title: Limited value of the international staging system for predicting long-term outcome of transplant-ineligible, newly diagnosed, symptomatic multiple myeloma in the era of novel agents.
abstract: We retrospectively investigated clinical outcomes and prognostic factors of 131 patients with transplant-ineligible newly diagnosed multiple myeloma (NDMM) who received melphalan and prednisolone (MP) as first-line therapy from 2006 to 2013. Eighty-one patients received salvage therapies incorporating bortezomib, lenalidomide, and/or thalidomide. The overall response rate to MP was 54.2 %, including 9.2 % of better than very good partial response. With a median follow-up period of 30.2 months, median overall survival (OS) and median time to next treatment (TNT) were 54.4 and 19.0 months, respectively. Univariate analysis revealed that performance status and serum calcium level significantly associated with both OS and TNT, and multivariate analysis revealed that the higher serum calcium level had a significantly unfavorable impact on OS and TNT. Importantly, staging informed by the international staging system (ISS) was not predictive for OS or TNT in the analyzed cohort. Our study revealed that, in the context of first-line MP therapy for NDMM, the salvage therapy incorporating novel agents produced a survival period of >30 months after the initiation of second-line therapy, suggesting that the predictive value of ISS for OS and TNT may be limited in the era of novel agents.
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan, junkuro@koto.kpu-m.ac.jp.
authors.forename: Junya
authors.initials: J
authors.lastname: Kuroda
authors.forename: Yuji
authors.initials: Y
authors.lastname: Shimura
authors.forename: Kensuke
authors.initials: K
authors.lastname: Ohta
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Tanaka
authors.forename: Hirohiko
authors.initials: H
authors.lastname: Shibayama
authors.forename: Satoru
authors.initials: S
authors.lastname: Kosugi
authors.forename: Shinichi
authors.initials: S
authors.lastname: Fuchida
authors.forename: Masayuki
authors.initials: M
authors.lastname: Kobayashi
authors.forename: Hitomi
authors.initials: H
authors.lastname: Kaneko
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Uoshima
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Ishii
authors.forename: Shosaku
authors.initials: S
authors.lastname: Nomura
authors.forename: Masafumi
authors.initials: M
authors.lastname: Taniwaki
authors.forename: Akifumi
authors.initials: A
authors.lastname: Takaori-Kondo
authors.forename: Chihiro
authors.initials: C
authors.lastname: Shimazaki
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Tsudo
authors.forename: Masayuki
authors.initials: M
authors.lastname: Hino
authors.forename: Itaru
authors.initials: I
authors.lastname: Matsumura
authors.forename: Yuzuru
authors.initials: Y
authors.lastname: Kanakura
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001897:Boronic Acids / Q000008:administration & dosage; D000069286:Bortezomib; D005260:Female; D006801:Humans; D000077269:Lenalidomide; D008297:Male; D008558:Melphalan / Q000008:administration & dosage; D008875:Middle Aged; D009101:Multiple Myeloma / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D009367:Neoplasm Staging; D011239:Prednisolone / Q000008:administration & dosage; D011379:Prognosis; D011719:Pyrazines / Q000008:administration & dosage; D019233:Retreatment; D016879:Salvage Therapy; D013792:Thalidomide / Q000008:administration & dosage / Q000031:analogs & derivatives; D016896:Treatment Outcome
chemical_list: D001897:Boronic Acids; D011719:Pyrazines; D013792:Thalidomide; D000069286:Bortezomib; D011239:Prednisolone; D000077269:Lenalidomide; D008558:Melphalan