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Limited value of the international staging system for predicting long-term outcome of transplant-ineligible, newly diagnosed, symptomatic multiple myeloma in the era of novel agents

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Abstract

We retrospectively investigated clinical outcomes and prognostic factors of 131 patients with transplant-ineligible newly diagnosed multiple myeloma (NDMM) who received melphalan and prednisolone (MP) as first-line therapy from 2006 to 2013. Eighty-one patients received salvage therapies incorporating bortezomib, lenalidomide, and/or thalidomide. The overall response rate to MP was 54.2 %, including 9.2 % of better than very good partial response. With a median follow-up period of 30.2 months, median overall survival (OS) and median time to next treatment (TNT) were 54.4 and 19.0 months, respectively. Univariate analysis revealed that performance status and serum calcium level significantly associated with both OS and TNT, and multivariate analysis revealed that the higher serum calcium level had a significantly unfavorable impact on OS and TNT. Importantly, staging informed by the international staging system (ISS) was not predictive for OS or TNT in the analyzed cohort. Our study revealed that, in the context of first-line MP therapy for NDMM, the salvage therapy incorporating novel agents produced a survival period of >30 months after the initiation of second-line therapy, suggesting that the predictive value of ISS for OS and TNT may be limited in the era of novel agents.

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Acknowledgments

We wish to thank Drs. M. Matsuda, T. Hamada, T. Kida, T. Kohara, K. Miyamoto, M. Shindo, Y. Matsumura, Y. Yoshii, Y. Adachi, H. Yagi, M. Iida, and all researchers of the KMF for their scientific support.

Conflict of interest

This work was partly supported by a research fund from the Celgene Corporation (Summit, NJ).

Author information

Authors and Affiliations

  1. Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan

    Junya Kuroda, Yuji Shimura & Masafumi Taniwaki

  2. Department of Hematology, Osaka Saiseikai Nakatsu Hospital, 2-10-39 Shibata, Kita-ku, Osaka, 530-0012, Japan

    Kensuke Ohta

  3. Department of Hematology and Rheumatology, Kinki University Faculty of Medicine, Sayama, Osaka, 589-8511, Japan

    Hirokazu Tanaka & Itaru Matsumura

  4. Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan

    Hirohiko Shibayama & Yuzuru Kanakura

  5. Department of Internal Medicine, Toyonaka Municipal Hospital, Toyonaka, Osaka, 560-8565, Japan

    Satoru Kosugi

  6. Department of Hematology, Social Insurance Kyoto Hospital, Kyoto, 603-8151, Japan

    Shinichi Fuchida & Chihiro Shimazaki

  7. Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, 606-8507, Japan

    Masayuki Kobayashi & Akifumi Takaori-Kondo

  8. Department of Hematology, Osaka Red Cross Hospital, Osaka, 543-8555, Japan

    Hitomi Kaneko & Mitsuru Tsudo

  9. Department of Hematology, Matsushita Memorial Hospital, Moriguchi, Osaka, 570-8540, Japan

    Nobuhiko Uoshima

  10. First Department of Internal Medicine, Kansai Medical University, Moriguchi, Osaka, 570-0074, Japan

    Kazuyoshi Ishii & Shosaku Nomura

  11. Department of Hematology, Graduate School of Medicine, Osaka City University, Osaka, 545-8585, Japan

    Masayuki Hino

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  1. Junya Kuroda
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  2. Yuji Shimura
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  3. Kensuke Ohta
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Kansai Myeloma Forum Investigators

Corresponding author

Correspondence to Junya Kuroda.

Additional information

J. Kuroda and Y. Shimura contribute equal to this study.

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Kuroda, J., Shimura, Y., Ohta, K. et al. Limited value of the international staging system for predicting long-term outcome of transplant-ineligible, newly diagnosed, symptomatic multiple myeloma in the era of novel agents. Int J Hematol 99, 441–449 (2014). https://doi.org/10.1007/s12185-014-1539-5

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  • DOI: https://doi.org/10.1007/s12185-014-1539-5

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