Complete response in myeloma extends survival without, but not with history of prior monoclonal gammopathy of undetermined significance or smouldering disease

University of Arkansas at Little Rock, Little Rock, Arkansas, United States
British Journal of Haematology (Impact Factor: 4.71). 03/2007; 136(3):393-9. DOI: 10.1111/j.1365-2141.2006.06441.x
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Complete response (CR) is still considered an important surrogate marker for outcome in multiple myeloma (MM). Long-term survival after transplantation, however, has been observed in a substantial proportion of patients who never achieved CR. The tandem transplant trial, Total Therapy 2, enrolled 668 patients, who were randomised up-front to thalidomide (THAL) or no THAL; 56 patients were identified as having had, for at least 6 months prior to initiation of therapy, monoclonal gammopathy of undetermined significance (MGUS, n = 21), smouldering MM (SMM, n = 22) or solitary plasmacytoma of bone (SPC, n = 13). The clinical characteristics and outcomes of patients with such 'evolved' MM (E-MM) and of those with 'unknown' prior history (U-MM) were compared. Fewer patients with MGUS/SMM-E-MM had anaemia or renal failure; CR was lower (22% vs. 48%) but 4-year estimates of event-free survival (54% vs. 56% with U-MM) and overall survival (65% vs. 70% with U-MM) were similar to those with SPC-E-MM or U-MM. In the latter group, achieving CR was associated with prolonged survival. In comparison with U-MM, E-MM evolved from MGUS/SMM was associated with lower CR rate without adversely affecting survival. In contrast, CR was an independent favourable feature for survival in U-MM.

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Available from: Joshua Epstein, May 22, 2015
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    • "Figure 2C depicts the different levels of response by treatment phase. Among 16 variables evaluated for association with CR, positive correlations were observed with light chain only subtype [Hazard Ratio (HR) ¼ 4AE29, P < 0AE001], IgA isotype (HR ¼ 2AE60, P < 0AE001), GEP-defined PROLIFERATION subgroup (Zhan et al, 2006) (HR ¼ 1AE76, P ¼ 0AE05), high albumin ‡ 35 g/l (HR ¼ 1AE65, P ¼ 0AE019) and absence of documented prior history of monoclonal gammopathy of undetermined significance (MGUS) or smoldering MM (HR ¼ 7AE84, P ¼ 0AE040) (Pineda-Roman et al, 2007). "
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