Patients with multiple myeloma refractory to induction therapy in the current era of novel agents have poor outcomes compared with those achieving a partial response or better, according to a recent study published online ahead of print in the American Journal of Hematology.

The American Cancer Society estimates that nearly 27,000 Americans will be diagnosed with multiple myeloma in 2015, and more than 11,200 will die from the disease in the same year.

The use of novel agents, such as lenalidomide and carfilzomib, has resulted in improved overall survival for patients with multiple myeloma, but limited data demonstrating the impact of refractoriness to these agents when used as initial therapy exist.

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For the study, researchers from the Mayo Clinic in Rochester, MN, sought to evaluate the survival difference between patients achieving at least a partial response to induction therapy and those were refractory to initial induction therapy.

Researchers analyzed data from 816 consecutive patients treated for multiple myeloma at their institution since 2006.

Results showed that median overall survival from the start of therapy was 7.6 years for responding patients vs 3.6 years for primary refractory patients (P<0.001). When only patients who received novel agents as part of induction therapy were included, the median overall survival was 7.9 years and 3.6 years, respectively (P<0.001).

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The analysis demonstrated a median overall survival of not reached, 6.1, 6.4, and 4.2 years for patients achieving a complete response, very good partial response, partial response, or less than partial response, respectively.

The findings suggest that patients with multiple myeloma refractory to initial induction therapy should be studied further to assess predictors of resistance.


  1. Majithia N, Rajkumar SV, Lacy MQ, et al. Outcomes of primary refractory multiple myeloma and the impact of novel therapies. Am J Hematol. 2015. [epub ahead of print]. doi: 10.1002/ajh.24131.