Oral melphalan and prednisone chemotherapy plus thalidomide compared with melphalan and prednisone alone in elderly patients with multiple myeloma: randomised controlled trial

Palumbo, Antônio; Bringhen, Sara; Caravita, Tommaso; Merla, Emanuela; Capparella, Vincenzo; Callea, Vincenzo; Cangialosi, Clotilde; Grasso, Mariella; Rossini, Fausto; Galli, Mónica; Catalano, Lucio; Zamagni, Elena; Petrucci, Maria Teresa; Stefano, Valerio De; Ceccarelli, Manuela; Ambrosini, Maria Teresa; Avonto, Ilaria; Falco, Patrizia; Ciccone, Giovannino; Liberati, Anna Marina; Musto, Pellegrino; Boccadoro, Mario

doi:10.1016/s0140-6736(06)68338-4

Cited by 759 publications

(550 citation statements)

References 33 publications

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“…The dramatic downhill course of patients with amyloid cardiomyopathy indicates that rapidly acting chemotherapy regimens are required to improve survival. The addition of thalidomide to alkylating agents, such as in the MPT regimen in multiple myeloma [8,9] and in the CTD regimen in AL amyloidosis [4], accelerates the time to response, with half of the patients responding within 1.4 months from starting MPT and after the first CTD cycle, respectively. Also in our study with MTD, the responses were rapid, 90% of them being achieved after the first three courses.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, patients with advanced cardiac dysfunction who present with heart failure and/or elevated serum concentration of N-terminal pronatriuretic peptide type B (NTproBNP) and cardiac troponins have a short median survival (3.5 months) and need a rapidly effective treatment [7]. In multiple myeloma, the addition of thalidomide to melphalan and prednisone (MPT) improves the response rate and reduces the time to response to a median of 1.4 months [8]. This regimen proved more effective than ASCT in elderly multiple myeloma patients [9].…”

Section: Introductionmentioning

confidence: 99%

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Treatment of patients with advanced cardiac AL amyloidosis with oral melphalan, dexamethasone, and thalidomide

et al. 2008

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Treatment of patients with advanced cardiac AL amyloidosis with oral melphalan, dexamethasone, and thalidomide

et al. 2008

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“…Six randomized studies have compared MPT with melphalan, prednisone (MP) [70][71][72][73][74][75]. An OS advantage has been observed in three trials [70,71,74].…”

Section: Options For Initial Treatment In Patients Not Eligible For Asctmentioning

confidence: 99%

“…Two metaanalyses show a clear superiority of MPT over MP [76,77]. MPT is associated with a Grade 3-4 toxicity rate of over 50%, and a DVT risk of 20% [72].…”

Section: Options For Initial Treatment In Patients Not Eligible For Asctmentioning

confidence: 99%

Multiple myeloma: 2013 update on diagnosis, risk‐stratification, and management

2013

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Disease overviewMultiple myeloma accounts for approximately 10% of hematologic malignancies.DiagnosisThe diagnosis requires 10% or more clonal plasma cells on bone marrow examination or a biopsy proven plasmacytoma plus evidence of associated end‐organ damage. In addition, the presence of 60% or more clonal plasma cells in the marrow is also considered as myeloma regardless of the presence or absence of end‐organ damage.Risk stratificationIn the absence of concurrent trisomies, patients with 17p deletion, t(14;16), and t(14;20) are considered to have high‐risk myeloma. Patients with t(4;14) translocation are considered intermediate‐risk. All others are considered as standard‐risk.Risk‐adapted initial therapyStandard‐risk patients can be treated with lenalidomide plus low‐dose dexamethasone (Rd), or a bortezomib‐containing triplet such as bortezomib, cyclophosphamide, dexamethasone (VCD). Intermediate‐risk and high‐risk patients require a bortezomib‐based triplet regimen. In eligible patients, initial therapy is given for approximately 4 months followed by autologous stem cell transplantation (ASCT). Standard‐risk patients can opt for delayed ASCT if stem cells can be cryopreserved. In patients are not candidates for transplant, initial therapy is given for approximately 12–18 months.Maintenance therapyAfter initial therapy, lenalidomide maintenance is considered for standard‐risk patients who are not in very good partial response or better, while maintenance with a bortezomib‐based regimen should be considered in pateints with intermediate or high‐risk myeloma.Management of refractory diseasePatients with indolent relapse can be treated first with two‐drug or three‐drug combinations. Patients with more aggressive relapse often require therapy with a combination of multiple active agents. Am. J. Hematol. 88:225–235, 2013. © 2013 Wiley Periodicals, Inc.

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“…However, the response duration was rather short and the median survival about 3 years. Recently, five randomized clinical phase III trials in which thalidomide was added to the melphalan/prednisone schedule as first line treatment demonstrated a higher response rate, a qualitative better response, increased progression-free survival and in three out of five also a benefit in overall survival [4][5][6][7][8][9]. Melphalan plus prednisone and thalidomide (MPT) is now regarded as a new standard for treatment of multiple myeloma in the elderly patient.…”

Section: Introductionmentioning

confidence: 99%

Effect of thalidomide with melphalan and prednisone on health-related quality of life (HRQoL) in elderly patients with newly diagnosed multiple myeloma: a prospective analysis in a randomized trial

et al. 2011

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Thalidomide with melphalan/prednisone (MPT) was defined as standard treatment in elderly patients with multiple myeloma (MM) based on five randomized trials. In one of these trials, HOVON49, a prospective health-related quality-of-life (HRQoL) study was initiated in order to assess the impact of thalidomide on QoL. Patients aged >65 years with newly diagnosed MM were randomized to receive melphalan plus prednisone (MP) or MPT, followed by thalidomide maintenance in the MPT arm. Two hundred eighty-four patients were included in this side study (MP, n= 149; MPT n=135). HRQoL was assessed with the EORTC Core QoL Questionnaire (QLQ-C30) and the myelomaspecific module (QLQ-MY24) at baseline and at predetermined intervals during treatment. The QLQ-C30 subscales physical function (P=0.044) and constipation (P<0.001) showed an improvement during induction in favour of the

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Oral melphalan and prednisone chemotherapy plus thalidomide compared with melphalan and prednisone alone in elderly patients with multiple myeloma: randomised controlled trial

Cited by 759 publications

References 33 publications

Treatment of patients with advanced cardiac AL amyloidosis with oral melphalan, dexamethasone, and thalidomide

Treatment of patients with advanced cardiac AL amyloidosis with oral melphalan, dexamethasone, and thalidomide

Multiple myeloma: 2013 update on diagnosis, risk‐stratification, and management

Effect of thalidomide with melphalan and prednisone on health-related quality of life (HRQoL) in elderly patients with newly diagnosed multiple myeloma: a prospective analysis in a randomized trial

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