Magnitude of response with myeloma frontline therapy does not predict outcome: Importance of time to progression in southwest oncology group chemotherapy trials
Magnitude of response with myeloma frontline therapy does not predict outcome: Importance of time to progression in southwest oncology group chemotherapy trials
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DOI：
10.1200/jco.2004.05.111
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发表时间：
2004-05-15
影响因子：
45.3
通讯作者：
Crowley, J
中科院分区：
文献类型：
--
作者：
Durie, BGM;Jacobson, J;Crowley, J
目的：对1982 ~ 1992年西南肿瘤组（SWOG）提出的4种治疗多发性骨髓瘤（MM）的标准剂量化疗方案进行评价。目的是澄清特定水平的骨髓瘤相关的单克隆蛋白减少和时间的预测价值，以第一次进展，使用成熟的datasets.Patients和MethodsStudy数据1,555符合条件的先前未经治疗的MM患者入组到SWOG III期试验8229，8624，9028，和9210在这些分析中使用。6个月和12个月的里程碑分析进行评估的结果为患者在每个response category.ResultsThe的整体和事件树的生存率为四个协议相结合，分别为33个月和18个月。使用6个月和12个月的标志，在标志之前没有疾病进展的患者中，应答者（大于或等于50%且大于或等于75%回归）与无应答者的30至35个月中位生存期没有差异。相反，在6个月和12个月的里程碑，发生疾病进展的患者的中位生存期分别为13个月和15个月，而未发生疾病进展的患者的中位生存期为34个月。使用的考克斯生存模型，与反应和进展被认为是时间依赖性的协变量，生存期的影响更进展的发生比由response.ConclusionThe反应的幅度，作为一个单一的变量，不预测生存期。缓解和疾病稳定的患者结局相同。只有疾病进展的患者预后较差。生存的最佳指标是至首次进展的时间。(C)2004年，美国临床肿瘤学会。
PurposeFour Southwest Oncology Group (SWOG) standard-dose chemotherapy protocols for multiple myeloma (MM) initiated between 1982 and 1992 were evaluated. The purpose was to clarify the predictive value of specific levels of myeloma-associated monoclonal protein reduction and time to first progression using mature data sets.Patients and MethodsStudy data on 1,555 eligible previously untreated patients with MM enrolled onto SWOG phase III trials 8229, 8624, 9028, and 9210 were used in these analyses. Six-month and 12-month landmark analyses were performed to evaluate the outcome for patients in each response category.ResultsThe overall and event-tree survivals for the four protocols combined were 33 months and 18 months, respectively. Using 6- and 12-month landmarks, the median survivals of 30 to 35 months were not different for responders ( greater than or equal to 50% and greater than or equal to 75% regression) versus nonresponders in patients without disease progression before the landmarks. Conversely, at the 6- and 12-month landmarks, the median survivals for patients who had experienced disease progression were 13 and 15 months, respectively, versus a 34-month median for patients who did not experience progression. Using the Cox survival model, with response and progression considered as time-dependent covariates, survival duration was influenced more by the occurrence of progression than by the occurrence of response.ConclusionThe magnitude of response, as a single variable, does not predict survival duration. Patients with response and stable disease have equivalent outcome. Only patients with progressive disease have a poorer outcome. The best indicator of survival is time to first progression. (C) 2004 by American Society of Clinical Oncology.