Seven-year median time to progression with thalidomide for smoldering myeloma: Partial response identifies subset requiring earlier salvage therapy for symptomatic disease

Bart Barlogie, Frits Van Rhee, John D. Shaughnessy, Joshua Epstein, Shmuel Yaccoby, Mauricio Pineda-Roman, Klaus Hollmig, Yazan Alsayed, Antje Hoering, Jackie Szymonifka, Elias Anaissie, Nathan Petty, Naveen S. Kumar, Geetika Srivastava, Bonnie Jenkins, John Crowley, Jerome B. Zeldis

Research output: Contribution to journalArticle

75 Citations (Scopus)

Abstract

Smoldering multiple myeloma (SMM) is usually followed expectantly without therapy. We conducted a phase 2 trial in 76 eligible patients with SMM, combining thalidomide (THAL, 200 mg/d) with monthly pamidronate. In the first 2 years, THAL dose reduction was required in 86% and drug was discontinued in 50%. Within 4 years, 63% improved, including 25% qualifying for partial response (PR); by then, 34 patients had progressed and 17 required salvage therapy. Unexpectedly, attaining PR status was associated with a shorter time to salvage therapy for disease progression (P<.001), perhaps reflecting greater drug sensitivity of more aggressive disease. Low beta-2-microglobulin levels less than 2 mg/L were independently associated with superior overall and event-free survival. Four-year survival and event-free survival estimates of 91% and 60%, respectively, together with a median postsalvage therapy survival of more than 5 years justify the conduct of a prospective randomized clinical trial to determine the clinical value of preemptive therapy in SMM. Trial registered at http://www.clinicaltrials.gov under identifier NCT00083382.

Original languageEnglish (US)
Pages (from-to)3122-3125
Number of pages4
JournalBlood
Volume112
Issue number8
DOIs
StatePublished - Oct 15 2008

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Salvaging
Salvage Therapy
Thalidomide
pamidronate
Secondary Prevention
Multiple Myeloma
beta 2-Microglobulin
Disease-Free Survival
Pharmaceutical Preparations
Survival
Disease Progression
Therapeutics
Randomized Controlled Trials

ASJC Scopus subject areas

  • Hematology
  • Biochemistry
  • Cell Biology
  • Immunology

Cite this

Seven-year median time to progression with thalidomide for smoldering myeloma : Partial response identifies subset requiring earlier salvage therapy for symptomatic disease. / Barlogie, Bart; Van Rhee, Frits; Shaughnessy, John D.; Epstein, Joshua; Yaccoby, Shmuel; Pineda-Roman, Mauricio; Hollmig, Klaus; Alsayed, Yazan; Hoering, Antje; Szymonifka, Jackie; Anaissie, Elias; Petty, Nathan; Kumar, Naveen S.; Srivastava, Geetika; Jenkins, Bonnie; Crowley, John; Zeldis, Jerome B.

In: Blood, Vol. 112, No. 8, 15.10.2008, p. 3122-3125.

Research output: Contribution to journalArticle

Barlogie, B, Van Rhee, F, Shaughnessy, JD, Epstein, J, Yaccoby, S, Pineda-Roman, M, Hollmig, K, Alsayed, Y, Hoering, A, Szymonifka, J, Anaissie, E, Petty, N, Kumar, NS, Srivastava, G, Jenkins, B, Crowley, J & Zeldis, JB 2008, 'Seven-year median time to progression with thalidomide for smoldering myeloma: Partial response identifies subset requiring earlier salvage therapy for symptomatic disease', Blood, vol. 112, no. 8, pp. 3122-3125. https://doi.org/10.1182/blood-2008-06-164228
Barlogie, Bart ; Van Rhee, Frits ; Shaughnessy, John D. ; Epstein, Joshua ; Yaccoby, Shmuel ; Pineda-Roman, Mauricio ; Hollmig, Klaus ; Alsayed, Yazan ; Hoering, Antje ; Szymonifka, Jackie ; Anaissie, Elias ; Petty, Nathan ; Kumar, Naveen S. ; Srivastava, Geetika ; Jenkins, Bonnie ; Crowley, John ; Zeldis, Jerome B. / Seven-year median time to progression with thalidomide for smoldering myeloma : Partial response identifies subset requiring earlier salvage therapy for symptomatic disease. In: Blood. 2008 ; Vol. 112, No. 8. pp. 3122-3125.
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