The Pharmaceutical Journal
Vol 279 No 7473 p395
13 October 2007

This article
Reprint   Photocopy

  Acrobat Reader

News summary

Thalidomide-based regimen improves survival in elderly patients with multiple myeloma

Thalidomide can improve the survival of elderly patients with multiple myeloma when used in combination with melphalan and prednisone, a Lancet study concludes (2007;
370:1209).

Investigators randomised 447 newly diagnosed patients (aged 65 to 75 years) with multiple myeloma to receive one of three treatment regimens: melphalan and prednisone; melphalan and prednisone plus thalidomide; or reduced-intensity stem cell transplantation with melphalan.

After a medium follow-up of 51.5 months, treatment with melphalan/prednisone plus thalidomide was associated with greater overall survival than with melphalan/prednisone (hazard ratio 0.59, 95 per cent confidence interval 0.46–0.81; P=0.0006) or with the stem cell transplant plus melphalan regimen (0.69, 0.49–0.96; P=0.027).

“ Our results strongly support the use of thalidomide in combination with melphalan and prednisone in previously untreated elderly patients with multiple myeloma and others who are ineligible for intensive transplantation regimens,” the authors say.

In an accompanying editorial (ibid, p1191), Antonio Palumbo and Mario Boccadoro from the University of Turin point out that, although the triple regimen is associated with higher risks of thromboembolism and peripheral neuropathy than the melphalan/prednisone combination, “we should also consider that we have learned how to manage these adverse events”.

The study authors suggest that “efforts should be made to reduce neurotoxicity, somnolence and constipation through use of a lower thalidomide dose (100mg or 200mg per day) along with a shorter treatment duration, and to prevent thromboembolism with adequate prophylaxis”.