Low‐dose thalidomide in combination with oral weekly cyclophosphamide and pulsed dexamethasone is a well tolerated and effective regimen in patients with relapsed and refractory multiple myeloma

Kyriakou, Charalampia; Thomson, Kirsty; D’Sa, Shirley; Flory, Angela J.; Hanslip, J; Goldstone, Anthony H.; Yong, Kwee

doi:10.1111/j.1365-2141.2005.05521.x

Cited by 104 publications

(49 citation statements)

References 46 publications

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“…Combining thalidomide with dexamethasone improves its efficacy in relapsed MM and phase II studies have reported an ORR of 41-56%. 59,60 The efficacy is further improved when thalidomide is used in triple or even quadruple combinations, including thalidomide with dexamethasone and bortezomib (VTD), dexamethasone and cyclophosphamide (CTD), bortezomib plus melphalan and prednisone (VMPT) or dexamethasone (VMDT), lenalidomide, melphalan and prednisone (RMPT), or VTD with pegylated liposomal doxorubicin. 23,[61][62][63][64][65][66] These regimens have been associated with an ORR of 63-90% with CR being reported in 2-35% of patients.…”

Section: Thalidomidementioning

confidence: 99%

Treatment of relapsed and refractory multiple myeloma

2016

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Section: Thalidomidementioning

confidence: 99%

Treatment of relapsed and refractory multiple myeloma

2016

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“…The regimen containing cyclophosphamide, thalidomide, and dexamethasone was well tolerated and effective in patients with relapsed MM, achieving ORR of 83-90% [16,17]. The combination of cyclophosphamide, bortezomib, and dexamethasone induced ORR in up to 75% of refractory or relapsed MM patients [15].…”

Section: Discussionmentioning

confidence: 94%

“…In refractory or relapsed myeloma, combinations including thalidomide or bortezomib with dexamethasone and cyclophosphamide have been extensively investigated [14][15][16][17][18]. The regimen containing cyclophosphamide, thalidomide, and dexamethasone was well tolerated and effective in patients with relapsed MM, achieving ORR of 83-90% [16,17].…”

Section: Discussionmentioning

confidence: 99%

Salvage treatment with upfront melphalan 100 mg/m2 and consolidation with novel drugs for fulminant progression of multiple myeloma

et al. 2009

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Patients (pts) with fulminant progression (FPG) of multiple myeloma (MM) after autologous stem cell transplantation (ASCT) have poor prognosis. Pancytopenia, extramedullary disease, and/or renal impairment are often present, and treatment options are limited. We have retrospectively evaluated 31 pts with FPG of MM after ASCT who were treated upfront salvage therapy with melphalan 100 mg/m 2 (MEL 100) followed by PBSC support and consolidation therapy using regimens containing thalidomide (n=16) or bortezomib (n=15). The overall response rate (ORR) was 58% (18/31). After MEL 100, one patient achieved complete remission (3%), 26% of pts very good partial remission, 29% of pts partial remission, and 42% of pts stable disease. Progression within 3 months after MEL 100 occurred in 35% of pts. The median follow-up from MEL 100 was 8 months. The median TTP was 5 months (range, 2-15 months), and the median OS was 8 months (range, 3-23 months). There were no treatment-related deaths. In fulminant progression of MM, upfront MEL 100 is a safe salvage regimen with good response rate (ORR, 58%). Treatment with upfront MEL 100 followed by a thalidomide-or bortezomibbased regimen can prolong overall survival to more than 12 months in 33% of pts with fulminant progression of MM.

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“…[26][27][28][29][30][31][32] Please see Table 1 for a summary of studies evaluating thalidomide-alkylator combinations. Overall, the available data suggest that the risk of TEE for patients with NDMM is similarly increased whether they are being treated with concurrent MPT or TD, whereas the risk for RRMM patients receiving thalidomide-cyclophosphamide combination therapy is minimally, if at all, increased over baseline.…”

Section: Thalidomide Plus Cytotoxic Chemotherapymentioning

confidence: 99%

Thrombotic Complications of Myeloma Therapy

Zonder

2006

Hematology

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Patients with multiple myeloma are at relatively high baseline risk of developing thromboembolic events (TEE), usually deep vein thromboses. There are numerous contributing factors, among them certain treatment regimens that include thalidomide or related compounds such as lenalidomide combined with glucocorticoids and/or cytotoxic chemotherapy. The risk of developing TEE appears to be particularly high when these immunomodulatory agents are combined with anthracyclines as treatment of newly-diagnosed disease. Up-front combinations including thalidomide plus pulse dexamethasone and/or alkylating agents are associated with an intermediate risk, whereas the same regimens for relapsed/refractory myeloma seem to be associated with the lowest risk. Several different thromboprophylaxis strategies have been effective in lowering the risk of developing clots: daily aspirin (81-325 mg/day), full-intensity warfarin (INR 2-3), and prophylactic enoxaparin (40 mg SQ daily). Low, fixed-dose warfarin may also reduce the risk of TEE, but the data on this are disputable. None of these TEE prevention strategies have been prospectively compared head-to-head, so the choice often reflects physician and/or patient preferences. The available evidence upon which one might make such a decision is reviewed here.Individuals with multiple myeloma (MM) are at increased risk for developing thromboembolic events (TEE) compared to the general population. 1 The exact incidence is difficult to determine since reported TEE rates likely vary according to the level of diagnostic vigilance. For example, in one retrospective chart review at the Cleveland Clinic, which has an established imaging algorithm for evaluating patients with MM and monoclonal gammopathy of uncertain significance who have symptoms of a possible TEE, the reported rate was approximately 10%.1 In contrast, the rates documented in patients treated with melphalan-prednisone or dexamethasone as part of large multicenter studies without uniform algorithms for documenting TEE were 5% and 3%, respectively.2,3 It is likely the actual background incidence falls in the 5-10% range. Factors that have been suggested as contributory to the risk of TEE in people with MM include newly diagnosed disease status 4 ; immobility due to pain and/or surgery; indwelling central venous catheters; extrinsic venous compression by plasmacytomas; acquired abnormalities in platelet function, 5 clotting factors, 6 and the coagulation cascade 7-9 ; the presence of inherited factors such as Factor V Leiden; and treatment with immunomodulatory agents including thalidomide and lenalidomide. The risk of developing TEE during therapy with combination regimens containing thalidomide and lenalidomide will be discussed, followed by recommendations on prevention and treatment.

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Low‐dose thalidomide in combination with oral weekly cyclophosphamide and pulsed dexamethasone is a well tolerated and effective regimen in patients with relapsed and refractory multiple myeloma

Cited by 104 publications

References 46 publications

Treatment of relapsed and refractory multiple myeloma

Treatment of relapsed and refractory multiple myeloma

Salvage treatment with upfront melphalan 100 mg/m2 and consolidation with novel drugs for fulminant progression of multiple myeloma

Thrombotic Complications of Myeloma Therapy

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