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

76 Scopus citations

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

ASJC Scopus subject areas

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

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    Barlogie, B., Van Rhee, F., Shaughnessy, J. D., Epstein, J., Yaccoby, S., Pineda-Roman, M., Hollmig, K., Alsayed, Y., Hoering, A., Szymonifka, J., Anaissie, E., Petty, N., Kumar, N. S., Srivastava, G., Jenkins, B., Crowley, J., & Zeldis, J. B. (2008). Seven-year median time to progression with thalidomide for smoldering myeloma: Partial response identifies subset requiring earlier salvage therapy for symptomatic disease. Blood, 112(8), 3122-3125. https://doi.org/10.1182/blood-2008-06-164228