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Published on: May 15, 2019
First thalidomide clinical trial in multiple myeloma: a decade
Frits van Rhee1, Madhav Dhodapkar, John D Shaughnessy
1Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
Blood
|May 27, 2008
Summary
Long-term follow-up of advanced myeloma patients treated with thalidomide shows cytogenetic abnormalities and lambda light chain isotype predict poor survival. Higher early thalidomide doses correlated with better outcomes.
Area of Science:
- Hematology
- Clinical Oncology
- Pharmacology
Background:
- Thalidomide was an early treatment for advanced or refractory myeloma.
- Understanding long-term outcomes and prognostic factors is crucial for myeloma management.
Purpose of the Study:
- To update the clinical outcomes of patients from the initial thalidomide trial for myeloma.
- To identify pretreatment variables impacting survival in advanced or refractory myeloma.
Main Methods:
- Multivariate analysis of pretreatment variables in 169 patients.
- Assessment of overall survival and event-free survival with a median follow-up of 9.2 years.
- Correlation of cytogenetic abnormalities, lambda light chain isotype, and cumulative thalidomide dose with survival.
Main Results:
- Seventeen patients remain alive, 10 are event-free after a median follow-up of 9.2 years.
- Cytogenetic abnormalities and lambda light chain isotype were associated with adverse overall and event-free survival.
- Patients without these risk factors had significantly better survival (40% survived ≥6 years) compared to those with risk factors (<5%).
- Higher cumulative thalidomide doses (>42 g in 3 months) were linked to superior survival outcomes.
Conclusions:
- Cytogenetic abnormalities and lambda light chain isotype are significant adverse prognostic factors in thalidomide-treated myeloma.
- Early thalidomide dosing may influence long-term clinical outcomes.
- Lambda-type myeloma's poor prognosis might be linked to its association with high-risk molecular features.
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