Microsoft PowerPoint - Usmani_ASH 2011_TT3 Imaging

Implications of Serial Magnetic Resonance Imaging and Positron Emission Tomography Scanning for
Survival of Previously Untreated Myeloma Patients Treated with Total Therapy 3
Saad Z Usmani1, Alan Mitchell2, Rachel Sexton2, Susan Panozzo1, Bijay Nair1,
Sarah Waheed1, Yazan Alsayed1, John Crowley2 and Bart Barlogie1
1Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR;
2 Cancer Research and Biostatistics, Seattle WA
BACKGROUND
Figure 8: OS and PFS by PET FDG Suppression Prior to Transplant
Magnetic resonance imaging (MRI) and fluorodeoxy-glucose
Figure 2: OS, PFS and CRD MBS
Figure 3: OS, PFS and CRD MRI
(FDG) positron emission tomography (PET) scanning are
Table 1: Patient Characteristics
Overall Survival
Progression-Free Survival
Focal Lesions
by Pre-TX PET FL Resolution (FLR) and GEP-70 Risk
by Pre-TX PET FL Resolution (FLR) and GEP-70 Risk
TT3a
TT3a
100%
100%
increasingly viewed as important state-of-the-art imaging tools
80%
80%
in the initial workup of patients with multiple myeloma (MM) .
Factor
Analysis Population
Progression-Free Survival
Overall Survival
By Baseline MBS Status
By Baseline MRI FL Status
60%
60%
TT3a
TT3a
100%
N = 240
100%
4-Year
4-Year
40%
40%
Events / N
Estimate
Median Age (Yrs)
Events / N
Estimate
80%
80%
a GEP-70 LR: 100% FLR
13 / 65
89% (81.7, 96.8)
a GEP-70 LR: 100% FLR
19 / 65
82% (71.8, 91.3)
b GEP-70 LR: < 100% FLR
12 / 35
69% (53.2, 83.9)
b GEP-70 LR: < 100% FLR
16 / 35
60% (43.8, 76.2)
Recent work from Italian investigators validated our previous
59.3 (32.5 - 74.5)
c GEP-70 HR: 100% FLR
6 / 12
58% (30, 86.6)
20%
c GEP-70 HR: 100% FLR
8 / 12
42% (15, 68.3)
60%
20%
60%
d GEP-70 HR: < 100% FLR
12 / 13
23% (3.5, 42.7)
d GEP-70 HR: < 100% FLR
12 / 13
23% (3.5, 42.7)
e No Baseline PET FL
10 / 71
87% (79.6, 95.1)
e No Baseline PET FL
16 / 71
82% (72.7, 90.7)
Logrank p: a v b = 0.124, a v c = 0.012, b v d < 0.001, c v d = 0.032
Logrank p: a v b = 0.084, a v c = 0.002, b v d < 0.001, c v d = 0.069
report on the prognostic implications of PET scanning in terms
Age >= 65 yr
68/240 (28%)
40%
40%
4-Year
0%
0%
4-Year
Events / N
Estimate
0
2
4
6
8
0
2
4
6
8
Events / N
Estimate
a Baseline MRI FL = 0
6 / 48
90% (80.2, 98.9)
Years After 1st Transplant
Years After 1st Transplant
20%
a Baseline MBS OL = 0
44 / 130
75% (67.9, 82.9)
b Baseline MRI FL 1-7
28 / 95
81% (73, 89.1)
b Baseline MBS OL 1-2
8 / 34
79% (65.8, 93)
20%
of poorer outcome in the presence of higher focal lesion (FL)
Standard Variables
c Baseline MRI FL > 7
28 / 69
62% (50.8, 73.8)
c Baseline MBS OL > 2
41 / 76
57% (45.4, 67.8)
d Baseline DHIM
11 / 28
68% (50.1, 85.6)
Logrank p: a v b = 0.273, a v c = 0.003, b v c = 0.005
Logrank p: a v b = 0.042, a v c = 0.001, b v c = 0.101, c v d = 0.966
0%
0%
0
2
4
6
8
0
2
4
6
8
Years after Initiation of Treatment
number, greater FDG uptake intensity, expressed as
Albumin < 3.5 g/dL
62/240 (26%)
Years after Initiation of Treatment
Progression-Free Survival
Progression-Free Survival
Figure 9: OS and PFS by PET FDG Suppression at Day 7 of VTDPACE
standardized uptake value (SUV), presence of extramedullary
B2M >= 3.5 mg/L
109/240 (45%)
By Baseline MBS Status
By Baseline MRI FL Status
TT3a
TT3a
100%
100%
Induction Cycle 1
disease (EMD) and, importantly, the beneficial consequences of
B2M > 5.5 mg/L
52/240 (22%)
80%
80%
Overall Survival
Creatinine >= 2.0 mg/dL
17/240 (7%)
Progression-Free Survival
by 7-day PET FL Resolution (FLR)
60%
by 7-day PET FL Resolution (FLR)
suppression of FDG avidity after both induction therapy and
60%
TT3a
TT3a
Pairwise Logrank p: a v b = 0.100, a v c = 0.016, b v c = 0.638
Pairwise Logrank p: a v b = 0.267, a v c = 0.033, b v c = 0.477
CRP >= 8 mg/L
79/239 (33%)
100%
40%
40%
4-Year
100%
4-Year
Events / N
Estimate
tandem transplant .
