Induction treatment with cyclophosphamide, thalidomide, and dexamethasone in newly diagnosed multiple myeloma: a phase II study.
BACKGROUND
Thalidomide has alternative mechanisms of action; it can be combined with dexamethasone or alkylating agents for the treatment of multiple myeloma (MM); however, the optimal doses and appropriate intervals of thalidomide continue to be debated.


METHODS
We assessed the clinical efficacy and toxicity of thalidomide in patients with newly diagnosed MM; 68 patients were treated with pulsed cyclophosphamide, thalidomide, and dexamethasone (CTD) chemotherapy for induction treatment.


RESULTS
After a median of 28 months' follow-up, the overall response rate was 79.4%, with a 42.6% complete response (CR) or very good partial response (VGPR). Patients with cytogenetically high-risk disease had poor CR/VGPR rates (27.3%) at a median of 11.5 months of time to progression (TTP) compared with patients with standard-risk disease who achieved CR/VGPR rates (50%) at a median of 20.3 months of TTP. The major adverse events included peripheral sensory neuropathy (14.3%), infection (10.2%), and thromboembolic complications (5.9%). Thirty-two patients who achieved more than a PR proceeded to peripheral blood stem cell collection with a median number of 5.0 x 106 CD34+ cells/kg collected.


CONCLUSIONS
CTD resulted in a favorable response with tolerable toxicity in patients with MM and did not affect the yield of the stem cell collection.
Chonnam National University Hwasun Hospital, Republic of Korea, Jeollanam-do, Republic of Korea.
Deok-Hwan
DH
Yang
Yeo-Kyeoung
YK
Kim
Sang-Kyun
SK
Sohn
Joo-Seop
JS
Chung
Young-Don
YD
Joo
Jae-Hoon
JH
Lee
Jung-Lim
JL
Lee
Jae-Sook
JS
Ahn
Joon-Ho
JH
Moon
Ho-Jin
HJ
Shin
Young-Jin
YJ
Choi
Won-Sik
WS
Lee
Hyeoung-Joon
HJ
Kim
Je-Jung
JJ
Lee
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000008:administration & dosage; D003907:Dexamethasone / Q000008:administration & dosage; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000401:mortality; D013792:Thalidomide / Q000008:administration & dosage
D013792:Thalidomide; D003907:Dexamethasone; D003520:Cyclophosphamide