TY - JOUR
T1 - Intermediate-dose melphalan improves survival of myeloma patients aged 50 to 70
T2 - Results of a randomized controlled trial
AU - Palumbo, Antonio
AU - Bringhen, Sara
AU - Petrucci, Maria Teresa
AU - Musto, Pellegrino
AU - Rossini, Fausto
AU - Nunzi, Martina
AU - Lauta, Vito Michele
AU - Bergonzi, Cesare
AU - Barbui, Anna
AU - Caravita, Tommaso
AU - Capaldi, Antonio
AU - Pregno, Patrizia
AU - Guglielmelli, Tommasina
AU - Grasso, Mariella
AU - Callea, Vincenzo
AU - Bertola, Alessandra
AU - Cavallo, Federica
AU - Falco, Patrizia
AU - Rus, Cecilia
AU - Massaia, Massimo
AU - Mandelli, Franco
AU - Carella, Angelo Michele
AU - Pogliani, Enrico
AU - Liberati, Anna Marina
AU - Dammacco, Franco
AU - Ciccone, Giovannino
AU - Boccadoro, Mario
PY - 2004/11/15
Y1 - 2004/11/15
N2 - High-dose therapy is an effective standard treatment for multiple myeloma patients. Evidence that intermediate-dose therapy improves survival is limited. At diagnosis, about 70% of patients are older than 65. Intermediate-dose regimen is very well tolerated in older patients. In a multicenter study, 194 patients were randomized to receive at diagnosis either conventional chemotherapy (6 courses of oral melphalan and prednisone [MP]) or intermediate-dose therapy (2 courses of melphalan at 100 mg/m2 [MEL100]) with stem cell support. Response rate was higher after MEL100. Near-complete remission (nCR) was 6% after MP and 25% after MEL100 (P = .0002). At 3 years, MEL100 increased event-free survival (EFS) from 16% to 37% and overall survival (OS) from 62% to 77% (P <.001). Similar results were observed in patients aged 65 to 70: nCR was 8% after MP and 25% after MEL100 (P = .05); at 3 years, MEL100 improved EFS from 18% to 31% (P = .01) and OS from 58% to 73% (P = .01). Patients aged 65 to 70 had a median OS of 37.2 months (MP) versus 58 months (MEL100). Intermediate-dose melphalan improves response rate, EFS, and OS in myeloma patients, specifically in those aged 65 to 70. It constitutes a more effective first-line regimen than standard treatment for elderly patients.
AB - High-dose therapy is an effective standard treatment for multiple myeloma patients. Evidence that intermediate-dose therapy improves survival is limited. At diagnosis, about 70% of patients are older than 65. Intermediate-dose regimen is very well tolerated in older patients. In a multicenter study, 194 patients were randomized to receive at diagnosis either conventional chemotherapy (6 courses of oral melphalan and prednisone [MP]) or intermediate-dose therapy (2 courses of melphalan at 100 mg/m2 [MEL100]) with stem cell support. Response rate was higher after MEL100. Near-complete remission (nCR) was 6% after MP and 25% after MEL100 (P = .0002). At 3 years, MEL100 increased event-free survival (EFS) from 16% to 37% and overall survival (OS) from 62% to 77% (P <.001). Similar results were observed in patients aged 65 to 70: nCR was 8% after MP and 25% after MEL100 (P = .05); at 3 years, MEL100 improved EFS from 18% to 31% (P = .01) and OS from 58% to 73% (P = .01). Patients aged 65 to 70 had a median OS of 37.2 months (MP) versus 58 months (MEL100). Intermediate-dose melphalan improves response rate, EFS, and OS in myeloma patients, specifically in those aged 65 to 70. It constitutes a more effective first-line regimen than standard treatment for elderly patients.
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U2 - 10.1182/blood-2004-02-0408
DO - 10.1182/blood-2004-02-0408
M3 - Article
C2 - 15265788
AN - SCOPUS:8644260170
VL - 104
SP - 3052
EP - 3057
JO - Blood
JF - Blood
SN - 0006-4971
IS - 10
ER -