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Blood, 15 February 2008, Vol. 111, No. 4, pp. 2491. This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by van Rhee, F. Articles by Barlogie, B. Search for Related Content PubMed Articles by van Rhee, F. Articles by Barlogie, B. Related Collections Related Articles in Blood Online Social Bookmarking                   What's this?  Previous Article  |  Table of Contents  |  Next Article  CORRESPONDENCE Response: Top tertile SFLC reduction indeed is an independent feature of myeloma aggressiveness We appreciate the thoughtful comments by Dr Dispenzieri concerning our observations that the one-third of patients with the steepest serum free-light chain (SFLC) reduction after induction cycles 1 and 2 had inferior event-free and overall survivals relative to those with lesser degrees of SFLC response. Dr Dispenzieri suggests that our results did not account for baseline levels and might in fact be a reflection of the fact that those with low baseline SFLC levels have lower percentage reductions and constitute a good prognosis group. While indeed greatest percentage SFLC reduction was observed among subjects with highest baseline SFLC levels, there was considerable overlap in the percentage reduction distributions among baseline SFLC tertile cohorts. We repeated the multivariate analysis suggested, excluding the 30 patients with normal baseline SFLC levels. As shown in Table 1, the results are essentially identical to those we published (Tables 4,51), with only a slight attenuation of P-values due to smaller numbers. We also wish to draw attention to Table 2 of our manuscript,1 which shows that the overall adverse consequences of top-tertile SFLC reduction pertain, in a an attenuated fashion, also to the subset with top-tertile SFLC baseline levels. Thus, our initial expectation that marked SFLC reduction might counteract the negative consequences of high SFLC baseline levels was not supported by clinical outcome results. In fact, as we concluded in our paper, features of myeloma aggressiveness as reflected by high baseline SFLC levels, while associated with more rapid and profound tumor cell kill and higher rates of complete remission, account for rapid tumor regrowth between treatments and ensuing early relapse and disease-related death. View this table: [in this window] [in a new window]   Table 1. Multivariate analysis of baseline parameters as well as of percentage SFLC reduction from baseline to levels obtained prior to cycle 2 of induction therapy and before transplantation, associated with event-free and overall survival, excluding subjects with normal SFLC baseline levels (kappa 1.93; lambda 2.64)      Authorship Top Authorship Reference   Conflict-of-interest disclosure: The authors declare no competing financial interests. Correspondence: Bart Barlogie, Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, 4301 West Markham, Slot 816, Little Rock, AR 72205; e-mail: barlogiebart{at}uams.edu. Frits van Rhee, John Crowley, and Bart Barlogie    Reference Top Authorship Reference   van Rhee F, Bolejack V, Hollmig K, et al. High serum-free light chain levels and their rapid reduction in response to therapy define an aggressive multiple myeloma subtype with poor prognosis. Blood 2007; 110:827–832.[Abstract/Free Full Text] CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? Related Articles in Blood Online: Is early, deep free light chain response really an adverse prognostic factor? Angela Dispenzieri Blood 2008 111: 2490-2491. [Full Text] [PDF] High serum-free light chain levels and their rapid reduction in response to therapy define an aggressive multiple myeloma subtype with poor prognosis Frits van Rhee, Vanessa Bolejack, Klaus Hollmig, Mauricio Pineda-Roman, Elias Anaissie, Joshua Epstein, John D. Shaughnessy, Jr, Maurizio Zangari, Guido Tricot, Abid Mohiuddin, Yazan Alsayed, Gail Woods, John Crowley, and Bart Barlogie Blood 2007 110: 827-832. [Abstract] [Full Text] [PDF] This article has been cited by other articles: A. Dispenzieri, L. Zhang, J. A. Katzmann, M. Snyder, E. Blood, R. DeGoey, K. Henderson, R. A. Kyle, M. M. Oken, A. R. Bradwell, et al. Appraisal of immunoglobulin free light chain as a marker of response Blood, May 15, 2008; 111(10): 4908 - 4915. [Abstract] [Full Text] [PDF] This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by van Rhee, F. Articles by Barlogie, B. Search for Related Content PubMed Articles by van Rhee, F. Articles by Barlogie, B. Related Collections Related Articles in Blood Online Social Bookmarking                   What's this?

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