Events / N
Estimate
a Baseline MRI FL = 0
11 / 48
79% (67.7, 90.7)
b Baseline MRI FL 1-7
32 / 95
78% (69.4, 86.4)
20%
a Baseline MBS OL = 0
44 / 130
75% (67.9, 82.9)
20%
80%
Hb < 10 g/dL
77/240 (32%)
b Baseline MBS OL 1-2
8 / 34
79% (65.8, 93)
c Baseline MRI FL > 7
35 / 69
58% (46.3, 69.7)
80%
c Baseline MBS OL > 2
41 / 76
57% (45.4, 67.8)
d Baseline DHIM
15 / 28
57% (38.7, 75.6)
Logrank p: a v b = 0.273, a v c = 0.003, b v c = 0.005
Logrank p: a v b = 0.249, a v c = 0.004, b v c = 0.027, c v d = 0.757
0%
0%
0
2
4
6
8
0
2
4
6
8
60%
60%
LDH >= 190 U/L
56/240 (23%)
Years after Initiation of Treatment
Years after Initiation of Treatment
With a median follow-up in our Total Therapy 3 (TT3) trial
40%
40%
Platelet Count < 150 x 10^9/L
28/240 (12%)
4-Year
4-Year
CR Duration
CR Duration
Events / N
Estimate
Events / N
Estimate
By Baseline MRI FL Status
a No Baseline FL
7 / 44
86% (75.6, 97.2)
a No Baseline FL
11 / 44
82% (69.9, 93.7)
(2003-33) of 6.5 years and a total enrollment of 303 patients, we
By Baseline MBS Status
20%
20%
TT3a
TT3a
b 100% PET FLR
8 / 25
76% (59.3, 92.7)
b 100% PET FLR
9 / 25
76% (59.3, 92.7)
Genetic Variables
100%
100%
c <100% PET FLR
32 / 87
70% (60.3, 79.9)
c <100% PET FLR
39 / 87
66% (55.5, 75.6)
Logrank P-value = .05
Logrank P-value = .09
0%
0%
now report on the collective impact of baseline (BL) and serial
80%
80%
0
2
4
6
8
Cytogenetic abnormalities
83/240 (35%)
0
2
4
6
8
Years from Landmark
Years from Landmark
60%
60%
imaging by MRI and PET on overall survival (OS), progression-
GEP-70 High Risk
32/217 (15%)
40%
40%
4-Year
4-Year
Events / N
Estimate
free survival (PFS) and duration of complete response (CRD), in
Events / N
Estimate
a Baseline MRI FL = 0
4 / 27
89% (77, 100)
GEP-80 High Risk
12/217 (6%)
20%
a Baseline MBS OL = 0
17 / 76
84% (75.7, 92.3)
20%
b Baseline MRI FL 1-7
13 / 60
83% (73.6, 92.7)
b Baseline MBS OL 1-2
3 / 23
87% (73.2, 100)
c Baseline MRI FL > 7
16 / 46
72% (58.7, 84.8)
c Baseline MBS OL > 2
16 / 46
69% (56.1, 82.8)
d Baseline DHIM
3 / 12
75% (50.5, 99.5)
Logrank p: a v b = 0.356, a v c = 0.088, b v c = 0.071
Logrank p: a v b = 0.581, a v c = 0.107, b v c = 0.154, c v d = 0.536
0%
0%
0
2
4
6
8
0
2
4
6
8
Table 2: Univariate Cox Regression Analysis of Laboratory and Imaging
the context of comprehensive baseline (BL) evaluation that
GEP Proliferation Index >= 10
23/217 (11%)
Years after CR Onset
Years after CR Onset
Parameters with OS and PFS
included gene expression profiling (GEP) data in a major subset
GEP Centrosome Index >= 3
50/217 (23%)
of the 240 patients with complete baseline imaging studies and
GEP CD-1 subgroup
10/217 (5%)
Overall Survival
Progression-Free Survival
no prior therapy.
