Researchers from Italy have reported that “the addition of first-line thalidomide to double ASCT [autologous stem cell transplant] improved clinical outcomes” for patients with multiple myeloma. The details of this study appeared in the October 20, 2009 issue of the Journal of Clinical Oncology.[1]

Autologous stem cell transplantation is an integral part of the treatment of younger patients with multiple myeloma. Traditionally, patients received induction therapy with VAD (vincristine, Adriamycin, and dexamethasone), followed by single or tandem transplants with high-dose melphalan. Second transplants are primarily beneficial for patients who fail to achieve a complete response or very good partial response following the first transplant.

Thalomid® (thalidomide) is an active agent for the treatment of myeloma, and induction regimens that incorporate Thalomid have higher response rates than VAD. French researchers have shown that Thalomid can improve the initial response rate prior to ASCT, but this had no effect on overall survival compared with induction therapy without Thalomid. Researchers from the University of Arkansas have also reported that the addition of Thalomid to tandem ASCT does not improve survival for patients with newly diagnosed multiple myeloma.

The current Italian study compared outcomes of 135 patients with multiple myeloma who received Thalomid from induction until the second ASCT with the outcomes of the same number of patients receiving the same treatment without Thalomid. These authors made the following observations:

• The rate of very good partial remissions (VGPR) or better was 68% for patients receiving Thalomid compared with 49% for patients not receiving Thalomid.
• 62% of patients receiving Thalomid retained a VGPR or better at four years compared with 33% of patients not receiving Thalomid.
• The four-year progression-free survival was 51% for patients receiving Thalomid compared with 41% for patients not receiving Thalomid.
• Overall survival was at five years was 69% for patients receiving Thalomid and 53% for patients not receiving Thalomid (P=0.07).
• Overall survival after relapse was 25 months for patients receiving Thalomid and 25 months for patients not receiving Thalomid.

Comments: These data are at odds with a previous French report and a report from the University of Arkansas showing no overall benefit of up-front Thalomid on the results of ASCT. However, there was only a trend for improvement in overall survival in the current study. The previous studies had suggested that the effectiveness of Thalomid given as salvage therapy explained the lack of survival benefit of up-front Thalomid. The current study suggests that a relatively short pre-transplant treatment with Thalomid does not compromise salvage therapy.

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