EHA Library - The official digital education library of European Hematology Association (EHA)

CYCLOPHOSPHAMIDE, THALIDOMIDE AND DEXAMETHASONE (CTD) AS INITIAL THERAPY FOR NEWLY DIAGNOSED MULTIPLE MYELOMA PATIENTS.
Author(s): ,
Jule Vasquez
Affiliations:
Medical Oncology,Instituto Nacional de enfermedades neoplásicas,Lima,Peru
,
Rossana Ruiz
Affiliations:
Medical Oncology,Instituto Nacional de enfermedades neoplásicas,Lima,Peru
,
Karina Aliaga
Affiliations:
Medical Oncology,Instituto Nacional de enfermedades neoplásicas,Lima,Peru
,
Fernando Valencia
Affiliations:
Medical Oncology,Instituto Nacional de enfermedades neoplásicas,Lima,Peru
,
Daniel Enriquez
Affiliations:
Medical Oncology,Instituto Nacional de enfermedades neoplásicas,Lima,Peru
,
Victor Palacios
Affiliations:
Medical Oncology,Hospital Cayetano Heredia,Lima,Peru
,
Shirley Quintana
Affiliations:
Medical Oncology,Instituto Nacional de enfermedades neoplásicas,Lima,Peru
Luis Casanova
Affiliations:
Medical Oncology,Instituto Oncologico Miraflores,Lima,Peru
(Abstract release date: 05/19/16) EHA Library. Vasquez J. 06/09/16; 134891; PB1991
Dr. Jule Vasquez
Dr. Jule Vasquez
Contributions
Abstract
Abstract: PB1991

Type: Publication Only

Background
Major progress has occurred in multiple myeloma (MM) treatment in recent years. . However, due to limited healthcare resources, newer agents are not readily available. In this setting traditional therapy such as oral cyclophosphamide, thalidomide and dexamethasone (CTD) represents an alternative for treatment in newly diagnosed MM.

Aims
To assess the clinical efficacy and toxicity of cyclophosphamide, thalidomide and dexamethasone.

Methods
Retrospective study with the regimen CTD (cyclophosphamide 400mg/m2 for 5 days, thalidomide 100mg/d increasing to 200 mg/day if tolerated, and dexamethasone 40mg weekly; in 28-day cycles), in patients with newly diagnosed MM treated at Instituto Nacional de Enfermedades Neoplasicas in Lima, Perú, between January 2008 and July 2013. Survival outcomes were estimated by Kaplan-Meier method.

Results
Fifty-nine patients were found to meet the selection criteria. Mean age was 56 years (27-68). Fifty-nine percent (n = 35) were male. Salmon Durie stage III disease was present in 88.1%. The median number of treatment cycles delivered was 11 (range 4-12). After a median of 31 months follow-up (range 5-81), the overall response rate was 69.5%, with a 39% stringent complete response (SCR), complete response (CR) and  very good partial response (VGPR), one patient (1.7%), three patients (5.1%), and  nineteen patients (32.2%) respectevely. Median progression free survival (PFS) was 35 months. Five-year overall survival (OS) was 58.5%. The most common adverse events include neutropenia of all grades (44.1%), febrile neutropenia (grade III/IV 18.6/11.9%),  severe infection (8.4%), deep venous thrombosis (6.8%). Out of 37 patients eligible for HSCT, 8 (21.6%) proceeded with it after this treatment regimen and 9 patients  (24.3%) out of 37 are in maintenance. Treatment-related deaths occurred in 4 patients (6.7%) whose ages were 62, 64, 74, and 76 years-old.

Conclusion
CTD achieves durable responses with tolerable toxicity. This regimen represents a feasible and effective approach for MM patients in low income healthcare settings with tolerable side effects profile.

Session topic: E-poster

Keyword(s): Chemotherapy, Cyclophosphamide, Multiple myeloma
Abstract: PB1991

Type: Publication Only

Background
Major progress has occurred in multiple myeloma (MM) treatment in recent years. . However, due to limited healthcare resources, newer agents are not readily available. In this setting traditional therapy such as oral cyclophosphamide, thalidomide and dexamethasone (CTD) represents an alternative for treatment in newly diagnosed MM.

Aims
To assess the clinical efficacy and toxicity of cyclophosphamide, thalidomide and dexamethasone.

Methods
Retrospective study with the regimen CTD (cyclophosphamide 400mg/m2 for 5 days, thalidomide 100mg/d increasing to 200 mg/day if tolerated, and dexamethasone 40mg weekly; in 28-day cycles), in patients with newly diagnosed MM treated at Instituto Nacional de Enfermedades Neoplasicas in Lima, Perú, between January 2008 and July 2013. Survival outcomes were estimated by Kaplan-Meier method.

Results
Fifty-nine patients were found to meet the selection criteria. Mean age was 56 years (27-68). Fifty-nine percent (n = 35) were male. Salmon Durie stage III disease was present in 88.1%. The median number of treatment cycles delivered was 11 (range 4-12). After a median of 31 months follow-up (range 5-81), the overall response rate was 69.5%, with a 39% stringent complete response (SCR), complete response (CR) and  very good partial response (VGPR), one patient (1.7%), three patients (5.1%), and  nineteen patients (32.2%) respectevely. Median progression free survival (PFS) was 35 months. Five-year overall survival (OS) was 58.5%. The most common adverse events include neutropenia of all grades (44.1%), febrile neutropenia (grade III/IV 18.6/11.9%),  severe infection (8.4%), deep venous thrombosis (6.8%). Out of 37 patients eligible for HSCT, 8 (21.6%) proceeded with it after this treatment regimen and 9 patients  (24.3%) out of 37 are in maintenance. Treatment-related deaths occurred in 4 patients (6.7%) whose ages were 62, 64, 74, and 76 years-old.

Conclusion
CTD achieves durable responses with tolerable toxicity. This regimen represents a feasible and effective approach for MM patients in low income healthcare settings with tolerable side effects profile.

Session topic: E-poster

Keyword(s): Chemotherapy, Cyclophosphamide, Multiple myeloma

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