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A018 Whole-Body MRI in Asymptomatic Plasma Cell Disease
Clinical Studies Including Transplantation another 81 patients are still awaited. Both groups were comparable with regard to age, myeloma stage, and prognostic factors, including cytogenetics and ISS stage. Results: 94% of the patients in the nodonor group had at least a PR (35% CR, 32% VGPR, and 26% PR) versus 96% of the patients in the donor group (40% CR, 34% VGPR, and 22% PR). After a median follow-up of 38 months after HDM, PFS and OS were also comparable between the 2 groups. Median PFS was 32 months versus 28 months for the donor group and no-donor group, respectively (P = .44), and median OS was 61 months and 54 months (P = .14). Among the 98 patients in the donor group who had an alloSCT nonrelapse mortality was 10% at 1 year and 13% at 3 years after alloSCT. Conclusion: This first preliminary analysis showed no improvement of tandem auto-allo RIC as part of first-line therapy in myeloma as compared autoSCT followed by maintenance therapy. A longer follow-up might be needed for definite conclusions. An update of the results including those patients with yet unknown tissue typing status and longer follow-up will be presented.
A018 Whole-Body MRI in Asymptomatic Plasma Cell Disease J Hillengass,1 K Fechtner,1 C Heiss,1 T Hielscher,2 K Neben,3 S Delorme,3 MA Weber,1 H Goldschmidt5 1
Department of Radiology, University of Heidelberg; 2Department
of Biostatistics German Cancer Research Center; 3Department of Hematology, Oncology and Rheumatology, University of Heidelberg; 4Department of Radiology German Cancer Research Center; 5Department of Hematology, Oncology and Rheumatology University of Heidelberg
Introduction and Aims: Magnetic resonance imaging (MRI) is the most sensitive technique for the detection of multiple myeloma (MM) lesions. While MRI of the axial skeleton has been used in most previous studies in patients with plasma cell disorders, modern magnetic resonance tomographs allow imaging of the whole body within reasonable time. In the present study, the prognostic value of this technique for progression into a higher stage of plasma cell disease was analyzed. Materials and Methods: In 250 individuals with monoclonal gammopathy of undetermined significance (MGUS; n = 84), asymptomatic MM (n = 149, including 16 patients with plasmacytoma and systemic disease according to other factors) and solitary plasmacytoma (n = 17) were examined with whole-body MRI on a 1.5 T-system. The examined region comprised head, thorax, abdomen, and legs excluding the distal forearms. Staging of patients was applied according to the classification proposed by the international myeloma working group with no respect to the MRI findings. Retrospectively, the effect of the presence of focal lesions in the axial (spine and pelvis) and extra-axial skeleton (all other parts of the body) as well as the whole body (including soft tissue) on progression-free survival was investigated by multivariate analyses, respectively. Progression of disease was defined as transition from MGUS to MM and from asymptomatic MM and plasmacytoma to a higher stage according to the Durie-Salmon classification. Results: In individuals with MGUS, 6 of 84 (9%) had focal lesions (1 to 3 lesions), 6 of 17 (35%) plasmacytoma patients had more than 1 focal lesion (2
S6
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to >20), and 42 of 149 (28%) patients with asymptomatic MM had focal lesions (1 to > 20). The presence of focal lesions was a significant adverse prognostic factor independent from the region, axial, extra-axial or whole body, examined with each P value < .001. Furthermore, an increasing number of lesions were correlated with a higher probability of progression. Conclusion: The presence and number of focal lesions detected in whole-body MRI has a high adverse prognostic significance for patients with plasma cell disease who would not require systemic therapy according to current standards.
A028 Superior Outcomes with Recent Treatments for Myeloma KB Delasalle, M Wang, S Thomas, S Giralt, R Alexanian University of Texas M. D. Anderson Cancer Center, Houston, TX
In recent years, progressively longer survival for patients with multiple myeloma has been observed with earlier diagnosis, better control of complications, and superior programs of chemotherapy. In this retrospective review, we describe response rates and survival among similar groups of patients, aged 22-65 years, who received different high-dose, pulse dexamethasone regimens (D alone or with interferon, melphalan or VAD for 569 patients 1987-2000), with thalidomide (TD for 136 patients 2001-2003), or with bortezomib/thalidomide (or lenalidomide; BTD or BLD for 53 patients 2004-2007). Primary response rates based on Bladé criteria improved serially from 62% for D, to 74% for TD and to 89% for BTD or BLD (P < .01), with corresponding increase of complete remission (CR) rates from 6%, 10%, to 17% (P = .01). More patients received intensive therapy (usually high-dose melphalan) supported by autologous stem cells within the first year (HDT) after TD, BTD, or BLD than after earlier D when insurance support was less available (77% vs. 44%; P < .01), so that overall frequencies of CR increased from 14% to 23% and to 40% with each program (P < .01). Aside from grade 3 neuropathy from bortezomib in 8% of patients, side effects with BTD or BLD were infrequent, and usually mild and reversible. All patients on TD, BTD, or BLD received anticoagulation with therapeutic intent. Consequently, median survival was prolonged from 4.4 years after D, to projections longer than 5.5 years after TD, BTD, or BLD (P < .01). One or two courses of BTD or BLD induced rapid onset of remission within 2 months and a very high primary response rate (89%). When followed by early intensive treatment supported by autologous blood stem cells, the eventual frequency of CR among all patients was high (40%) and the projected survival was longer than that observed previously.
