Superiority of Thalidomide vs VAD as primary Auto PBSC Therapy

Researchers from Italyrecently conducted a clinical trial to compare thalidomide to the chemotherapy regimen VAD (vincristine, doxorubicin, dexamethasone) in patients with newly diagnosed multiple myeloma. 200 patients received thalidomide or VAD prior to an autologous stem cell transplant. 76% of patients treated with thalidomide achieved an anti-myeloma response, compared with 52% of patients treated with VAD.

The researchers concluded that thalidomide appears superior to VAD as treatment prior to autologous stem cell infusion in patients with newly diagnosed multiple myeloma.
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(Abstract from "Blood" article follows)

The aim of the present study was to compare thalidomide-dexamethasone (Thal-Dex) and vincristine-doxorubicin-dexamethasone (VAD) as primary therapy in preparation for autologous peripheral blood stem cell (PBSC) transplantation for multiple myeloma (MM). For this purpose, we performed a retrospective matched case-control analysis of 200 patients who entered two consecutive studies from 1996 to 2004 and received Thal-Dex (n=100) or VAD (n=100) administered for 4 months before collection of PBSC and autologous transplantation. Matching criteria included age, clinical stage and serum beta2-microglobulin levels. In comparison with VAD, Thal-Dex resulted in a significantly higher response rate (52% versus 76%, respectively; P=0.0004) and effected more profound reduction in myeloma cell mass of both IgG (P=0.02) and IgA (P=0.03) type. More frequent toxicities included nonfatal deep vein thrombosis with Thal-Dex (15%) and granulocytopenia with VAD (12%). In each of the two treatment groups, 91% of patients proceeded to PBSC mobilization. The median number of collected CD34+ cells was 7.85 x 10⁶/kg in the Thal-Dex group and 10.5 x 10⁶/kg in the control group. Thal-Dex may be considered an effective and relatively well tolerated oral alternative to the more complex VAD regimen as front-line therapy for MM patients who are candidates to subsequent autologous transplantation.

Michele Cavo^*, Elena Zamagni, Patrizia Tosi, Paola Tacchetti, Claudia Cellini, Delia Cangini, Antonio de Vivo, Nicoletta Testoni, Chiara Nicci, Carolina Terragna, Tiziana Grafone, Giulia Perrone, Michela Ceccolini, Sante Tura, and Michele Baccarani

Institute of Hematology and Medical Oncology 'Seragnoli', University of Bologna, Bologna, Italy

Blood First Edition Paper, prepublished online March 10, 2005; DOI 10.1182/blood-2005-02-0522