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Limited value of the international staging system for predicting long-term outcome of transplant-ineligible,newly diagnosed,symptomatic multiple myeloma in the era of novel agents |
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| Authors: | Junya Kuroda Yuji Shimura Kensuke Ohta Hirokazu Tanaka Hirohiko Shibayama Satoru Kosugi Shinichi Fuchida Masayuki Kobayashi Hitomi Kaneko Nobuhiko Uoshima Kazuyoshi Ishii Shosaku Nomura Masafumi Taniwaki Akifumi Takaori-Kondo Chihiro Shimazaki Mitsuru Tsudo Masayuki Hino Itaru Matsumura Yuzuru Kanakura |
| Affiliation: | 1. Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan 2. Department of Hematology, Osaka Saiseikai Nakatsu Hospital, 2-10-39 Shibata, Kita-ku, Osaka, 530-0012, Japan 3. Department of Hematology and Rheumatology, Kinki University Faculty of Medicine, Sayama, Osaka, 589-8511, Japan 4. Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan 5. Department of Internal Medicine, Toyonaka Municipal Hospital, Toyonaka, Osaka, 560-8565, Japan 6. Department of Hematology, Social Insurance Kyoto Hospital, Kyoto, 603-8151, Japan 7. Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, 606-8507, Japan 8. Department of Hematology, Osaka Red Cross Hospital, Osaka, 543-8555, Japan 9. Department of Hematology, Matsushita Memorial Hospital, Moriguchi, Osaka, 570-8540, Japan 10. First Department of Internal Medicine, Kansai Medical University, Moriguchi, Osaka, 570-0074, Japan 11. Department of Hematology, Graduate School of Medicine, Osaka City University, Osaka, 545-8585, Japan |
| Abstract: | We retrospectively investigated clinical outcomes and prognostic factors of 131 patients with transplant-ineligible newly diagnosed multiple myeloma (NDMM) who received melphalan and prednisolone (MP) as first-line therapy from 2006 to 2013. Eighty-one patients received salvage therapies incorporating bortezomib, lenalidomide, and/or thalidomide. The overall response rate to MP was 54.2 %, including 9.2 % of better than very good partial response. With a median follow-up period of 30.2 months, median overall survival (OS) and median time to next treatment (TNT) were 54.4 and 19.0 months, respectively. Univariate analysis revealed that performance status and serum calcium level significantly associated with both OS and TNT, and multivariate analysis revealed that the higher serum calcium level had a significantly unfavorable impact on OS and TNT. Importantly, staging informed by the international staging system (ISS) was not predictive for OS or TNT in the analyzed cohort. Our study revealed that, in the context of first-line MP therapy for NDMM, the salvage therapy incorporating novel agents produced a survival period of >30 months after the initiation of second-line therapy, suggesting that the predictive value of ISS for OS and TNT may be limited in the era of novel agents. |
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