Graft outcome - Impact of complete remission with intensive therapy in patients with responsive multiple myeloma

Clinical outcomes were assessed in 68 consecutive patients with multiple my eloma of high or intermediate tumor mass that had responded to VAD or dexam ethasone-based therapy and were consolidated with early intensive therapy a nd autologous stem cell transplantation. Results were compared with those o f 50 comparable patients who refused or were unable to receive intensive tr eatment for socioeconomic reasons. Following high-dose therapy, the rate of CR increased from 6 to 37%, with median survival prolonged by 10 months. S urvival of 21 patients with disease converted from PR to CR (median 8.3 yea rs) was significantly longer than that of similarly-treated patients who re mained in PR (median 5.0 years). CR of myeloma represents the major surroga te marker of long survival and the primary goal of myeloablative treatment for patients in PR. Twelve of 18 patients with rapid reduction of myeloma p rotein (T1/2 < 0.5 months), and myeloma protein reduction to <1.0 g/dl afte r primary therapy achieved CR (67%), identifying pretransplant features fav orable to intensive therapy. Among 35 patients with slower reduction or hig her residual myeloma protein, CR occurred in eight patients (23%) (P < 0.01 ), for whom other treatments should be considered. The kinetics of response to initial therapy should be considered in selecting patients more likely to achieve CR and consequent long survival after intensive treatment.