Long-term prognostic significance of response in multiple myeloma after stem cell transplantation

full-text ►Long-term prognostic significance of response in multiple myeloma after stem cell transplantation: "Long-term prognostic significance of response in multiple myeloma after stem cell transplantation

1. Joaquin Martinez-Lopez1,
2. Joan Blade2,
3. María-Victoria Mateos3,
4. Carlos Grande1,
5. Adrián Alegre4,
6. José García-Laraña5,
7. Anna Sureda6,
8. Javier de la Rubia7,
9. Eulogio Conde8,
10. Rafael Martinez9,
11. Felipe de Arriba10,
12. Maria C. Viguria11,
13. Joan Besalduch12,
14. Rafael Cabrera13,
15. José D. Gonzalez-San Miguel14,
16. José Luis Guzman-Zamudio15,
17. Maria Carmen Gomez del Castillo1,
18. José Maria Moraleda16,
19. Juan C. García-Ruiz17,
20. Jesús San Miguel3,
21. Juan José Lahuerta1, and
22. for the GEM (Grupo Español de MM) and PETHEMA (Programa para el Estudio de la Terapéutica en Hemopatía Maligna) Cooperative Study Groups

+ Author Affiliations

1. 1Hospital Universitario 12 de Octubre, Madrid, Spain;
2. 2Hospital Clinic, Institut d'Investigacions Biomédiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain;
3. 3Hospital Universitario de Salamanca, Centro de Investigación del Cáncer–IBMCC (USAL-CSIC), Salamanca, Spain;
4. 4Hospital Universitario de la Princesa, Madrid, Spain;
5. 5Hospital Universitario Ramón y Cajal, Madrid, Spain;
6. 6Hospital de la Santa Creu i Sant Pau, Barcelona, Spain;
7. 7Hospital La Fe, Valencia, Spain;
8. 8Hospital Marques de Valdecilla, Santander, Spain;
9. 9Hospital Clínico San Carlos, Madrid, Spain;
10. 10Hospital Morales Messeguer, Murcia, Spain;
11. 11Hospital de Navarra, Navarra, Spain;
12. 12 Hospital Son Dureta, Haematology Department, Palma de Mallorca, Spain;
13. 13Clinica Puerta de Hierro, Madrid, Spain;
14. 14Hospital Insular de Las Palmas, Las Palmas, Spain;
15. 15Hospital General Jerez de la Frontera, Cádiz, Spain;
16. 16Hospital Virgen de la Arrixaca, University of Murcia, Murcia, Spain; and
17. 17Hospital de Cruces, Bilbao, Spain

1. Presented in abstract form at 51st Annual Meeting of the American Society of Hematology, New Orleans, LA, December 2009.


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Abstract

For establishing the true effect of different response categories in patients with multiple myeloma (MM) treated with autologous stem cell transplantation, we evaluated, after a median follow-up of 153 months, 344 patients with MM who received a transplant between 1989 and 1998. Overall survival (OS) at 12 years was 35% in complete response (CR) patients, 22% in near complete response (nCR), 16% in very good partial response (VGPR), and 16% in partial response (PR) groups. Significant differences in OS and progression-free survival were found between CR and nCR groups (P = .01 and P = .002, respectively), between CR and VGPR groups (P = .0001 and P = .003), or between CR and PR groups (P = .003 and P = < 10−5); no differences were observed between the nCR and VGPR groups (P = .2 and P = .9) or between these groups and the PR group (P = .1 and P = .8). A landmark study found a plateau phase in OS after 11 years; 35% patients in the CR group and 11% in the nCR+VGPR+PR group are alive at 17 years; 2 cases had relapsed in the nCR+VGPR+PR group. In conclusion, MM achieving CR after autologous stem cell transplantation is a central prognostic factor. The relapse rate is low in patients with > 11 years of follow-up, possibly signifying a cure for patients in CR.

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