title: Phase II study of cyclophosphamide, interferon-alpha and betamethasone (CIB) as induction therapy for patients 60-75 years of age with multiple myeloma stages II and III.
abstract: Cyclophosphamide, interferon-alpha and betamethasone are all effective agents for the treatment of multiple myeloma (MM) with different mechanisms of action. The clinical effect of a combination of cyclophosphamide 725 mg/m(2) i.v. days 1 and 3, interferon-alpha 7 x 10(6) IE/m(2) s.c./day, days 1-4 and betamethasone 30 mg orally days 1-4 (CIB) was studied in patients aged 60-75 years with previously untreated MM stages II and III. Granulocyte-macrophage colony-stimulating factor (GM-CSF) 5 microg/kg/day s.c. was administered to all patients from day 5 until the day the granulocyte count exceeded 1.0 x 10(9)/l. CIB was repeated every fourth week. Interferon-alpha 3 x 10(6) IE s.c. t.i.w. was given as maintenance therapy in responding patients.A total of 28 patients (median age: 67 years) entered the study. In all, 12 patients had stage II and 16 had stage III MM. A total of 22 patients (79%) showed an objective response, including five complete remissions (CR) and 17 partial remissions (PR). All seven patients with Bence-Jones MM responded (five CR and two PR). The median response duration time was 14 months (range 5-38+). CIB was relatively well tolerated although febrile neutropenia or septicaemia occurred in 5% of the cycles and a dose-reduction of cyclophosphamide due to grade IV neutropenia was performed in 11% of the patients.CIB seems to be an effective regimen for remission induction in MM patients aged up to 75 years as an alternative to VAD (vincristine, doxorubicin, dexamethasone) if a regimen with intensity higher than that of oral melphalan/prednisone is warranted.
authors.affiliation: Department of Hematology, Karolinska Hospital, Stockholm, Sweden.
authors.forename: Jeanette
authors.initials: J
authors.lastname: Lundin
authors.forename: Anders
authors.initials: A
authors.lastname: Osterborg
authors.forename: Magnus
authors.initials: M
authors.lastname: Björkholm
authors.forename: Bo
authors.initials: B
authors.lastname: Björkstrand
authors.forename: Fredrik
authors.initials: F
authors.lastname: Celsing
authors.forename: Viktoria
authors.initials: V
authors.lastname: Hjalmar
authors.forename: Olle
authors.initials: O
authors.lastname: Linder
authors.forename: Michaela
authors.initials: M
authors.lastname: Luthman
authors.forename: Mats
authors.initials: M
authors.lastname: Merup
authors.forename: Ulf
authors.initials: U
authors.lastname: Tidefelt
authors.forename: Hakan
authors.initials: H
authors.lastname: Mellstedt
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use* / Q000633:toxicity; D001536:Bence Jones Protein; D001623:Betamethasone / Q000008:administration & dosage; D003520:Cyclophosphamide / Q000008:administration & dosage; D005260:Female; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000627:therapeutic use; D006801:Humans; D016898:Interferon-alpha / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D009503:Neutropenia / Q000139:chemically induced / Q000517:prevention & control; D011336:Probability; D012074:Remission Induction / Q000379:methods; D018805:Sepsis / Q000139:chemically induced
chemical_list: D016898:Interferon-alpha; D016178:Granulocyte-Macrophage Colony-Stimulating Factor; D003520:Cyclophosphamide; D001536:Bence Jones Protein; D001623:Betamethasone