title: Thalidomide in combination with vincristine, epirubicin and dexamethasone (VED) for previously untreated patients with multiple myeloma.
abstract: The present study aimed to evaluate the side-effects and efficacy of thalidomide in combination with an anthracycline-containing chemotherapy regimen in previously untreated myeloma patients. Thalidomide (400 mg/d) was combined with bolus injections of vincristine and epirubicin and oral dexamethasone (VED). Chemotherapy cycles were repeated every 3 wk until no further reduction in myeloma protein was observed, whereas the treatment with thalidomide was continued until disease progression. Thirty-one patients were enrolled, 12 patients were exclusively treated with thalidomide in combination with VED and 19 patients additionally received high-dose melphalan, for consolidation. Adverse events and response to therapy were assessed prior to treatment with high-dose chemotherapy. Response to thalidomide combined with VED was complete remission in six patients (19%), partial remission in 19 patients (61%), stable disease in five patients (16%), and progressive disease in one patient (3.2%). Grade 3 and 4 adverse events consisted of leukocytopenia in 10 patients (32%), and thrombocytopenia and anemia in one patient each (3.2%). Neutropenic infections grade 3 and 4 occurred in seven (23%) and three patients (9.7%), respectively, including two patients (6.5%) who died from septic shock. Deep vein thrombosis occurred in eight patients (26%), constipation in 20 patients (65%), and polyneuropathy in 20 patients (65%). The probability of event-free survival and overall survival in the whole group of patients at 36 months were 26 and 62%, respectively. In conclusion, the combination of thalidomide with VED appears to be highly effective in previously untreated patients with multiple myeloma, but it is associated with a high rate of thrombotic events, polyneuropathy, and neutropenic infections.
authors.affiliation: Department of Internal Medicine (Cancer Research), West German Cancer Center, University of Essen Medical School, Essen, Germany. philipp.schuett@uni-essen.de
authors.forename: P
authors.initials: P
authors.lastname: Schütt
authors.forename: P
authors.initials: P
authors.lastname: Ebeling
authors.forename: U
authors.initials: U
authors.lastname: Buttkereit
authors.forename: D
authors.initials: D
authors.lastname: Brandhorst
authors.forename: B
authors.initials: B
authors.lastname: Opalka
authors.forename: M
authors.initials: M
authors.lastname: Hoiczyk
authors.forename: M
authors.initials: M
authors.lastname: Flasshove
authors.forename: J
authors.initials: J
authors.lastname: Hense
authors.forename: P
authors.initials: P
authors.lastname: Bojko
authors.forename: K
authors.initials: K
authors.lastname: Metz
authors.forename: T
authors.initials: T
authors.lastname: Moritz
authors.forename: S
authors.initials: S
authors.lastname: Seeber
authors.forename: M R
authors.initials: MR
authors.lastname: Nowrousian
mesh_terms: D000328:Adult; D000368:Aged; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D003907:Dexamethasone / Q000008:administration & dosage; D015251:Epirubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy*; D012074:Remission Induction; D013792:Thalidomide / Q000008:administration & dosage* / Q000009:adverse effects; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D020533:Angiogenesis Inhibitors; D015251:Epirubicin; D013792:Thalidomide; D014750:Vincristine; D003907:Dexamethasone