Thalidomide-Dexamethasone as Induction Therapy before Autologous Stem Cell Transplantation in Patients with Newly Diagnosed Multiple Myeloma and Renal Insufficiency

Patrizia Tosi, Elena Zamagni, Paola Tacchetti, Michela Ceccolini, Giulia Perrone, Annamaria Brioli, Maria Caterina Pallotti, Lucia Pantani, Alessandro Petrucci, Michele Baccarani, Michele Cavo

Research output: Contribution to journalArticlepeer-review

Abstract

The aim of this study was to evaluate the efficacy and the toxicity of thalidomide-dexamethasone (Thal-Dex) as induction therapy before autologous peripheral blood stem cell (PBSC) transplantation in patients with newly diagnosed multiple myeloma (MM) with renal insufficiency. The study included 31 patients with a baseline creatinine clearance value ≤50 mL/min, 7 of whom required chronic hemodialysis. Patients received 4 months of Thal-Dex, followed by PBSC collection and subsequent transplantation. After induction, a partial response (PR) or greater was obtained in 23 patients (74%), including 8 (26%) who achieved a very good PR. Renal function improved more frequently in patients achieving a PR or greater (82%, vs 37% in patients achieving less than a PR; P = .04). Twenty-six patients underwent PBSC mobilization; in 17 of these patients (65%), >4 × 106 CD34+ cells/kg were collected. Double autologous transplantation was performed in 15 patients, and a single autologous transplantation was performed in 7 patients. After a median of 32 months of follow-up, median event-free survival was 30 months, and median survival was not determined. According to our data, Thal-Dex is effective and safe in patients with newly diagnosed MM and renal insufficiency. Given the relationship between recovery of renal function and response to induction treatment, more intensive Thal + bortezomib regimens could be explored to rescue higher numbers of patients.

Original languageEnglish
Pages (from-to)1115-1121
Number of pages7
JournalBiology of Blood and Marrow Transplantation
Volume16
Issue number8
DOIs
Publication statusPublished - Aug 2010

Keywords

  • Autologous transplantation
  • Myeloma
  • Renal insufficiency
  • Thalidomide

ASJC Scopus subject areas

  • Transplantation
  • Hematology

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