Long-Term Progression-Free Survival in Patients Treated With RVD Induction and Risk-Adapted Maintenance.

Abstract

Background: A subset of patients with newly diagnosed multiple myeloma (NDMM) achieves prolonged remission following modern induction and maintenance, but predictors of long-term progression-free survival (PFS) and the durability of remission beyond a decade remain incompletely defined.

Methods: We retrospectively analyzed 1000 consecutive NDMM patients treated with lenalidomide, bortezomib, and dexamethasone (RVD) induction followed by risk-adapted maintenance from 2007 to 2016. Patients diagnosed after October 2015 were excluded to ensure ≥10 years of follow-up. Long-term progression-free survivors (LT-PFS) were defined as remaining progression-free for ≥10 years. Demographics, clinical characteristics, and outcomes were compared between LT-PFS and non-LT-PFS groups, and logistic regression identified predictors of LT-PFS. Survival was estimated by the Kaplan-Meier method, with a landmark analysis among patients progression-free at 10 years.

Results: Among 774 patients analyzed, 165 (21.3%) achieved LT-PFS. Compared with non-LT-PFS patients, LT-PFS patients were younger, had lower disease stage, more favorable cytogenetics, more often received maintenance therapy, and achieved deeper responses to induction therapy. Median cohort PFS was 4.6 years, with a 10-year PFS rate of 26.2%. Landmark analysis demonstrated continued risk of late events, with 17% of LT-PFS patients experiencing progression or death beyond 10 years, and median PFS not reached.

Conclusion: Approximately one-fifth of NDMM patients treated with RVD-based therapy achieved sustained remission at 10 years, though a meaningful risk of late relapse persisted. Favorable disease biology, younger age, and maintenance therapy are associated with long-term PFS. These findings define a clinically relevant long-term remission state and provide a benchmark for evaluating outcomes with contemporary quadruplet regimens.