title: Changing trends in prognostic factors for patients with multiple myeloma after autologous stem cell transplantation during the immunomodulator drug/proteasome inhibitor era.
abstract: We evaluated the clinical significance of prognostic factors including the International Staging System (ISS) and modified European Group for Blood and Marrow Transplantation response criteria in 1650 Japanese patients with multiple myeloma (MM) who underwent upfront single autologous stem cell transplantation (ASCT). We categorized patients into two treatment cohorts: pre-novel agent era (1995-2006) and novel agent era (2008-2011). The combined percentage of pre-ASCT complete response and very good partial response cases (463 of 988, 47%) significantly increased during the novel agent era compared with the pre-novel agent era (164 of 527, 31%; P < 0.0001). The 2-year overall survival (OS) rate of 87% during the novel agent era was a significant improvement relative to that of 82% during the pre-novel agent era (P = 0.019). Although significant differences in OS were found among ISS stages during the pre-novel agent era, no significant difference was observed between ISS I and II (P = 0.107) during the novel agent era. The factors independently associated with a superior OS were female gender (P = 0.002), a good performance status (P = 0.024), lower ISS (P < 0.001), pre-ASCT response at least partial response (P < 0.001) and ASCT during the novel agent era (P = 0.017). These results indicate that the response rate and OS were significantly improved, and the ISS could not clearly stratify the prognoses of Japanese patients with MM who underwent upfront single ASCT during the novel agent era.
authors.affiliation: Cellular Transplantation Biology (Hematology/Respirology), Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Takamatsu
authors.forename: Sumihisa
authors.initials: S
authors.lastname: Honda
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Miyamoto
authors.forename: Kenji
authors.initials: K
authors.lastname: Yokoyama
authors.forename: Shotaro
authors.initials: S
authors.lastname: Hagiwara
authors.forename: Toshiro
authors.initials: T
authors.lastname: Ito
authors.forename: Naoto
authors.initials: N
authors.lastname: Tomita
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Iida
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Iwasaki
authors.forename: Hisashi
authors.initials: H
authors.lastname: Sakamaki
authors.forename: Ritsuro
authors.initials: R
authors.lastname: Suzuki
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Sunami
mesh_terms: D000276:Adjuvants, Immunologic / Q000627:therapeutic use*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000276:immunology* / Q000378:metabolism; D011379:Prognosis; D061988:Proteasome Inhibitors / Q000008:administration & dosage; D012189:Retrospective Studies; D015996:Survival Rate; D014182:Transplantation, Autologous / Q000379:methods; D055815:Young Adult
chemical_list: D000276:Adjuvants, Immunologic; D007155:Immunologic Factors; D061988:Proteasome Inhibitors
keywords: Autologous stem cell transplantation; International Staging System; immunomodulator drugs; multiple myeloma; proteasome inhibitors