According to a recent article published ahead of print in the journal Blood, the treatment combination consisting of the chemotherapy agent melphalan (Alkeran®) plus the steroid prednisone appears to be favorable to dexamethasone-based therapies among newly diagnosed patients with multiple myeloma who are not candidates for high-dose therapy.
Multiple myeloma is a cancer of the blood that affects the plasma cells. Plasma cells are an important part of the immune system and produce antibodies to help fight infection and disease. Multiple myeloma is characterized by an excess production of abnormal plasma cells, which can result in symptoms such as increased risk for bacterial infections or impaired immune responses. Other effects of myeloma may include damage to the kidneys, osteoporosis, anemia, and an elevated blood calcium level.
The only potential curative treatment option for multiple myeloma involves high-dose therapy and a stem cell transplant. However, this procedure is often prohibitively dangerous to a large portion of patients with multiple myeloma, either due to other existing medical conditions or increased age. As a result, treatment combinations among patients not eligible for standard therapy are still being evaluated. Since patients with multiple myeloma survive a long time without being cured, quality of life is an important consideration when deciding upon optimal treatment strategies.
Researchers from France recently conducted a clinical trial to compare dexamethasone-based therapies to melphalan/predisone in the treatment of newly diagnosed patients with multiple myeloma. This study included 488 patients who were not eligible for high-dose therapy. (Dexamethasone is a steroid that may be used alone or in combination with other agents for the treatment of multiple myeloma.)
Patients received one of the following treatment combinations: melphalan-prednisone, dexamethasone alone, melphalan-dexamethasone, and dexamethasone-interferon alpha. Overall survival was consistent among the four treatment groups:
- Anticancer responses were higher among patients treated with melphalan-dexamethasone.
- Progression-free survival was higher among patients who had melphalan in their treatment regimen.
- There was no difference in overall survival between the four treatment groups.
- Quality of life and side effects were significantly worse in patients with dexamethasone in their treatment regimen.
The researchers concluded that melphalan-prednisone appears to be the treatment of choice when considering dexamethasone-based therapy for newly diagnosed multiple myeloma patients. Dexamethasone does not improve survival. It does, however, increase side effects compared with melphalan-prednisone. Different agents and treatment combinations may be superior to melphalan-prednisone for patients with multiple myeloma; therefore, it is important that patients discuss individual risks and benefits of all treatment choices with their physician.
Reference: Facon T, Mary J, Pegourie B, et al. Dexamethasone-based regimens versus melphalan-prednisone for elderly multiple myeloma patients ineligible for high-dose therapy. Blood. 2005 Sep 20; [Epub ahead of print]