Thalidomide for previously untreated elderly patients with multiple myeloma: meta-analysis of 1685 individual patient data from 6 randomized clinical trials
Peter FayersAntonio PalumboCyrille HulinAnders WaagePierre W. WijermansMeral BeksaçSara GalimbertiJean–Yves MaryPeter GimsingFabian TermorshuizenRauf HaznedarTommaso CaravitaPhilippe MoreauIngemar TuressonPellegrino MustoLotfi BenboubkerM. Ronald SchaafsmaPieter SonneveldThierry Façon
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Objective To assess the effectiveness and safety of thalidomide for treating multiple myeloma.Methods Randomized controlled trials(RCTs) of thalidomide for multiple myeloma were collected from CHKD Data Library(1994-2010),Wanfang Medical Journals(1994-2010).The methodological qualities of the included studies were evaluated,and data analyses were performed using the Cochrane Collaboration's software RevMan 4.3.Results A total of 7 RCTs involving 193 patients were included.As for total effective rate and the effectiveness of reducing M-protein and reducing myeloma cells amounts,improving anaemia complete remission rate,significant differences were found between with or without thalidomide for the treatment of multiple myeloma(OR=3.54,95%CI=1.83-6.81;OR=3.19,95%CI=1.75-5.82;OR=3.07,95%CI=1.67-5.67;OR=2.96,95%CI=1.58-5.54).Conclusion According to the domestic evidence,treatment for multiple myeloma with thalidomide can improve the total effectiveness.However,more high–quality,large-sample,randomized,double-blind,controlled trials are required.
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The field of multiple myeloma therapeutics has been an active one for many years, but perhaps no more so than in the past decade. The introduction of thalidomide, lenalidomide and bortezomib in the treatment of this disease highlights clinical advances made during this period. While these agents were initially utilized in the setting of relapsed and refactory disease, they are now part of the therapeutic armamentarium for transplant-eligible and transplant-ineligible patients with newly diagnosed multiple myeloma. The principles of management applied in the care of newly diagnosed multiple myeloma are reviewed in this article, along with the clinical studies supporting the use of thalidomide, lenalidomide and bortezomib in newly diagnosed multiple myeloma. Management of treatment-related side effects is also discussed, since it constitutes a critical element in the successful management of patients with this disease. Combination regimens utilizing thalidomide, lenalidomide and bortezomib are also highlighted, as these regimens are likely to play an increasingly important role in myeloma therapy in the future.
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Early anticancer research involving thalidomide was abandoned in the 1960s as the catastrophe surrounding the drug emerged, but research efforts were picked up in the 1990s when thalidomide’s antiangiogenic and anti-tumour necrosis factor properties were explored. More than 50,000 patients with multiple myeloma are estimated to have been treated with thalidomide to date. Research with thalidomide provides clear and convincing evidence that thalidomide monotherapy is efficacious in relapsed and refractory patients with multiple myeloma. Results typically show a consistent 30% (95% confidence interval 27–32%) response rate (partial response + complete response, defined as a reduction of at least 50% in the monoclonal protein). Thalidomide treatment compares favourably with other typical treatments for multiple myeloma. In seven trials that included 332 patients, vincristine, adriamycin and dexamethasone (VAD) had a response rate of 39% (32–45%), while a trial in 193 patients showed a response rate with bortezomib of 27% (21–34%). The use of thalidomide in combination therapy could boost its efficacy further. More studies to look at the toxicity of the drug need to be carried out. Despite thalidomide’s dark past, this drug is of major interest and could be brought back to clinical use in a controlled manner.
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Thalidomide given at relatively low, tolerable doses reduces tumour burden in patients with relapsing or progressing multiple myeloma, according to results presented at the International Myeloma Workshop last week (Sept 1-5, Stockholm, Sweden). “Nothing untoward happened in the way of side effects”, says lead investigator Brian Durie (Cedars-Sinai Comprehensive Cancer Center, Los Angeles, CA, USA). “Thalidomide is working well enough now for us to think about using it as a first or second-line treatment”, rather than as a last resort.
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Objective: To discuss the clinical efficacy of the Thalidomide combined with MP and VAD in the patients with multiple myeloma. Methods: Clinic data of 42 patients with multiple myeloma used Thalidomide combined with MP and VAD were analyzed retrospectively. Results: 32 with multiple myeloma in first-time treatment group were given Thalidomide combined with MP, the total effective rate was 81.2%; 10 cases with multiple myeloma in relapse group were given Thalidomide combined with VAD, the total effective rate was 80.0%. Conclusion: Thalidomide combined with MP and VAD in the treatment of multiple myeloma were better than that of conventional therapy scheme (MP or VAD), and less side effects, good tolerance of patients or certain efficacy.
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