title: Association between complete response and outcomes in transplant-eligible myeloma patients in the era of novel agents.
abstract: OBJECTIVE
  Achieving complete response (CR) has been linked to improved progression-free (PFS) and overall (OS) survival in myeloma. A meta-analysis was conducted to investigate whether this holds true in the era of novel agents (bortezomib, lenalidomide, thalidomide).
  
  
  METHODS
  A total of 24 studies in newly diagnosed patients undergoing autologous stem cell transplantation (ASCT) that reported associations between responses and long-term outcomes (PFS/OS rates post-ASCT by response, or hazard ratios with 95% confidence intervals from Cox models) were identified and analyzed.
  
  
  RESULTS
  Achievement of CR vs. <CR post-ASCT reduced risk of progression/death by 38% [risk ratio (RR): 0.62, P < 0.0001]; risk of death was 41% lower (RR: 0.59, P < 0.0001). Subgroup meta-analyses showed significant PFS risk reduction with CR post-ASCT with novel (RR: 0.32, P < 0.006) and non-novel (RR: 0.72, P < 0.0001) agents, and corresponding OS risk reduction with novel (RR: 0.33, P = 0.0013) and non-novel (RR: 0.64, P < 0.0001) agents. Risk reduction was greater with novel vs. non-novel agents (PFS: P = 0.047; OS: P = 0.058).
  
  
  CONCLUSIONS
  Achieving CR during first-line therapy remains important in the novel-agent era; magnitude of association between achieving CR and outcomes appears higher for CR obtained using novel vs. non-novel agents.
authors.affiliation: Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA.
authors.forename: Helgi
authors.initials: H
authors.lastname: van de Velde
authors.affiliation: Janssen Research and Development, Horsham, PA, USA.
authors.forename: Anil
authors.initials: A
authors.lastname: Londhe
authors.affiliation: Janssen Research & Development, High Wycombe, UK.
authors.forename: Ozlem
authors.initials: O
authors.lastname: Ataman
authors.affiliation: FireKite, an Ashfield Company, part of UDG Healthcare plc, Maidenhead, UK.
authors.forename: Helen L
authors.initials: HL
authors.lastname: Johns
authors.affiliation: FireKite, an Ashfield Company, part of UDG Healthcare plc, Maidenhead, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Hill
authors.affiliation: FireKite, an Ashfield Company, part of UDG Healthcare plc, Maidenhead, UK.
authors.forename: Emma
authors.initials: E
authors.lastname: Landers
authors.affiliation: Johnson & Johnson, Titusville, NJ, USA.
authors.forename: Jesse A
authors.initials: JA
authors.lastname: Berlin
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D053208:Kaplan-Meier Estimate; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000401:mortality* / Q000628:therapy; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012074:Remission Induction; D014182:Transplantation, Autologous; D016896:Treatment Outcome
keywords: bortezomib; complete response; lenalidomide; meta-analysis; multiple myeloma; overall survival; progression-free survival; thalidomide; treatment outcome