Palumbo A et al. (2008) Oral melphalan, prednisone, and thalidomide in elderly patients with multiple myeloma: updated results of a randomized controlled trial. Blood 112: 3107–3114

In patients with multiple myeloma, the combination of melphalan, prednisone and thalidomide (MPT) has been shown to result in better response rates and progression-free survival than melphalan and prednisone (MP) alone. Palumbo and colleagues reported the updated results of a trial that compared oral MP and MPT treatments in elderly patients with multiple myeloma.

The study enrolled 331 patients with multiple myeloma aged ≥65 years to receive either MP (n = 164) or MPT (n = 167). The primary end points were response rate and progression-free survival, with overall survival as a secondary end point. With a median follow-up of 38.1 months, the median overall survival rates for patients in the MP and MPT groups, respectively, were 47.6 months and 45.0 months (P = 0.79). By contrast, the progression-free survival in these two groups were 14.5 months and 21.8 months, respectively (P = 0.0004). Compared with MP, MPT improved progression-free survival in patients >75 years, who had increased β2-microglobulin levels, high International Staging System disease stage, anemia, renal insufficiency or bone-marrow plasmacytosis. Bortezomib or thalidomide administration as salvage therapy significantly improved survival after progression in patients who received MP at diagnosis (P = 0.0002), but not in patients who were treated with MPT.

This study showed that in elderly patients with multiple myeloma, oral MPT therapy improved response and progression-free survival rates but not overall survival, compared with MP therapy alone.