title: Complete remission in multiple myeloma examined as time-dependent variable in terms of both onset and duration in Total Therapy protocols.
abstract: 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.
authors.affiliation: Cancer Research and Biostatistics, Seattle, WA, USA.
authors.forename: Antje
authors.initials: A
authors.lastname: Hoering
authors.forename: John
authors.initials: J
authors.lastname: Crowley
authors.forename: John D
authors.initials: JD
authors.lastname: Shaughnessy
authors.forename: Klaus
authors.initials: K
authors.lastname: Hollmig
authors.forename: Yazan
authors.initials: Y
authors.lastname: Alsayed
authors.forename: Jackie
authors.initials: J
authors.lastname: Szymonifka
authors.forename: Sarah
authors.initials: S
authors.lastname: Waheed
authors.forename: Bijay
authors.initials: B
authors.lastname: Nair
authors.forename: Frits
authors.initials: F
authors.lastname: van Rhee
authors.forename: Elias
authors.initials: E
authors.lastname: Anaissie
authors.forename: Bart
authors.initials: B
authors.lastname: Barlogie
mesh_terms: 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