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Oral
combination of melphalan, prednisone and thalidomide
in elderly patients with multiple myeloma Since
1960 standard treatment for multiple myeloma patients older than 65 years
of age has remained oral melphalan and prednisone. So far no major
improvement in outcome from the original combination MP has been achieved
in these elderly patients and new treatments are urgently needed.
Thalidomide is an immunomodulatory drug with strong antimyeloma activity.
It is an effective treatment for multiple myeloma at disease recurrence
and at diagnosis, both as a single agent and in combination with steroids
or chemotherapy. Few data are available on the association of thalidomide
with standard chemotherapy in newly diagnosed elderly patients. We
recently described a randomised trial that compared oral melphalan and
prednisone plus thalidomide (MPT) with MP alone in 60 to 85 years old
patients. Two
hundred and fifty-five myeloma patients at diagnosis received either oral
MP for six four-week cycles plus thalidomide or MP alone. Patients in MPT
arm experienced higher response rates (76% versus 48%) than patients who
were not. Event-free survival was significantly improved, by approximately
16 months, in patients who received thalidomide as compared with those who
did not. In the MPT group the frequency of adverse events was higher, but
this frequency was reduced by standard procedures. In
conclusion oral MPT is superior to MP as first-line treatment for elderly
patients with multiple myeloma in term of response rate and event-free
survival. Longer follow-up is needed to assess the effect on overall
survival. Our prospective randomised study provides the first evidence that the oral combination of melphalan prednisone and thalidomide is more effective than standard treatment.
Bibliographical reference: Sara
Bringhen, Antonio Palumbo Divisione
di Ematologia dell'Università di Torino, Azienda Ospedaliera San Giovanni
Battista, Torino, Italy
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