A030 Long-Term Care Guidelines for Myeloma Patients D Moran,1 E Bilotti,1 S Rome,2 T Richards,3 BM Faiman,4 K Colson,5 J Westphal,6 J Tariman,7 JE Spong,8 K Miller,9 T Miceli,10 E McCullagh,11 PA Mangan,12 G Love,13 K Lilleby,14 BS Jenkins,15 D Doss,5 K Daily,16 P Bertolotti2 1
Hackensack University Medical Center, Hackensack, NJ; 2Cedars-
Clinical Lymphoma & Myeloma Supplement February 2009
A018 Whole-Body MRI in Asymptomatic Plasma Cell Disease J Hillengass,1 K Fechtner,1 C Heiss,1 T Hielscher,2 K Neben,3 S Delorme,3 MA Weber,1 H Goldschmidt5 1
Department of Radiology, University of Heidelberg; 2Department
of Biostatistics German Cancer Research Center; 3Department of Hematology, Oncology and Rheumatology, University of Heidelberg; 4Department of Radiology German Cancer Research Center; 5Department of Hematology, Oncology and Rheumatology University of Heidelberg
Introduction and Aims: Magnetic resonance imaging (MRI) is the most sensitive technique for the detection of multiple myeloma (MM) lesions. While MRI of the axial skeleton has been used in most previous studies in patients with plasma cell disorders, modern magnetic resonance tomographs allow imaging of the whole body within reasonable time. In the present study, the prognostic value of this technique for progression into a higher stage of plasma cell disease was analyzed. Materials and Methods: In 250 individuals with monoclonal gammopathy of undetermined significance (MGUS; n = 84), asymptomatic MM (n = 149, including 16 patients with plasmacytoma and systemic disease according to other factors) and solitary plasmacytoma (n = 17) were examined with whole-body MRI on a 1.5 T-system. The examined region comprised head, thorax, abdomen, and legs excluding the distal forearms. Staging of patients was applied according to the classification proposed by the international myeloma working group with no respect to the MRI findings. Retrospectively, the effect of the presence of focal lesions in the axial (spine and pelvis) and extra-axial skeleton (all other parts of the body) as well as the whole body (including soft tissue) on progression-free survival was investigated by multivariate analyses, respectively. Progression of disease was defined as transition from MGUS to MM and from asymptomatic MM and plasmacytoma to a higher stage according to the Durie-Salmon classification. Results: In individuals with MGUS, 6 of 84 (9%) had focal lesions (1 to 3 lesions), 6 of 17 (35%) plasmacytoma patients had more than 1 focal lesion (2
S6
•
to >20), and 42 of 149 (28%) patients with asymptomatic MM had focal lesions (1 to > 20). The presence of focal lesions was a significant adverse prognostic factor independent from the region, axial, extra-axial or whole body, examined with each P value < .001. Furthermore, an increasing number of lesions were correlated with a higher probability of progression. Conclusion: The presence and number of focal lesions detected in whole-body MRI has a high adverse prognostic significance for patients with plasma cell disease who would not require systemic therapy according to current standards.
A028 Superior Outcomes with Recent Treatments for Myeloma KB Delasalle, M Wang, S Thomas, S Giralt, R Alexanian University of Texas M. D. Anderson Cancer Center, Houston, TX
In recent years, progressively longer survival for patients with multiple myeloma has been observed with earlier diagnosis, better control of complications, and superior programs of chemotherapy. In this retrospective review, we describe response rates and survival among similar groups of patients, aged 22-65 years, who received different high-dose, pulse dexamethasone regimens (D alone or with interferon, melphalan or VAD for 569 patients 1987-2000), with thalidomide (TD for 136 patients 2001-2003), or with bortezomib/thalidomide (or lenalidomide; BTD or BLD for 53 patients 2004-2007). Primary response rates based on Bladé criteria improved serially from 62% for D, to 74% for TD and to 89% for BTD or BLD (P < .01), with corresponding increase of complete remission (CR) rates from 6%, 10%, to 17% (P = .01). More patients received intensive therapy (usually high-dose melphalan) supported by autologous stem cells within the first year (HDT) after TD, BTD, or BLD than after earlier D when insurance support was less available (77% vs. 44%; P < .01), so that overall frequencies of CR increased from 14% to 23% and to 40% with each program (P < .01). Aside from grade 3 neuropathy from bortezomib in 8% of patients, side effects with BTD or BLD were infrequent, and usually mild and reversible. All patients on TD, BTD, or BLD received anticoagulation with therapeutic intent. Consequently, median survival was prolonged from 4.4 years after D, to projections longer than 5.5 years after TD, BTD, or BLD (P < .01). One or two courses of BTD or BLD induced rapid onset of remission within 2 months and a very high primary response rate (89%). When followed by early intensive treatment supported by autologous blood stem cells, the eventual frequency of CR among all patients was high (40%) and the projected survival was longer than that observed previously.
A030 Long-Term Care Guidelines for Myeloma Patients D Moran,1 E Bilotti,1 S Rome,2 T Richards,3 BM Faiman,4 K Colson,5 J Westphal,6 J Tariman,7 JE Spong,8 K Miller,9 T Miceli,10 E McCullagh,11 PA Mangan,12 G Love,13 K Lilleby,14 BS Jenkins,15 D Doss,5 K Daily,16 P Bertolotti2 1
Hackensack University Medical Center, Hackensack, NJ; 2Cedars-
Clinical Lymphoma & Myeloma Supplement February 2009