Work

Phase I/II study of melphalan, prednisone and lenalidomide combination for patients with newly diagnosed multiple myeloma who are not candidates for stem cell transplantation

Year: 2015

Type: article

Abstract: Myeloma is a disease of older individuals, with median age at presentation of ~66 years. 1 High-dose chemotherapy and autologous stem cell transplant is an important part of the treatment strategy but many patients are not candidates because of their inability to tolerate the rigors of high-dose chemotherapy. 2 For many years, the cornerstone of multiple myeloma treatment in patients who are not candidates for autologous transplant was melphalan and prednisone combination (MP), which has only modest activity and low response rates, particularly complete remission rate. 3 The availability of immunomodulatory drugs and proteasome inhibitors has led to remarkable improvement in outcomes of multiple myeloma, and several investigators have built on the MP backbone by adding these agents. 4 , 5 , 6 , 7 , 8 Combination of melphalan, prednisone and thalidomide (MPT) was compared with MP in randomized trials and showed better response rates, improvement in progression-free survival and some trials also showed improved overall survival with MPT. However, MPT was associated with increased toxicity such as sedation, neuropathy and DVT. 9 Thus, despite its efficacy, a concern about the toxicity and impairment of quality of life has hampered its widespread utilization in clinical practice. The combination of bortezomib, melphalan and prednisone was also associated with higher response rates, complete remission rate, progression-free survival and overall survival compared with MP in a randomized trial. 8 However, risk of neuropathy and the inconvenience of parenteral administration of bortezomib are notable drawbacks of this regimen, particularly for an older patient.

Source: Blood Cancer Journal

DOI: 10.1038/bcj.2015.23