Source: Ann Emerg Med  |  Posted 9 years ago

The combination of melphalan, thalidomide and dexamethasone is active in multiple myeloma patients who have been heavily pre-treated and whose prognosis is otherwise poor.

Researchers from the Cleveland Clinic in Cleveland, Ohio, United States say that such patients generally tolerate the therapy.

The 21 participants in this study had relapsed, refractory Durie-Salmon stage III multiple myeloma and had either failed at least three previous regimens or presented with poor performance status, neutropenia or thrombocytopenia. They were treated with up to four cycles of a combination of 50 milligrams intravenous melphalan, thalidomide titrated to a target of 400 mg orally daily and 40mg/day oral dexamethasone on days one to four.

The combination therapy produced grade 4 neutropenia in 52% of participants and thrombocytopenia in 38%. The researchers observed three Grade 3 non-haematological toxicities: in 14%, neuropathy/paresthesia in 5% and nausea in 5%.

Four patients died, two died from neutropenia complications and two from progressive disease. But, combination therapy was "highly active" in this poor-prognosis population, the investigators state.

Median progression-free survival was 270 days, with a range of 73 to 787 days. Median overall survival was 382 days.