The role of complete response in multiple myeloma
Centre René Gauducheau, Bd Jacques Monod 44850, St Herblain, France. Blood
(Impact Factor: 10.45).
08/2009; 114(15):3139-46. DOI: 10.1182/blood-2009-03-201053
In multiple myeloma (MM), the impact of complete response (CR) could be shown only after introduction of high-dose therapy plus autologous stem cell transplantation (ASCT). In the context of ASCT, achieving CR (negative immunofixation and normal bone marrow) or at least very good partial response is associated with longer progression-free survival and in most studies longer survival. With novel agents, high CR rates are achieved and this prognostic impact of CR is being shown as well, both in relapsed and in newly diagnosed MM. However the benefit of CR achievement depends on the type of treatment and is not identical for all patients. In elderly patients, treatments inducing more CR may be more toxic. Although CR achievement is necessary in patients with poor-risk disease, it might not be as critical for long survival in more indolent MM. CR achievement is not the only objective of treatment because it is possible to further improve the depth of response and the outcome by continuing treatment after CR achievement. Finally, there are several levels of CR and in the future it will be necessary to confirm the prognostic impact of immunophenotypic or molecular CR or of CR defined by imaging procedures.
Available from: europepmc.org
- "Whether single or double ASCT is better remains controversial [25-29]. Considering that achieving a deeper response is associated with a longer OS [30-32], tandem ASCT should be suggested in patients who fail to achieve at least a very good partial response (VGPR) after the first ASCT [25,26,28,32,33]. "
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ABSTRACT: Many advances in the treatment of multiple myeloma have been made due to the use of transplantation and the introduction of novel agents including thalidomide, lenalidomide, and bortezomib. The first step is recognizing the symptoms and starting prompt treatment. Different strategies should be selected for young and elderly subjects. Young patients are commonly eligible for transplantation, which is now considered the standard approach for this setting, and various inductions therapies containing novel agents are available before transplantation. Elderly patients are usually not eligible for transplantation, and gentler approaches with new drugs combinations are used for their treatment.
The Korean Journal of Internal Medicine 05/2013; 28(3):263-73. DOI:10.3904/kjim.2013.28.3.263 · 1.43 Impact Factor
Available from: link.springer.com
- "Regarding the impact of ASCT in response, there was an increase in CR rate (44.7%) as compared to the end of induction, and this reflected in an advantage of 27 vs 7 months in PFS as compared to those who achieved only PR, respectively. However, this relationship is not consensual, particularly in regard to OS as results are more controversial amongst several studies [32-36]. One may question the definition of CR in a pathology characterized by a quasi-inevitable relapse ; one should probably speak of a good response (CR + VGPR), incomplete response (PR) or no response groups as major determinant conditioning outcome. "
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Multiple Myeloma (MM) is the commonest indication for autologous stem cell transplantation (ASCT).
We retrospectively analysed data from 85 patients with MM submitted to ASCT in our centre from 2000 to 2010: 132 ASCT were realized, 80 of them as tandem.
After induction, 17.6% were in complete remission (CR), 41.2% in very good partial remission (VGPR) and 41.2% in partial remission (PR). After transplant 44.7% were in CR, 15.3% in VGPR and 40% in PR. With 22 months (range – 3 to 117 months) of median follow-up, median overall survival (OS) was 43 months and progression-free survival (PFS) 22 months. At 5 years, OS was 45.3% (36.7-53.9%, 95%) and PFS 24.5% (18-31%, 95%). Patients with CR after ASCT had significantly longer PFS as compared to patients with PR (27 vs 7 months; p = 0.034) but not when compared to patients with VGPR (27 vs 19 months, p = 0.485). The tandem approach represented an advantage in OS and PFS when compared to only one ASCT (31 vs 19 months - p = 0.018, and 40 vs 31 - p = 0.04, respectively).
Our results highlight the impact of response to transplant in patients PFS and tandem modality showed to carry better PFS and OS then the single transplant.
11/2012; 1(1):35. DOI:10.1186/2162-3619-1-35
Available from: Andrew R Belch
- "Others have shown that patients receiving high dose cytoreduction with auto- or allo-graft rescue are more likely to achieve molecular complete remissions and a subset of these patients have improved progression-free survival
[29,30]. It appears that the benefits of complete remissions may occur mainly in the context of intensive therapy and stem cell rescue
[11,21,31,32]. Consistent with these observations, the loss of correlation between pre-treatment VDJ% and outcome, compared to the non-transplant group, may further highlight the efficacy of high dose therapy followed by auto- or allo- stem cell transplant. "
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In multiple myeloma (MM), the immunoglobulin heavy chain VDJ gene rearrangement is a unique clonotypic signature that identifies all members of the myeloma clone independent of morphology or phenotype. Each clonotypic MM cell has only one genomic copy of the rearranged IgH VDJ.
Pre-treatment bone marrow aspirates from myeloma patients at diagnosis or in relapse were evaluated for the number of clonotypic cells using real time quantitative PCR (RPCR). RPCR measured the level of clonal cells, termed VDJ%, in 139 diagnosis and relapse BM aspirates from MM patients.
Patients with a VDJ% below the median had a significantly longer event free survival (EFS) then those with a VDJ% higher than the median (p=0.0077, HR=0.57). Further, although the VDJ% from non-transplant patients predicted EFS (p=0.0093), VDJ% failed to predict outcome after autologous stem cell transplant (p=0.53).
Our results suggest that for non-transplant patients, the tumor burden before treatment, perhaps reflecting cancer stem cell progeny/output, is an indirect measure that may indicate the number of MM cancer stem cells and hence event free survival.
Molecular Cancer 10/2012; 11(1):78. DOI:10.1186/1476-4598-11-78 · 4.26 Impact Factor
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