title: Metronomic therapy is an effective salvage treatment for heavily pre-treated relapsed/refractory multiple myeloma.
abstract: Relapsed/refractory multiple myeloma represents a major challenge in multiple myeloma therapy. For patients with relapsed/refractory multiple myeloma, we developed a treatment schema of metronomically scheduled drug therapy. We identified 186 patients who had been treated with metronomic therapy between March 2004 and January 2012 with a median follow up of 24.2 months. Median age was 61 years (range 36-83). Median number of prior therapies was 14 (range 1-51). Median number of completed metronomic therapy cycles was 1 (range 1-5), while 45 of 186 (25%) received 2 or more cycles. Responses included complete remission in 11 of 186 patients (6%), very good partial remission in 12 of 186 (7%), partial remission in 65 of 179 (36%), and minimal response in 29 of 186 (16%), for an overall response rate of 63% (117 of 186). Median overall survival and progression-free survival were 11.2 and 3.6 months, respectively. Hematologic toxicity grading was problematic as 146 of 186 (78%) of patients presented with at least grade 2 thrombocytopenia within 90 days prior to starting metronomic therapy. Grade 4 leukopenia, anemia, and/or thrombocytopenia following metronomic therapy occurred in 108 of 186 (58%), 12 of 186 (6%), and 147 of 186 (79%) patients, respectively. Incidence of grade 3-4 neutropenic fever was 4 of 186 (2%). Most patients (177 of 186, 95%) were treated in an outpatient unit and secondary admissions due to regimen-related toxicity occurred in 37 of 186 (20%). Treatment-related mortality was evident in 2 of 186 (1%). In conclusion, metronomic therapy is an effective late salvage treatment in relapsed/refractory multiple myeloma, with a high overall response rate and a favorable toxicity profile.
authors.affiliation: Myeloma Institute for Research and Therapy, Little Rock, AR, USA.
authors.forename: Xenofon
authors.initials: X
authors.lastname: Papanikolaou
authors.forename: Jackie
authors.initials: J
authors.lastname: Szymonifka
authors.forename: Adam
authors.initials: A
authors.lastname: Rosenthal
authors.forename: Christoph J
authors.initials: CJ
authors.lastname: Heuck
authors.forename: Alan
authors.initials: A
authors.lastname: Mitchell
authors.forename: Donald
authors.initials: D
authors.lastname: Johann
authors.forename: Jason
authors.initials: J
authors.lastname: Keller
authors.forename: Sarah
authors.initials: S
authors.lastname: Waheed
authors.forename: Saad Z
authors.initials: SZ
authors.lastname: Usmani
authors.forename: Frits
authors.initials: F
authors.lastname: Van Rhee
authors.forename: Clyde
authors.initials: C
authors.lastname: Bailey
authors.forename: Nathan
authors.initials: N
authors.lastname: Petty
authors.forename: Antje
authors.initials: A
authors.lastname: Hoering
authors.forename: John
authors.initials: J
authors.lastname: Crowley
authors.forename: Bart
authors.initials: B
authors.lastname: Barlogie
mesh_terms: D059250:Administration, Metronomic; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002945:Cisplatin / Q000008:administration & dosage; D003907:Dexamethasone / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000401:mortality*; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000401:mortality*; D016879:Salvage Therapy / Q000379:methods*; D015996:Survival Rate / Q000639:trends; D013792:Thalidomide / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D013792:Thalidomide; D003907:Dexamethasone; D004317:Doxorubicin; D002945:Cisplatin