First-line thalidomide–dexamethasone therapy in preparation for autologous stem cell transplantation in young patients (<61 years) with symptomatic multiple myeloma

Abstract

Summary:Thalidomide-dexamethasone therapy was given in patients (o61 years) with previously untreated symptomatic multiple myeloma. The aim of this study was to assess the efficacy and toxicity of this combination as first-line therapy, and to determine its effect on stem cell collection and engraftment. During first-line therapy, thalidomide and dexamethasone were administered for 75 days (200 mg/day) and 3 months, respectively. The monthly dose of dexamethasone was 20 mg/m 2 /day for 4 days, with cycles repeated on days 9 to 12 and 17 to 20 on the first and the third month of therapy. After first-line therapy, a collection of peripheral blood stem cells (PBSC) was performed. Between May 2003 and September 2004, 60 patients were included. On an intent-to-treat basis, the overall response (Xpartial response) rate was 74%, including 24% of patients who obtained a complete remission. Grade 3-4 toxicities consisted of infections (12%), deep-vein thrombosis (3%), constipation (5%), and neuropathy (5%). A total of 58 patients (96%) proceeded to PBSC mobilisation and yielded a median number of 8 Â 10 6 CD34 þ cells/kg. First-line thalidomide-dexamethasone therapy is effective and relatively well tolerated in young patients with symptomatic multiple myeloma. This combination does not affect PBSC mobilisation.

Single autologous stem-cell transplantation followed by maintenance therapy with thalidomide is superior to double autologous transplantation in multiple myeloma: results of a multicenter randomized clinical trial

“…29 In the future, it will be important to define whether prior exposure and response to thalidomide induction therapy will have an impact on its use as maintenance treatment. 30 This study provides a precedent for use of novel therapies such as thalidomide to help prepare patients for ASCT and as maintenance to sustain a posttransplantation response.…”

Thalidomide in newly diagnosed multiple myeloma: influence of thalidomide treatment on peripheral blood stem cell collection yield

“…[14][15][16] Moreover, Weber et al 5 reached adequate results via mobilization with G-CSF alone after Thal/Dex administration. Importantly, one leukapheresis was sufficient in 75% (VAD) and 70% (TAD) of the HOVON-50 group for single ABSCT and 60% (VAD) and 45% (TAD) in the GMMG group for double ABSCT.…”

Successful mobilization of peripheral blood stem cells with bortezomib + high-dose cyclophosphamide + G-CSF in a light chain myeloma patient after failure with Total Therapy 2

“…cells collected is their viability. Stem cell viability, as indicated by the time required for engraftment and repopulation of the hematopoietic compartment, is reportedly not affected negatively by inclusion of bortezomib in a wide variety of induction therapies [18,20,24,[31][32][33].…”