title: Evaluation of low-dose thalidomide as induction and maintenance therapy in patients with multiple myeloma not eligible for stem cell transplantation.
abstract: BACKGROUND
  The role of thalidomide in induction and long-term maintenance therapy in patients with multiple myeloma not eligible for stem cell transplantation remains unclear. The aim of the present study was to evaluate the effect of low-dose thalidomide as induction therapy and as maintenance therapy for 24 months in patients with a complete remission after the induction chemotherapy and to monitor the survival and relapse rates.
  
  
  METHODS
  Between October 2005 and September 2013, 50 patients with multiple myeloma received six courses of Cyclophosphamide-Vincristine Adriamycin and Dexamethazone (c-VAD) and pamidronate, and thalidomide 100 mg daily during induction, then thalidomide 100 mg daily for 24 months as maintenance. The effects of thalidomide were assessed objectively and subjectively. Whenever necessary, electromyography and nerve capacity volume were performed monthly for 6 months, then once every 3 months until the end of treatment.
  
  
  RESULTS
  Primary response was 96% (CR or very good PR in 48/50 patients). Fifteen out of the remaining 48 patients relapsed during the follow-up period. Nine out of the 15 patients who relapsed showed very good partial response to treatment and four patients showed partial response. Survival rate was 81% in these patients. The primary outcome measures showed a mean and median progression-free survival of 33 and 27 months, respectively, and a mean and median overall survival of 43 and 39 months, respectively.
  
  
  CONCLUSIONS
  Low-dose thalidomide during induction therapy combined with conventional chemotherapy and a 2-year maintenance may be effective in preventing the relapse and improving the overall survival.
authors.affiliation: Internal Medicine Department, Talaghani Hospital, Kermanshah University of Medical Science, Kermanshah, Iran.
authors.forename: Mozaffar
authors.initials: M
authors.lastname: Aznab
authors.affiliation: Department of Biostatistics, Social Development and Health Promotion Research Center, Public Health College, Kermanshah University of Medical Sciences, Kermanshah, Iran.
authors.forename: Mansour
authors.initials: M
authors.lastname: Rezaei
authors.affiliation: Internal Medicine Department, Talaghani Hospital, Kermanshah University of Medical Science, Kermanshah, Iran.
authors.forename: Jafar
authors.initials: J
authors.lastname: Navabi
authors.affiliation: Internal Medicine Department, Talaghani Hospital, Kermanshah University of Medical Science, Kermanshah, Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Moieni
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D060828:Induction Chemotherapy; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy*; D015996:Survival Rate; D013792:Thalidomide / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D013792:Thalidomide
keywords: C-VAD; induction; maintenance; multiple myeloma; thalidomide