Long-term outcome in relapsed and refractory multiple myeloma treated with thalidomide. Balancing efficacy and side-effects.
A total of 303 MM patients were retrospectively reviewed to evaluate long-term efficacy and toxicity of thalidomide alone or in combination with steroids. Overall response rate was 57% (CR/VGPR 12%). Median TTP, PFS and OS were 13.4 months, 20.6 months, and 26.2 months, respectively. PFS and OS were significantly different according to response (p < 0.0001), with better outcome in patients achieving CR/VGPR (PFS and OS 35.4 months and 63 months, respectively). PFS and OS of patients achieving SD or PR were overlapping (p = 0.3). The addition of steroids significantly increased the response rate (p = 0.01). The most clinically relevant complications were neuropathy (40%), constipation (26%), thromboembolic events (7%). Thalidomide was reduced for toxicity in 68 patients (24%) and permanently discontinued in 36 (12%). In conclusion, thalidomide produces high response rate in relapsed/refractory MM. The best outcome is observed in patients with good quality response, but even patients with suboptimal response may obtain durable survival.
Divisione di Ematologia, Fondazione IRCCS Policlinico S. Matteo, Università di Pavia, Pavia, Italy. a.corso@smatteo.pv.it
Alessandro
A
Corso
Patrizia
P
Zappasodi
Luciana
L
Barbarano
Maria Teresa
MT
Petrucci
Antonio
A
Palumbo
Tommaso
T
Caravita
Silvia
S
Mangiacavalli
Anna Maria
AM
Cafro
Marzia
M
Varettoni
Francesca
F
Gay
Enrica
E
Morra
Mario
M
Lazzarino
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy*; D012008:Recurrence; D012189:Retrospective Studies; D013792:Thalidomide / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
D013792:Thalidomide