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Plateau phase in multiple myeloma: an analysis of long‐term follow‐up of 432 patients
Author(s) -
Oivanen Tiina M.
Publication year - 1996
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1046/j.1365-2141.1996.413952.x
Subject(s) - medicine , melphalan , multiple myeloma , plateau (mathematics) , chemotherapy , gastroenterology , multivariate analysis , creatinine , incidence (geometry) , prednisolone , surgery , mathematical analysis , physics , mathematics , optics
Data from an 8‐year follow‐up of 432 myeloma patients were analysed for incidence, duration and prognostic value of plateau phase and factors favouring its achievement. The first‐line chemotherapy was melphalan and prednisolone in 121 cases, combination chemotherapy in 311 cases. The survival times were similar despite different response rates. Any response resulted in survival significantly ( P <0.001) better than in patients with progressive disease, but the level of response had no influence in this respect. A plateau of at least 3 months was achieved in 81%, at least 6 months in 74%, at least 12 months in 59% and at least 24 months in 33%. Groups with significantly different ( P <0.001) survivals were identified: a plateau of <3 months, 3–11 months, 12–23 months, and 24 months or longer, with median survivals of 10, 27, 46 and 81 months, respectively. In the multivariate analysis of pretreatment variables, only haemoglobin (Hb) ( P <0.001) and creatinine at 2 months ( P <0.01) were significant for a plateau >12 months. After inclusion of chemotherapy data, Hb and time taken to reach the best response were still significant ( P =0.002). The predictive power of high Hb and slow response for achieving a plateau of 6 or 12 months was 79%. Accordingly, the criteria for response of treatment for multiple myeloma should include a stable period of at least 3 months; the criteria for a plateau a stable period of at least 12 months in order to have real prognostic significance.