A recent study conducted in Scandinavia shows that the combination treatment of melphalan ^[1] (Alkeran), prednisone ^[2] and thalidomide ^[3] (Thalomid), referred to as MPT, has significant anti-myeloma effects when compared to melphalan and prednisone treatment, referred to as MP, in elderly patients.  However, MPT treatment did not increase progression-free and overall survival or improve quality of life compared to MP treatment.

Studies examining the effect of adding thalidomide to MP treatment have previously been conducted in several European countries.  All studies found that the addition of thalidomide increased anti-myeloma effects. However, the results varied significantly for progression-free and overall survival. 

In their study, researchers investigated the effects of adding thalidomide to MP treatment in 357 newly diagnosed myeloma patients from Norway, Sweden, and Denmark who were not candidates for stem cell transplantation.  The median age of patients was 74 years.  Patients were randomly assigned to either receive MPT or MP treatment.  Anti-myeloma effect was determined by the degree of response to treatment. 

Within the first twelve months of treatment, 57 percent of patients receiving MPT therapy achieved at least a partial response compared to 40 percent of patients receiving MP therapy. Thirteen percent of patients on MPT achieved a complete response compared to 4 percent of patients on MP.

Median overall survival for patients treated with MPT combination was 29 months compared to 32 months for patients treated with MP. There was no difference in progression-free survival (15 vs. 14 months) and median time to progression (13 months vs. 12 months) between the two treatment groups.

Patients treated with MPT experienced more side effects than those treated with MP. The most common side effects were constipation, tingling or numbness in fingers and toes, involuntary shaking, difficulty with coordination, confusion, stroke, dizziness and skin rashes.

Thirty-two percent of patients on MPT discontinued treatment within the first three months, compared to 11 percent of patients on MP.

Researchers concluded that MPT showed significant anti-myeloma effects in elderly patients but that did not have an impact on progression-free and overall survival. They added that the differences in results for progression-free and overall survival between the European studies may be due to patient selection and the dose and schedule at which thalidomide was given.

They recommended keeping thalidomide dosages as low as possible in elderly patients to avoid drug-related side effects or treatment discontinuation.

For more information, please see the study in the journal Blood ^[4] (abstract).