Abstract
Although autologous stem cell transplant is an effective therapy for patients with multiple myeloma and extends progression-free survival (PFS) and overall survival (OS), patients show a continued pattern of recurrent disease. Twenty-nine patients were enrolled in a phase II study investigating the tolerability and efficacy of maintenance thalidomide following single autologous peripheral blood stem cell transplant. Six to eight weeks after transplant, patients were started on maintenance thalidomide at 50 mg a day. The dose was gradually escalated to a target dose of 400 mg a day and continued until disease progression or 6 months after achieving complete remission (CR) for a maximum total duration of 18 months. At 6 months, 13 patients (45%) achieved CR or near complete remission (positive immunofixation without any evidence of disease). The estimated 2-year OS was 83% and PFS was 49%. Median tolerated dose of thalidomide was 200 mg a day. In conclusion, thalidomide as maintenance therapy is feasible and may improve outcome after single autologous stem cell transplant.
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References
Cunningham D, Powles R, Malpas J, Raje N, Milan S, Viner C et al. A randomized trial of maintenance interferon following high dose chemotherapy in multiple myeloma; long term follow up results. Br J Haematol 1998; 102: 495–502.
Hideshima T, Chauhan D, Shima Y, Raje N, Davies F, Tai Y et al. Thalidomide and its analogs overcome drug resistance of human multiple myeloma cells to conventional therapy. Blood 2000; 96: 2943–2950.
Davis F, Raje N, Hideshima T, Lentzsch S, Yong G, Tai Y et al. Thalidomide and immuno modulatory derivatives augment natural killer cell cytotoxicity in multiple myeloma. Blood 2001; 98: 210–216.
Gupta D, Treon SP, Shima Y, Hideshma T, Podark K, Tai Y et al. Adherence of multiple myeloma cells to bone marrow stromal cell upregulates vascular endothelial growth factor secretion: therapeutic applications. Leukemia 2001; 15: 1950–1961.
Weber D, Rankin K, Gavino M, Delsalle K, Alexanian R . Thalidomide alone or with dexamethasone for previously untreated multiple myeloma. J Clin Oncol 2003; 21: 16–19.
Singhal S, Mehta J, Desikan R, Ayers D, Roberson P, Eddlemon P et al. Anti-tumor activity of thalidomide in refractory multiple myeloma. N Engl J Med 1999; 34: 1565–1571.
Mahoney D, Molina A, Sahebi F, Stockerl-Goldstein K, Sandmaier B, Bensinger W et al. Allografting with non-myleloablative. Conditioning following cyotoreductive autografts for the treatment of patients with multiple myeloma. Blood 2003; 102: 3447–3454.
Blade J, Samson D, Reece D, Apperley J, Bjorkstrand B, Gahrton G et al. Criteria for evaluating disease response and progression in patients with multiple myeloma treated by high-dose therapy and hematopoietic stem cell transplant: myeloma subcommittee of the EBMT. Br J Haematol 1998; 102: 1115–1123.
Stewart K, Chen C, Howson-Jan K, White D, Roy J, Kovacs M et al. Results of multicenter randomized phase II trial of thalidomide and prednisone maintenance therapy for multiple myeloma after autologous stem cell transplant. Clin Cancer Res 2004; 24: 8170–8176.
Scarpace S, Hahn T, Roy H, Brown K, Paplham P, Chanan-Khan A et al. Arterial thrombosis in four patients treated with thalidomide. Leukemia and Lymphoma 2005; 46: 239–242.
Zangari M, Barlogie B, Thertulien R, Jacobson J, Eddleman P, Fink L et al. Thalidomide and deep venous thrombosis in multiple myeloma:risk factors and effect on survival. Clin Lymphoma 2003; 4: 32–35.
Barlogie B, Desikan R, Eddelmon P, Spencer T, Zeldis J, Munshi N et al. Extended survival in advanced and refractory multiple myeloma after single-agent thalidomide: identification of prognostic factors in a phase 2 study of 169 patients. Blood 2001; 98: 492–494.
Neben K, Moehler T, Benner A, Egere G, Ho A, Goldschmidt H et al. Dose-dependent effect of thalidomide on overall survival in relapsed multiple myeloma. Clin Cancer Res 2002; 8: 3377–3382.
Palumbo A, Bertola A, Falco P, Cavallo F, Giaccone L, Bringhen S et al. Efficacy of low dose thalidomide and dexamethasone as first salvage regimen in multiple myeloma. Hematol J 2004; 5: 318–324.
Durie BG . Low-dose thalidomide in myeloma: efficacy and biologic significance. Semin Oncol 2002; 29 (6 Suppl): 34–38.
Alexanian R, Weber D, Giralt S, Delasalle KL . Consolidation therapy of multiple myeloma with thalidomide–dexamethasone after intensive therapy. Ann Oncol 2002; 13: 1116–1119.
Attal M, Harousseau HL, Leyvraz S, Doyen C, Hulin C, Benboubker L et al. Maintenance treatment with thalidomide after autologous transplantation for myeloma. First analysis of prospective randomized study of IFM99-02. Blood 2004; 10 (abstract 535).
Tricot G, Rasmussen E, Anaissie E, Van Rhee F, Zangari M, Holling K et al. Total therapy 2 (TT 2) for multiple myeloma: thalidomide effects superior complete response and event-free survival; similar overall survival linked to shorter post relapse survival. Blood 2005; 106 (abstract 423).
Feyler S, Rawstron A, Jackson G, Snowden J, Hawkins K, Johnson RL . Thalidomide maintenance following high dose therapy in multiple myeloma: a UK myeloma forum phase 2 study. Blood 2005; 106 (abstract 641).
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Sahebi, F., Spielberger, R., Kogut, N. et al. Maintenance thalidomide following single cycle autologous peripheral blood stem cell transplant in patients with multiple myeloma. Bone Marrow Transplant 37, 825–829 (2006). https://doi.org/10.1038/sj.bmt.1705339
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DOI: https://doi.org/10.1038/sj.bmt.1705339