Superiority of thalidomide and dexamethasone over vincristine-doxorubicindexamethasone (VAD) as primary therapy in preparation for autologous transplantation for multiple myeloma.
The aim of the present study was to compare thalidomide-dexamethasone (Thal-Dex) and vincristine-doxorubicin-dexamethasone (VAD) as primary therapy in preparation for autologous peripheral blood stem-cell (PBSC) transplantation for multiple myeloma (MM). For this purpose, we performed a retrospective matched case-control analysis of 200 patients who entered 2 consecutive studies from 1996 to 2004 and received Thal-Dex (n = 100) or VAD (n = 100) administered for 4 months before collection of PBSCs and autologous transplantation. Matching criteria included age, clinical stage, and serum beta2-microglobulin levels. In comparison with VAD, Thal-Dex resulted in a significantly higher response rate (52% versus 76%, respectively; P < .001) and effected more profound reduction in myeloma cell mass of both immunoglobulin G (IgG; P = .02) and IgA (P = .03) type. More frequent toxicities included nonfatal deep vein thrombosis with Thal-Dex (15%) and granulocytopenia with VAD (12%). In each of the 2 treatment groups, 91% of patients proceeded to PBSC mobilization. The median number of collected CD34+ cells was 7.85 x 10(6)/kg in the Thal-Dex group and 10.5 x 10(6)/kg in the control group. Thal-Dex may be considered an effective and relatively well-tolerated oral alternative to the more complex VAD regimen as front-line therapy for MM patients who are candidates for subsequent autologous transplantation.
Cavo
Michele
M
Institute of Hematology and Medical Oncology Seràgnoli, via Massarenti 9, 40138, Bologna, Italy. mcavo@med.unibo.it
Zamagni
Elena
E
Tosi
Patrizia
P
Tacchetti
Paola
P
Cellini
Claudia
C
Cangini
Delia
D
de Vivo
Antonio
A
Testoni
Nicoletta
N
Nicci
Chiara
C
Terragna
Carolina
C
Grafone
Tiziana
T
Perrone
Giulia
G
Ceccolini
Michela
M
Tura
Sante
S
Baccarani
Michele
M
D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D016022:Case-Control Studies; D003907:Dexamethasone / Q000008:administration & dosage* / Q000009:adverse effects; D004317:Doxorubicin / Q000008:administration & dosage* / Q000009:adverse effects; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D009101:Multiple Myeloma / Q000628:therapy*; D012189:Retrospective Studies; D013792:Thalidomide / Q000008:administration & dosage* / Q000009:adverse effects; D014750:Vincristine / Q000008:administration & dosage* / Q000009:adverse effects
D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D013792:Thalidomide; D014750:Vincristine; D003907:Dexamethasone; D004317:Doxorubicin