Balancing act for elderly myeloma

Abstract

In this issue of Blood, Waage and colleagues present a phase 3 study comparing the combination melphalan-prednisone-thalidomide (MPT) with melphalan-prednisone plus placebo (MP) for the treatment of elderly patients with multiple myeloma. Though responses were in favor of MPT, they did not translate in prolonged progression-free or overall survival.

Multiple Myeloma Treatment Strategies with Novel Agents in 2011: A European Perspective

“…The Turkish study also showed a beneficial effect of MPT over MP in terms of response and a lower early mortality rate [60]. The discrepancy in efficacy outcomes reported for the various MPT trials may be explained by differences in inclusion criteria, particularly regarding patient age and performance status, greatly differing doses of thalidomide, and differences in the duration of thalidomide treatment, with some trials incorporating thalidomide both during induction and maintenance and other trials using thalidomide only during induction [61]. A recent meta-analysis on the survival of 1,682 individual patients treated with MPT or MP in six randomized studies revealed that the addition of thalidomide to MP led to a significantly longer PFS interval (20.4 months versus 14.9 months; p ϭ .001), and although the OS time was longer (39.3 months versus 32.7 months), the difference was not statistically significant (p ϭ .085) [62].…”