GEP CD-2 subgroup
27/217 (12%)
Variable
n/N (%)
HR (95% CI)
P-
value
R2
HR (95% CI)
P-
value
R2
GEP HY subgroup
75/217 (35%)
Standard Variables
PATIENTS AND METHODS
GEP LB subgroup
36/217 (17%)
1.35 (0.88,
Age >= 65 yr
68/240 (28%)
1.44 (0.89, 2.34)
0.139
2.8%
0.173
2.0%
2.09)
GEP MF subgroup
20/217 (9%)
Figure 4: OS, PFS and CRD PET
Figure 5: OS, PFS and CRD PET
1.43 (0.92,
Analyses were restricted to 240 truly untreated patients in
Albumin < 3.5 g/dL
62/240 (26%)
1.61 (0.98, 2.62)
0.058
3.8%
0.113
2.2%
2.23)
GEP MS subgroup
27/217 (12%)
Focal Lesions
SUV Intensity
TT3, as even one cycle of prior therapy pertaining to 64
109/240
2.25 (1.48,
B2M >= 3.5 mg/L
2.25 (1.40, 3.61)
<.001
14.5%
<.001
14.4%
GEP PR subgroup
22/217 (10%)
(45%)
3.41)
patients had been shown to alter PET results.
4.00 (2.64,
Overall Survival
B2M > 5.5 mg/L
52/240 (22%)
4.18 (2.63, 6.64)
<.001
25.3%
<.001
22.1%
Imaging Variables
Overall Survival
By Maximum Focal Lesion SUV
6.06)
By Baseline PET FL Status
TT3a
TT3a
100%
100%
1.54 (1.02,
Cox regression modeling was employed for overall survival
CRP >= 8 mg/L
79/239 (33%)
1.34 (0.84, 2.15)
0.225
1.9%
0.040
4.0%
Baseline PET FL > 0
156/240 (65%)
80%
2.33)
80%
1.85 (1.23,
(OS) and progression free survival
Baseline PET FL > 3
83/240 (35%)
60%
Hb < 10 g/dL
77/240 (32%)
1.77 (1.11, 2.82)
0.016
6.5%
0.003
7.4%
60%
2.79)
40%
2.79 (1.83,
Baseline MRI FL > 0
164/240 (68%)
40%
4-Year
LDH >= 190 U/L
56/240 (23%)
2.81 (1.75, 4.49)
<.001
16.9%
<.001
16.6%
4-Year
Events / N
Estimate
4.25)
RESULTS
Events / N
Estimate
20%
a Baseline PET FL = 0
17 / 84
85% (76.6, 92.5)
b Baseline PET FL-SUV <= 3.9
14 / 54
80% (68.9, 90.4)
20%
a Baseline PET FL = 0
17 / 84
85% (76.6, 92.5)
c Baseline PET FL-SUV > 3.9
42 / 102
67% (57.5, 75.8)
Baseline MRI FL > 7
69/240 (29%)
b Baseline PET FL 1-3
16 / 73
85% (76.7, 93.1)
c Baseline PET FL > 3
40 / 83
59% (48.4, 69.7)
Logrank p: a v b = 0.349, a v c = 0.003, b v c = 0.128
Genetic Variables
Logrank p: a v b = 0.794, a v c < 0.001, b v c < 0.001
0%
0%
0
2
4
6
8
0
2
4
6
8
Years after Initiation of Treatment
2.09 (1.39,
Years after Initiation of Treatment
Table 1 depicts BL parameters in the 240 patients without any
Baseline MBS OL > 0
110/240 (46%)
Cytogenetic abnormalities
83/240 (35%)
2.53 (1.60, 4.02)
<.001
16.9%
<.001
11.2%
3.14)
3.46 (2.15,
prior therapy in the context of those with up to 1 cycle of
Baseline MBS OL > 2
76/240 (32%)
Progression-Free Survival
Progression-Free Survival
GEP-70 High Risk
32/217 (15%)
4.10 (2.44, 6.88)
<.001
18.5%
<.001
14.7%
By Baseline PET FL Status
By Maximum Focal Lesion SUV
5.59)
TT3a
TT3a
100%
100%
8.77 (4.44,
7.37 (3.81,
treatment, whereas Figure depicts the compliance with
Baseline EMD
14/240 (6%)
GEP-80 High Risk
12/217 (6%)
<.001
17.3%
<.001
16.1%
17.29)
14.26)
80%
80%
1.32 (0.68,
intended imaging frequency.
