TY  - JOUR
AU  - Lehners, Nicola
AU  - Becker, Natalia
AU  - Benner, Axel
AU  - Pritsch, Maria
AU  - Löpprich, Martin
AU  - Mai, Elias Karl
AU  - Hillengass, Jens
AU  - Goldschmidt, Hartmut
AU  - Raab, Marc-Steffen
TI  - Analysis of long-term survival in multiple myeloma after first-line autologous stem cell transplantation: impact of clinical risk factors and sustained response.
JO  - Cancer medicine
VL  - 7
IS  - 2
SN  - 2045-7634
CY  - Hoboken, NJ
PB  - Wiley
M1  - DKFZ-2018-00183
SP  - 307 - 316
PY  - 2018
AB  - The widespread use of high-dose therapy and autologous stem cell transplantation (ASCT) as well as the introduction of novel agents have significantly improved outcomes in multiple myeloma (MM) enabling long-term survival. We here analyze factors influencing survival in 865 newly diagnosed MM patients who underwent first-line ASCT at our center between 1993 and 2014. Relative survival and conditional survival were assessed to further characterize long-term survivors. Achievement of complete response (CR) post-ASCT was associated with prolonged progression-free survival (PFS) in the whole cohort and with significantly superior overall survival (OS) in the subgroup of patients receiving novel agent-based induction therapy. Landmark analyses performed at 1, 3, and 5 years post-ASCT revealed that sustainment of any response had a highly significant influence on survival with no significant differences between sustained CR and sustained inferior responses. Furthermore, outcome was independently improved by administration of maintenance therapy. A subset of patients did experience long-term survival >15 years. However, conditional survival demonstrated a persistent risk of myeloma-associated death and cumulative relative survival curves did not show development of a clear plateau, even in prognostically advantageous groups. In conclusion, in this large retrospective study, sustained response after first-line ASCT was found to be a major prognostic factor for OS independent of depth of sustained response. Administration of maintenance therapy further improved outcome, supporting the hypothesis that interventions to prolong responses achieved post-ASCT may be essential to reach long-term survival, especially in the setting of persisting residual disease.
LB  - PUB:(DE-HGF)16
C6  - pmid:29282899
C2  - pmc:PMC5806105
DO  - DOI:10.1002/cam4.1283
UR  - https://inrepo02.dkfz.de/record/132496
ER  -