Abstract
We conducted a retrospective evaluation of response and survival for 293 patients with multiple myeloma treated since June 2000 with primary thalidomide- or bortezomib-based combinations, of whom 207 patients received intensive therapy supported by autologous blood stem cells within the first year. Survival times were calculated after a landmark of 1 year from start of therapy, so that subsequent median survival was 8.9 years for patients with CR, 4.9 years for those with PR and 0.6 year for patients with NR (P<0.001). Multivariate analyses confirmed CR or PR as the major favorable factors with less impact on prognosis for age or disease stage. Both novel agents and high-dose therapy (HDT) resulted in high frequencies of PR or CR, with early HDT useful for many patients with NR or PR in improving response status and subsequent survival.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Attal M, Harousseau JL, Stoppa AM, Sotto JJ, Fuzibet JG, Rossi JF et al. A prospective, randomized trial of autologous bone marrow transplantation and chemotherapy in multiple myeloma. Intergroupe Francais du Myelome. N Engl J Med 1996; 335: 91–97.
Child J, Morgan G, Davies F, Owen R, Bell S, Hawkins K et al. High-dose chemotherapy with hematopoietic stem-cell rescue for multiple myeloma. N Eng J Med 2003; 348: 1875–1883.
Weber D, Rankin K, Gavino M, Delasalle K, Alexanian R . Thalidomide alone or with dexamethasone for previously untreated multiple myeloma. J Clin Oncol 2003; 21: 16–19.
Rajkumar SV, Hayman S, Gertz MA, Dispenzieri A, Lacy MQ, Greipp PR et al. Combination therapy with thalidomide plus dexamethasone for newly diagnosed myeloma. J Clin Oncol 2002; 20: 4319–4323.
Richardson PG, Xie W, Mitsiades C, Chanan-Khan AA, Lonial S, Hassoun H et al. Single-agent bortezomib in previously untreated multiple myeloma: efficacy, characterization of peripheral neuropathy, and molecular correlations with response and neuropathy. J Clin Oncol 2009; 27: 3518–3525.
Jagannath S, Durie BG, Wolf J, Camacho E, Irwin D, Lutzky J et al. Bortezomib therapy alone and in combination with dexamethasone for previously untreated symptomatic multiple myeloma. Br J Haematol 2005; 129: 776–783.
Wang M, Giralt S, Delasalle K, Handy B, Alexanian R . Bortezomib in combination with thalidomide-dexamethasone for previously untreated multiple myeloma. Hematology 2007; 12: 235–239.
Wang M, Delasalle K, Giralt S, Alexanian R . Rapid control of previously untreated multiple myeloma with bortezomib—lenalidomide—dexamethasone. Hematology 2010; 15: 70–73.
Wang M, Delasalle K, Feng L, Thomas S, Giralt S, Qazilbash M et al. CR represents an early index of potential long survival in multiple myeloma. Bone Marrow Transplant 2009; 45: 498–504.
Greipp PR, San Miguel J, Durie BG, Crowley JJ, Barlogie B, Bladé J et al. International staging system for multiple myeloma. J Clin Oncol 2005; 23: 3412–3420.
Alexanian R, Weber D, Giralt S, Dimopoulos M, Delasalle K, Smith T et al. Impact of complete remission with intensive therapy in patients with responsive multiple myeloma. Bone Marrow Transplant 2001; 27: 1037–1043.
Alexanian R, Weber D, Delasalle K, Handy B, Champlin R, Giralt S . Clinical outcomes with intensive therapy for patients with primary resistant multiple myeloma. Bone Marrow Transplant 2004; 34: 229–234.
Durie B, Harousseau JL, Miguel J, Blade J, Barlogie B, Anderson K et al. International uniform response criteria for multiple myeloma. Leukemia 2006; 20: 1467–1473.
Blade J, Samson D, Reece D, Apperley J, Bjorkstrand B, Gahrton G et al. Criteria for evaluating disease response and progression in patients with multiple myeloma treated by high-dose therapy and haemopoietic stem cell transplantation. Br J Haematol 1998; 102: 1115–1123.
Kaplan E, Meier P . Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958; 53: 457–481.
Mantel N . Evaluation of survival data and two new rank order statistics arising in its consideration. Cancer Chemotherapy Rep 1966; 50: 163–170.
Anderson J, Cain K, Gelber R . Analysis of survival by tumor response. J Clin Oncol 1983; 1: 710–719.
Cox D . Regression models and life tables. J Royal Stat Soc 1972; 34: 187–220.
Lahuerta J, Mateos M, Martinez-Lopez J, Rosinol L, Sureda A, de la Rubia J et al. Influence of pre- and post-transplantation responses on outcome of patients with multiple myeloma: sequential improvement of response and achievement of complete response are associated with longer survival. J Clin Oncol 2008; 26: 5775–5782.
Gertz M, Kumar S, Lacy M, Dispenzeri A, Dingli D, Hayman S et al. Stem cell transplantation in multiple myeloma; impact of response failure with thalidomide or lenalidomide induction. Blood 2010; 115: 2348–2353.
Snapper I, Kahn A . Multiple Myeloma. Semin Hematol 1964; 124: 87–143.
Barlogie B, Anaissie E, Haessler J, van Rhee F, Pineda-Roman M, Hollmig K et al. Complete remission sustained for 3 years from treatment initiation is a powerful surrogate marker for extended survival in multiple myeloma. Cancer 2008; 113: 355–359.
Kumar S, Dingli S, Dispenzeri A, Lacy M, Hayman S, Buadi F et al. Impact of additional cytoreduction following autologous SCT in multiple myeloma. Bone Marrow Transplant 2008; 42: 259–264.
Acknowledgements
We are indebted to Lisa Foucheaux-Heider for typing this paper.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
Alexanian, R., Wang, M., Delasalle, K. et al. Value of novel agents and intensive therapy for patients with multiple myeloma. Bone Marrow Transplant 49, 422–425 (2014). https://doi.org/10.1038/bmt.2013.189
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/bmt.2013.189