Interested in long-term success/failure rates of stem cell transplants? Check-out this Abstract from this month’s Blood, the journal of the American Society of Hematology:
Long-term prognostic significance of response in multiple myeloma after stem cell transplantation
Joaquin Martinez-Lopez1,*, Joan Blade2, María-Victoria Mateos3, Carlos Grande1, Adrián Alegre4, José García-Laraña5, Anna Sureda6, Javier de la Rubia7, Eulogio Conde8, Rafael Martinez9, Felipe de Arriba10, Maria C. Viguria11, Joan Besalduch12, Rafael Cabrera13, José D. Gonzalez-San Miguel14, José Luis Guzman-Zamudio15, Maria Carmen Gomez del Castillo1, José Maria Moraleda16, Juan C. García-Ruiz17, Jesús San Miguel3, and Juan José Lahuerta1
+ Author Affiliations:
1 Hospital Universitario 12 de Octubre, Madrid, Spain; 2 Hospital Clinic, Institut d’Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain; 3 Hospital Universitario de Salamanca, Centro de Investigacion del Cancer-IBMCC (USAL-CSIC), Salamanca, Spain; 4 Hospital Universitario de la Princesa, Madrid, Spain; 5 Hospital Universitario Ramon y Cajal, Madrid, Spain; 6 Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; 7 Hospital La Fe, Valencia, Spain; 8 Hospital Marques de Valdecilla, Santander, Spain; 9 Hospital Clinico San Carlos, Madrid, Spain; 10 Hospital Morales Messeguer, Murcia, Spain; 11 Hospital de Navarra, Navarra, Spain; 12 Hospital Son Dureta, Hematology Department, Palma de Mallorca, Spain; 13 Clinica Puerta de Hierro, Madrid, Spain; 14 Hospital Insular de Las Palmas, Las Palmas, Spain; 15 Hospital General Jerez de la Frontera, Cadiz, Spain; 16 Hospital Virgen de la Arrixaca, University of Murcia, Murcia, Spain; 17 Hospital de Cruces, Bilbao, Spain
* Corresponding author; email: firstname.lastname@example.org
For establishing the true impact of different response categories in multiple myeloma patients treated with autologous stem cell transplantation we evaluated, after a median follow-up of 153 months, 344 MM patients transplanted between 1989 and 1998. OS at 12 years were 35% in Complete Response (CR) patients, 22% in Near Complete Response (nCR), 16% in Very Good Partial Response (VGPR), and 16% in Partial Response (PR) groups. Significant differences in OS and PFS were found between CR and nCR groups (P=.01 and .002, respectively), between CR and VGPR (P= .0001 and .003) or between CR and PR (P= .003 and <10-5); no differences were observed between the nCR and VGPR groups (P= .2 and .9) or between these groups and the PR group (P= .1 and .8). A landmark study found a plateau phase in OS after 11 years; 35% patients in the CR group and 11% in the nCR+VGPR+PR group are alive at 17 years; two cases had relapsed in the nCR+VGPR+PR group.
Conclusion: in MM achieving CR after autologous stem cell transplantation is a central prognostic factor. The relapse rate is very low in patients with >11 years of follow-up, possibly signifying a cure for patients in CR.
Submitted January 27, 2011.
Accepted March 31, 2011.
Copyright © 2005 American Society of Hematology
Complete study results are only available to ASH members. But the abstract certainly gives us a lot to work with. The bottom line: Achieving CR after transplant greatly increases the median life expectancy of a patient.
But I have some questions. What if CR is achieved by using novel therapy agents without transplantation? What happens then? Does using newer, more efficient induction therapy agents like thalidomide, Revlimid or Velcade, change the stats?
Think about it: These are impressive results, considering the time period in question. Pre-1999? Wow! 35% of the CR group was still alive after 11 years? I’m surprised the numbers are so high…
Bet you could come up with a list of questions, too. I will follow-up on these results as more information becomes available.
Feel good and keep smiling! Pat