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Cyclophosphamide, thalidomide, and dexamethasone (CTD) as initial therapy for patients with multiple myeloma unsuitable for autologous transplantation

Morgan, G. J., Davies, F. E., Gregory, W. M., Russell, N. H., Bell, S. E., Szubert, A. J., Coy, N. N., Cook, G., Feyler, S., Byrne, J. L., Roddie, H., Rudin, C., Drayson, M. T., Owen, R. G., Ross, F. M., Jackson, G. H. and Child, J. A. (2011) Cyclophosphamide, thalidomide, and dexamethasone (CTD) as initial therapy for patients with multiple myeloma unsuitable for autologous transplantation Blood, 118, (5), pp. 1231-1238. (doi:10.1182/blood-2011-02-338665).

Record type: Article


As part of the randomized MRC Myeloma IX trial, we compared an attenuated regimen of cyclophosphamide, thalidomide, and dexamethasone (CTDa; n = 426) with melphalan and prednisolone (MP; n = 423) in patients with newly diagnosed multiple myeloma ineligible for autologous stem-cell transplantation. The primary endpoints were overall response rate, progression-free survival, and overall survival (OS). The overall response rate was significantly higher with CTDa than MP (63.8% vs 32.6%; P < .0001), primarily because of increases in the rate of complete responses (13.1% vs 2.4%) and very good partial responses (16.9% vs 1.7%). Progression-free survival and OS were similar between groups. In this population, OS correlated with the depth of response (P < .0001) and favorable interphase fluorescence in situ hybridization profile (P < .001). CTDa was associated with higher rates of thromboembolic events, constipation, infection, and neuropathy than MP. In elderly patients with newly diagnosed multiple myeloma (median age, 73 years), CTDa produced higher response rates than MP but was not associated with improved survival outcomes. We highlight the importance of cytogenetic profiling at diagnosis and effective management of adverse events. This trial was registered at International Standard Randomized Controlled Trials Number as #68454111.

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Published date: 4 August 2011
Organisations: Human Development & Health


Local EPrints ID: 337721
ISSN: 0006-4971
PURE UUID: 375fff89-80b9-4280-8eec-a233cbeb9438

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Date deposited: 02 May 2012 14:38
Last modified: 18 Jul 2017 06:01

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Author: G. J. Morgan
Author: F. E. Davies
Author: W. M. Gregory
Author: N. H. Russell
Author: S. E. Bell
Author: A. J. Szubert
Author: N. N. Coy
Author: G. Cook
Author: S. Feyler
Author: J. L. Byrne
Author: H. Roddie
Author: C. Rudin
Author: M. T. Drayson
Author: R. G. Owen
Author: F. M. Ross
Author: G. H. Jackson
Author: J. A. Child

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