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Melphalan, prednisone, and lenalidomide versus melphalan, prednisone, and thalidomide in untreated multiple myeloma

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  2. Risk factors for infections in newly diagnosed Multiple Myeloma patients: A Danish retrospective nationwide cohort study

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  • Sonja Zweegman
  • Bronno van der Holt
  • Ulf-Henrik Mellqvist
  • Morten Salomo
  • Gerard M J Bos
  • Mark-David Levin
  • Heleen Visser-Wisselaar
  • Markus Hansson
  • Annette W G van der Velden
  • Wendy Deenik
  • Astrid Gruber
  • Juleon L L M Coenen
  • Torben Plesner
  • Saskia K Klein
  • Bea C Tanis
  • Damian L Szatkowski
  • Rolf E Brouwer
  • Matthijs Westerman
  • M Rineke B L Leys
  • Harm A M Sinnige
  • Einar Haukås
  • Klaas G van der Hem
  • Marc F Durian
  • E Vera J M Mattijssen
  • Niels W C J van de Donk
  • Marian J P L Stevens-Kroef
  • Pieter Sonneveld
  • Anders Waage
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The combination of melphalan, prednisone, and thalidomide (MPT) is considered standard therapy for newly diagnosed patients with multiple myeloma who are ineligible for stem cell transplantation. Long-term treatment with thalidomide is hampered by neurotoxicity. Melphalan, prednisone, and lenalidomide, followed by lenalidomide maintenance therapy, showed promising results without severe neuropathy emerging. We randomly assigned 668 patients between nine 4-week cycles of MPT followed by thalidomide maintenance until disease progression or unacceptable toxicity (MPT-T) and the same MP regimen with thalidomide being replaced by lenalidomide (MPR-R). This multicenter, open-label, randomized phase 3 trial was undertaken by Dutch-Belgium Cooperative Trial Group for Hematology Oncology and the Nordic Myeloma Study Group (the HOVON87/NMSG18 trial). The primary end point was progression-free survival (PFS). A total of 318 patients were randomly assigned to receive MPT-T, and 319 received MPR-R. After a median follow-up of 36 months, PFS with MPT-T was 20 months (95% confidence interval [CI], 18-23 months) vs 23 months (95% CI, 19-27 months) with MPR-R (hazard ratio, 0.87; 95% CI, 0.72-1.04; P = .12). Response rates were similar, with at least a very good partial response of 47% and 45%, respectively. Hematologic toxicity was more pronounced with MPR-R, especially grades 3 and 4 neutropenia: 64% vs 27%. Neuropathy of at least grade 3 was significantly higher in the MPT-T arm: 16% vs 2% in MPR-R, resulting in a significant shorter duration of maintenance therapy (5 vs 17 months in MPR-R), irrespective of age. MPR-R has no advantage over MPT-T concerning efficacy. The toxicity profile differed with clinically significant neuropathy during thalidomide maintenance vs myelosuppression with MPR.

Original languageEnglish
JournalBlood
Volume127
Issue number9
Pages (from-to)1109-16
Number of pages8
ISSN0006-4971
DOIs
Publication statusPublished - 3 Mar 2016

    Research areas

  • Aged, Aged, 80 and over, Disease-Free Survival, Female, Humans, Maintenance Chemotherapy, Male, Melphalan, Middle Aged, Multiple Myeloma, Prednisone, Thalidomide, Treatment Outcome, Withholding Treatment, Clinical Trial, Phase III, Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't

ID: 49943420