Thalidomide–dexamethasone as primary therapy for advanced multiple myeloma

Wang, Michael; Weber, Donna M.; Delasalle, Kay; Alexanian, Raymond

doi:10.1002/ajh.20382

Cited by 38 publications

(20 citation statements)

References 13 publications

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“…46 Thal/dex did seem to induce a higher overall and CR rate, but more patients suffered progressive disease, indicating additional follow-up will be needed to determine which regimen provides a superior long-term outcome. Of note, however, two more mature single-arm studies of thal/dex have reported a briefer median time to progression and OS 47,48 than has been seen Abbreviations: MP, melphalan and prednisone; MPT, melphalan and prednisone with thalidomide; n, number of patients in each cohort Abbreviations: Mel 100, patients received two cycles of infusional vincristine, doxorubicin, and oral dexamethasone, followed by stem cell mobilization and up to two autologous stem cell transplants with melphalan as a preparative regimen at 100 mg/m 2 ; mos., months; MP, melphalan and prednisone; MPT, melphalan and prednisone with thalidomide; n, number of patients in each cohort with MPT, suggesting that thal/dex alone may not be optimal for nontransplant patients. Of greater interest may be the combination of thalidomide, pegylated liposomal doxorubicin, and dexamethasone (ThaDD ; Table 6), which was studied in 50 patients over the age of 65.…”

Section: Regimens Not Based On Mpmentioning

confidence: 99%

Initial Therapy of Multiple Myeloma Patients Who Are Not Candidates for Stem Cell Transplantation

Orłowski¹

2006

Hematology

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Multiple myeloma patients deemed to not be candidates for high-dose therapy followed by stem cell rescue who nonetheless need chemotherapy have traditionally received an oral regimen combining melphalan and prednisone. With the advent of novel agents, however, such as immunomodulatory drugs and proteasome inhibitors that are active in the relapsed/refractory setting, there has been an impetus to incorporate these new options into front-line therapy. Several phase II studies have recently revealed that addition of either thalidomide, lenalidomide, or bortezomib to melphalan and prednisone increased the overall and complete response rates, albeit at the cost of some increased toxicity. Randomized phase III studies of melphalan and prednisone with thalidomide have already shown that, compared to melphalan and prednisone alone, the three-drug regimen prolonged time to progression and overall survival in this population, thereby defining a new standard of care. Moreover, our increasing knowledge of the molecular role that cytogenetic abnormalities play in the biology of multiple myeloma and our growing chemotherapeutic armamentarium are beginning to allow us to rationally select therapies based on these characteristics of each patient's disease. Such a risk-and molecular-adapted strategy to the therapy of multiple myeloma promises to revolutionize and personalize our care of these patients and bring us closer to a cure for this disease.Using the diagnostic criteria recommended by the International Working Group, patients with multiple myeloma are classified as having either asymptomatic or symptomatic (Table 1) disease. 1 The latter population, generally considered candidates for a chemotherapy-based intervention, are then further divided into those who either are or are not eligible for high-dose chemotherapy followed by stem cell rescue. 2 Criteria that are weighed to help make this second distinction have generally included age, performance status, and co-morbid medical conditions. 2 There is some variability in these parameters and how they are applied, since studies examining stem cell transplantation have used different criteria. In regard to age, for example, which is the most objective of these measures, initial studies tended to enroll patients younger than 65 years of age, 3 while more recent studies suggest that transplant is safe in at least some who are over the age of 70 (for example 4,5 ). On the other hand, data suggesting that patients with poor-risk chromosomal features have a short time to progression after autologous transplantation have led to suggestions that even younger patients with these abnormalities may not be candidates for standard approaches. Nonetheless, as little as two years ago, there was general agreement that the standard of care for patients who were not eligible for transplantation and yet needed chemotherapy was melphalan

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Section: Regimens Not Based On Mpmentioning

confidence: 99%

Initial Therapy of Multiple Myeloma Patients Who Are Not Candidates for Stem Cell Transplantation

Orłowski¹

2006

Hematology

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“…As thalidomide and its analogs are more effective with earlier treatment initiation, they have been included in a variety of induction schedules with substantially lower thalidomide doses (100-200 mg/day), thereby minimizing toxicity [40][41][42]. It is possible that this dose may be able to be lowered even further in newer combination strategies [40][41][42][43][44]. The OPTIMUM study compared the tolerability and efficacy of high-dose dexamethasone (Dex) vesus 100, 200, or 400 mg of thalidomide for up to 12 cycles in 499 patients with relapsed/refractory MM, and demonstrated an improved time to progression (TTP) and response duration with all three thalidomide doses when compared to high-dose dexamethasone [45,46].…”

