Attal M et al. (2006) Maintenance therapy with thalidomide improves survival in patients with multiple myeloma. Blood 108: 3289–3294

In patients with multiple myeloma, the average duration of response after chemotherapeutic protocols and autologous stem cell transplantation does not exceed 3 years; therefore, maintenance protocols that could prolong response and survival need to be established. A recent trial showed that thalidomide maintenance therapy is suitable for patients with multiple myeloma.

The trial randomized 597 patients with similar baseline characteristics to one of three treatment arms: no maintenance therapy (n = 200; arm A), pamidronate only (n = 196; arm B) or pamidronate plus thalidomide (n = 201; arm C). The percentage of patients with a complete or very good partial response was greater in arm C (67%) than in arm A (55%) or arm B (57%), while overall survival 4 years after enrollment was 87% in arm C compared with 77% and 74% for arms A and B, respectively. Moreover, patients treated with thalidomide had significantly improved event-free (P = 0.002), relapse-free (P = 0.003) and overall (P = 0.04) survival compared with non-thalidomide-treated patients. Thalidomide treatment was significantly beneficial for patients without a chromosome 13 deletion (P = 0.006) but not for patients with such a deletion (P = 0.2). Patients in the three arms had similar survival rates after relapse without skeletal events. In the thalidomide-treated group, however, certain drug-related adverse events were more prominent than in the nontreated groups, leading to discontinuation of thalidomide in 39% of the patients.

The authors suggest that thalidomide-based maintenance therapy after transplantation increases overall survival in multiple myeloma patients and could benefit patients who do not have a chromosome 13 deletion.