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Multiple Myeloma Response-CR or VGPR- NO Difference

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Complete Response (CR) or Very Good Partial Response (VGPR) In Newly Diagnosed Multiple Myeloma Makes NO Difference in Overall Survival. None. 

The word “response” for newly diagnosed multiple myeloma (MM) patients simply means how you/your MM reacts when you undergo your first line of cytotoxic therapy. My understanding is that, on average, approximately 75% of MM patients “respond” to induction chemotherapy.

The levels of “response” are below.

It would be logical to think that a CR or VGPR status translated into a longer overall survival. I know I thought this when I had my autologous stem cell transplant. According to the two studies linked and excerpted below, I was wrong to think this.

To Enlarge, Click the image below-

Please don’t misunderstand me. Yes, a CR is a positive indicator for a longer overall survival. But the opposite is not true. Not achieving a CR does not mean that you will not live a long OS.

I had my autologous stem cell transplant in 12/95, relapsed about a year later and here I am writing this blog post 23 plus years later.

Further, yes, all newly diagnosed MM patients want to reach CR from their induction chemotherapy. And if you do reach CR or VGPR, that’s great. However, if you have NOT reached CR or VGPR from induction therapy, don’t panic. You have NOT failed your induction therapy.

Or as Dr. Rajkumar (MM specialist) put it:

“It is one thing to say that achievement of CR is a prognostic marker, but quite another to take that to mean we need to treat patients until they reach CR.”

Please, please, please try to understand what Dr. Rajkumar is saying above. Countless MM patients undergo more and more toxic chemotherapy trying desperately trying to reach CR. Two things are happening when the patient does this.

  1. Your body, your immune system is being damaged the more toxicity you undergo. The more damage done to your body, the more short, long-term and late stage side effects you will endure.
  2. You may or may not reach CR by undergoing more chemotherapy. And even if you do reach CR, there is no study, no research that says that you will reach, on average, a longer overall survival aka length of life.

Stringent complete response (sCR)- sCR is the highest classification of treatment response and is better than complete response (CR), very good partial response (VGPR), partial response (PR), or stable disease (SD). sCR is defined as the CR criteria as well as a normal free light chain ratio and the absence of clonal cells in the bone marrow measured by immunohistochemistry or immunofluorescence.

Complete response (CR)- A treatment response category developed by the International Myeloma Working Group (IMWG). CR indicates no detectable evidence of tumor in the body.

Very good partial response (VGPR)- VGPR is a less favorable response to treatment than stringent complete response (sCR) or complete response (CR) but is better than partial response (PR) or stable disease (SD). VGPR is defined as monoclonal protein levels detectable by immunofixation but not electrophoresis in serum and urine. Additionally, VGPR is defined by a ≥90% reduction in serum monoclonal protein and a monoclonal protein level in urine of <100 mg/24 h.

Partial response (PR)-PR is a less favorable response to treatment than stringent complete response (sCR), complete response (CR), or very good partial response (VGPR) but is better than stable disease (SD). PR is defined as having a ≥50% reduction in serum monoclonal protein and a reduction in 24-hour urine monoclonal protein of ≥90% or to <200 mg/24 h. Additionally, a ≥50% reduction in the size of soft tissue plasmacytomas is required if the patient had plasmacytoma at baseline.

Stable disease (SD)- A disease state where a patient has some response to treatment but a <50% reduction in monoclonal protein levels, and the disease state is neither improving nor getting worse. The International Myeloma Working Group (IMWG) has defined SD as not meeting any of the criteria for the other response categories and recommends against using SD as a measure of treatment efficacy.

25 plus years of living with MM and coaching MM patients has taught me that the key to living a long overall survival with MM is to use the best of both conventional FDA approved MM therapies and combine them with the best of non-conventional, evidence-based MM therapies to manage your MM. It is not about CR, VGPR or MDR.

It is about the quality of life (QOL) and overall survival (OS).

Have you been diagnosed with multiple myeloma? If so, what stage? What symptoms are you experiencing? Bone pain? Anemia? Kidney damage?

Please scroll down the page, post a question or a comment and I will reply to you ASAP.

Thank you,

David Emerson

  • Long-term MM Survivor
  • MM Cancer Coach
  • Director PeopleBeatingCancer

Recommended Reading:

No Association Between Response Rates and Survival in Newly Diagnosed Multiple Myeloma

“There was no association between conventional response outcomes, such as CR or VGPR, and survival in patients with newly diagnosed multiple myeloma, according to the results of a meta-regression analysis published recently in the European Journal of Hematology…

“We explored the relationship between response to initial treatment and survival in patients with newly diagnosed multiple myeloma, based on data from 63 randomized clinical trials”…

Meta-regression analyses failed to demonstrate any association between CR or VGPR with either overall survival or progression-free survival both in patients receiving autologous stem cell transplant [ASCT] and in non-ASCT patients.”

Should Myeloma Patients Panic If They Do Not Achieve A Complete Response?

“Of course, the cause of my worry is not that patients have not achieved the magical CR or minimal residual disease-negative status, but at how mis­in­ter­pre­ta­tion of data can lead to needless concern, unnecessary chemo­ther­a­py increased side effects and cost of care, and even harm

In newly diagnosed patients treated with induction, stem cell transplantation, and Revlimid maintenance therapy, the proportion of patients who get to a complete response is approximately 30 percent. Does this mean that 70 percent of myeloma patients have “failed”?

Even with more expensive triplet induction regimens such as Revlimid, Velcade, and dexamethasone(Decadron) (abbreviated as RVD), only 40 percent of newly diagnosed myeloma patients achieve complete response. An aggressive seven-drug induction regimen followed by two back-to-back transplants, and three years of maintenance used in the “Total Therapy 3” regimen results in a complete response rate of 55 percent.

Should one-half of newly diagnosed myeloma patients panic that they have not reached a complete response? That would be over 10,000 worried patients each year in the United States alone.  The short answer is no; absolutely not.

Multiple myeloma is a remarkably heterogeneous disease; the outcomes vary dramatically depending on the patient’s chromosomal abnormalities. The type of myeloma one patient has may be completely different than the myeloma another patient has; it may not even be the same disease…”


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