Efficacy and toxicity of the combination chemotherapy of thalidomide, alkylating agent, and steroid for relapsed/refractory myeloma patients: a report from the Korean Multiple Myeloma Working Party (KMMWP) retrospective study

Abstract

We analyzed the treatment responses, toxicities, and survival outcomes of patients with relapsed or refractory multiple myeloma who received daily thalidomide, cyclophosphamide, and dexamethasone (CTD) or daily thalidomide, melphalan, and prednisolone (MTP) at 17 medical centers in Korea. Three‐hundred and seventy‐six patients were enrolled. The combined chemotherapy of thalidomide, corticosteroid, and an alkylating agent (TAS) was second‐line chemotherapy in 142 (37.8%) patients, and third‐line chemotherapy in 135 (35.9%) patients. The response rate overall was 69.4%. Patients who were not treated with bortezomib and lenalidomide before TAS showed a higher response rate compared to those who were exposed to these agents. The estimated median progression‐free survival and overall survival times were 10.4 months and 28.0 months, respectively. The adverse events during TAS were generally tolerable, but 39 (10.4%) patients experienced severe infectious complications. There were no differences in terms of efficacy between CTD and MTP, but infectious complications were more common in CTD group. TAS is an effective treatment regimen which induces a high response rate in relapsed or refractory multiple myeloma patients. Due to the high incidence of grade 3 or 4 infection, proper management of infection is necessary during the TAS treatment, especially the CTD.

A Mini-Review on Thalidomide: Chemistry, Mechanisms of Action, Therapeutic Potential and Anti-Angiogenic Properties in Multiple Myeloma

“…One of these, lenalidomide, is already used for the treatment of the refractory myeloma and it is in phase 2 and 3 clinical trials [16,17]. It is possible that the combination therapy of thalidomide with other anticancer agents or monoclonal antibody could lead to additive or synergistic interactions and also reduce the possibility of chemical resistance [18,19].…”

Treatment of relapsed and refractory multiple myeloma

“…A combination regimen such as thalidomide, alkylating agent, and corticosteroid (TAS) showed a median PFS and OS of 10.4 months and 28.0 months, respectively. However, 10% of patients experienced severe infectious complications that warranted intensive supportive care during the TAS treatment [ 42 ]. While the use of thalidomide in the RRMM setting is now less frequent due to the advent of more potent drugs and due to its considerable side effects, such as peripheral neuropathy, fatigue, and venous thromboembolism, thalidomide plus corticosteroid therapy with or without an alkylating agent could be an option in specific circumstances.…”