Combination therapy with thalidomide plus dexamethasone for newly diagnosed myeloma.
OBJECTIVE
Multiple myeloma is a malignancy of plasma cells and is characterized by increased marrow angiogenesis. Thalidomide, an agent with antiangiogenic properties, is effective in relapsed myeloma. We report the results of a study combining thalidomide and dexamethasone as initial therapy for myeloma.


METHODS
Fifty patients with newly diagnosed myeloma were studied. Thalidomide was given at a dose of 200 mg/d orally. Dexamethasone was given at a dose of 40 mg/d orally on days 1 to 4, 9 to 12, and 17 to 20 (odd cycles) and 40 mg/d on days 1 to 4 (even cycles), repeated monthly.


RESULTS
Of all 50 patients, a confirmed response was seen in 32 patients yielding a response rate of 64% (95% confidence interval, 49% to 77%). Thirty-one patients (62%) proceeded to stem-cell collection after four cycles of therapy including 26 who underwent stem-cell transplantation and five who chose stem-cell cryopreservation. Major grade 3 or 4 toxicities were observed in 16 patients (32%), and the most frequent were deep vein thrombosis (six patients), constipation (four patients), rash (three patients), and dyspnea (two patients). Three deaths occurred during active therapy because of a pancreatitis, pulmonary embolism, and infection.


CONCLUSIONS
We conclude that the combination of thalidomide plus dexamethasone is a feasible and active regimen in the treatment of multiple myeloma. It merits further study as an oral alternative to infusional chemotherapy with vincristine, doxorubicin, and dexamethasone and other intravenous regimens currently used as pretransplantation induction therapy for myeloma.
Rajkumar
S Vincent
SV
Division of Hematology, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA. rajks@mayo.edu
Hayman
Suzanne
S
Gertz
Morie A
MA
Dispenzieri
Angela
A
Lacy
Martha Q
MQ
Greipp
Philip R
PR
Geyer
Susan
S
Iturria
Nancy
N
Fonseca
Rafael
R
Lust
John A
JA
Kyle
Robert A
RA
Witzig
Thomas E
TE
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D003248:Constipation / Q000139:chemically induced; D003907:Dexamethasone / Q000008:administration & dosage; D004417:Dyspnea / Q000139:chemically induced; D005076:Exanthema / Q000139:chemically induced; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000473:pathology; D013792:Thalidomide / Q000008:administration & dosage; D020246:Venous Thrombosis / Q000139:chemically induced*
D013792:Thalidomide; D003907:Dexamethasone