All content on this site is intended for healthcare professionals only. By acknowledging this message and accessing the information on this website you are confirming that you are a Healthcare Professional. If you are a patient or carer, please visit the International Myeloma Foundation or HealthTree for Multiple Myeloma.

The Multiple Myeloma Hub uses cookies on this website. They help us give you the best online experience. By continuing to use our website without changing your cookie settings, you agree to our use of cookies in accordance with our updated Cookie Policy

Introducing

Now you can personalise
your Multiple Myeloma Hub experience!

Bookmark content to read later

Select your specific areas of interest

View content recommended for you

Find out more
  TRANSLATE

The Multiple Myeloma Hub website uses a third-party service provided by Google that dynamically translates web content. Translations are machine generated, so may not be an exact or complete translation, and the Multiple Myeloma Hub cannot guarantee the accuracy of translated content. The Multiple Myeloma Hub and its employees will not be liable for any direct, indirect, or consequential damages (even if foreseeable) resulting from use of the Google Translate feature. For further support with Google Translate, visit Google Translate Help.

Steering CommitteeAbout UsNewsletterContact
LOADING
You're logged in! Click here any time to manage your account or log out.
LOADING
You're logged in! Click here any time to manage your account or log out.
2018-05-07T07:17:04.000Z

Time to plateau shows prognostic value in NDMM

May 7, 2018
Share:

Bookmark this article

This current era of novel agents has led to improved survival and increased response rates in multiple myeloma (MM) patients. Numerous studies have shown an association between a complete response (CR) from the use of novel agents and an improved overall survival (OS) in MM patients. However, 20% of transplant-eligible and transplant-ineligible MM patients who have achieved a CR will still die early (≤ 4 years). Therefore, additional prognostic factors need to be identified in order to move towards response-customized treatment.

Patrick W. Mellors, from the Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, US, and colleagues, assessed the association between survival outcomes and the time taken to reach ‘a best response plateau’ (TPlat) in newly diagnosed MM (NDMM) patients. The findings of this study were published in the American Journal of Hematology in April 2018.

Study design:

  • N = 1,099 NDMM patients (pts) diagnosed between December 2005 and December 2015 at Mayo Clinic Rochester
  • Pt eligibility:
    • Initial treatment with a novel agent (IMiD, PI, or a combination)
    • Pts achieved ≤1 partial response to first-line therapy
  • Time to plateau (TPlat) was defined as time from the administration of first-line therapy to best response to first-line therapy and pts were separated into two groups:
    • Pts achieved their best response to treatment in ≤ 120 days (TPlat ≤ 120 days)
    • Pts achieved their best response to treatment in > 120 days (TPlat > 120 days)

Patient characteristics:

  • Median age at diagnosis (years) = 63 (23–89)
  • Follow-up (years) = 3.8 (0.2–11.4)
  • OS (years) = 8.8 (8.1–NR)
  • International Stage System (ISS): I = 220 pts; II = 327 pts and III = 230 pts
  • Best response to first-line therapy: CR = 289 pts; very good partial response (VGPR) = 504 pts and partial response (PR) = 306 pts
  • Cytogenetic high-risk abnormalities (del(17p), t(14;16) and t(14;20)) = 188 pts
  • Most common first-line therapy: lenalidomide, and dexamethasone (Rd) = 37%; bortezomib, cyclophosphamide, and dexamethasone (VCD) = 24%; bortezomib, lenalidomide, and dexamethasone (VRd) = 16%; bortezomib and dexamethasone (Vd) = 7% and ixazomib, cyclophosphamide, and dexamethasone (ICd) = 4%

Key Findings:

  • Time to plateau (months) = 4.9 (0.7–58.6)
  • Duration of plateau (years) = 1.8 (0.2–11.0)
  • Survival analysis showed that:
    • Pts with TPlat > 120 days had longer median OS (mOS) and median progression free survival (mPFS) than pts with TPlat ≤ 120 days (P < 0.001)
    • Immunomodulatory (IMiD) drugs were not associated with mOS (HR = 0.75, 95% CI, 0.53–1.06, P = 0.098)
    • Proteasome inhibitors (PIs) were not associated with mOS (HR = 0.91, 95% CI, 0.65– 1.26, P = 0.577)
    • Pts with TPlat > 240 days demonstrated longer survival in comparison to pts with TPlat ≤ 240 days (P < 0.001)
    • Significant improvement in mOS was maintained in patients with TPlat > 120 days based on age (subgroups: < 65 and ≥ 65 years-old) and ASCT treatment (P < 0.001 for all comparisons)

These findings suggest a survival benefit in NDMM patients who responded more gradually to initial therapy compared to those that responded more rapidly. Time to best response (TPlat) was also found to be an independent prognostic value for patients both eligible and non-eligible for transplant, as the effects of TPlat remained the same after adjustments for numerous risk factors such as sex, age and best response during first-line therapy.

  1. Mellors PW. et al. Time to plateau as a predictor of survival in newly diagnosed multiple myeloma. American Journal of Hematology. April 2018. DOI: 10.1002/ajh.25113

Newsletter

Subscribe to get the best content related to multiple myeloma delivered to your inbox