Impact of complete response on progression-free survival and overall survival in newly diagnosed myeloma patients treated with autologous stem cell transplantation or conventional chemotherapy: results of a pooled analysis of 5 phase III trials

A. Spencer, G. Gaidano, S. Zweegman, S. Grandi, R. van der Holt, T. Caravita, C. Cerrato, F. Rossini, C. Musolino, P. Sonneveld, M. Boccadoro, R. Hajek, F. Di Raimondo, V. Magarotto, S. Croockewit, A. Palumbo, M. Offidani, A. Larocca, R. Ria, I.D. VincelliA. Bosi, G. Rossi, R. Mina, M. Ruggeri, M.T. Petrucci, P. Lud k

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Abstract

Introduction: Several studies correlated the achievement of a complete response (CR) in Newly diagnosed Multiple Myeloma (NDMM) patients to long-term survival, both in young and elderly patients. We investigated the impact of age and front-line treatment on survival among CR patients. Patients and Methods: NDMM patients enrolled in 5 phase III trials were analysed. Three trials included autologous stem cell transplantation (ASCT) eligible patients: RV-MM-209 (MPR vs Mel200, followed by lenalidomide vs no maintenance), RV-MM-EMN-441 (CRD vs Mel200 followed by lenalidomide vs lenalidomide-prednisone maintenance) and HOVON65/GMMG-HD4 (PAD vs VAD, followed by bortezomib or thalidomide maintenance). Two studies enrolled elderly patients: GIMEMA-MM0305 (VMPT-VT vs VMP) and EMN01 (MPR vs CPR vs Rd, followed by lenalidomide vs lenalidomideprednisone maintenance). The primary objective was the evaluation of the impact of CR on overall survival (OS) and progression-free survival (PFS) and the relationship with age [young (ASCT-eligible) vs elderly (ASCT-ineligible) patients] and type of treatment [ASCT vs conventional chemotherapy (CC)]. Univariate analyses of OS and PFS were performed. Response was treated as time-dependent variable in a landmark analysis (at 4 months). Results: 2792 NDMM patients were retrospectively analysed; best response was available in 2646 patients. After a median follow-up of 47 months, median OS was 86 months in CR patients and 80 months in VGPR/PR patients (HR0.6, p75 years. Conclusions: CRconfirmed to be a long-term outcome predictor of OS and PFS in both young and elderly patients. ASCT induced a more profound CR with longer remission than CC. In the very elderly (>75 years) the importance ofCR should be balanced against the safety profile.
Original languageEnglish
Pages (from-to)e53-e54
JournalClinical Lymphoma Myeloma and Leukemia
Volume15
DOIs
Publication statusPublished - 27 Sep 2015

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