title: Importance of achieving stringent complete response after autologous stem-cell transplantation in multiple myeloma.
abstract: OBJECTIVE
  To study the impact of achieving stringent complete response (sCR), an increasingly attainable goal, after autologous stem-cell transplantation (ASCT) in patients with multiple myeloma (MM).
  
  
  METHODS
  Maximal response rates were determined in 445 consecutive patients who underwent ASCT within 12 months of diagnosis of MM. The patients achieving varying degrees of complete response (CR) are the focus of our study.
  
  
  RESULTS
  One hundred and nine patients (25%) achieved sCR after ASCT. The median overall survival (OS) rate from the time of transplantation for patients attaining sCR was not reached (NR), in contrast to those patients achieving conventional complete response (CR; n = 37; OS, 81 months) or near CR (nCR; n = 91; OS, 60 months; P < .001). Five-year OS rates were 80%, 53%, and 47% for sCR, CR, and nCR, respectively. The median time to progression (TTP) from ASCT of patients achieving sCR was significantly longer (50 months) than TTP of patients achieving CR or nCR (20 months and 19 months, respectively). On multivariable analysis, post-ASCT response of sCR was an independent prognostic factor for survival (hazard ratio, 0.44; 95% CI, 0.25 to 0.80; versus CR; P = .008), in addition to proliferation rate, pre-ASCT cytogenetics, and performance status. OS rates of patients attaining sCR continued to remain superior at 2-year landmark (median, NR v 70 months for conventional CR group; P = .007).
  
  
  CONCLUSIONS
  Improved long-term outcome is seen after ASCT with achievement of sCR when compared with lesser degrees of responses. Myeloma trials reporting the response rates should identify patients achieving sCR and CR separately, owing to markedly disparate outcomes of the two categories.
authors.affiliation: From the Mayo Clinic, Rochester, MN.
authors.forename: Prashant
authors.initials: P
authors.lastname: Kapoor
authors.forename: Shaji K
authors.initials: SK
authors.lastname: Kumar
authors.forename: Angela
authors.initials: A
authors.lastname: Dispenzieri
authors.forename: Martha Q
authors.initials: MQ
authors.lastname: Lacy
authors.forename: Francis
authors.initials: F
authors.lastname: Buadi
authors.forename: David
authors.initials: D
authors.lastname: Dingli
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Russell
authors.forename: Suzanne R
authors.initials: SR
authors.lastname: Hayman
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Witzig
authors.forename: John A
authors.initials: JA
authors.lastname: Lust
authors.forename: Nelson
authors.initials: N
authors.lastname: Leung
authors.forename: Yi
authors.initials: Y
authors.lastname: Lin
authors.forename: Steven R
authors.initials: SR
authors.lastname: Zeldenrust
authors.forename: Arleigh
authors.initials: A
authors.lastname: McCurdy
authors.forename: Philip R
authors.initials: PR
authors.lastname: Greipp
authors.forename: Robert A
authors.initials: RA
authors.lastname: Kyle
authors.forename: S Vincent
authors.initials: SV
authors.lastname: Rajkumar
authors.forename: Morie A
authors.initials: MA
authors.lastname: Gertz
mesh_terms: D000328:Adult; D000368:Aged; D049109:Cell Proliferation; D018572:Disease-Free Survival; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000401:mortality / Q000601:surgery*; D011379:Prognosis; D011446:Prospective Studies; D014182:Transplantation, Autologous; D016896:Treatment Outcome