Multiple myeloma is a cancer that develops from cells in the bone marrow called plasma cells. Since 1960 oral melphalan and prednisone (MP) have been regarded as the standard of care in elderly multiple myeloma patients. Several other chemotherapy combinations have been tested, but none showed any significant clinical benefit. In a trial involving 255 patients, Antonio Palumbo (University of Torino, Italy) and colleagues found that those treated with melphalan, prednisone, and thalidomide had higher response rates and longer event-free survival than those who were treated with MP alone. This benefit, however, must be balanced against increased rates of thrombosis, neurological toxic effects and infection, warn the authors.
Dr Palumbo concludes: "After 50 years of unsuccessful attempts to find new and more effective treatment approaches suitable for most patients with myeloma, our results lend support to the use of thalidomide in the initial treatment of elderly patients with multiple myeloma."
In an accompanying Comment Shaji Kumar (Mayo Clinic, Rochester, MN, USA) states that these results combined with the preliminary results of a study in France are enough to change clinical practice. He calls this a 'historic moment in myeloma therapy.'
Contact: Dr Antonio Palumbo, Azienda Ospedaliera San Giovanni Battista, Divisione di Ematologia dell'Università di Torino, Via Genova 3, Torino, 10126, Italy. T) +390116336107
Comment: Dr Shaji Kumar, Division of Hematology, Mayo Clinic, Rochester, MN 55905, USA. T)(01) 507 266 0523 Kumar.shaji@mayo.edu
The Lancet