FL-SUV > 3.9 (Bartel)
102/240 (43%)
GEP TP53 deletion
23/217 (11%)
1.85 (0.94, 3.64)
0.074
3.6%
0.411
0.9%
60%
60%
2.56)
FL-SUV > 4.2 (Cavo)
95/240 (40%)
GEP Centrosome Index >=
2.13 (1.35,
40%
40%
50/217 (23%)
2.46 (1.48, 4.08)
<.001
13.1%
0.001
9.2%
4-Year
4-Year
OS and PFS were adversely affected by the presence of FL
Events / N
Estimate
Events / N
Estimate
3
3.35)
20%
a Baseline PET FL = 0
23 / 84
79% (69.8, 87.3)
20%
a Baseline PET FL = 0
23 / 84
79% (69.8, 87.3)
b Baseline PET FL 1-3
23 / 73
81% (71.6, 90.1)
b Baseline PET FL-SUV <= 3.9
18 / 54
76% (64.2, 87.6)
GEP Proliferation Index >=
3.45 (2.04,
c Baseline PET FL > 3
47 / 83
52% (41.1, 62.6)
c Baseline PET FL-SUV > 3.9
52 / 102
60% (50.2, 69.4)
23/217 (11%)
3.89 (2.21, 6.86)
<.001
13.7%
<.001
11.1%
number at baseline, whether defined by MBS (Figure 2), MRI
Logrank p: a v b = 0.678, a v c < 0.001, b v c < 0.001
Logrank p: a v b = 0.414, a v c = 0.003, b v c = 0.091
0%
0%
10
5.82)
0
2
4
6
8
0
2
4
6
8
Years after Initiation of Treatment
Years after Initiation of Treatment
Imaging Variables
(Figure 3), or PET (Figure 4)
1.67 (1.10,
Baseline MRI FL > 7
69/240 (29%)
1.72 (1.07, 2.76)
0.025
5.7%
0.017
5.1%
CR Duration
2.54)
CR Duration
By Maximum Focal Lesion SUV
OS and PFS were adversely affected by the FL-SUV intensity
By Baseline PET FL Status
TT3a
2.05 (1.36,
TT3a
100%
100%
Baseline MBS OL > 2
76/240 (32%)
2.68 (1.69, 4.24)
<.001
17.5%
<.001
9.8%
3.09)
on PET (Figure 5)
Figure 1: Compliance with intended PET and MRI frequency.
80%
(All
80%
2.43 (1.62,
Baseline PET FL > 3
83/240 (35%)
2.78 (1.75, 4.42)
<.001
19.9%
<.001
15.4%
60%
3.66)
60%
In addition, extra-medullary disease (EMD) detected by PET
patients who began maintenance therapy did so within two years.
102/240
1.87 (1.24,
40%
FL-SUV > 3.9 (Bartel)
1.96 (1.23, 3.13)
0.005
10.1%
0.003
8.9%
40%
4-Year
(43%)
2.82)
4-Year
Events / N
Estimate
a Baseline PET FL = 0
8 / 52
88% (79.4, 97.1)
especially affected OS and PFS unfavorably ( Figure 6).
Events / N
Estimate
20%
b Baseline PET FL-SUV <= 3.9
7 / 38
87% (76.1, 97.6)
2.10 (1.40,
20%
a Baseline PET FL = 0
8 / 52
88% (79.4, 97.1)
b Baseline PET FL 1-3
7 / 45
89% (78.8, 98.8)
c Baseline PET FL-SUV > 3.9
21 / 55
67% (54.9, 79.7)
FL-SUV > 4.2 (Cavo)
95/240 (40%)
2.29 (1.44, 3.65)
<.001
14.6%
<.001
11.9%
c Baseline PET FL > 3
21 / 48
63% (48.8, 76.2)
Logrank p: a v b = 0.721, a v c = 0.013, b v c = 0.064
3.17)
Logrank p: a v b = 0.948, a v c = 0.002, b v c = 0.004
0%
0%
0
2
4
6
8
Years after CR Onset
3.18 (1.64,
0
2
4
6
8
In the context of GEP-defined 70-gene risk model (GEP70), FL
Years after CR Onset
Baseline EMD
14/240 (6%)
2.76 (1.32, 5.76)
0.007
5.5%
<.001
6.7%
6.17)
Timing of FDG-PET
Timing of MRI
0.50 (0.31,
number distinguished significantly poorer outcomes in low-
By Protocol Step
By Protocol Step
Baseline PET CR
82/240 (34%)
0.44 (0.25, 0.79)
0.005
13.6%
0.005
10.2%
0.82)
0.49 (0.26,
risk myeloma whereas, for high-risk disease, only a trend was
Baseline MRI CR
48/240 (20%)
0.33 (0.14, 0.75)
0.009
19.1%
0.025
8.3%
0.92)
observed (Figure 7).
