Abstract
In this era of target therapies, novel data on the correlation between response endpoints and survival outcomes in multiple myeloma have arisen. To determine the impact of quality of response on clinical outcomes, using first-line treatment, and identify risk factors influencing progression-free survival (PFS) and overall survival (OS) among myeloma patients. Retrospective analysis on myeloma patients who were treated at the Clinic of Hematology and Clinical Immunology, University Clinical Centre, Niš, Serbia, over a four-year period. A total of 108 newly diagnosed patients who received first-line therapy consisting of conventional chemotherapy or novel agent-based regimens were included in this analysis. The quality of response to first-line therapy for the whole cohort was classified as follows: complete response (CR) in 19%; very good partial response (VGPR) in 23%; partial response (PR) in 38%; and less than PR for the remaining patients. After a median follow-up of 25.4 months, the three-year PFS and OS for the entire study population were 47% and 70%, respectively. Achievement of CR was the main factor associated with significantly prolonged PFS and OS, in comparison with patients who reached VGPR and PR. Likewise, addition of the new drugs bortezomib and thalidomide to standard chemotherapy led to considerably extended PFS and OS, compared with conventional therapy alone. This analysis demonstrated that the quality of response after application of first-line treatment using novel agent-based regimens among multiple myeloma patients was a prognostic factor for PFS and OS, which are the most clinically relevant outcomes.
Highlights
Multiple myeloma (MM) is an incurable plasma cell neoplasm exemplified by changeable survival ranging from several months to more than 15 years
Assessment on the influence of the degree of treatment response on progression-free survival (PFS) and overall survival (OS) showed that the three-year PFS and OS were significantly prolonged among patients who achieved complete response (CR), compared with those who achieved very good partial response (VGPR) or partial response (PR).[7]
Equal distribution between international staging system (ISS) stages I, II and III was recorded among patients in the CR, VGPR and PR groups; this equal distribution was seen in relation to clinical stages
Summary
Multiple myeloma (MM) is an incurable plasma cell neoplasm exemplified by changeable survival ranging from several months to more than 15 years. First-line treatment response is one of the most crucial prognostic factors related to PFS and OS among patients with newly diagnosed MM.[3] Use of a combination of thalidomide, melphalan and prednisone as first-line treatment in patients with multiple myeloma, in comparison with melphalan-prednisone, was shown to provide significant improvements, both in PFS (15.0 versus 11.0 months) and in OS (two-year OS rates were 67% versus 43%).[4] The time to progression among patients receiving bortezomib plus melphalan-prednisone was significantly longer than the time among those receiving melphalan-prednisone alone (24.0 versus 16.6 months).[5] the VISTA study confirmed longer OS (three-year OS rates were 68.5% versus 54.0%) and other clinical benefits through use of bortezomib plus melphalan-prednisone versus use of melphalan-prednisone.[6] Assessment on the influence of the degree of treatment response on PFS and OS showed that the three-year PFS and OS were significantly prolonged among patients who achieved complete response (CR), compared with those who achieved very good partial response (VGPR) or partial response (PR).[7] In this era of target therapies, novel data on the correlation between response endpoints and survival outcomes in multiple myeloma have arisen. CONCLUSIONS: This analysis demonstrated that the quality of response after application of first-line treatment using novel agent-based regimens among multiple myeloma patients was a prognostic factor for PFS and OS, which are the most clinically relevant outcomes
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Schedule a callMore From: Sao Paulo medical journal = Revista paulista de medicina
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