BACKGROUND AND OBJECTIVES: From 1994 to 1997 we conducted a population-based, prospective study on intensive therapy in newly diagnosed symptomatic myeloma patients younger than 60 years, comparing their survival to that of a conventionally treated historic population. Long-term results are presented, including the impact of the degree of response on survival and relapse pattern after transplantation. DESIGN AND METHODS: The prospective population was formed of 397 patients and the historic population of 313 patients. Both populations were calculated to comprise more than 75% of the expected number of new cases. RESULTS: After a median follow-up of 7 years survival was longer in the prospective population than in the historic one (median 60 versus 39 months; p=0.0002). When comparing only patients eligible for intensive therapy the median survival was 63 versus 44 months (p<0.0001). Attaining a complete response was associated with prolonged event-free survival but not overall survival. The pattern of relapse after transplantation was heterogeneous but could be divided into four major groups; insidious, classical, plasmacytoma form and transformed disease. The median survival after relapse was 29 months. The relapse pattern and time to relapse predicted outcome. Patients relapsing with an insidious or classical form of disease with skeletal events only, or after a long lasting first response were likely to respond well to conventional salvage therapy. In contrast, relapse with multiple symptoms, transformed disease or a short duration of first response implied bad prognosis. INTERPRETATION AND CONCLUSIONS: The relapse pattern after autologous transplantation is heterogeneous and response to salvage therapy is variable. The degree of response and event-free survival after transplantation are not reliable surrogate markers for survival.
BACKGROUND AND OBJECTIVES: From 1994 to 1997 we conducted a population-based, prospective study on intensive therapy in newly diagnosed symptomatic myelomapatients younger than 60 years, comparing their survival to that of a conventionally treated historic population. Long-term results are presented, including the impact of the degree of response on survival and relapse pattern after transplantation. DESIGN AND METHODS: The prospective population was formed of 397 patients and the historic population of 313 patients. Both populations were calculated to comprise more than 75% of the expected number of new cases. RESULTS: After a median follow-up of 7 years survival was longer in the prospective population than in the historic one (median 60 versus 39 months; p=0.0002). When comparing only patients eligible for intensive therapy the median survival was 63 versus 44 months (p<0.0001). Attaining a complete response was associated with prolonged event-free survival but not overall survival. The pattern of relapse after transplantation was heterogeneous but could be divided into four major groups; insidious, classical, plasmacytoma form and transformed disease. The median survival after relapse was 29 months. The relapse pattern and time to relapse predicted outcome. Patients relapsing with an insidious or classical form of disease with skeletal events only, or after a long lasting first response were likely to respond well to conventional salvage therapy. In contrast, relapse with multiple symptoms, transformed disease or a short duration of first response implied bad prognosis. INTERPRETATION AND CONCLUSIONS: The relapse pattern after autologous transplantation is heterogeneous and response to salvage therapy is variable. The degree of response and event-free survival after transplantation are not reliable surrogate markers for survival.
Authors: Carolyn Miller Reilly; Deborah Watkins Bruner; Sandra A Mitchell; Lori M Minasian; Ethan Basch; Amylou C Dueck; David Cella; Bryce B Reeve Journal: Support Care Cancer Date: 2013-01-12 Impact factor: 3.603
Authors: Ji Hyun Lee; Yong Park; Ka-Won Kang; Je-Jung Lee; Ho Sup Lee; Hyeon-Seok Eom; Young Rok Do; Jin Seok Kim; Sung-Soo Yoon; Dong-Yeop Shin; Youngil Koh; Ki-Hyun Kim; Won Sik Lee; Jae-Cheol Jo; Yoo Jin Lee; Ji Yun Lee; Dae Sik Kim; Hyeok Shim; Myung Hee Chang; Sung-Hyun Kim; Chang-Ki Min Journal: Ann Hematol Date: 2021-01-15 Impact factor: 3.673
Authors: Sergio Giralt; Laurent Garderet; Brian Durie; Gordon Cook; Gosta Gahrton; Benedetto Bruno; Paremesweran Hari; Henk Lokhorst; Phillip McCarthy; Amrita Krishnan; Pieter Sonneveld; Harmut Goldschmidt; Sundar Jagannath; Bart Barlogie; Maria Mateos; Peter Gimsing; Orhan Sezer; Joseph Mikhael; Jin Lu; Meletios Dimopoulos; Amitabha Mazumder; Antonio Palumbo; Rafat Abonour; Kenneth Anderson; Michel Attal; Joan Blade; Jenny Bird; Michele Cavo; Raymond Comenzo; Javier de la Rubia; Hermann Einsele; Ramon Garcia-Sanz; Jens Hillengass; Sarah Holstein; Hans Erik Johnsen; Douglas Joshua; Guenther Koehne; Shaji Kumar; Robert Kyle; Xavier Leleu; Sagar Lonial; Heinz Ludwig; Hareth Nahi; Anil Nooka; Robert Orlowski; Vincent Rajkumar; Anthony Reiman; Paul Richardson; Eloisa Riva; Jesus San Miguel; Ingemar Turreson; Saad Usmani; David Vesole; William Bensinger; Muzaffer Qazilbash; Yvonne Efebera; Mohamed Mohty; Christina Gasparreto; James Gajewski; Charles F LeMaistre; Chris Bredeson; Phillipe Moreau; Marcelo Pasquini; Nicolaus Kroeger; Edward Stadtmauer Journal: Biol Blood Marrow Transplant Date: 2015-09-30 Impact factor: 5.742
Authors: D Zamarin; S Giralt; H Landau; N Lendvai; A Lesokhin; D Chung; G Koehne; D Chimento; S M Devlin; E Riedel; M Bhutani; D Babu; H Hassoun Journal: Bone Marrow Transplant Date: 2012-08-13 Impact factor: 5.483
Authors: C Fernández de Larrea; R Jiménez; L Rosiñol; E Giné; N Tovar; M T Cibeira; F Fernández-Avilés; C Martínez; M Rovira; J Bladé Journal: Bone Marrow Transplant Date: 2013-09-30 Impact factor: 5.483
Authors: Sk Kumar; D Dingli; A Dispenzieri; Mq Lacy; S R Hayman; Fk Buadi; Sv Rajkumar; Mr Litzow; Ma Gertz Journal: Bone Marrow Transplant Date: 2008-06-16 Impact factor: 5.483