Prognostic factor analyses of myeloma survival with intergroup trial S9321 (INT 0141): Examining whether different variables govern different time segments of survival

Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, 4301 West Markham #816, Little Rock, AR 72205, USA.
Annals of Hematology (Impact Factor: 2.63). 12/2010; 90(4):423-8. DOI: 10.1007/s00277-010-1130-y
Source: PubMed


Multiple myeloma (MM) survival plots usually display steeper initial and shallower subsequent slopes reflecting differences in disease biology and likely prognostic factors (PF). S9321 trial was selected to determine PF operative at baseline and subsequent 3, 4, 5, and 7-year landmarks (LM-0, LM-3, LM-4, LM-5, and LM-7). With a median follow-up of 8.2 years, survival was similar in transplant and standard therapy arms, justifying data pooling. Median survival for 775 eligible patients is 48 months. According to proportional hazards models, seven of 12 investigated baseline variables retained independent significance for LM-0, of which only two (beta-2-microglobulin and age) extended out to LM-7; the remaining five comprised features of disease aggressiveness (lactate dehydrogenase, calcium, platelet count, C-reactive protein) and host co-morbidity (performance status). Our observations of LM dependency of PF can be exploited toward advancing myeloma therapy by stratifying patients according to whether early or late portions of the survival history are being targeted.

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    • "conventional karyotyping, fluorescent in situ hybridisation, and/or gene expression profiling (Fermand et al, 2005; Greipp et al, 2005; Rajkumar and Kyle, 2005; Kyle and Rajkumar, 2009; Chang et al, 2010; Hose et al, 2011; Munshi et al, 2011). High-dose chemotherapy followed by autologous stem cell transplantation is a cornerstone within the current standard treatment for symptomatic myeloma patients fit for intensive treatment (Child et al, 2003; Terpos et al, 2003; Barlogie et al, 2004; Blade et al, 2005; Fermand et al, 2005; Rajkumar and Kyle, 2005; Wang et al, 2007; Palumbo et al, 2009; Rajkumar, 2009; Lonial, 2010; Cavo et al, 2011). In fact, a number of studies have established the benefit of autologous transplantation for myeloma patients in prolonging the time to progression and, at least in some of them, also in improving overall survival (Attal et al, 1996; Child et al, 2003; Barlogie et al, 2004; Blade et al, 2005; Cavo et al, 2011). "
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