Dexamethasone-based regimens versus melphalan-prednisone for elderly multiple myeloma patients ineligible for high-dose therapy
| Autor: | Bernard Grosbois, Marc Renaud, H. Orfeuvre, Antoine Thyss, Michel Blanc, Jean-Luc Harousseau, Jean-Yves Mary, Gérard Lepeu, Cyrille Hulin, Marc Wetterwald, Véronique Dorvaux, Ibrahim Yakoub-Agha, Thierry Facon, Philippe Casassus, Jean-Paul Eschard, A Sadoun, Jean-François Rossi, Mathieu Monconduit, M C Vekemans, Brigitte Pegourie, Laurent Voillat, Jérôme Jaubert, Hervé Maisonneuve, Beatrice Thielemans, Frédéric Maloisel, Isabelle Azais, Michel Attal, Chantal Doyen, Augustin Ferrant, Jacques Troncy, Régis Bataille, Philippe Collet, Houchingue Eghbali, Bruno Anglaret |
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| Rok vydání: | 2006 |
| Předmět: |
Male
Melphalan medicine.medical_specialty medicine.drug_class Immunology Context (language use) Infections Biochemistry Dexamethasone Disease-Free Survival law.invention Randomized controlled trial Prednisone law hemic and lymphatic diseases Internal medicine Antineoplastic Combined Chemotherapy Protocols medicine Humans Survival analysis Multiple myeloma Aged Neoplasm Staging business.industry Patient Selection Interferon-alpha Cell Biology Hematology medicine.disease Survival Analysis Surgery Treatment Outcome Corticosteroid Female Multiple Myeloma business medicine.drug |
| Zdroj: | Blood. 107:1292-1298 |
| ISSN: | 1528-0020 0006-4971 |
| DOI: | 10.1182/blood-2005-04-1588 |
| Popis: | Dexamethasone alone increases life expectancy in patients with relapsed multiple myeloma (MM); however, no large randomized study has compared dexamethasone and dexamethasone-based regimens with standard melphalan-prednisone in newly diagnosed MM patients ineligible for high-dose therapy. In the Intergroupe Francophone du Myelome (IFM) 95-01 trial, 488 patients aged 65 to 75 years were randomized between 4 regimens of treatment: melphalan-prednisone, dexamethasone alone, melphalan-dexamethasone, and dexamethasone-interferon alpha. Response rates at 6 months (except for complete response) were significantly higher among patients receiving melphalan-dexamethasone, and progression-free survival was significantly better among patients receiving melphalan (P < .001, for both comparisons), but there was no difference in overall survival between the 4 treatment groups. Moreover, the morbidity associated with dexamethasone-based regimens was significantly higher than with melphalan-prednisone, especially for severe pyogenic infections in the melphalan-dexamethasone arm and hemorrhage, severe diabetes, and gastrointestinal and psychiatric complications in the dexamethasone arms. Overall, these results indicated that dexamethasone should not be routinely recommended as first-line treatment in elderly patients with MM. In the context of the IFM 95-01 trial, the standard melphalan-prednisone remained the best treatment choice when efficacy and patient comfort were both considered. These results might be useful in the context of future combinations with innovative drugs. |
| Databáze: | OpenAIRE |
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