The impact of frontline risk-adapted strategy on the overall survival of patients with newly diagnosed multiple myeloma: An analysis of the Singapore multiple myeloma study group.
Summary of "The impact of frontline risk-adapted strategy on the overall survival of patients with newly diagnosed multiple myeloma: An analysis of the Singapore multiple myeloma study group."
INTRODUCTION:
Risk stratification is vital for prognostication and informing treatment decisions in multiple myeloma (MM). We study the prognostic values of the International Staging System (ISS) and underlying cytogenetics in the bortezomib era, and assess the impacts of an upfront risk-adapted approach in the treatment of MM.
METHODS:
We compare the overall survival (OS) of 221 MM patients diagnosed from 2006-2009 (era 2) where upfront bortezomib combination was approved for high-risk MM with the OS of 262 patients diagnosed from 2000 to 2005 (era 1) where bortezomib could only be administered at relapse. High-risk MM is defined by presence ISS III disease with renal impairment or adverse cytogenetics.
RESULTS:
Baseline characteristics were comparable between the 2 eras. At median follow-up of 20 months, 0% and 26% of patients had received frontline bortezomib in eras 1 and 2 respectively. The median OS were 4.2 years and not reached for eras 1 and 2 respectively (p=0.03). On multivariate analysis stratified by era, the most significant prognostic factor shifts from cytogenetics in era 1 to the quality of response in era 2
CONCLUSION:
Frontline use of bortezomib in a risk-adapted manner may avert early mortality and is better able to overcome adverse risks compared to its sequential use. © 2012 John Wiley & Sons A/S.
Affiliation
Department of Hematology, Singapore General Hospital, Singapore.
Journal Details
This article was published in the following journal.
Name: European journal of haematology
ISSN: 1600-0609
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/22553948
- DOI: http://dx.doi.org/10.1111/j.1600-0609.2012.01797.x
Medical and Biotech [MESH] Definitions
Intention To Treat Analysis
Strategy for the analysis of RANDOMIZED CONTROLLED TRIALS AS TOPIC that compares patients in the groups to which they were originally randomly assigned.
Graft Survival
The survival of a graft in a host, the factors responsible for the survival and the changes occurring within the graft during growth in the host.
Risk Reduction Behavior
Reduction of high-risk choices and adoption of low-risk quantity and frequency alternatives.
Survival
Continuance of life or existence especially under adverse conditions; includes methods and philosophy of survival.
Managed Competition
A strategy for purchasing health care in a manner which will obtain maximum value for the price for the purchasers of the health care and the recipients. The concept was developed primarily by Alain Enthoven of Stanford University and promulgated by the Jackson Hole Group. The strategy depends on sponsors for groups of the population to be insured. The sponsor, in some cases a health alliance, acts as an intermediary between the group and competing provider groups (accountable health plans). The competition is price-based among annual premiums for a defined, standardized benefit package. (From Slee and Slee, Health Care Reform Terms, 1993)
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