Maintenance therapy with interferon‐α (IFN‐α) versus IFN‐α plus chemotherapy in multiple myeloma (MM)

Abstract

Results of studies using IFN‐α treatment for maintaining remission and prolonging survival in multiple myeloma (MM) are in conflict and trials seeking optimum use for this biological response modifier are continuing. Between 1989 and 1993 a prospective randomized multicentre trial was undertaken to evaluate the role of the combination of IFN‐α with chemotherapy (CT) in maintenance treatment of MM. For remission induction, in patients 65 yr or younger, we used VAD (group A) and for the remaining Melphalan and Prednisone (MP) (group B). For maintenance, patients were randomized to receive IFN‐α 3times106 i.u. s.c. t.i.w. (group I) or alternating monthly cycles of IFN‐α and CT. The CT cycles were also alternated (VAD, MP, CP) in an effort to prevent the development of multidrug resistance. Median survival of the two maintenance groups from randomization (36 months for group I and 31 months for group II, p=0.3) as well as response duration (13 months in group I and 15 months in group II, p=0.95) were similar. Toxicities were more pronounced both with VAD induction and in the combination maintenance arm. The addition of chemotherapy to the IFN maintenance regimen in MM did not have an advantage over IFN alone.

O papel da terapia de manutenção no Mieloma Múltiplo

“…11 Alguns estudos, como o conduzido pelo Medical Research Council (MRC), salientam que não há diferenças significativas entre o grupo sem terapia e o grupo mantido com IFN-α após a terapia indução, salientado que a recaída após a manutenção com IFN-α foi mais intensa, menos responsiva à terapia de resgate e com encurtamento da sobrevida. 6,12 Passados quase vinte anos da publicação de Mandelli, o seguimento dos pacientes em tratamento de manutenção com IFN-α permitiu as várias observações descritas. Inicialmente, o estudo randomizado conduzido pelo NMSG evidenciou um ganho de seis meses em sobrevida livre de doença, porém apenas um ganho não significativo na sobrevida global, além de relatar a redução da qualidade de vida durante o período de uso do IFN-α.…”