High Risk Multiple Myeloma - Finally There Is a Hopeful Prognosis!!!
BY GARY PETERSEN
A recent post on Pat Killingworth's site discussed Dr. Sagar Lonial's views (of Emory University) on stem cell transplant. However, the item that caught my eye was a comment by one his readers which quoted some quite remarkable high risk multiple myeloma survival rates. He mentioned a December 2013 article in Leukemia which stated the following:
Consolidation and maintenance therapy with lenalidomide, bortezomib and dexamethasone (RVD) in high-risk myeloma patients
A K Nooka, J L Kaufman, S Muppidi, A Langston, L T Heffner, C Gleason, D Casbourne, D Saxe, L H Boise and S Lonial
Prior studies have shown that myeloma patients exhibiting either genetically defined high-risk disease or plasma cell leukemia have a poor outcome with a median overall survival (OS) of 3 years. Results of IFM 2005-01 and 02 suggest that relatively limited bortezomib-containing induction regimens did not produce a major survival benefit among these patients. However, results of recent studies suggest that combination therapy may benefit these patients when given early and again later in the treatment. We evaluated a combination maintenance consolidation regimen (RVD) following autologous stem cell transplant (ASCT) for high-risk patients to evaluate the impact of this approach on outcome. Following initiation of RVD maintenance, 51% of patients achieved stringent complete response (sCR), with 96% achieving at least VGPR as best response. Median progression free survival (PFS) for all patients is 32 months with a 3-year OS of 93%. The regimen was well tolerated with no grade 34 neuropathy. Early ASCT followed by RVD maintenance is a promising strategy for high-risk myeloma patients and delivered excellent response rates, and promising PFS and OS.
Why this has not been a headline story for myeloma everywhere is beyond me and I am a little embarrassed that it has taken me this long to become aware of this data. The National Cancer Institutes lists the average 3 year relative survival of all patients (high and low risk) at 60%, and the 3 year relative survival for the Emory trial is 98.8%. This is a truly remarkable performance, where the subjects in the trial have a 3 year life expectancy nearly equal to the general population at age 70. Thank You Dr. Lonial for such remarkable work.