Early relapse post autologous transplant is a stronger predictor of survival compared with pretreatment patient factors in the novel agent era: analysis of the Singapore Multiple Myeloma Working Group
The clinical outcome of multiple myeloma is heterogeneous. Both the depth of response to induction and transplant as well as early relapse within a year are correlated with survival, but it is unclear which factor is most relevant in Southeast Asian patients with multiple myeloma. We retrospectively...
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| Veröffentlicht in: | Bone marrow transplantation (Basingstoke) 2016-07, Vol.51 (7), p.933-937 |
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| creator | Ong, S Y de Mel, S Chen, Y X Ooi, M G Surendran, S Lin, A Koh, L P Linn, Y C Ho, A Y L Hwang, W Y K Phipps, C Loh, S M Y Goh, Y T Tan, D Chng, W J Gopalakrishnan, S K |
| description | The clinical outcome of multiple myeloma is heterogeneous. Both the depth of response to induction and transplant as well as early relapse within a year are correlated with survival, but it is unclear which factor is most relevant in Southeast Asian patients with multiple myeloma. We retrospectively analyzed outcomes of 215 patients who were treated with upfront autologous transplant in Singapore between 2000 and 2014. In patients who received novel agent (NA)-based induction, achieving only partial response (PR) post-induction was associated with poorer OS (HR 1.95,
P
=0.047) and PFS (HR 2.9,
P |
| doi_str_mv | 10.1038/bmt.2016.43 |
| format | Article |
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P
=0.047) and PFS (HR 2.9,
P
<0.001), while achieving only PR post-transplant was strongly correlated with both OS (HR 3.3,
P
=0.001) and PFS (HR 7.6,
P
<0.001), compared with patients who achieved very good partial response (VGPR) or better. Early relapse was detected in 18% of all patients, although nearly half had initially achieved VGPR or better post-transplant. Early relapse after NA-based induction led to significantly shorter OS (median 22 months vs not reached,
P
<0.001), and was strongly associated with OS (HR 13.7,
P
<0.001). The impact of suboptimal post-transplant response and early relapse on survival may be more important than pretransplant factors, such as International Staging System or cytogenetics, and should be considered in risk stratification systems to rationalize therapy.</description><identifier>ISSN: 0268-3369</identifier><identifier>EISSN: 1476-5365</identifier><identifier>DOI: 10.1038/bmt.2016.43</identifier><identifier>PMID: 26974274</identifier><language>eng</language><publisher>London: Nature Publishing Group UK</publisher><subject>692/699/1541/1990/804 ; 692/700/565/2319 ; Adult ; Aged ; Asian Continental Ancestry Group ; Autografts ; Bone marrow ; Care and treatment ; Cell Biology ; Cytogenetics ; Development and progression ; Female ; Health aspects ; Hematology ; Hematopoietic Stem Cell Transplantation - mortality ; Humans ; Internal Medicine ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Multiple myeloma ; Multiple Myeloma - mortality ; Multiple Myeloma - therapy ; original-article ; Patient outcomes ; Patients ; Prognosis ; Public Health ; Quality of life ; Recurrence ; Recurrence (Disease) ; Remission Induction ; Retrospective Studies ; Risk factors ; Singapore ; Stem cell transplantation ; Stem Cells ; Survival ; Survival Analysis ; Transplantation, Autologous</subject><ispartof>Bone marrow transplantation (Basingstoke), 2016-07, Vol.51 (7), p.933-937</ispartof><rights>Macmillan Publishers Limited 2016</rights><rights>COPYRIGHT 2016 Nature Publishing Group</rights><rights>Copyright Nature Publishing Group Jul 2016</rights><rights>Macmillan Publishers Limited 2016.