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Complete Response After Stem Cell Transplant For Myeloma Indicates Best Prognosis

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Published: May 31, 2011 4:49 pm

Spanish researchers recently published long-term follow-up results confirming that a complete response following stem cell transplantation in multiple myeloma patients increases overall and progression-free survival compared to a very good or partial response.

Treatment with high-dose chemotherapy followed by stem cell transplantation is a standard therapeutic approach for younger, newly diagnosed multiple myeloma patients. There has been some debate among researchers, however, as to whether the quality of response following transplantation can predict patient outcome.

In 2000, the same group of researchers published results demonstrating that complete response should be an important goal of stem cell transplantation as it improved overall survival rates in multiple myeloma patients (see the 2000 study). The goal of the current study was to confirm these results after a longer follow-up period.

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The researchers studied 344 multiple myeloma patients who had received stem cell transplants between 1989 and 1998. All 344 patients were included in the original 2000 study. When the follow-up analysis was done in February 2010, updated information was available for 322 of these patients.

Based on the long-term follow-up study, the average progression-free survival period for complete responders following transplantation was 47 months, compared to 30 months for near complete responders, 27 months for very good partial responders, and 23 months for partial responders. At a 12 year follow-up point, 28 percent of complete responders remained progression-free, while 19 percent of near complete responders, 10 percent of very good partial responders, and 11 percent of partial responders remained progression-free.

Overall survival was 91 months for patients achieving a complete response, 56 months, 55 months, and 43 months for patients achieving a near complete, very good partial, and partial response, respectively. At a follow up of 12 years, the overall survival rates were 35 percent for complete responders, 22 percent for near complete responders, and 16 percent for both very good and partial responders.

Based on their results, the researchers concluded that those patients who achieved a complete response following transplantation had a significant survival advantage over those who did not achieve a complete response. Patients who received a near complete response, very good partial response, or partial response were considered to have similar progression-free and overall survival times.

The study also found that a plateau in the progression-free survival and overall survival times occurred 11 years after transplantation. In other words, the number of patients who progressed or died over time leveled off around 11 years, such that those patients who were still alive and still in remission at 11 years were likely to continue living in remission.

A total of 35 percent of patients who achieved a complete response reached plateau, and all patients still in complete response at plateau had not relapsed in an average of five years beyond plateau. The study authors suggested this indicates that these patients may be cured.

Of the patients who achieved a near complete, very good partial, or partial response, 11 percent reached plateau. Two patients in this group relapsed since the plateau.

For more information, see the study published in Blood (abstract).

Photo by Nissim Benvenisty on Public Library of Science – some rights reserved.
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8 Comments »

  • Stan said:

    Nice article.
    If complete remission is the goal, wouldn't this research suggest that tandem transplant is a good idea for those who can handle it?

  • Aaron said:

    It makes sense that complete response is a good thing. Yes, no doubt it has benefit.

    But my question would be, how outdated are the statistics since the data collection started well before novel therapies. Can we draw any inferences from this in today's treatments?

  • Pamela Lussier said:

    I was thinking the same thing Aaron. I have received total remission from one year of Velcade,Dex, Thalomid and I have been there for more than three years. Does that count? does it matter how you got there?

  • Gilbert alderson said:

    Ialso concur with Aaron.

  • Kishore said:

    I am currently heading for the stem cell in about two weeks.after reading this I feel very hopeful about the outcomes.

  • Joseph G. Cheek said:

    I (73) was diagnosed with MM in summer of 2008. Transplant in July 2009 with less than 1% MM cells detectable after Velcade,Ciclophosphamide, and Dexamethasone. October 2009 biopsy showed no MM cells. October 20010 biopsy showed no MM cells. July 2011 biopsy showed 80+% MM cells. What happened?

  • Mike Wood said:

    Diagnosed in the summer of 2009. SCT in Feb '10. Numbers have remained stable (as of this writing) Currently on Revlimid 10mg, 21 on, 7 off. Also monthly IV of Aredia.
    To Joe,
    I wasn't aware that the "numbers" could jump so dramatically. Keep us posted.

  • ameer said:

    my father is50 years old and had autologus stemcell transplan n physically is doing very good.now its almost 2 month from the date he had his trasplant. my doctors said his progress is good but illness is not in complete remission. and may be he need another transplant my question is this how long does it take to get complete response of transplant after transplant? and can i enjoy my dad,s company for like 10 to 15 years??