Outcomes with early response to first-line treatment in patients with newly diagnosed multiple myeloma

We evaluated the impact of achieving a rapid response in 840 newly diagnosed multiple myeloma patients from 2004 to 2015. Rates of very good partial response (VGPR) or better were 29% (240/840) after 2 cycles of treatment, 42% (350/840) after 4 cycles of treatment, and 66% (552/840) as best response...

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Published in:Blood advances 2019-03, Vol.3 (5), p.744-750
Main Authors: Tandon, Nidhi, Sidana, Surbhi, Rajkumar, S. Vincent, Gertz, Morie A., Buadi, Francis K., Lacy, Martha Q., Kapoor, Prashant, Gonsalves, Wilson I., Dispenzieri, Angela, Kourelis, Taxiarchis V., Warsame, Rahma, Dingli, David, Fonder, Amie L., Hayman, Suzanne R., Hobbs, Miriam A., Hwa, Yi Lisa, Kyle, Robert A., Leung, Nelson, Go, Ronald S., Lust, John A., Russell, Stephen J., Kumar, Shaji K.
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Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Female
Humans
Lymphoid Neoplasia
Male
Middle Aged
Multiple Myeloma - diagnosis
Multiple Myeloma - mortality
Multiple Myeloma - therapy
Multivariate Analysis
Remission Induction
Risk Factors
Survival Analysis
Time-to-Treatment
Treatment Outcome
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cited_by cdi_FETCH-LOGICAL-c479t-c5eff764e4d781fc822ebd11a0d36af2999277f6ca15a9c118b79269f3caf45e3
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container_title Blood advances
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creator Tandon, Nidhi
Sidana, Surbhi
Rajkumar, S. Vincent
Gertz, Morie A.
Buadi, Francis K.
Lacy, Martha Q.
Kapoor, Prashant
Gonsalves, Wilson I.
Dispenzieri, Angela
Kourelis, Taxiarchis V.
Warsame, Rahma
Dingli, David
Fonder, Amie L.
Hayman, Suzanne R.
Hobbs, Miriam A.
Hwa, Yi Lisa
Kyle, Robert A.
Leung, Nelson
Go, Ronald S.
Lust, John A.
Russell, Stephen J.
Kumar, Shaji K.
description We evaluated the impact of achieving a rapid response in 840 newly diagnosed multiple myeloma patients from 2004 to 2015. Rates of very good partial response (VGPR) or better were 29% (240/840) after 2 cycles of treatment, 42% (350/840) after 4 cycles of treatment, and 66% (552/840) as best response. Early responders after 2 cycles of treatment had higher rates of light chain disease, anemia, renal failure, International Staging System (ISS) stage III disease, and high-risk cytogenetics, especially t(4;14), and were more likely to have received triplet therapy and undergo transplant. Median progression-free survival (PFS) and overall survival (OS) were not different among patients with ≥VGPR and
doi_str_mv 10.1182/bloodadvances.2018022806
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Vincent ; Gertz, Morie A. ; Buadi, Francis K. ; Lacy, Martha Q. ; Kapoor, Prashant ; Gonsalves, Wilson I. ; Dispenzieri, Angela ; Kourelis, Taxiarchis V. ; Warsame, Rahma ; Dingli, David ; Fonder, Amie L. ; Hayman, Suzanne R. ; Hobbs, Miriam A. ; Hwa, Yi Lisa ; Kyle, Robert A. ; Leung, Nelson ; Go, Ronald S. ; Lust, John A. ; Russell, Stephen J. ; Kumar, Shaji K.</creator><creatorcontrib>Tandon, Nidhi ; Sidana, Surbhi ; Rajkumar, S. Vincent ; Gertz, Morie A. ; Buadi, Francis K. ; Lacy, Martha Q. ; Kapoor, Prashant ; Gonsalves, Wilson I. ; Dispenzieri, Angela ; Kourelis, Taxiarchis V. ; Warsame, Rahma ; Dingli, David ; Fonder, Amie L. ; Hayman, Suzanne R. ; Hobbs, Miriam A. ; Hwa, Yi Lisa ; Kyle, Robert A. ; Leung, Nelson ; Go, Ronald S. ; Lust, John A. ; Russell, Stephen J. ; Kumar, Shaji K.