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The role of maintenance thalidomide therapy in multiple myeloma: MRC Myeloma IX results and meta-analysis

The role of maintenance thalidomide therapy in multiple myeloma: MRC Myeloma IX results and meta-analysis
The role of maintenance thalidomide therapy in multiple myeloma: MRC Myeloma IX results and meta-analysis
Thalidomide maintenance has the potential to modulate residual multiple myeloma (MM) after an initial response. This trial compared the effect of thalidomide maintenance and no maintenance on progression-free survival (PFS) and overall survival (OS) in MM patients. After intensive or nonintensive induction therapy, 820 newly diagnosed MM patients were randomized to open-label thalidomide maintenance until progression, or no maintenance. Interphase FISH (iFISH) analysis was performed at study entry. Median PFS was significantly longer with thalidomide maintenance (log-rank P < .001). Median OS was similar between regimens (log-rank P = .40). Patients with favorable iFISH showed improved PFS (P = .004) and a trend toward a late survival benefit. Patients with adverse iFISH receiving thalidomide showed no significant PFS benefit and worse OS (P = .009). Effective relapse therapy enhanced survival after progression, translating into a significant OS benefit. Meta-analysis of this and other studies show a significant late OS benefit (P < .001, 7-year difference hazard ratio = 12.3; 95% confidence interval, 5.5-19.0). Thalidomide maintenance significantly improves PFS and can be associated with improved OS. iFISH testing is important in assessing the clinical impact of maintenance therapy. Overview analysis demonstrated that thalidomide maintenance was associated with a significant late OS benefit.
0006-4971
7-15
Morgan, Gareth J.
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Gregory, Walter M.
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Davies, Faith E.
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Bell, Sue E.
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Szubert, Alexander J.
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Brown, Julia M.
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Coy, Nuria N.
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Cook, Gordon
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Russell, Nigel H.
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Rudin, Claudius
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Roddie, Huw
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Drayson, Mark T.
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Owen, Roger G.
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Ross, Fiona M.
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Jackson, Graham H.
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Child, J. Anthony
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Morgan, Gareth J.
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Gregory, Walter M.
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Davies, Faith E.
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Bell, Sue E.
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Szubert, Alexander J.
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Brown, Julia M.
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Coy, Nuria N.
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Cook, Gordon
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Russell, Nigel H.
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Rudin, Claudius
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Roddie, Huw
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Drayson, Mark T.
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Owen, Roger G.
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Ross, Fiona M.
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Jackson, Graham H.
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Child, J. Anthony
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Morgan, Gareth J., Gregory, Walter M., Davies, Faith E., Bell, Sue E., Szubert, Alexander J., Brown, Julia M., Coy, Nuria N., Cook, Gordon, Russell, Nigel H., Rudin, Claudius, Roddie, Huw, Drayson, Mark T., Owen, Roger G., Ross, Fiona M., Jackson, Graham H. and Child, J. Anthony (2012) The role of maintenance thalidomide therapy in multiple myeloma: MRC Myeloma IX results and meta-analysis. Blood, 119 (1), 7-15. (doi:10.1182/blood-2011-06-357038). (PMID:22021371)

Record type: Article

Abstract

Thalidomide maintenance has the potential to modulate residual multiple myeloma (MM) after an initial response. This trial compared the effect of thalidomide maintenance and no maintenance on progression-free survival (PFS) and overall survival (OS) in MM patients. After intensive or nonintensive induction therapy, 820 newly diagnosed MM patients were randomized to open-label thalidomide maintenance until progression, or no maintenance. Interphase FISH (iFISH) analysis was performed at study entry. Median PFS was significantly longer with thalidomide maintenance (log-rank P < .001). Median OS was similar between regimens (log-rank P = .40). Patients with favorable iFISH showed improved PFS (P = .004) and a trend toward a late survival benefit. Patients with adverse iFISH receiving thalidomide showed no significant PFS benefit and worse OS (P = .009). Effective relapse therapy enhanced survival after progression, translating into a significant OS benefit. Meta-analysis of this and other studies show a significant late OS benefit (P < .001, 7-year difference hazard ratio = 12.3; 95% confidence interval, 5.5-19.0). Thalidomide maintenance significantly improves PFS and can be associated with improved OS. iFISH testing is important in assessing the clinical impact of maintenance therapy. Overview analysis demonstrated that thalidomide maintenance was associated with a significant late OS benefit.

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More information

Submitted date: 6 June 2011
e-pub ahead of print date: 20 October 2011
Published date: 5 January 2012
Organisations: Human Development & Health

Identifiers

Local EPrints ID: 337684
URI: http://eprints.soton.ac.uk/id/eprint/337684
ISSN: 0006-4971
PURE UUID: f01ebdfb-2839-4cf6-bf52-0838bd493339

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Date deposited: 02 May 2012 11:37
Last modified: 14 Mar 2024 10:57

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Contributors

Author: Gareth J. Morgan
Author: Walter M. Gregory
Author: Faith E. Davies
Author: Sue E. Bell
Author: Alexander J. Szubert
Author: Julia M. Brown
Author: Nuria N. Coy
Author: Gordon Cook
Author: Nigel H. Russell
Author: Claudius Rudin
Author: Huw Roddie
Author: Mark T. Drayson
Author: Roger G. Owen
Author: Fiona M. Ross
Author: Graham H. Jackson
Author: J. Anthony Child

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