%0 Journal Article
%T Curability of Multiple Myeloma
%A Raymond Alexanian
%A Kay Delasalle
%A Michael Wang
%A Sheeba Thomas
%A Donna Weber
%J Bone Marrow Research
%D 2012
%I Hindawi Publishing Corporation
%R 10.1155/2012/916479
%X Among 792 patients with multiple myeloma treated from 1987 to 2010 and assessed after 18 months, there were 167 patients with complete remission. For those 60 patients treated between 1987每1998 and with long followup, the latest relapse occurred after 11.8 years, so that 13 patients have remained in sustained complete remission for longer than 12 years (range 12每22 years). These results suggest that 3% of all patients treated during that period may be cured of multiple myeloma. In addition to immunofixation, more sensitive techniques for the detection of residual disease should be applied more consistently in patients with apparent complete remission in order to identify those with potential cure. 1. Introduction In recent years, there have been major advances in the treatment of multiple myeloma, due to new agents, superior drug combinations, and widespread use of intensive therapy supported by autologous stem cells [1每5]. Thus, remission of disease has been achieved in 85每90% of currently treated patients, including 30每40% with complete remission (CR) [5每8]. This paper assessed the potential for curability among 792 patients with newly diagnosed myeloma treated at a single center over a long time span. 2. Patients and Methods Between 1987每2010, we identified 792 newly diagnosed patients treated with primary, intermittent, high-dose dexamethasone-based regimens in sequential protocols (e.g., VAD, combinations with thalidomide, bortezomib, etc.) [1每3, 7, 8]. Patients older than 65 were excluded in order to assess results among those more likely to receive intensive therapy. Patients with nonsecretory or ※hyposecretory§ disease (e.g., only Bence Jones protein <50ˋmg/day) were excluded in order to define remission status clearly (Table 1). In order to assess the impact of improved treatments and the impact of prolonged complete remission (CR), we assessed outcomes separately for those treated initially between 1987每1998 or 1999每2010. None of the patients treated between 1987每1998 had received thalidomide, lenalidomide, or bortezomib at diagnosis, but approximately 25% had received at least one of these drugs upon relapse; in contrast, all of the 330 patients treated between 1999每2010 had received at least one of those drugs as part of primary or salvage therapy. Cytogenetics was not evaluated since few patients were studied during the early treatment period. Table 1: Patient population (1987每2010). Among all patients, intensive therapy (HDT) supported by autologous stem cells had been given within 1 year to 35% of those treated between 1987每1998 and to
%U http://www.hindawi.com/journals/bmr/2012/916479/