Melphalan/Prednisone in MM Patients ineligible for High-Dose Therapy

According to a recent article, the treatment combination consisting of the chemotherapy agent melphalan (Alkeran®) plus the steroid prednisone appears to be favorable to dexamethasone-based therapies among newly diagnosed patients with multiple myeloma who are not candidates for high-dose therapy.

The only potential curative treatment option for multiple myeloma involves high-dose therapy and a stem cell transplant. However, this procedure is often prohibitively dangerous to a large portion of patients with multiple myeloma, either due to other existing medical conditions or increased age. As a result, treatment combinations among patients not eligible for standard therapy are still being evaluated. Since patients with multiple myeloma survive a long time without being cured, quality of life is an important consideration when deciding upon optimal treatment strategies.

Researchers from France recently conducted a clinical trial to compare dexamethasone-based therapies to melphalan/predisone in the treatment of newly diagnosed patients with multiple myeloma. This study included 488 patients who were not eligible for high-dose therapy. (Dexamethasone is a steroid that may be used alone or in combination with other agents for the treatment of multiple myeloma.)

Patients received one of the following treatment combinations: melphalan-prednisone, dexamethasone alone, melphalan-dexamethasone, and dexamethasone-interferon alpha. Overall survival was consistent among the four treatment groups:

• Anticancer responses were higher among patients treated with melphalan-dexamethasone.
• Progression-free survival was higher among patients who had melphalan in their treatment regimen.
• There was no difference in overall survival between the four treatment groups.
• Quality of life and side effects were significantly worse in patients with dexamethasone in their treatment regimen.

The researchers concluded that melphalan-prednisone appears to be the treatment of choice when considering dexamethasone-based therapy for newly diagnosed multiple myeloma patients. Dexamethasone does not improve survival. It does, however, increase side effects compared with melphalan-prednisone. Different agents and treatment combinations may be superior to melphalan-prednisone for patients with multiple myeloma; therefore, it is important that patients discuss individual risks and benefits of all treatment choices with their physician.

Reference: Facon T, Mary J, Pegourie B, et al. Dexamethasone-based regimens versus melphalan-prednisone for elderly multiple myeloma patients ineligible for high-dose therapy. Blood. 2005 Sep 20; [Epub ahead of print]