Maintenance therapy with thalidomide improves survival in patients with multiple myeloma.

Abstract

Newer chemotherapeutic protocols as well as high-dose chemotherapy have increased the response rate in myeloma. However, these treatments are not curative. Effective maintenance strategies are now required to prolong the duration of response. We conducted a randomized trial of maintenance treatment with thalidomide and pamidronate. Two months after high-dose therapy, 597 patients younger than age 65 years were randomly assigned to receive no maintenance (arm A), pamidronate (arm B), or pamidronate plus thalidomide (arm C). A complete or very good partial response was achieved by 55% of patients in arm A, 57% in arm B, and 67% in arm C (P = .03). The 3-year postrandomization probability of event-free survival was 36% in arm A, 37% in arm B, and 52% in arm C (P < .009). The 4-year postdiagnosis probability of survival was 77% in arm A, 74% in arm B, and 87% in arm C (P < .04). The proportion of patients who had skeletal events was 24% in arm A, 21% in arm B, and 18% in arm C (P = .4). Thalidomide is an effective maintenance therapy in patients with multiple myeloma. Maintenance treatment with pamidronate does not decrease the incidence of bone events.

• Authors: Michel Attal, Jean-Luc Harousseau, Serge Leyvraz, Chantal Doyen, Cyrille Hulin, Lofti Benboubker, Ibrahim Yakoub Agha, Jean-Henri Bourhis, Laurent Garderet, Brigitte Pegourie, Charles Dumontet, Marc Renaud, Laurent Voillat, Christian Berthou, Gerald Marit, Mathieu Monconduit, Denis Caillot, Bernard Grobois, Herve Avet-Loiseau, Philippe Moreau, Thierry Facon, Inter-Groupe Francophone du Myélome (IFM)
• Journal: Blood (Blood) Vol. 108 Issue 10 Pg. 3289-94 (Nov 15 2006) ISSN: 0006-4971 [Print] United States
• PMID: 16873668 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Diphosphonates
• Thalidomide
• Pamidronate

Topics

• Aged
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Bone Diseases (etiology)
• Diphosphonates (administration & dosage, toxicity)
• Disease-Free Survival
• Female
• Hematopoietic Stem Cell Transplantation
• Humans
• Male
• Middle Aged
• Multiple Myeloma (complications, mortality, therapy)
• Pamidronate
• Prognosis
• Recurrence
• Remission Induction (methods)
• Salvage Therapy
• Survival Analysis
• Survival Rate
• Thalidomide (administration & dosage, toxicity)