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c576t-c75edb8967a3715a97239b633226736b4b4fbf157e1dc1954685f179716cca703</citedby><cites>FETCH-LOGICAL-c576t-c75edb8967a3715a97239b633226736b4b4fbf157e1dc1954685f179716cca703</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1038/bmt.2016.43$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1038/bmt.2016.43$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26974274$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ong, S Y</creatorcontrib><creatorcontrib>de Mel, S</creatorcontrib><creatorcontrib>Chen, Y X</creatorcontrib><creatorcontrib>Ooi, M G</creatorcontrib><creatorcontrib>Surendran, S</creatorcontrib><creatorcontrib>Lin, A</creatorcontrib><creatorcontrib>Koh, L P</creatorcontrib><creatorcontrib>Linn, Y C</creatorcontrib><creatorcontrib>Ho, A Y L</creatorcontrib><creatorcontrib>Hwang, W Y K</creatorcontrib><creatorcontrib>Phipps, C</creatorcontrib><creatorcontrib>Loh, S M Y</creatorcontrib><creatorcontrib>Goh, Y T</creatorcontrib><creatorcontrib>Tan, D</creatorcontrib><creatorcontrib>Chng, W J</creatorcontrib><creatorcontrib>Gopalakrishnan, S K</creatorcontrib><title>Early relapse post autologous transplant is a stronger predictor of survival compared with pretreatment patient factors in the novel agent era: analysis of the Singapore Multiple Myeloma Working Group</title><title>Bone marrow transplantation (Basingstoke)</title><addtitle>Bone Marrow Transplant</addtitle><addtitle>Bone Marrow Transplant</addtitle><description>The clinical outcome of multiple myeloma is heterogeneous. Both the depth of response to induction and transplant as well as early relapse within a year are correlated with survival, but it is unclear which factor is most relevant in Southeast Asian patients with multiple myeloma. We retrospectively analyzed outcomes of 215 patients who were treated with upfront autologous transplant in Singapore between 2000 and 2014. In patients who received novel agent (NA)-based induction, achieving only partial response (PR) post-induction was associated with poorer OS (HR 1.95,
P
=0.047) and PFS (HR 2.9,
P
<0.001), while achieving only PR post-transplant was strongly correlated with both OS (HR 3.3,
P
=0.001) and PFS (HR 7.6,
P
<0.001), compared with patients who achieved very good partial response (VGPR) or better. Early relapse was detected in 18% of all patients, although nearly half had initially achieved VGPR or better post-transplant. Early relapse after NA-based induction led to significantly shorter OS (median 22 months vs not reached,
P
<0.001), and was strongly associated with OS (HR 13.7,
P
<0.001). The impact of suboptimal post-transplant response and early relapse on survival may be more important than pretransplant factors, such as International Staging System or cytogenetics, and should be considered in risk stratification systems to rationalize therapy.</description><subject>692/699/1541/1990/804</subject><subject>692/700/565/2319</subject><subject>Adult</subject><subject>Aged</subject><subject>Asian Continental Ancestry Group</subject><subject>Autografts</subject><subject>Bone marrow</subject><subject>Care and treatment</subject><subject>Cell Biology</subject><subject>Cytogenetics</subject><subject>Development and progression</subject><subject>Female</subject><subject>Health aspects</subject><subject>Hematology</subject><subject>Hematopoietic Stem Cell Transplantation - mortality</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Multiple myeloma</subject><subject>Multiple Myeloma - mortality</subject><subject>Multiple Myeloma - therapy</subject><subject>original-article</subject><subject>Patient outcomes</subject><subject>Patients</subject><subject>Prognosis</subject><subject>Public Health</subject><subject>Quality of life</subject><subject>Recurrence</subject><subject>Recurrence (Disease)</subject><subject>Remission Induction</subject><subject>Retrospective Studies</subject><subject>Risk factors</subject><subject>Singapore</subject><subject>Stem cell transplantation</subject><subject>Stem Cells</subject><subject>Survival</subject><subject>Survival