Response rate and survival in myeloma patients receiving prednisone alone

McIntyre, O. Ross; Pajak, T F; Kyle, Robert A.; Cornwell, Gibbons G.; Leone, Luciane Pons Di

doi:10.1002/mpo.2950130502

Cited by 27 publications

(12 citation statements)

References 14 publications

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“…Prednisone as a single agent has also been shown to produce an objective response rate of 44% in a reanalysis of two myeloma treatment protocols. 17 The classic MP combination was born in 1969 when a trial of 183 patients with melphalan versus MP demonstrated a survival improvement by 6 months in MP arm. 18 Over the next 3 decades, multiple combination chemotherapies were compared with MP, yielding conflicting results.…”

Section: Discussionmentioning

confidence: 99%

Melphalan and prednisone versus melphalan, prednisone and thalidomide for elderly and/or transplant ineligible patients with multiple myeloma: a meta-analysis

et al. 2011

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Trials comparing efficacy of melphalan prednisone (MP) with MP plus thalidomide in transplant ineligible, elderly patients with multiple myeloma have provided conflicting evidence. Although there is agreement regarding improved response rates (RRs) and higher toxicity with the addition of thalidomide to MP, the impact on progression free survival (PFS) and overall survival (OS) is less clear. We performed a meta-analysis comparing efficacy of melphalan, prednisone and thalidomide (MPT) and MP by pooling results on RR, PFS and OS reported in all the identified randomized controlled trials (RCTs) under a random effects model. Overall, six prospective RCTs, with data extractable from five published trials (n ¼ 1568) were identified. The pooled odds ratio of responding to therapy with MPT vs MP was 3.39 (Po0.001, 95% CI: 2.24-5.12). The pooled hazard ratios for PFS and OS were and 0.68 (Po0.001; 95% CI: 0.55-0.82) and 0.80 (P ¼ 0.07; 95% CI: 0.63-1.02), respectively, in favor of MPT. The odds ratios for high grade peripheral neuropathy and deep venous thrombosis were 6.6 and 2.4, respectively, in favour of MP. There was significant heterogeneity among the RCTs. Our meta-analysis demonstrates that in previously untreated, transplant ineligible, elderly myeloma patients, the addition of T to MP results in significantly improved RR and PFS with a trend towards improvement in OS compared with MP alone, but at a cost of significantly greater toxicity.

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Section: Discussionmentioning

confidence: 99%

Melphalan and prednisone versus melphalan, prednisone and thalidomide for elderly and/or transplant ineligible patients with multiple myeloma: a meta-analysis

et al. 2011

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“…37 In a reanalysis of 2 Cancer and Leukemia Group B myeloma treatment protocols, prednisone as a single agent produced a 44% objective response rate. 38 The classic regimen of melphalan plus prednisone (MP) was established in a randomized trial of 183 myeloma patients led by Alexanian et al, in which survival was 6 months longer with MP compared with melphalan alone. 39 Harley et al introduced the combination of carmustine, melphalan, cyclophosphamide, and prednisone in the treatment of multiple myeloma.…”

