title: Thalidomide plus dexamethasone is an effective salvage regimen for myeloma patients relapsing after autologous transplant.
abstract: 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.
authors.affiliation: Divisione di Ematologia dell'Università di Torino, Torino, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Palumbo
authors.forename: Patrizia
authors.initials: P
authors.lastname: Falco
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Ambrosini
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Petrucci
authors.forename: Pellegrino
authors.initials: P
authors.lastname: Musto
authors.forename: Tommaso
authors.initials: T
authors.lastname: Caravita
authors.forename: Patrizia
authors.initials: P
authors.lastname: Pregno
authors.forename: Alessandra
authors.initials: A
authors.lastname: Bertola
authors.forename: Federica
authors.initials: F
authors.lastname: Cavallo
authors.forename: Giovannino
authors.initials: G
authors.lastname: Ciccone
authors.forename: Mario
authors.initials: M
authors.lastname: Boccadoro
mesh_terms: 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
chemical_list: D013792:Thalidomide; D003907:Dexamethasone