Initial cytoreductive treatment with thalidomide plus bolus vincristine/doxorubicin and reduced dexamethasone followed by autologous stem cell transplantation for multiple myeloma
Autor: | Sung Sook Lee, Sang-We Kim, Jae-Cheol Jo, Shin Kim, Geundoo Jang, Sun Jin Sym, Cheolwon Suh, Byung Woog Kang, Jung Shin Lee, Dae Ho Lee |
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Rok vydání: | 2009 |
Předmět: |
Adult
Male medicine.medical_specialty Vincristine medicine.medical_treatment Urology Antineoplastic Agents Transplantation Autologous Dexamethasone Disease-Free Survival Autologous stem-cell transplantation Antineoplastic Combined Chemotherapy Protocols medicine Humans Pharmacology (medical) Pharmacology Chemotherapy business.industry Combination chemotherapy Middle Aged medicine.disease Thalidomide Surgery Regimen Treatment Outcome Oncology Doxorubicin Female Multiple Myeloma business Febrile neutropenia Stem Cell Transplantation medicine.drug |
Zdroj: | Investigational New Drugs. 29:175-181 |
ISSN: | 1573-0646 0167-6997 |
Popis: | Background High-dose chemotherapy supported by autologous stem cell transplantation (ASCT) after combined chemotherapy with infusional vincristine/doxorubicin plus dexamethasone is effective in multiple myeloma (MM). Outpatient treatment with bolus vincristine/doxorubicin infusion plus dexamethasone is convenient and has acceptable efficacy and toxicity for MM. Thalidomide has recently been shown to have significant antimyeloma activity. We assessed the efficacy and toxicity of the combination of bolus vincristine/doxorubicin and reduced dose dexamethasone with thalidomide (T-bVAd), administered on an outpatient basis, in untreated MM. Patients and methods Twenty-six patients prospectively received T-bVAd, consisting of intravenous (i.v.) vincristine 0.4 mg plus doxorubicin 9 mg/m2, administered as a single bolus on days 1 to 4, dexamethasone 20 mg per os daily for 4 days, and thalidomide 200 mg/day at bedtime. Response assessment was conducted after each 4-week treatment cycle. Patients who achieved response were allowed to proceed to high-dose chemotherapy with ASCT. Results On an intention-to-treat basis, 23 of the 26 patients (88%) responded to treatment, with 16 (61%) achieving complete response (CR), 2 (8%) very good partial response (VGPR) and 5 (19%) partial response. Only three patients (12%) were rated as non-responders. Grade 3 and 4 hematologic toxicities consisted of neutropenia (13%), febrile neutropenia (6%), and thrombocytopenia (4%), without significant nonhematologic events. Of the 23 patients who showed response, 7 proceeded to single ASCT and 9 to tandem ASCT. With median follow-up time of 15.3 months (range, 9–25 months), median event free survival (EFS) and overall survival (OS) have not been reached yet, and OS and EFS rates for patients who achieved complete response after T-bVAd regimen were significantly higher than patients not. Conclusions Induction therapy with T-bVAd, administered as an outpatient regimen, was efficient and relatively well tolerated in the treatment of MM. |
Databáze: | OpenAIRE |
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