[goldmine848]

Study on functional curability in multiple myeloma

by goldmine848 on Thu Dec 20, 2018 9:33 pm

This study examines long-term survival and looks at whether multiple myeloma can be functionally cured in some myeloma patient subgroups. It is thought-provoking. It has a narrow focus and so is not applicable to a large portion of the myeloma patient population, but it provides some hope for many of us.

Usmani, SZ, et al, "Clinical predictors of long-term survival in newly diagnosed transplant eligible multiple myeloma – an IMWG Research Project," Blood Cancer Journal, Nov 23, 2018 (full text of article)

Abstract:

Purpose: Multiple myeloma is considered an incurable hematologic cancer but a subset of patients can achieve long-term remissions and survival. The present study examines the clinical features of long-term survival as it correlates to depth of disease response.

Patients & Methods: This was a multi-institutional, international, retrospective analysis of high-dose melphalan-autologous stem cell transplant (HDM-ASCT) eligible multiple myeloma patients included in clinical trials. Clinical variable and survival data were collected from 7291 multiple myeloma patients from Czech Republic, France, Germany, Italy, Korea, Spain, the Nordic Myeloma Study Group and the United States. Kaplan–Meier curves were used to assess progression-free survival (PFS) and overall survival (OS). Relative survival (RS) and statistical cure fractions (CF) were computed for all patients with available data.

Results: Achieving CR at 1 year was associated with superior PFS (median PFS 3.3 years vs. 2.6 years, p < 0.0001) as well as OS (median OS 8.5 years vs. 6.3 years, p < 0.0001). Clinical variables at diagnosis associated with 5-year survival and 10-year survival were compared with those associated with 2-year death. In multivariate analysis, age over 65 years (OR 1.87, p = 0.002), IgA Isotype (OR 1.53, p = 0.004), low albumin < 3.5 g/dL (OR = 1.36, p = 0.023), elevated beta 2 microglobulin ≥ 3.5 mg/dL (OR 1.86, p < 0.001), serum creatinine levels ≥ 2 mg/dL (OR 1.77, p = 0.005), hemoglobin levels < 10 g/dL (OR 1.55, p = 0.003), and platelet count < 150k/μL (OR 2.26, p < 0.001) appeared to be negatively associated with 10-year survival. The relative survival for the cohort was ~0.9, and the statistical cure fraction was 14.3%.

Conclusions: These data identify CR as an important predictor of long-term survival for HDM-ASCT eligible multiple myeloma patients. They also identify clinical variables reflective of higher disease burden as poor prognostic markers for long-term survival.

[Mike F]

Re: Study on functional curability in multiple myeloma

by Mike F on Fri Dec 21, 2018 7:09 pm

Thanks for posting that, Andrew - very interesting study. I found the following to be particularly interesting:

"In the present analysis, we see a cure fraction of 14.37% for the study population which is impressive; yet we must bear in mind that this is a select, HDM-ASCT eligible multiple myeloma patient population on clinical trials. It is important to emphasize that, in order to have a mature long-term follow-up, most patients included in the present study were treated with conventional agents before the era of novel drugs."

14.7% is better than I would have expected for a functional cure rate, given the fact that these people were treated before the days of RVD induction and such. That's a pretty hopeful bit of news for those who have been diagnosed more recently. Certainly, my assumption has always been that my disease has zero chance of a functional cure without either an allo transplant, some new therapy, or a miracle. Unless I'm reading this wrong (and someone please jump in if that's the case) then one might actually have some chance of living to a ripe old age after being diagnosed with myeloma.