Teruhito Takakuwa1,2, Kensuke Ohta1,3, Eiji Nakatani4, Tomoki Ito5, Hitomi Kaneko6, Shin-Ichi Fuchida7, Yuji Shimura8, Hideo Yagi9, Hirohiko Shibayama10, Junya Kanda11, Hitoji Uchiyama12, Satoru Kosugi13, Hirokazu Tanaka14, Eri Kawata15, Nobuhiko Uoshima15, Jun Ishikawa16, Masaru Shibano17, Takahiro Karasuno18, Maki Shindo11, Yoshifumi Shimizu19, Kazunori Imada6, Yuzuru Kanakura10, Junya Kuroda8, Masayuki Hino2, Shosaku Nomura5, Akifumi Takaori-Kondo11, Chihiro Shimazaki7, Itaru Matsumura14. 1. Department of Hematology, Osaka Saiseikai Nakatsu Hospital. 2. Department of Hematology, Osaka City University Graduate School of Medicine. 3. Hematology Ohta Clinic, Shinsaibashi. 4. Division of Statistical Analysis, Research Support Center, Shizuoka General Hospital. 5. Division of hematology, First Department of Internal Medicine, Kansai Medical University Medical Center. 6. Department of Hematology, Japanese Red Cross Osaka Hospital. 7. Department of Hematology, Japan Community Health care Organization Kyoto Kuramaguchi Medical Center. 8. Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine. 9. Department of Hematology and Oncology, Nara Prefecture General Medical Center. 10. Department of Hematology and Oncology, Osaka University Graduate School of Medicine. 11. Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University. 12. Department of Hematology, Japanese Red Cross Kyoto Daiichi Hospital. 13. Department of Internal Medicine (Hematology), Toyonaka Municipal Hospital. 14. Department of Hematology and Rheumatology, Kindai University Faculty of Medicine. 15. Department of Hematology, Japanese Red Cross Kyoto Daini Hospital. 16. Department of Hematology, Osaka International Cancer Institute. 17. Department of Hematology, Sakai City Medical Center. 18. Department of Hematology, Rinku General Medical Center. 19. Department of Hematology, Takarazuka Municipal Hospital.
Abstract
OBJECTIVES: The plateau phase emerging during the treatment of multiple myeloma (MM) is known to last steadily for a certain period, even without treatment. Therefore, the treatment started at plateau phase is expected to be associated with a better outcome. In this study, this hypothesis was evaluated retrospectively for previously treated MM patients in Kansai Myeloma Forum database who received lenalidomide (LEN) with or without dexamethasone for the first time. METHOD: Disease stability index (DSI) was defined as: (maximum - minimum values of M-protein during the 90 days before the start of LEN) divided by M-protein values at the start of LEN. The patients were classified to 3 groups: stable (S), DSI ≤0.25; increasing (I), DSI >0.25 with increasing M-protein; decreasing (D), DSI>0.25 with decreasing M-protein. OUTCOMES: In univariate analysis of 352 patients, DSI, age, non-IgG type, and low albumin were statistically significant prognostic factor for both progression-free survival and overall survival. Multivariate analysis revealed that the median overall survival of the group I was significantly worse compared with that of group S or D (p=0.015). CONCLUSION: DSI is an independent prognostic factor for treatment with LEN for previously treated MM. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
OBJECTIVES: The plateau phase emerging during the treatment of multiple myeloma (MM) is known to last steadily for a certain period, even without treatment. Therefore, the treatment started at plateau phase is expected to be associated with a better outcome. In this study, this hypothesis was evaluated retrospectively for previously treated MM patients in Kansai Myeloma Forum database who received lenalidomide (LEN) with or without dexamethasone for the first time. METHOD: Disease stability index (DSI) was defined as: (maximum - minimum values of M-protein during the 90 days before the start of LEN) divided by M-protein values at the start of LEN. The patients were classified to 3 groups: stable (S), DSI ≤0.25; increasing (I), DSI >0.25 with increasing M-protein; decreasing (D), DSI>0.25 with decreasing M-protein. OUTCOMES: In univariate analysis of 352 patients, DSI, age, non-IgG type, and low albumin were statistically significant prognostic factor for both progression-free survival and overall survival. Multivariate analysis revealed that the median overall survival of the group I was significantly worse compared with that of group S or D (p=0.015). CONCLUSION: DSI is an independent prognostic factor for treatment with LEN for previously treated MM. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.