Analysis</subject><subject>Transplantation, Autologous</subject><issn>0268-3369</issn><issn>1476-5365</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqNkt9rFDEQxxdRbK0--S4BQQS9M7-z61sptQoVH1R8XGb3Zu9Ss5ttkj25_9A_yyxX5SpFJA8TMp_5DjP5FsVTRpeMivJN06clp0wvpbhXHDNp9EIJre4Xx5TrciGEro6KRzFeUcqkpOphccR1ZSQ38rj4eQ7B7UhAB2NEMvqYCEzJO7_2UyQpwBBHB0MiNhIgMQU_rDGQMeDKtskH4jsSp7C1W3Ck9f0IOUN-2LSZmRQQUo-5fIRk59jBXBWJHUjaIBn8Fh2B9ZzCAG8JDOB2MTfLujPw2Q5rGH1A8nFyyY4uX3bofA_kmw_fc5ZcBD-Nj4sHHbiIT27iSfH13fmXs_eLy08XH85OLxetMjotWqNw1ZSVNiAMU1AZLqpGC8G5NkI3spFd0zFlkK1aVimpS9UxUxmm2xYMFSfFy73uGPz1hDHVvY0turwjzBurWUlLI1Rl9P-gPP8Wlyyjz_9Cr_wU8ipizbXkzGSM_4vKWqzUUrADrTU4rO3Q-fyL7dy6PpWqLKlQUmVqeQeVzwp72_oBO5vfbxW8OCjYILi0id5Nyfoh3gZf7cE2-BgDdvUYbA9hVzNaz46ts2Pr2bG1FJl-djPT1PS4-sP-tmgGXu-BmFOz9w6GvkPvF4Ac9ZU</recordid><startdate>20160701</startdate><enddate>20160701</enddate><creator>Ong, S Y</creator><creator>de Mel, S</creator><creator>Chen, Y X</creator><creator>Ooi, M G</creator><creator>Surendran, S</creator><creator>Lin, A</creator><creator>Koh, L P</creator><creator>Linn, Y C</creator><creator>Ho, A Y L</creator><creator>Hwang, W Y K</creator><creator>Phipps, C</creator><creator>Loh, S M Y</creator><creator>Goh, Y T</creator><creator>Tan, D</creator><creator>Chng, W J</creator><creator>Gopalakrishnan, S K</creator><general>Nature Publishing Group UK</general><general>Nature Publishing Group</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7QP</scope><scope>7T5</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20160701</creationdate><title>Early relapse post autologous transplant is a stronger predictor of survival compared with pretreatment patient factors in the novel agent era: analysis of the Singapore Multiple Myeloma Working Group</title><author>Ong, S Y ; de Mel, S ; Chen, Y X ; Ooi, M G ; Surendran, S ; Lin, A ; Koh, L P ; Linn, Y C ; Ho, A Y L ; Hwang, W Y K ; Phipps, C ; Loh, S M Y ; Goh, Y T ; Tan, D ; Chng, W J ; Gopalakrishnan, S K</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c576t-c75edb8967a3715a97239b633226736b4b4fbf157e1dc1954685f179716cca703</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>692/699/1541/1990/804</topic><topic>692/700/565/2319</topic><topic>Adult</topic><topic>Aged</topic><topic>Asian Continental Ancestry Group</topic><topic>Autografts</topic><topic>Bone marrow</topic><topic>Care and treatment</topic><topic>Cell Biology</topic><topic>Cytogenetics</topic><topic>Development and progression</topic><topic>Female</topic><topic>Health aspects</topic><topic>Hematology</topic><topic>Hematopoietic Stem Cell Transplantation - mortality</topic><topic>Humans</topic><topic>Internal Medicine</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Multiple myeloma</topic><topic>Multiple Myeloma - mortality</topic><topic>Multiple Myeloma - therapy</topic><topic>original-article</topic><topic>Patient outcomes</topic><topic>Patients</topic><topic>Prognosis</topic><topic>Public Health</topic><topic>Quality of life</topic><topic>Recurrence</topic><topic>Recurrence (Disease)</topic><topic>Remission Induction</topic><topic>Retrospective Studies</topic><topic>Risk factors</topic><topic>Singapore</topic><topic>Stem cell transplantation</topic><topic>Stem Cells</topic><topic>Survival</topic><topic>Survival Analysis</topic><topic>Transplantation, Autologous</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ong, S Y</creatorcontrib><creatorcontrib>de Mel, S</creatorcontrib><creatorcontrib>Chen, Y X</creatorcontrib><creatorcontrib>Ooi, M G</creatorcontrib><creatorcontrib>Surendran, S</creatorcontrib><creatorcontrib>Lin, A</creatorcontrib><creatorcontrib>Koh, L P</creatorcontrib><creatorcontrib>Linn, Y C</creatorcontrib><creatorcontrib>Ho, A Y L</creatorcontrib><creatorcontrib>Hwang, W Y K</creatorcontrib><creatorcontrib>Phipps, C</creatorcontrib><creatorcontrib>Loh, S M Y</creatorcontrib><creatorcontrib>Goh, Y T</creatorcontrib><creatorcontrib>Tan, D</creatorcontrib><creatorcontrib>Chng, W J</creatorcontrib><creatorcontrib>Gopalakrishnan, S