Gradual vs. Fast Response in Myeloma?

“The five-year survival rate was 77 percent for (myeloma) patients who achieved their best response to initial treatment in more than 120 days, and 56 percent for patients who achieved their best response in 120 days or less.”

According to the studies discussed and excerpted below, the newly diagnosed myeloma patient who responds gradually to his/her therapy can live up to 21% longer than the MMer who responds faster. The study doesn’t say that the MMer must achieve MDR or even complete remission.

The study just cites patients who achieve their “best response.” A deep response to treatment is a strong but not perfect predictor of overall survival.

According to the American Cancer Society, the average five year survival of MMers is about 7 years.

Unfortunately, while the study says that gradually responding is good, it doesn’t say how MMers can respond gradually to their initial therapy. Some newly diagnosed MMers respond rapidly and some don’t…

Patients who achieved their “best response” more gradually live longer, on average, than MMers who respond quickly- in less than 120 days. The study doesn’t say what is meant by a “best response.” According to the study, undergoing an autologous stem cell transplant or not makes no difference in how long an MMer lives. What matters is how gradual he or she responds to treatment.

What do the studies confirm?

Average five-year survival can improve by more than 20% for those responding gradually to therapy
Deep response to treatment does not guarantee long overall survival
“Complete response” to initial treatment does not guarantee long overall survival either

If a newly diagnosed MM patient acheived their “best response” to chemotherapy, is it possible that evidence-based complementary therapies such as nutrition, supplementation, lifestyle, etc. can lengthen the MMers remission? I think it is.

Thank you,

David Emerson

MM Survivor
MM Cancer Coach
Director PeopleBeatingCancer

Gradual Response To Initial Treatment May Be Sign Of Better Prognosis In Multiple Myeloma

“Results of a retrospective study conducted at the Mayo Clinic indicate that multiple myeloma patients who respond more gradually to their initial treatment may have better overall survival.

Specifically, the authors of the new study find that newly diagnosed patients who required more than 120 days to achieve their best response to initial treatment had better progression-free and overall survival than patients who achieved their best response in 120 days or less.

The five-year survival rate was 77 percent for patients who achieved their best response to initial treatment in more than 120 days, and 56 percent for patients who achieved their best response in 120 days or less.

The positive impact on survival of a more gradual response to treatment was seen both in patients who received a stem cell transplant as part of their initial treatment and in patients who did not.

The impact also was present when the researchers controlled for a variety of other factors that could affect prognosis, such as the patient’s age, their best response to treatment, and whether or not they had high-risk chromosomal abnormalities.

The study is based on data for more than 1,000 multiple myeloma patients who were diagnosed between 2005 and 2015 at the Mayo Clinic in Rochester, Minnesota.

Based on their findings, the study authors suggest that patients who respond more gradually to initial treatment may represent a subgroup of patients whose disease is less likely to progress rapidly and less likely to develop resistance to treatment.

Background

Overall survival in multiple myeloma patients has increased markedly since the introduction of novel therapies such as thalidomide, Revlimid (lenalidomide), and Velcade (bortezomib) in the last 20 years (see related Beacon news article).

The new treatments have given physicians more options with which to treat multiple myeloma, extending the time each patient has until treatment options are exhausted.

In addition, the new treatments have made it possible to achieve deeper responses to treatment, which generally lengthens the time until a patient’s disease progresses and a new treatment must be tried.

Yet a deep response to initial treatment does not always guarantee long overall survival. The authors of the new study note that “survival analyses in both transplant and non-transplant populations have demonstrated that up to 20 percent of patients achieving a [complete response to initial treatment] will die within four years.”

There has been conflicting evidence, however, about whether the speed of a patient’s response to initial treatment positively or negatively affects patient prognosis.

Studies done before the introduction of novel myeloma therapies suggested that a rapid response to initial treatment was associated with poorer survival outcomes. Studies involving patients who have received treatment with novel myeloma therapies have had more mixed results…

Given the lack of consensus in studies investigating speed of response in the age of novel therapies, the authors of the new study decided to investigate the issue using data from patients at their own institution…

Study Results

The study authors found that median time to best response among the patients in their dataset was 4.9 months, and the median duration of best response was 1.8 years.

More importantly, the researchers found that the time it took for patients to achieve their best response to initial treatment affected both their progression-free survival and overall survival.

The researchers divided the patients in the study into two groups:

Patients who achieved their best response to treatment in 120 days or less
Patients who took more than 120 days to reach their best response.

Median progression-free survival was 2.1 years for patients in the first (fast-responding) group, and 3.3 years in the second (slow-responding) group.

Median overall survival was about six years in the first (fast-responding) group, and has not yet been reached in the second (slow-responding) group.

The five-year survival rates are 56 percent and 77 percent for the fast- and slow-responding groups, respectively.

These differences in survival between the two patient groups are statistically very significant.

The impact of response kinetics for multiple myeloma in the era of novel agents

“The response depth, time to best response (T_BR) and duration of best response (D_BR) were collected. Depth of response was associated with superior outcomes, consistent with findings from other studies. However, the early responders (defined as T_BR ≤3 months) showed significantly worse survival compared with late responders. We found that patients with rapid complete remission experienced inferior survivals comparable to those attaining a gradual partial remission…”

Time to plateau as a predictor of survival in newly diagnosed multiple myeloma

“Response rates in newly diagnosed multiple myeloma have improved dramatically with the introduction of highly effective novel therapies. However, survival in patients achieving optimal responses to initial treatment can vary significantly, and new prognostic indicators are required to improve risk stratification…

Recently Diagnosed or Relapsed? Stop Looking For a Miracle Cure, and Use Evidence-Based Therapies To Enhance Your Treatment and Prolong Your Remission

Gradual vs. Fast Response in Myeloma?

“The five-year survival rate was 77 percent for (myeloma) patients who achieved their best response to initial treatment in more than 120 days, and 56 percent for patients who achieved their best response in 120 days or less.”

Recommended Reading:

Gradual Response To Initial Treatment May Be Sign Of Better Prognosis In Multiple Myeloma

The impact of response kinetics for multiple myeloma in the era of novel agents

Time to plateau as a predictor of survival in newly diagnosed multiple myeloma

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5 comments

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Recently Diagnosed or Relapsed? Stop Looking For a Miracle Cure, and Use Evidence-Based Therapies To Enhance Your Treatment and Prolong Your Remission

Gradual vs. Fast Response in Myeloma?

“The five-year survival rate was 77 percent for (myeloma) patients who achieved their best response to initial treat­ment in more than 120 days, and 56 percent for patients who achieved their best response in 120 days or less.”

Recommended Reading:

Gradual Response To Initial Treatment May Be Sign Of Better Prognosis In Multiple Myeloma

The impact of response kinetics for multiple myeloma in the era of novel agents

Time to plateau as a predictor of survival in newly diagnosed multiple myeloma

Leave a Comment:

5 comments

Popular posts

Multiple Myeloma Diet

Multiple Myeloma Survivor- A Different kind of Second Opinion-

C-B-D Enhances Velcade (BORT)

Are Endometrial Polyps Overtreated?

“The five-year survival rate was 77 percent for (myeloma) patients who achieved their best response to initial treatment in more than 120 days, and 56 percent for patients who achieved their best response in 120 days or less.”