</creatorcontrib><description>We evaluated the impact of achieving a rapid response in 840 newly diagnosed multiple myeloma patients from 2004 to 2015. Rates of very good partial response (VGPR) or better were 29% (240/840) after 2 cycles of treatment, 42% (350/840) after 4 cycles of treatment, and 66% (552/840) as best response. Early responders after 2 cycles of treatment had higher rates of light chain disease, anemia, renal failure, International Staging System (ISS) stage III disease, and high-risk cytogenetics, especially t(4;14), and were more likely to have received triplet therapy and undergo transplant. Median progression-free survival (PFS) and overall survival (OS) were not different among patients with ≥VGPR and &lt;VGPR after 2 cycles (PFS, 28 vs 30 months, P = .6; OS, 78 vs 96 months, P = .1) and 4 cycles (PFS, 31 vs 29 months; OS, 89 vs 91 months, P = .9), although both were improved, with ≥VGPR as best response (PFS, 33 vs 22 months, P &lt; .001; OS, 102 vs 77 months, P = .003). On multivariate analysis stratified by transplant status, achievement of ≥VGPR after 2 cycles was not associated with improved PFS (hazard ratio [95% confidence interval]; transplant cohort, 1.1 [0.7-1.6]; nontransplant cohort, 1.2 [0.8-1.7]) or OS (transplant cohort, 1.6 [0.9-2.9]; nontransplant cohort, 1.5 [1.0-2.4]). Covariates in the model included high-risk cytogenetics, ISS stage III, triplet therapy, creatinine ≥2 mg/dL, light chain disease, and age. Although patients with high-risk disease are more likely to achieve early response, a rapid achievement of a deep response by itself does not affect long-term outcomes. 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Rates of very good partial response (VGPR) or better were 29% (240/840) after 2 cycles of treatment, 42% (350/840) after 4 cycles of treatment, and 66% (552/840) as best response. Early responders after 2 cycles of treatment had higher rates of light chain disease, anemia, renal failure, International Staging System (ISS) stage III disease, and high-risk cytogenetics, especially t(4;14), and were more likely to have received triplet therapy and undergo transplant. Median progression-free survival (PFS) and overall survival (OS) were not different among patients with ≥VGPR and &lt;VGPR after 2 cycles (PFS, 28 vs 30 months, P = .6; OS, 78 vs 96 months, P = .1) and 4 cycles (PFS, 31 vs 29 months; OS, 89 vs 91 months, P = .9), although both were improved, with ≥VGPR as best response (PFS, 33 vs 22 months, P &lt; .001; OS, 102 vs 77 months, P = .003). On multivariate analysis stratified by transplant status, achievement of ≥VGPR after 2 cycles was not associated with improved PFS (hazard ratio [95% confidence interval]; transplant cohort, 1.1 [0.7-1.6]; nontransplant cohort, 1.2 [0.8-1.7]) or OS (transplant cohort, 1.6 [0.9-2.9]; nontransplant cohort, 1.5 [1.0-2.4]). Covariates in the model included high-risk cytogenetics, ISS stage III, triplet therapy, creatinine ≥2 mg/dL, light chain disease, and age. Although patients with high-risk disease are more likely to achieve early response, a rapid achievement of a deep response by itself does not affect long-term outcomes. 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On multivariate analysis stratified by transplant status, achievement of ≥VGPR after 2 cycles was not associated with improved PFS (hazard ratio [95% confidence interval]; transplant cohort, 1.1 [0.7-1.6]; nontransplant cohort, 1.2 [0.8-1.7]) or OS (transplant cohort, 1.6 [0.9-2.9]; nontransplant cohort, 1.5 [1.0-2.4]). Covariates in the model included high-risk cytogenetics, ISS stage III, triplet therapy, creatinine ≥2 mg/dL, light chain disease, and age. Although patients with high-risk disease are more likely to achieve early response, a rapid achievement of a deep response by itself does not affect long-term outcomes. [Display omitted]</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>30824418</pmid><doi>10.1182/bloodadvances.2018022806</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0003-3288-7614</orcidid><oa>free_for_read</oa></addata></record>
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subjects Adult
Aged
Aged, 80 and over
Female
Humans
Lymphoid Neoplasia
Male
Middle Aged
Multiple Myeloma - diagnosis
Multiple Myeloma - mortality
Multiple Myeloma - therapy
Multivariate Analysis
Remission Induction
Risk Factors
Survival Analysis
Time-to-Treatment
Treatment Outcome
title Outcomes with early response to first-line treatment in patients with newly diagnosed multiple myeloma
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