Complete remission in multiple myeloma examined as time-dependent variable in terms of both onset and duration in Total Therapy protocols.
Landmark analyses are used to investigate the importance for survival of achieving complete response (CR), an important initial goal of myeloma therapy. With median times to CR in Total Therapy (TT) trials of approximately 1 year, this approach excludes a sizeable fraction of patients dying before such a landmark. To permit inclusion of all trial participants, we investigated the prognostic implications of both onset and duration of CR as time-dependent variables. Superseding the adverse effects of cytogenetic abnormalities and other standard prognostic parameters, both failure to achieve CR (non-CR) and, especially, loss of CR (los-CR) were independently associated with inferior survival in TT1, TT2, and TT3 protocols. In the context of gene array-defined risk, available in TT2 and TT3 subsets, both los-CR and non-CR terms were retained in the survival model as dominant adverse variables, stressing the prognostic importance of sustaining CR status, especially in high-risk disease.
Hoering
Antje
A
Cancer Research and Biostatistics, Seattle, WA, USA.
Crowley
John
J
Shaughnessy
John D
JD
Hollmig
Klaus
K
Alsayed
Yazan
Y
Szymonifka
Jackie
J
Waheed
Sarah
S
Nair
Bijay
B
van Rhee
Frits
F
Anaissie
Elias
E
Barlogie
Bart
B
D017668:Age of Onset; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000401:mortality; D012074:Remission Induction; D015996:Survival Rate; D013997:Time Factors