We evaluate the efficacy of the oral combination of thalidomide, cyclophosphamide and dexamethasone (ThaCyDex) in 71 refractory/relapsed multiple myeloma patients, including a prognostic analysis to predict both response and survival. Patients received thalidomide at escalating doses (200-800 mg/ day), daily cyclophosphamide (50 mg/day) and pulsed dexamethasone (40 mg/day, 4 days every 3 weeks). On an intentionto-treat basis and using the EBMT response criteria, 2% patients reached complete response (CR), 55% partial response (PR) and 26% minor response (MR) yielding a total response (CR þ PR þ MR) rate of 83% after 3 months of therapy. After 6 months of therapy, responses were maintained including a 10% CR. The 2-year progression free and overall survival were 57 and 66%, respectively. A favorable response was associated with b 2 microglobulin p4 mg/dl, platelets 480 Â 10 9 /l and nonrefractory disease. Regarding survival, low b 2 microglobulin (p4 mg/dl), age (p65 years) and absence of extramedullary myelomatous lesion were associated with a longer survival. Major adverse effects included constipation (24%), somnolence (18%), fatigue (17%) and infection (13%). Only 7% of patients developed a thrombo-embolic event. ThaCyDex is an oral regimen that induces a high response rate and long remissions, particularly in relapsing patients with b 2 microglobulin p4 mg/dl and p65 years.

No abstract

Although the results from chemotherapy for advanced ovarian carcinoma have improved over the past 15 years with the introduction of platinum compounds, there are still a large number of patients who will relapse from complete response (clinical or pathological) to first line therapy, and there is little published data on prognostic factors for survival after relapse. A total of 270 patients from two randomized trials in ovarian carcinoma conducted in Scotland were reviewed and the data from 117 patients who were disease free after first line treatment were analyzed to determine prognostic factors associated with disease‐free survival and survival after relapse respectively. The most important prognostic factors adversely influencing time to relapse were the presence of ascites at presentation and an advanced tumor stage. For time from relapse to death, the most important adverse features were: early relapse, no chemotherapy at relapse, histology other than serous and stage at diagnosis (either stage IC/II or stage III/IV with residual disease 2 cm). From our results, 26% of patients who achieve complete response are alive and disease‐free after 5 years, while 56% relapsed within 2 years. Of the patients whose disease‐free period following initial complete response extends beyond 600 days, 50% can expect a further period of at least 600 days following relapse and subsequent therapy. Patients with ascites and advanced stage may be suitable for consideration of a more aggressive approach (high dose chemotherapy) once complete response is confirmed, the aim being to improve the disease‐free period.

No abstract