[Nanette]

Thalidomide ONLY as multiple myeloma maintenance therapy?

by Nanette on Tue Jun 01, 2010 3:08 pm

Does it seem unorthodox that my husband was treated with ONLY thalidomide? It seems that in every other instance I read about, patients are treated with a combination of drugs.

When diagnosed, I'd asked his doctor what "stage" he was in. She said that he was "barely stage I". After his auto stem cell transplant, he's been using thalidomide as maintenance, and was recently declared to be in Complete Remission/Response.

Thanks in advance for your thoughts about this. BTW: His doctor is the head of the Stem Cell Transplant team at Tulane Medical Center in NOLA.

Nanette

[Beacon Staff]

Re: Thalidomide ONLY as multiple myeloma maintenance therapy?

by Beacon Staff on Tue Jun 01, 2010 4:53 pm

Hi Nanette,

The National Comprehensive Cancer Network issues treatment guidelines for a wide range of cancers, and these guidelines are widely followed. The guidelines for multiple myeloma include several different options for patients who have had a stem cell transplant. The options are:

• Thalidomide (category 1)
• Revlimid (category 2A)
• Thalidomide with prednisone (category 2B)
• Interferon (category 2B)
• Steroids (category 2B)

The different categories next to each option indicate the amount of evidence and degree of consensus around the recommendation. A Category 1 recommendation is one with high-level evidence and uniform consensus. A Category 2A recommendation is one with lower-level evidence but uniform consensus. A Category 2B recommendation is one with lower-level evidence and non-uniform consensus.

So thalidomide alone as maintenance therapy is actually a "legitimate" therapy option for someone like Dom. In fact, it's viewed as supported by "high-level" evidence, and has uniform support as maintenance therapy.

Now, that doesn't mean that it is the most commonly prescribed maintenance therapy for someone like Dom. We don't have any data to help you answer that question. Perhaps others can speak from their own experience on that issue.

Note: The NCCN guideline on maintenance are a bit tricky to interpret when it comes to thalidomide. The exact text of the guideline is "thalidomide (category 1) +/- predisone (category 2B)", which we have interpreted to mean "thalidomide (category 1)" and "thalidomide + prednisone (category 2B)." But it's possible we've made an error in our interpretation.

[Nanette]

Re: Thalidomide ONLY as multiple myeloma maintenance therapy?

by Nanette on Tue Jun 01, 2010 11:19 pm

WOW. That made us smile. Thank you for the reply.