Thalidomide plus dexamethasone is an effective salvage regimen for myeloma patients relapsing after autologous transplant.
OBJECTIVE
High-dose therapy followed by autologous transplant (AT) is the effective induction treatment for newly diagnosed multiple myeloma (MM) patients. The best salvage therapy has not been defined; treatment options include thalidomide plus dexamethasone (TD), AT and conventional chemotherapy (CC). The aim of the study was to define the best treatment option for patients relapsing after AT.


METHODS
We compared the outcome of 90 MM patients treated at diagnosis with AT and then salvaged with TD (43 patients), AT (28 patients) or CC (19 patients). The major prognostic factors, the median times between diagnosis and start of salvage treatment and the progression-free survival (PFS) from diagnosis were similar among the three groups.


RESULTS
The response rate was higher after salvage AT and after TD, and lower after CC (P < 0.001). TD significantly prolonged PFS from first relapse (P < 0.0001). Median PFS was 20.3 months after TD, 9 months after AT, and 4.5 months after CC. Overall survival (OS) from first relapse was significantly improved by TD (median OS 55.5 months) but not by AT (15 months) or CC (27.5 months) (P = 0.008). Multivariate analysis indicated that TD and age were the only independent risk factors associated with improved outcome.


CONCLUSIONS
TD improved PFS and OS in myeloma patients relapsing after AT.
Palumbo
Antonio
A
Divisione di Ematologia dell'Università di Torino, Torino, Italy.
Falco
Patrizia
P
Ambrosini
Maria Teresa
MT
Petrucci
Maria Teresa
MT
Musto
Pellegrino
P
Caravita
Tommaso
T
Pregno
Patrizia
P
Bertola
Alessandra
A
Cavallo
Federica
F
Ciccone
Giovannino
G
Boccadoro
Mario
M
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003907:Dexamethasone / Q000008:administration & dosage*; D004341:Drug Evaluation; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000401:mortality / Q000628:therapy; D012008:Recurrence; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods* / Q000401:mortality; D016019:Survival Analysis; D013792:Thalidomide / Q000008:administration & dosage*; D014182:Transplantation, Autologous; D016896:Treatment Outcome
D013792:Thalidomide; D003907:Dexamethasone