Post-Baseline Variables (Time-dependent)
1.41 (0.92,
PET CR ***
1.53 (0.93, 2.52)
0.092
NA
0.117
NA
Complete FDG suppression prior to first transplant affected
2.18)
Figure 6: OS, PFS and CRD by
Figure 7: OS, PFS and CRD by
0.81 (0.50,
MRI CR ***
0.64 (0.37, 1.11)
0.114
NA
0.366
NA
subsequent OS and PFS favorably (Figure 8), especially in the
1.29)
Extramedullary Disease
GEP-70 Risk and PET
0.43 (0.27,
Clin. CR ***
0.38 (0.23, 0.65)
<.001
NA
<0.001
NA
GEP-70-defined high-risk subset so that such patients fared
Focal Lesions
Table 3: Multivariate Cox Regression Analysis of La
0. bor
0.67)
49 (0.
a
26,
tory and
Clin. PR or Better ***
0.43 (0.22, 0.85)
0.016
NA
0.031
NA
almost as well as the low-risk group.
0.94)
Overall Survival
Overall Survival
Imaging Parameters with OS and PFS
By Baseline EMD Status
By Baseline PET FL Status and GEP-70 Risk
HR Hazard Ratio, 95% CI 95% Confidence Interval, Pvalue from Wald ChiSquare Test in Cox Regression R2:R
TT3a
TT3a
100%
100%
Earlier FDG suppression by day 7 of induction therapy also
squared using method by O'Quigley and Xu, *** Signifies timedependent variable, Rsquared not available
Overall Survival
Progression-Free Survival
80%
80%
favorably affected the subsequent outcomes (Figure 9).
60%
60%
Variable
n/N (%)
HR (95% CI)
P-value
HR (95% CI)
P-value
40%
40%
4-Year
In multivariate analysis, >3 PET lesions featured with poorer
Events / N
Estimate
Multivariate model excluding GEP data
4-Year
a GEP-70 LR: PET FL <= 3
22 / 129
88% (82.7, 94.1)
20%
Events / N
Estimate
b GEP-70 LR: PET FL > 3
22 / 56
68% (55.5, 80.3)
Baseline EMD
8 / 14
43% (16.9, 68.8)
20%
c GEP-70 HR: PET FL <= 3
7 / 13
62% (34.4, 88.6)
B2M > 5.5 mg/L
52/239 (22%)
2.00 (1.21, 3.30)
0.007
2.19 (1.40, 3.43)
<.001
OS (HR=1.98 95%CI, p=0.011) and PFS (HR=1.78, 95%CI,
No Baseline EMD
65 / 226
78% (72.4, 83.3)
d GEP-70 HR: PET FL > 3
15 / 19
32% (11.8, 51.4)
Logrank P-value = .005
Logrank p: a v b < 0.001, a v c < 0.001, b v d = 0.002, c v d = 0.153
0%
0%
0
2
4
6
8
0
2
4
6
8
Years after Initiation of Treatment
Years after Initiation of Treatment
LDH >= 190 U/L
56/239 (23%)
1.91 (1.16, 3.15)
0.011
1.96 (1.25, 3.07)
0.003
p=0.021).
