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Clinical predictors of long-term survival in newly diagnosed transplant eligible multiple myeloma - an IMWG Research Project

Usmani, Saad Z.; Hoering, Antje; Cavo, Michele; Miguel, Jesus San; Goldschimdt, Hartmut; Hajek, Roman; Turesson, Ingemar LU ; Lahuerta, Juan Jose; Attal, Michel and Barlogie, Bart, et al. (2018) In Blood Cancer Journal 8(12).
Abstract

PURPOSE: multiple myeloma is considered an incurable hematologic cancer but a subset of patients can achieve long-term remissions and survival. The present study examines the clinical features of long-term survival as it correlates to depth of disease response. PATIENTS & METHODS: this was a multi-institutional, international, retrospective analysis of high-dose melphalan-autologous stem cell transplant (HDM-ASCT) eligible MM patients included in clinical trials. Clinical variable and survival data were collected from 7291 MM patients from Czech Republic, France, Germany, Italy, Korea, Spain, the Nordic Myeloma Study Group and the United States. Kaplan-Meier curves were used to assess progression-free survival (PFS) and overall... (More)

PURPOSE: multiple myeloma is considered an incurable hematologic cancer but a subset of patients can achieve long-term remissions and survival. The present study examines the clinical features of long-term survival as it correlates to depth of disease response. PATIENTS & METHODS: this was a multi-institutional, international, retrospective analysis of high-dose melphalan-autologous stem cell transplant (HDM-ASCT) eligible MM patients included in clinical trials. Clinical variable and survival data were collected from 7291 MM patients from Czech Republic, France, Germany, Italy, Korea, Spain, the Nordic Myeloma Study Group and the United States. Kaplan-Meier curves were used to assess progression-free survival (PFS) and overall survival (OS). Relative survival (RS) and statistical cure fractions (CF) were computed for all patients with available data. RESULTS: achieving CR at 1 year was associated with superior PFS (median PFS 3.3 years vs. 2.6 years, p < 0.0001) as well as OS (median OS 8.5 years vs. 6.3 years, p < 0.0001). Clinical variables at diagnosis associated with 5-year survival and 10-year survival were compared with those associated with 2-year death. In multivariate analysis, age over 65 years (OR 1.87, p = 0.002), IgA Isotype (OR 1.53, p = 0.004), low albumin < 3.5 g/dL (OR = 1.36, p = 0.023), elevated beta 2 microglobulin ≥ 3.5 mg/dL (OR 1.86, p < 0.001), serum creatinine levels ≥ 2 mg/dL (OR 1.77, p = 0.005), hemoglobin levels < 10 g/dL (OR 1.55, p = 0.003), and platelet count < 150k/μL (OR 2.26, p < 0.001) appeared to be negatively associated with 10-year survival. The relative survival for the cohort was ~0.9, and the statistical cure fraction was 14.3%. CONCLUSIONS: these data identify CR as an important predictor of long-term survival for HDM-ASCT eligible MM patients. They also identify clinical variables reflective of higher disease burden as poor prognostic markers for long-term survival.

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Blood Cancer Journal
volume
8
issue
12
publisher
Nature Publishing Group
external identifiers
  • scopus:85057092329
ISSN
2044-5385
DOI
10.1038/s41408-018-0155-7
language
English
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yes
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0325f21c-a38b-452e-8866-f0daf26f3255
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2018-12-03 14:29:53
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2019-01-06 14:18:17
@article{0325f21c-a38b-452e-8866-f0daf26f3255,
  abstract     = {<p>PURPOSE: multiple myeloma is considered an incurable hematologic cancer but a subset of patients can achieve long-term remissions and survival. The present study examines the clinical features of long-term survival as it correlates to depth of disease response. PATIENTS &amp; METHODS: this was a multi-institutional, international, retrospective analysis of high-dose melphalan-autologous stem cell transplant (HDM-ASCT) eligible MM patients included in clinical trials. Clinical variable and survival data were collected from 7291 MM patients from Czech Republic, France, Germany, Italy, Korea, Spain, the Nordic Myeloma Study Group and the United States. Kaplan-Meier curves were used to assess progression-free survival (PFS) and overall survival (OS). Relative survival (RS) and statistical cure fractions (CF) were computed for all patients with available data. RESULTS: achieving CR at 1 year was associated with superior PFS (median PFS 3.3 years vs. 2.6 years, p &lt; 0.0001) as well as OS (median OS 8.5 years vs. 6.3 years, p &lt; 0.0001). Clinical variables at diagnosis associated with 5-year survival and 10-year survival were compared with those associated with 2-year death. In multivariate analysis, age over 65 years (OR 1.87, p = 0.002), IgA Isotype (OR 1.53, p = 0.004), low albumin &lt; 3.5 g/dL (OR = 1.36, p = 0.023), elevated beta 2 microglobulin ≥ 3.5 mg/dL (OR 1.86, p &lt; 0.001), serum creatinine levels ≥ 2 mg/dL (OR 1.77, p = 0.005), hemoglobin levels &lt; 10 g/dL (OR 1.55, p = 0.003), and platelet count &lt; 150k/μL (OR 2.26, p &lt; 0.001) appeared to be negatively associated with 10-year survival. The relative survival for the cohort was ~0.9, and the statistical cure fraction was 14.3%. CONCLUSIONS: these data identify CR as an important predictor of long-term survival for HDM-ASCT eligible MM patients. They also identify clinical variables reflective of higher disease burden as poor prognostic markers for long-term survival.</p>},
  author       = {Usmani, Saad Z. and Hoering, Antje and Cavo, Michele and Miguel, Jesus San and Goldschimdt, Hartmut and Hajek, Roman and Turesson, Ingemar and Lahuerta, Juan Jose and Attal, Michel and Barlogie, Bart and Lee, Jae Hoon and Kumar, Shaji and Lenhoff, Stig and Morgan, Gareth and Rajkumar, S. Vincent and Durie, Brian G.M. and Moreau, Philippe},
  issn         = {2044-5385},
  language     = {eng},
  number       = {12},
  publisher    = {Nature Publishing Group},
  series       = {Blood Cancer Journal},
  title        = {Clinical predictors of long-term survival in newly diagnosed transplant eligible multiple myeloma - an IMWG Research Project},
  url          = {http://dx.doi.org/10.1038/s41408-018-0155-7},
  volume       = {8},
  year         = {2018},
}