Suzierose jumped right in the deep end with her first topic. Overall survival (OS) is always a touchy subject among readers. We all want to hear good news. The problem with OS: One half get good news and the other half don’t.
And sometimes even being on the good sign of the medial line doesn’t necessarily mean good news, especially when dealing with a cancer like multiple myeloma. Check-out what she has to say and let’s meet on the other side:
MYELOMA CINDERELLA: WHAT KEY FACTORS HAVE BEEN IDENTIFIED FOR OVERALL SURVIVAL?
Pat did a column where he extrapolated the numbers to predict how much more time the new agents might extend MM patients lives. It made me think about what information is out there right now from long term trials in terms of predicting survival.
Avet Loiseau did a presentation for fellows as part of the Journal of Clinical Oncology journal club in November 2012 were he discussed the results of the subanalysis of patients treated in IFM-99-02 and IFM 99-04 in an attempt to identify variables that predict overall survival (OS) for myeloma patients.
There is substantial heterogeneity in MM patient outcomes, due to multiple subtypes of the disease. This makes it difficult to identify parameters associated with OS as it will require longer follow-up of the patients. Yet, poor outcomes have been shown in multiple trials for patients with chromosomal changes t(4;14) and del (17p). In an attempt, to identify factors associated with increased survival a subanalysis of 2 very large trials was done.
The key factors identified in MM patients in patients with 8 year survival was defined by:
no t(4:14), del (17p) or 1q gain chromosomal changes.
low B-2 microglobulin level (< 5.5mg/dl) at baseline
younger than 55 years of age
NDMM patients should be evaluated for t(4:14) and del (17p) as the initial course of treatment, since treatment of a MM patient can be very different based on these variables. Each patient should also know what percent of their plasma cells have the mutation. Deletion (17p) is positive if present in 60% of the plasma cells and Gain of 1q is positive if present in 30% of plasma cells, as a negative prognostic factor.
The percent of patients in the subanalysis who had both abnormalities was
85% for del(13) and t(4;14)
86% for del (17p)
57% 1q gain and t(4:14)
30% 1q gain and absence of t(4:14)
No association was shown between 17p deletion and 1q gain nor between 17p and t(4:14).
In summary, based on the long-term analysis of these 2 large trials, your chances of surviving 8 years is 75% if you are under 55, have a B2 microglobulin of less than 5.5mg/dl, no anemia and do not have deletion 17p, gain 1q or translocation (4;14.)
The therapy in the trials were:
- Tandem autologous stem cell transplantation (ASCT)
- Induction with 3 or 4 courses of vincristine/doxorubicin/dexamethasone (VAD)
- 2 courses high-dose melphalan with ASCT
- IFM 99-02
- Thalidomide maintenance in one arm
- OS not prolonged
- IFM 99-04
- Second conditioning regimen: melphalan/dexamethasone
- With or without B-E8 (mouse anti–IL-6 monoclonal antibody)
- No maintenance therapy
Some of us are realists. Others simply don’t want to know. Regardless, data like this helps to prove what our doctors have been telling us for the last five years is true: Myeloma patients are living longer these days–much longer.
I do have a few questions for suzierose. Does this mean low risk patients that only received the therapies described above are really living 8 years? Without the help of Velcade or Revlimid? Either way, this puts a pretty positive spin on things if patients using such basic therapy can live more than twice as long as I was told I would live in 2007.
Reads like pretty good news for me. Easy for me to say; I’m in the low risk group. Please, please remember that OS numbers are improving even for high risk patients. And a patient’s odds go up if they respond well to treatment and can reach CR, regardless of genetic prognostication.
Feel good and keep smiling! Pat