Real-world multicenter study of thalidomide in NDMM patients in Taiwan

Maintenance therapy plays a critical role in optimizing outcomes for newly diagnosed multiple myeloma (NDMM) patients. In Taiwan, the bortezomib, thalidomide, and dexamethasone (VTD) regimen is widely used due to full reimbursement. However, the role of thalidomide maintenance remains underutilized. This study evaluates real-world outcomes of thalidomide-based induction and maintenance therapy in Taiwanese NDMM patients.

We conducted a multi-center retrospective analysis using Thado® Real-World Data. Patients receiving first-line thalidomide-based induction, with or without maintenance, were categorized by transplantation status. Outcomes were assessed based on the International Myeloma Working Group (IMWG) criteria, including objective response rate (ORR), progression-free survival (PFS), and overall survival (OS). Cox regression was used to identify predictors of PFS.

Among 286 patients, 165 were nontransplant and 121 underwent stem cell transplantation (SCT). Thalidomide maintenance significantly improved PFS in both groups, with the bortezomib, thalidomide, and dexamethasone followed by SCT and thalidomide maintenance (VTD-SCT-T) subgroup achieving the longest PFS (44.5 months). ORRs were high across all subgroups. Multivariate analysis confirmed thalidomide maintenance, SCT, and greater than or equal to very good partial response (VGPR) as independent predictors of better PFS. Adverse events were generally mild, with low rates of peripheral neuropathy and no reported venous thromboembolism.

VTD induction followed by thalidomide maintenance is effective and well-tolerated in both transplant-eligible and ineligible NDMM patients. These real-world findings support the expanded use of thalidomide maintenance therapy in Taiwan and highlight its potential to provide long-term disease control with manageable toxicity.