Researchers from the M. D. Anderson Cancer Center have reported that achieving a complete remission (CR) was the dominant prognostic factor for long survival of patients with multiple myeloma (MM). The details of this large retrospective review were published in the March 2010 issue of Bone Marrow Transplantation.[1]

The goal of treatment of patients with MM is to achieve CR with the assumption that this will improve survival. However, there have been very few long-term studies to validate this hypothesis. Many studies have shown that patients who achieve a CR have a longer progression-free survival (PFS) than patients who achieve a partial response (PR) or no response. Furthermore, it has been demonstrated that patients who are in PR prior to high-dose chemotherapy with stem cell support and achieve a CR have an improved PFS. It has also been demonstrated that patients in CR prior to high-dose therapy do not have a further increase in PFS.

The current study evaluated response and survival in 758 patients with MM treated at the M. D. Anderson Cancer Center. Three hundred ninetly-five of these patients received high-dose chemotherapy with stem cell support within one year of diagnosis.

• After two years patients in CR had a subsequent median survival of 9.7 years compared with 4.4 years for patients in PR and 2.7 years for non responders (NR).
• High-dose therapy converted 67% of patients from NR to PR or CR and induced CR in 26% of patients with PR.
• Intensive therapy did not prolong survival for patients with CR after primary therapy.
• Multivariate analyses showed that CR was the dominant prognostic factor for long survival. Other important factors were Stage I disease, PR, and intensive treatment.
• 2% of patients have remained in CR for more than 10 years.

Comments: These data confirm the importance of achieving a CR in achieving prolonged survival of patients with MM. Over the past several years, conventional chemotherapy has achieved higher and higher CR rates due to the development of new active agents. This may mean that fewer patients will require intensive treatments to achieve CR and subsequent long-term survival.

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