K</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Immunology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biological Science Database</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Bone marrow transplantation (Basingstoke)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ong, S Y</au><au>de Mel, S</au><au>Chen, Y X</au><au>Ooi, M G</au><au>Surendran, S</au><au>Lin, A</au><au>Koh, L P</au><au>Linn, Y C</au><au>Ho, A Y L</au><au>Hwang, W Y K</au><au>Phipps, C</au><au>Loh, S M Y</au><au>Goh, Y T</au><au>Tan, D</au><au>Chng, W J</au><au>Gopalakrishnan, S K</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Early relapse post autologous transplant is a stronger predictor of survival compared with pretreatment patient factors in the novel agent era: analysis of the Singapore Multiple Myeloma Working Group</atitle><jtitle>Bone marrow transplantation (Basingstoke)</jtitle><stitle>Bone Marrow Transplant</stitle><addtitle>Bone Marrow Transplant</addtitle><date>2016-07-01</date><risdate>2016</risdate><volume>51</volume><issue>7</issue><spage>933</spage><epage>937</epage><pages>933-937</pages><issn>0268-3369</issn><eissn>1476-5365</eissn><abstract>The clinical outcome of multiple myeloma is heterogeneous. Both the depth of response to induction and transplant as well as early relapse within a year are correlated with survival, but it is unclear which factor is most relevant in Southeast Asian patients with multiple myeloma. We retrospectively analyzed outcomes of 215 patients who were treated with upfront autologous transplant in Singapore between 2000 and 2014. In patients who received novel agent (NA)-based induction, achieving only partial response (PR) post-induction was associated with poorer OS (HR 1.95,
P
=0.047) and PFS (HR 2.9,
P
<0.001), while achieving only PR post-transplant was strongly correlated with both OS (HR 3.3,
P
=0.001) and PFS (HR 7.6,
P
<0.001), compared with patients who achieved very good partial response (VGPR) or better. Early relapse was detected in 18% of all patients, although nearly half had initially achieved VGPR or better post-transplant. Early relapse after NA-based induction led to significantly shorter OS (median 22 months vs not reached,
P
<0.001), and was strongly associated with OS (HR 13.7,
P
<0.001). The impact of suboptimal post-transplant response and early relapse on survival may be more important than pretransplant factors, such as International Staging System or cytogenetics, and should be considered in risk stratification systems to rationalize therapy.</abstract><cop>London</cop><pub>Nature Publishing Group UK</pub><pmid>26974274</pmid><doi>10.1038/bmt.2016.43</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Bone marrow transplantation (Basingstoke), 2016-07, Vol.51 (7), p.933-937 |
| issn | 0268-3369 1476-5365 |
| language | eng |
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| source | MEDLINE; Nature Journals Online; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; SpringerLink Journals - AutoHoldings |
| subjects | 692/699/1541/1990/804 692/700/565/2319 Adult Aged Asian Continental Ancestry Group Autografts Bone marrow Care and treatment Cell Biology Cytogenetics Development and progression Female Health aspects Hematology Hematopoietic Stem Cell Transplantation - mortality Humans Internal Medicine Male Medicine Medicine & Public Health Middle Aged Multiple myeloma Multiple Myeloma - mortality Multiple Myeloma - therapy original-article Patient outcomes Patients Prognosis Public Health Quality of life Recurrence Recurrence (Disease) Remission Induction Retrospective Studies Risk factors Singapore Stem cell transplantation Stem Cells Survival Survival Analysis Transplantation, Autologous |
| title | Early relapse post autologous transplant is a stronger predictor of survival compared with pretreatment patient factors in the novel agent era: analysis of the Singapore Multiple Myeloma Working Group |
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