Last Saturday the Myeloma Beacon ran an opinion piece by one of the best and brightest multiple myeloma specialists, Mayo Clinic’s Dr. Vincent Rajkumar, titled, Should Myeloma Patients Panic If They Do Not Achieve A Complete Response?
In it, Dr. Rajkumar stressed that myeloma patients should not despair if they are unable to achieve a complete response (remission) following months or years of treatment. Just as important, the good doctor also noted that:
It is one thing to say that achievement of complete response is a prognostic marker, but quite another to take that to mean we need to treat patients until they reach complete response. It is also incorrect from a statistical standpoint to compare the outcomes of patients in complete response versus those not in complete response, since all early deaths that occur before patients have time to respond will be included in the “no complete response” group. Even landmark analysis methods, which attempt to correct this problem, may not fully rectify the biases that occur. Therefore, most study designs assessing the importance of complete response are fundamentally flawed.
He goes on to write:
For most patients with myeloma, not achieving a complete response should not be construed as failure. Part of the reason for this paradox is that the term complete response as defined in myeloma carries nowhere near the same implication as a complete response in large cell lymphoma or childhood leukemia. Part of it, more importantly, is because we are dealing with a heterogeneous condition in terms of chromosomal abnormalities.
To argue against complete response is not an easy task. My goal is not to minimize the reassurance that patients in complete response get with that knowledge. Achieving a complete response, especially a sustained one, is indeed a good prognostic marker. But that does not mean that patients who fail to achieve that benchmark should panic; neither does it mean that they need to change course and try a different treatment regimen.
In fact, a large subset of patients who do not achieve complete response will live just as long as patients who do.
Dr. Rajkumar realizes his methods are conservative, and that his approach is like a salmon swimming upstream these days; it’s all about doing everything possible to achieve CR and to do everything possible to destroy any residual disease.
But his incremental approach tends to be less toxic and easier for patients to handle, yet still nets impressive overall survival results without “nuking” them in the process.
You can read his long and thoughtful column by copying and pasting this into your browser:
Feel good and keep smiling! Pat