Serum C-reactive protein at diagnosis and response to therapy is the most powerful factor predicting outcome of multiple myeloma treated with thalidomide/ anthracycline-based therapy.
BACKGROUND
Few studies have focused on factors affecting outcome in patients with multiple myeloma (MM) treated with thalidomide-based therapy. We investigated factors affecting response, progression-free survival (PFS), and overall survival (OS) in patients with MM treated with the thalidomide, dexamethasone, and pegylated liposomal doxorubicin (ThaDD) regimen with the aim to select patients benefiting more from this therapy.


METHODS
Sixty-six patients with MM were treated first line with the ThaDD regimen. We analyzed demographics and disease-related characteristics to search for factors affecting response (> or = very good partial remission [VGPR] vs. < VGPR], PFS, and OS.


RESULTS
Overall, 45 patients (68%) showed response > or = VGPR; median TTP and OS were 23.5 months and 35.5 months, respectively. Multivariate analysis selected only serum C-reactive protein (sCRP) as a predictive factor for response (P < .0001). By multivariate analysis, normal sCRP level (P = .001) and response to treatment > or = VGPR (P = .007) were found to be associated with longer PFS. The factors that remained significantly associated with a longer OS when assessed by multivariate analysis were normal sCRP level (P = .005) and response to therapy > or = VGPR (P = .019).


CONCLUSIONS
Serum C-reactive protein before therapy and response after therapy are the only factors useful in identifying patients benefiting from anthracycline/thalidomide-based therapy.
Clinica di Ematologia Azienda Ospedaliero-Universitaria, Ospedali Riuniti Ancona, Italy. m.offidani@ospedaliriuniti.marche.it
Massimo
M
Offidani
Laura
L
Corvatta
Claudia
C
Polloni
Maria-Novella
MN
Piersantelli
Piero
P
Galieni
Giuseppe
G
Visani
Francesco
F
Alesiani
Massimo
M
Catarini
Marino
M
Brunori
Maurizio
M
Burattini
Riccardo
R
Centurioni
Mario
M
Ferranti
Luciano
L
Giuliodori
Marco
M
Candela
Anna
A
Mele
Monica
M
Marconi
Pietro
P
Leoni
D000368:Aged; D018943:Anthracyclines / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D015415:Biomarkers / Q000032:analysis*; D002097:C-Reactive Protein / Q000032:analysis*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000097:blood* / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D011379:Prognosis; D012307:Risk Factors; D016019:Survival Analysis; D013792:Thalidomide / Q000008:administration & dosage; D016896:Treatment Outcome
D018943:Anthracyclines; D015415:Biomarkers; D013792:Thalidomide; D002097:C-Reactive Protein