Section: Thalidomide and Thalidomide Analogsmentioning

confidence: 99%

Section: Thalidomide and Thalidomide Analogsmentioning

confidence: 99%

Consensus statement from European experts on the diagnosis, management, and treatment of multiple myeloma: from standard therapy to novel approaches

Engelhardt

Kleber

Udi

et al. 2010

Leukemia & Lymphoma

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Original Citation:Consensus statement from European experts on the diagnosis, management, and treatment of multiple myeloma: from standard therapy to novel approaches. Terms of use:Open Access (Article begins on next page) Anyone can freely access the full text of works made available as "Open Access". Works made available under a Creative Commons license can be used according to the terms and conditions of said license. Use of all other works requires consent of the right holder (author or publisher) if not exempted from copyright protection by the applicable law. Availability: This is the author's manuscriptThis version is available http://hdl.handle.net/2318/81898 since This is an author version of the contribution published on: Questa è la versione dell'autore dell'opera: [August 2010, Vol. 51, No. 8 , Pages 1424-1443 (doi:10.3109/10428194.2010 ABSTRACTTreatment for multiple myeloma (MM) has changed beyond recognition over the past two decades. During the early 1980s, MM inevitably resulted in a slow progressive decline in quality of life until death after about 2 years, while today patients can expect a 50% chance of achieving a complete remission, median survival of 5 years, and a 20% chance of surviving longer than 10 years. An international expert opinion meeting (including members of the GIMEMA and DSMM study groups) was held in 2009. One of the outcomes of the meeting was the development of a consensus statement outlining contemporary optimal clinical practice for the treatment of MM. The international panel recommended that the state of the art therapy for MM should comprise: (a) evidence-based supportive care, (b) effective and well-tolerated chemotherapeutic regimens, (c) autologous hematopoietic stem cell transplant (ASCT) for patients suitable for intensive conditioning therapy, and (d) evidence-based incorporation of novel anti-MM agents. Maintenance strategies have also become increasingly important for the prolongation of remission after front-line therapies. In addition, improved understanding of the biology of MM has led to the development of novel biological therapeutic agents such as thalidomide, lenalidomide, bortezomib, and others. These agents specifically target intracellular mechanisms and interactions, such as those within the bone marrow microenvironment, and have been integrated into MM treatment. This report reviews recent clinical advances in the treatment strategies available for MM and provides an overview of the state of the art management of patients with MM.

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“…In the treatment of multiple myeloma, TH is increased up to 1,000 mg daily in combination with dexamethasone [65], whereas the same dose as monotherapy was not tolerated in patients with myelodysplastic syndrome [66]. Srinivas and Guardino [67] compared 200- with 800-mg doses of TH in patients with metastatic renal cell carcinoma and found advantages in tolerability and even survival for the lower dosage.…”

Section: Discussionmentioning

confidence: 99%

Thalidomide as Palliative Treatment in Patients with Advanced Secondary Glioblastoma

Hassler¹,

Sax²,

Flechl³

et al. 2014

Oncology

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Background: For its numerous abilities including sedation, we have been using thalidomide (TH) as the ‘last therapeutic option' in patients with advanced gliomas. We noticed that a small subgroup, i.e. patients with secondary glioblastoma (GBM, whose GBM has evolved over several months or years from a less malignant glioma), survived for prolonged periods. Therefore, we retrospectively evaluated the outcomes of patients with secondary GBM treated with TH at our centre. Patients and Methods: Starting in the year 2000, we have studied 23 patients (13 females, 10 males, with a median age of 31.5 years) with secondary GBM who have received palliative treatment with TH 100 mg at bedtime. All patients had previously undergone radiotherapy and received at least 1 and up to 5 regimens of chemotherapy. Results: The median duration of TH administration was 4.0 months (range 0.8-32). The median duration of overall survival after the start of TH therapy was 18.3 months (range 0.8-57). Eleven patients with secondary GBM survived longer than 1 year. Symptomatic improvement was most prominent in the restoration of a normal sleep pattern. Conclusion: The palliative effects of TH, especially the normalization of a sleep pattern, were highly valued by patients and families. The prolongation of survival of patients with secondary GBM has not been reported previously. © 2014 S. Karger AG, Basel

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Thalidomide–dexamethasone as primary therapy for advanced multiple myeloma

Cited by 38 publications

References 13 publications

Initial Therapy of Multiple Myeloma Patients Who Are Not Candidates for Stem Cell Transplantation

Initial Therapy of Multiple Myeloma Patients Who Are Not Candidates for Stem Cell Transplantation

Consensus statement from European experts on the diagnosis, management, and treatment of multiple myeloma: from standard therapy to novel approaches

Thalidomide as Palliative Treatment in Patients with Advanced Secondary Glioblastoma

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