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

Mauricio Pineda-Roman, Vanessa Bolejack, Varant Arzoumanian, Elias Anaissie, Frits Van Rhee, Maurizio Zangari, Ron Walker, Klaus Hollmig, John D. Shaughnessy, Joshua Epstein, Somashekar Krishna, John Crowley, Bart Barlogie

Research output: Contribution to journalArticlepeer-review

59 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)393-399
Number of pages7
JournalBritish Journal of Haematology
Volume136
Issue number3
DOIs
StatePublished - Feb 2007

Keywords

  • Complete response
  • Monoclonal gammopathy of undetermined significance
  • Myeloma
  • Smouldering myeloma
  • Survival

ASJC Scopus subject areas

  • Hematology

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