Section: Origins Of Alkylator and Corticosteroid-based Therapymentioning

confidence: 99%

Multiple myeloma

Kyle

Rajkumar

2008

Blood

Self Cite

960

831

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Multiple myeloma is a clonal plasma cell malignancy that accounts for slightly more than 10% of all hematologic cancers. In this paper, we present a historically focused review of the disease, from the description of the first case in 1844 to the present. The evolution of drug therapy and stem-cell transplantation for the treatment of myeloma, as well as the development of new agents, is discussed. We also provide an update on current concepts of diagnosis and therapy, with an emphasis on how treatments have emerged from a historical perspective IntroductionMultiple myeloma (MM) is a malignant plasma cell disorder that accounts for approximately 10% of all hematologic cancers. 1,2 It usually evolves from an asymptomatic premalignant stage of clonal plasma cell proliferation termed "monoclonal gammopathy of undetermined significance" (MGUS). MGUS is present in more than 3% of the population above the age of 50 and progresses to myeloma or related malignancy at a rate of 1% per year. 3,4 In some patients, an intermediate asymptomatic but more advanced premalignant stage, referred to as "smoldering multiple myeloma" (SMM), is clinically recognized. 5 The annual incidence of myeloma, age-adjusted to the 2000 US population, is 4.3 per 100 000. 6 Myeloma and MGUS are twice as common in blacks compared with whites and slightly more common in males than females.We provide a historically based review of myeloma from its first description to the present, with an emphasis on the evolution of diagnosis and therapy for the disease over the past 160 years ( Figure 1). Historical overview Identification and description of the diseaseAlthough multiple myeloma has most likely been present for thousands of years, the first well-documented case was the second patient described by Solly in 1844. 7 This 39-year-old woman, Sarah Newbury, developed fatigue and bone pain from multiple fractures (Figure 2). At autopsy, 4 years after the onset of symptoms, the bone marrow was found to be replaced by a red substance whose cells were very similar to those found at the autopsy of Thomas Alexander McBean. Solly thought that the disease was an inflammatory process and that it began with a "morbid action" of the blood vessels in which the "earthy matter of the bone is absorbed and thrown out by the kidneys in the urine." Was he contemplating the role of angiogenesis in the pathophysiology of the disease?The best known case of multiple myeloma is that of Thomas Alexander McBean, "a highly-respectable tradesman," 45 years of age. He had developed fatigue and had noted that his "body linen was stiffened by his urine." While on holiday in September 1844, he vaulted out of an underground cavern and he suddenly "felt as if something had snapped or given way within the chest" and for some minutes he lay unable to stir because of severe pain. The pain was temporarily relieved by a "strengthening plaster to the chest" but recurred 3 to 4 weeks later. A pound of blood was removed and leeches were applied for "maintenance therapy." This was followe...

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“…It is well documented that glucocorticoids have antitumor activity in myeloma. [14][15][16][17][18] For patients either responding or showing stable disease following conventional chemotherapy, a single-arm study demonstrated that maintenance therapy with oral prednisone (50 mg 3 times per week) and interferon resulted in a long duration of remission and overall survival. 19 In a Southwest Oncology Group (SWOG) study, 89 patients responding to induction vincristine, doxorubicin, and dexamethasone (VAD) chemotherapy were randomized to receive maintenance therapy with either maintenance prednisone (50 mg 3 times per week with interferon or interferon alone).…”

Section: Introductionmentioning

confidence: 99%

Maintenance therapy with alternate-day prednisone improves survival in multiple myeloma patients

Berenson

Crowley

Grogan

et al. 2002

Blood

229

122

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The role of maintenance therapy in multiple myeloma is controversial. Recent studies have shown an improvement in both progression-free and overall survival for patients receiving maintenance treatment with a combination of interferon and glucocorticoids, compared with interferon alone. The role of glucocorticoids alone as maintenance therapy has not been previously addressed. We compared alternate-day, oral prednisone at 2 different dose levels (10 mg versus 50 mg) for remission maintenance among previously untreated myeloma patients following a response to induction with standard-dose vincristine, doxorubicin, and dexamethasone with prednisone (VAD-P) or VAD-P plus quinine (VAD-P/Q). There were 250 eligible patients registered on Southwest Oncology Group study 9210 and randomized to receive VAD-P or VAD-P/Q. There were 125 patients achieving at least a 25% tumor reduction following induction therapy who were randomized to either physiologic (10 mg) or pharmacologic (50 mg) doses of alternate-day, oral prednisone until disease progression. At the time of study entry, patient characteristics were similar in VAD-P and VAD-P/Q patients and in the 2 arms randomized to maintenance therapy. After a median follow-up of 53 months, there was no difference in either progression-free or overall survival between the 2 induction regimens. However, from the time of maintenance randomization, both progression-free (14 versus 5 months; P ‫؍‬ .003) and overall survival (37 versus 26 months; P ‫؍‬ .05) were significantly improved in patients receiving 50 mg as compared with 10 mg alternate-day prednisone. There was no difference in treatment-related adverse events between the groups. Thus, 50 mg, oral, alternateday prednisone is effective maintenance treatment for multiple myeloma patients who achieve a response to induction chemotherapy. (Blood. 2002;99:3163-3168)

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Response rate and survival in myeloma patients receiving prednisone alone

Cited by 27 publications

References 14 publications

Melphalan and prednisone versus melphalan, prednisone and thalidomide for elderly and/or transplant ineligible patients with multiple myeloma: a meta-analysis

Melphalan and prednisone versus melphalan, prednisone and thalidomide for elderly and/or transplant ineligible patients with multiple myeloma: a meta-analysis

Multiple myeloma

Maintenance therapy with alternate-day prednisone improves survival in multiple myeloma patients

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