Triplet Regimen in Multiple Myeloma: Favorable Outcomes

A study published in JCO Global Oncology evaluated mid-to long-term outcomes of multiple myeloma (MM) treatment in Peru.

“Major progress has occurred in MM treatment in recent years, but this is not seen in low- and middle-income countries,” wrote the study authors.

The investigators retrospectively analyzed 59 patients with newly diagnosed MM who were treated at a single institution between April 2008 and December 2012. The median patient age was 56 years, and ages ranged from 27 to 78 years. More than half (59%) were male and 24% had International Staging System grade 3 disease.

The patients received treatment with the triplet combination cyclophosphamide, thalidomide, and dexamethasone. In a 28-day cycle, patients were administered cyclophosphamide 400 mg/m² for five days, thalidomide 100 mg once daily (if tolerated) and dexamethasone 40 mg once weekly. Median follow-up was 81 months (range = 5-138). Survival was the primary endpoint.

The cohort completed a median of 11 treatment cycles (range = 4-12).  The overall response rate was 69.5%. Five percent of patients achieved a complete response, and 32% achieved a very good partial response.

Median progression-free survival (PFS) was 35 months, and the rate of PFS at three years and five years were 47.4% and 24.9%, respectively. The median overall survival (OS) was 81 months. Three-year OS was 63.4% and five-year overall survival was 57.5%.

The most common adverse event was neutropenia, and grade 3 or higher neutropenia occurred in 30.5%. Four patients in the study were lost due to treatment-related causes (6.7%). Ten of 23 patients (43.5%) eligible for stem cell transplantation proceeded to transplant.

In summary, the authors wrote, “Cyclophosphamide, thalidomide, and dexamethasone achieve good response rates with tolerable toxicity, especially in patients age 65 years or younger representing a feasible approach for patients with MM in low-income health care settings.”

Reference

Morgan GJ, Davies FE, Gregory WM, et al. Cyclophosphamide, thalidomide, and dexamethasone as induction therapy for newly diagnosed multiple myeloma patients destined for autologous stem-cell transplantation: MRC Myeloma IX randomized trial results. Haematologica. 2012 Mar; 97(3): 442–450.