At the recent ASH conference, Palumbo and colleagues presented a new induction therapy composed of bortezomib (Velcade), doxurubicin, and dexamethasone that is specifically targeted to elderly patients.

Palumbo and colleagues treated 122 patients aged 65 to 75 with PAD as an induction therapy for four 21-day cycles. They then harvested stem cells, conditioned with Melphalan, and followed with a reduced-intensity stem cell transplant. After the transplant, patients received four 28-day cycles of Revlimid and prednisone and followed by Revlimid alone.

Between the 122 patients, 59 percent achieved at least a partial very good response, and 13 percent of these achieved complete remission. Over a year later, 92 percent of patients were still living in remission.

Side effects of PAD included thrombocitopenia ^[2] (lowered platelet count), neutropenia ^[3] (increase in neutrophil count), infections, gastrointestinal toxicities, peripheral neuropathy ^[4] (pain and numbness in the hands and feet), and deep vein thrombosis (blood clots in the legs and pelvis).

Similar success rates have been achieved with other induction therapies for elderly patients who are not candidates for autologous stem cell transplants. Melphalan-prednisone-bortezomib achieved complete remission in 35 percent of participants and 45 percent achieved a very good partial response. A study using Revlimid and dexamethasone reported 42 percent complete remission/very good partial responses with low-dose dexamethasone.

Compared to previous studies, the Palumbo study demonstrated a higher overall positive response, but a lower percentage of patients achieved complete remission. However, the different health conditions and medications between the studies make a direct comparison difficult.

Sources: Abstract 159 ^[5] from the ASH conference, as well as Plasma Cell Disorders ^[6] and Onkologie ^[7].