Reply to S. Girnius et al

CR group), PR was 51% (95% CI, 24% to 74%; P ϭ .005),and NR was 42% (95% CI, 17% to 65%; P Ͻ .001).Patients with a PR had inferior survival compared with those with a VGPR (P ϭ .0287),but similar survival when compared with those with NR (P ϭ .3907).Median EFS was similar for CR and VGPR (63 v 60 months; P ϭ .1909),whereas it was significantly lower for PR and NR (21 and 7 months, respectively).The EFS for PR was different from VGPR (P ϭ .001)and NR (P ϭ .0175).Patients achieving a CR or VGPR after HDM/SCT, as defined by the new criteria, 1 had indistinguishable OS and EFS, with median OS exceeding 9 years.These results are similar to our previous observation that PR with a greater than 90% reduction in serum-involved FLC was associated with a similar OS compared with patients in hematologic CR. 4 VGPR selects the subset of patients without a CR who have durable clinical remission and survival and do not need additional therapy until progression.We are unable to detect an OS difference between PR and NR, although there may be a selection bias, given that patients with NR were presumably less likely to be alive for a 1-year evaluation and were excluded from the analysis.There are limitations in our analysis.First, serum FLCs were not measured regularly before 2003, so compared with our original report, 3 thesurvivalisbasedmoreonestimatesthanactuarialsurvival.Second,our analysis occurred at 1 year, whereas Palladini et al 1 assessed serum FLC responses at 6 months.In our previous report, 3 19% of patients (81 of 421) died before a 1-year evaluation, so patients who were intolerant to therapy or had more aggressive disease were excluded.Last, only 140 patients met inclusion criteria, a number likely too small to detect subtle differences, particularly in the PR and NR groups, which comprised only 15 and 16 patients, respectively.Nonetheless, we conclude that the new response criteria have prognostic value in patients undergoing HDM/ SCTwhoareevaluatedforresponseat1year.Withthistreatment,patients achieving a VGPR have an excellent OS and EFS, indistinguishable from those achieving a CR.