Efficacy and toxicity of the combination chemotherapy of thalidomide, alkylating agent, and steroid for relapsed/refractory myeloma patients: a report from the Korean Multiple Myeloma Working Party (KMMWP) retrospective study

• Published in: Cancer medicine (Malden, MA) MA), 2017-01, Vol.6 (1), p.100-108
• Main Authors: Kwon, Jihyun, Min, Chang‐Ki, Kim, Kihyun, Han, Jae‐joon, Moon, Joon Ho, Kang, Hye Jin, Eom, Hyeon‐Seok, Kim, Min Kyoung, Kim, Hyo Jung, Yoon, Dok Hyun, Lee, Jeong‐Ok, Lee, Won Sik, Lee, Jae Hoon, Lee, Je‐Jung, Choi, Yoon‐seok, Kim, Sung hyun, Yoon, Sung‐soo
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Alkylating agent; Antineoplastic Agents, Alkylating - administration & dosage; Antineoplastic Agents, Alkylating - adverse effects; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Bortezomib; Chemotherapy; Clinical Cancer Research; Clinical trials; Corticosteroids; Cyclophosphamide; Cyclophosphamide - administration & dosage; Cyclophosphamide - adverse effects; Dexamethasone; Dexamethasone - administration & dosage; Dexamethasone - adverse effects; Disease-Free Survival; Dose-Response Relationship, Drug; Drug dosages; Female; Glucocorticoids - administration & dosage; Glucocorticoids - adverse effects; Humans; Infections; Male; Medical prognosis; Melphalan; Melphalan - administration & dosage; Melphalan - adverse effects; Middle Aged; Multiple myeloma; Multiple Myeloma - drug therapy; Neoplasm Recurrence, Local - drug therapy; Original Research; Patients; Peripheral neuropathy; Prednisolone; Prednisolone - administration & dosage; Prednisolone - adverse effects; Proteins; Response rates; Retrospective Studies; Studies; Survival; Survival Analysis; Thalidomide; Thalidomide - administration & dosage; Thalidomide - adverse effects; Toxicity; Treatment Outcome
• ISSN: 2045-7634; 2045-7634
• DOI: 10.1002/cam4.970

We analyzed the treatment responses, toxicities, and survival outcomes of patients with relapsed or refractory multiple myeloma who received daily thalidomide, cyclophosphamide, and dexamethasone (CTD) or daily thalidomide, melphalan, and prednisolone (MTP) at 17 medical centers in Korea. Three‐hundred and seventy‐six patients were enrolled. The combined chemotherapy of thalidomide, corticosteroid, and an alkylating agent (TAS) was second‐line chemotherapy in 142 (37.8%) patients, and third‐line chemotherapy in 135 (35.9%) patients. The response rate overall was 69.4%. Patients who were not treated with bortezomib and lenalidomide before TAS showed a higher response rate compared to those who were exposed to these agents. The estimated median progression‐free survival and overall survival times were 10.4 months and 28.0 months, respectively. The adverse events during TAS were generally tolerable, but 39 (10.4%) patients experienced severe infectious complications. There were no differences in terms of efficacy between CTD and MTP, but infectious complications were more common in CTD group. TAS is an effective treatment regimen which induces a high response rate in relapsed or refractory multiple myeloma patients. Due to the high incidence of grade 3 or 4 infection, proper management of infection is necessary during the TAS treatment, especially the CTD. We found that the combination chemotherapy of thalidomide, steroid, and alkylating agent was very effective for relapsed or refractory multiple myeloma patients even after previous treatment with novel agents. The risk of infection was higher in cyclophosphamide‐combined regimen than melphalan.