Induction and maintenance therapy in multiple myeloma: a multicenter trial of MP versus VCMP

Peest, D.; Deicher, H.; Coldewey, R.; Schmoll, H.-J.; Schedel, I.

doi:10.1016/0277-5379(88)90160-5

Cited by 46 publications

(19 citation statements)

References 22 publications

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“…With this approach, the median duration of response is long and not improved by maintenance. In other randomised series in which the induction treatment was stopped after a fixed number of courses (Peest et al, 1988) or after a fixed period of therapy (Cohen et al, 1979;Kildahl-Andersen et al, 1988), the duration of shorter responses was improved by maintenance, but there was not a survival advantage over stopping the treatment after induction. Cytostatic maintenance may indeed continue the effect of previous induction therapy in selecting plasma cell clones with aneuploidy and/or expressing the p170 glycoprotein (Ucci et al, 1992), which are often drug resistant.…”

Section: Toxicity Of Induction Therapymentioning

confidence: 93%

Treatment of multiple myeloma according to the extension of the disease: a prospective, randomised study comparing a less with a more aggressive cytostatic policy

Riccardi

Ucci²,

Luoni³

et al. 1994

Br J Cancer

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Summary The purpose of the study was to ascertain whether the prognostic significance of staging in multiple myeloma (MM) is influenced by the aggressiveness of effective induction treatment and/or by continuing or discontinuing maintenance chemotherapy. Patients patients, still independent of both induction and post-induction policies. In MM, the significance of staging for survival is independent of both the aggressiveness of induction policy and of continuing or discontinuing maintenance chemotherapy after the maximal tumour reduction has been achieved. Both MPH-P and the association of PTC, VCR and P are effective in inducing first response and also second response in patients failing on the alternative regimen, but PTC-VCR-P causes more side-effects. Thus, the overwhelming majority of patients with MM can safely be given MPH-P as first therapy, and this treatment may be delayed in early disease.Attempts to improve survival of the general population of patients with multiple myeloma (MM) have been focused mainly on chemotherapies more aggressive than the standard melphalan-prednisone (MPH-P) regimen, irrespective of the extent of the disease. Little has been done to evaluate, in prospective studies, the survival value of tailoring therapy according to the stage of the disease, as is done with several other tumours in spite of there being no doubt that early Correspondence: A. Riccardi,

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Section: Toxicity Of Induction Therapymentioning

confidence: 93%

Treatment of multiple myeloma according to the extension of the disease: a prospective, randomised study comparing a less with a more aggressive cytostatic policy

Riccardi

Ucci²,

Luoni³

et al. 1994

Br J Cancer

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“…Since the introduction of chemotherapy with melphalan and prednison (MP) for multiple myeloma two decades ago [1], no other drug combination has been convincingly shown to induce a better survival despite increased remission rates with several different schedules [2,3]. In a phase II study we have found that the multidrug combination vincristine, BCNU, adriamycin, melphalan, dexamethasone (VBAMDex) could induce considerably higher remission rates with acceptable toxicity than expected for MP both in untreated and in pre treated myeloma patients [4].…”

Section: Introductionmentioning

confidence: 99%

Melphalan and Prednisone (MP) versus Vincristine, BCNU, Adriamycin, Melphalan and Dexamethasone (VBAMDex) Therapy for Multiple Myeloma

Peest

Deicher²,

Coldewey³

et al. 1990

Oncol Res Treat

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136 untreated multiple myeloma patients of stage II and III were collected in the study. 37/51 stage II patients had progressive disease and were treated with melphalan and prednisone (MP). 85 patients were of stage III and randomized into MP and vincristine, BCNU, adriamycin, melphalan and dexamethasone (VBAMDex) treatment groups. 55% of MP treated patients responded versus 75% of the VBAMDex group. Since the study has been activated only 16 months ago, no difference in survival could be observed.

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“…Time to first relapse was significantly shorter in the no maintenance group (P ¼ 0.0011). Peest et al 6 reported similarly significant prolongations in time to relapse/progression using a maintenance regimen of either MP or VCMP (vincristine, cyclophosphamide, melphalan, prednisone). Neither of these studies, however, was able to demonstrate an overall survival benefit over the no-maintenance control group.…”

Section: Discussionmentioning

confidence: 92%

Sequential, cycling maintenance therapy for post transplant multiple myeloma

Chen

Nanji

Prabhu

et al. 2005

Bone Marrow Transplant

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High-dose chemotherapy with autologous stem cell transplantation in patients with newly diagnosed multiple myeloma can prolong survival but is not curative. Maintenance therapy post transplant may prolong the diseasefree interval and impact overall survival. We have conducted a phase II pilot study of 28 post transplant myeloma patients treated with a sequential, cycling maintenance regimen. The regimen was designed to include a variety of active myeloma agents chosen for ease of administration to enhance patient compliance and scheduled sequentially to minimize toxicity. The 12-month cycling schedule included dexamethasone (months 1-3); melphalan and prednisone (months 4, 5); cyclophosphamide and prednisone (months 6, 7); a-interferon (months 8-10); followed by a drug holiday (months 11, 12). The regimen was generally well tolerated with five patients developing reversible grade III-IV toxicity (diabetes-induced hyperglycemia in four, neutropenia in one). There was one toxic death on study due to non-neutropenic pneumonia and sepsis. Median event-free survival from transplant was 36.9 months (95% CI 23.6 -upper limit not yet reached) with median overall survival not yet reached at a median follow-up of 44 months. This concept of cycling, sequential maintenance with various agents, perhaps including newer biological, targeted agents, warrants further investigation in multiple myeloma.

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Induction and maintenance therapy in multiple myeloma: a multicenter trial of MP versus VCMP

Cited by 46 publications

References 22 publications

Treatment of multiple myeloma according to the extension of the disease: a prospective, randomised study comparing a less with a more aggressive cytostatic policy

Treatment of multiple myeloma according to the extension of the disease: a prospective, randomised study comparing a less with a more aggressive cytostatic policy

Melphalan and Prednisone (MP) versus Vincristine, BCNU, Adriamycin, Melphalan and Dexamethasone (VBAMDex) Therapy for Multiple Myeloma

Sequential, cycling maintenance therapy for post transplant multiple myeloma

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