Progression-Free Survival
Progression-Free Survival
By Baseline PET FL Status and GEP-70 Risk
Cytogenetic abnormalities
83/239 (35%)
2.61 (1.59, 4.28)
<.001
2.05 (1.33, 3.17)
0.001
By Baseline PET FL Status
TT3a
TT3a
100%
CONCLUSION
100%
Baseline MBS OL > 2
75/239 (31%)
2.09 (1.26, 3.47)
0.004
1.58 (1.01, 2.46)
0.044
80%
80%
Baseline PET FL > 3
82/239 (34%)
2.33 (1.41, 3.84)
<.001
2.07 (1.34, 3.19)
0.001
The data presented herein confirm and extend the previously
60%
60%
Clin. CR ***
0.26 (0.15, 0.46)
<.001
0.32 (0.20, 0.52)
<.001
40%
4-Year
reported results on the role and utility of MRI and PET imaging
40%
Events / N
Estimate
a GEP-70 LR: PET FL <= 3
34 / 129
82% (75.5, 88.9)
4-Year
20%
b GEP-70 LR: PET FL > 3
27 / 56
59% (46, 71.9)
Multivariate model including GEP data
c GEP-70 HR: PET FL <= 3
8 / 13
62% (34.4, 88.6)
20%
Events / N
Estimate
d GEP-70 HR: PET FL > 3
16 / 19
26% (8, 44.7)
On Study
in the diagnosis and management of newly diagnosed multiple
Baseline EMD
10 / 14
29% (4.9, 52.2)
No Baseline EMD
83 / 226
73% (66.7, 78.4)
Logrank p: a v b = 0.002, a v c = 0.002, b v d = 0.002, c v d = 0.202
GEP-70 LR: B2M > 5.5 mg/dL
47/216 (22%)
2.77 (1.46, 5.25)
0.002
2.65 (1.52, 4.61)
<.001
Logrank P-value = .0003
0%
7-Day
0%
0
2
4
6
8
0
2
4
6
8
Years after Initiation of Treatment
myeloma.
Pre Ind. (Phase 2)
On Study
Years after Initiation of Treatment
GEP-70 High Risk
32/216 (15%)
2.89 (1.53, 5.45)
0.001
2.96 (1.70, 5.17)
<.001
Pre Tx1
Pre Tx1
CR Duration
CR Duration
Cytogenetic abnormalities
78/216 (36%)
2.76 (1.61, 4.73)
<.001
1.86 (1.17, 2.97)
0.009
Presence of MM lesions on MRI and PET, presence of EMD and
By Baseline EMD Status
By Baseline PET FL Status and GEP-70 Risk
Pre Tx2
Pre Tx2
TT3a
TT3a
100%
100%
Baseline PET FL > 3
74/216 (34%)
2.44 (1.43, 4.14)
0.001
2.22 (1.42, 3.46)
<.001
failure of FDG suppression with induction chemotherapy and
Pre Consol.
Pre Consol.
80%
80%
Clin. CR ***
0.30 (0.17, 0.54)
<.001
0.33 (0.20, 0.54)
<.001
Pre Maint.
Pre Maint.
transplantation connote adverse outcome and can serve as
60%
60%
Baseline MBS OL > 2
67/216 (31%)
2.24 (1.32, 3.78)
0.003
NS
40%
40%
4-Year
prognostic indicators of long-term survival.
0
6
12
18
24
0
6
12
18
24
Events / N
Estimate
4-Year
LDH >= 190 U/L
50/216 (23%)
NS
1.96 (1.23, 3.13)
0.005
a GEP-70 LR: PET FL <= 3
11 / 81
90% (83.5, 96.6)
20%
Events / N
Estimate
b GEP-70 LR: PET FL > 3
12 / 33
70% (54, 85.4)
Baseline EMD
3 / 6
50% (10, 90)
20%
c GEP-70 HR: PET FL <= 3
3 / 7
71% (38, 100)
No Baseline EMD
33 / 139
81% (74.7, 87.7)
d GEP-70 HR: PET FL > 3
8 / 11
27% (1, 53.6)
Logrank P-value = .09
HR- Hazard Ratio, 95% CI- 95% Confidence Interval, P-value from Wald Chi-Square Test in Cox Regression
Logrank p: a v b = 0.008, a v c = 0.041, b v d = 0.021, c v d = 0.113
FDG suppression after first transplant was especially
Months from Enrol ment
Months from Enrol ment
0%
0%
0
2
4
6
8
0
2
4
6
8
Multivariate model uses stepwise selection with entry level 0.1 and variable remains if meets the 0.05 level.
Years after CR Onset
Years after CR Onset
NS Not selected for this endpoint
significant in further distinguishing the poor responders within
the GEP70-defined high-risk myeloma.
Conflict of Interest: SU is a consultant to Celgene, Millennium and Onyx, and has received speaking honoraria from Celgene.