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@ARTICLE{Lehners:132496,
      author       = {N. Lehners$^*$ and N. Becker$^*$ and A. Benner$^*$ and M.
                      Pritsch and M. Löpprich and E. K. Mai and J. Hillengass$^*$
                      and H. Goldschmidt and M.-S. Raab$^*$},
      title        = {{A}nalysis of long-term survival in multiple myeloma after
                      first-line autologous stem cell transplantation: impact of
                      clinical risk factors and sustained response.},
      journal      = {Cancer medicine},
      volume       = {7},
      number       = {2},
      issn         = {2045-7634},
      address      = {Hoboken, NJ},
      publisher    = {Wiley},
      reportid     = {DKFZ-2018-00183},
      pages        = {307 - 316},
      year         = {2018},
      abstract     = {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.},
      cin          = {G170 / C060},
      ddc          = {610},
      cid          = {I:(DE-He78)G170-20160331 / I:(DE-He78)C060-20160331},
      pnm          = {317 - Translational cancer research (POF3-317)},
      pid          = {G:(DE-HGF)POF3-317},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:29282899},
      pmc          = {pmc:PMC5806105},
      doi          = {10.1002/cam4.1283},
      url          = {https://inrepo02.dkfz.de/record/132496},
}