Maintenance Treatment with Recombinant Interferon Alfa-2b in Patients with Multiple Myeloma Responding to Conventional Induction Chemotherapy

Abstract

The use of interferon for the induction treatment of multiple myeloma has been shown to be effective in about 20 percent of patients. We studied its effects on long-term survival when it was used for maintenance treatment. Between April 1985 and May 1988, 101 patients with symptomatic multiple myeloma who had had a substantial objective response or a lesser objective response with disappearance of symptoms ("disease stabilization") after 12 courses of induction chemotherapy were randomly assigned to receive recombinant interferon alfa-2b as maintenance therapy (n = 50) or to receive no treatment (n = 51). As of December 1989, 66 of the 101 patients have relapsed (25 given interferon and 41 not treated). The median duration of response (from the time of randomization) was 26 months in the patients given interferon and 14 months in the untreated patients (P = 0.0002). A total of 37 patients have died (14 given interferon and 23 not treated). The median duration of survival (from randomization) was 52 months in the interferon group and 39 months in the control group (P = 0.0526). Among the patients who had had a substantial objective response to induction chemotherapy, the difference in survival time was statistically significant (P = 0.03526). Interferon had to be stopped because of toxic effects in 3 of 12 patients initially treated with 10 MU (megaunits) per square meter of body-surface area. After the dose was reduced to 3 MU per square meter, the only toxic effect was a mild influenza-like syndrome lasting two to three weeks. We conclude that maintenance treatment with interferon prolongs response and survival in patients with multiple myeloma who have responded to conventional induction chemotherapy.

Maintenance treatment with interferon alpha-2b in multiple myeloma: a prospective randomized study from PETHEMA (Program for the Study and Treatment of Hematological Malignancies, Spanish Society of Hematology)

“…This finding is in agreement with most studies on IFN maintenance in MM. [20][21][22][23] However, it is worth mentioning that in our study the median response duration was prolonged for only 6 months in the IFN arm compared with the observation group and that the statistical significance is borderline. In this regard, the prolongation of response in studies showing a significant benefit from IFN maintenance has also been modest, with differences in median response duration ranging from 5 to 12 months.…”

“…In this regard, the prolongation of response in studies showing a significant benefit from IFN maintenance has also been modest, with differences in median response duration ranging from 5 to 12 months. [20][21][22][23] In contrast to these observations, other trials have failed to show a significant advantage in response duration for IFN maintenance. 8,[24][25][26] Regarding overall survival, most available data, including our own study, suggest that there are no significant differences in survival from the time of randomization in patients maintained with IFN as compared to the observation group.…”

“…8,21,24,25 However, two studies have shown a significant survival prolongation in favor of IFN maintenance in patients achieving an objective response to inducation therapy and maintained with IFN. 20,22 In addition, a third study showed a survival benefit of borderline significance (P = 0.049) from IFN maintenance when the statistical analysis was done after adjusting for chance imbalances in baseline prognostic factors. 23 The reasons for these discrepancies are unclear.…”

“…[20][21][22][23][24][25][26] In our series, IFN had to be discontinued at some time in 20% of the patients. However, about 75% of our patients were able to receive at least 3 MU of IFN three times per week for all the planned period.…”

Autologous stem cell transplantation after first remission induction treatment in multiple myeloma: A report of the french registry on autologous transplantation in multiple myeloma

“…Relapse-free survival (RFS) was evaluated in patients achieving at least a PR after ASCT from the time of remission achievement until relapse or until last visit. Relapse was assessed according to criteria defined by Mandelli et al [12]. Time-to-treatment failure (TTF) was defined as the time from ASCT to any type of failure (failure of ASCT, relapse or death).…”