mieloma 2000 protocol who were uniformly treated with vincristine, carmustine, cyclophosphamide, melphalan, and predisone/vincristine, carmustine, adryamcine, and dexamethasone induction followed by high-dose therapy and autologous stem-cell transplantation.
  
  
  RESULTS
  Post-transplantation response markedly influenced outcomes. Patients achieving CR had significantly longer EFS (median, 61 v 40 months; P < 10(-5)) and OS (medians not reached; P = .01) versus patients achieving nCR, who likewise had somewhat better outcomes compared with patients achieving PR (median EFS, 34 months, P = .07 v nCR; median OS, 61 months, P = .04). EFS and OS and influence of response were similar among older (age 65 to 70 years) and younger (age < 65 years) patients. Similar findings were observed with pretransplantation response, with trends toward EFS (P = .1; P = .05) and OS (P = .1; P = .07) benefit in patients achieving CR versus nCR and PR, respectively. Post-transplantation response was markedly influenced by pretransplantation response; improvements in response were associated with prolonged survival.
  
  
  CONCLUSIONS
  Quality of response post-transplantation, notably CR, is significantly associated with EFS and OS prolongation in newly diagnosed patients with MM. There were trends toward similar associations with pretransplantation response status.
authors.affiliation: Hospital Universitario de Salamanca, Salamanca, Spain.
authors.forename: Juan José
authors.initials: JJ
authors.lastname: Lahuerta
authors.forename: Maria Victoria
authors.initials: MV
authors.lastname: Mateos
authors.forename: Joaquin
authors.initials: J
authors.lastname: Martínez-López
authors.forename: Laura
authors.initials: L
authors.lastname: Rosiñol
authors.forename: Anna
authors.initials: A
authors.lastname: Sureda
authors.forename: Javier
authors.initials: J
authors.lastname: de la Rubia
authors.forename: José
authors.initials: J
authors.lastname: García-Laraña
authors.forename: Rafael
authors.initials: R
authors.lastname: Martínez-Martínez
authors.forename: Miguel T
authors.initials: MT
authors.lastname: Hernández-García
authors.forename: Dolores
authors.initials: D
authors.lastname: Carrera
authors.forename: Joan
authors.initials: J
authors.lastname: Besalduch
authors.forename: Felipe
authors.initials: F
authors.lastname: de Arriba
authors.forename: José María
authors.initials: JM
authors.lastname: Ribera
authors.forename: Lourdes
authors.initials: L
authors.lastname: Escoda
authors.forename: Belén
authors.initials: B
authors.lastname: Hernández-Ruiz
authors.forename: Javier
authors.initials: J
authors.lastname: García-Frade
authors.forename: Concepción
authors.initials: C
authors.lastname: Rivas-González
authors.forename: Adrían
authors.initials: A
authors.lastname: Alegre
authors.forename: Joan
authors.initials: J
authors.lastname: Bladé
authors.forename: Jesús F
authors.initials: JF
authors.lastname: San Miguel
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000401:mortality / Q000628:therapy*; D011446:Prospective Studies; D012074:Remission Induction; D013030:Spain; D033581:Stem Cell Transplantation; D013997:Time Factors; D019172:Transplantation Conditioning; D014182:Transplantation, Autologous; D016896:Treatment Outcome