Cyclophosphamide, Thalidomide, and Dexamethasone as Initial Therapy for Patients With Newly Diagnosed Multiple Myeloma in a Middle-Income Country: 7-Year Follow-Up
PURPOSEMajor progress has occurred in multiple myeloma (MM) treatment in recent years, but this is not seen in low- and middle-income countries.MATERIALS AND METHODSWe retrospectively assessed the efficacy and safety of cyclophosphamide, thalidomide, and dexamethasone (cyclophosphamide 400 mg/m2 for...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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American Society of Clinical Oncology
2021-12-01
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| Series: | JCO Global Oncology |
| Online Access: | https://ascopubs.org/doi/10.1200/GO.20.00665 |
| _version_ | 1818772972884721664 |
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| author | Jule Vasquez Rossana Ruiz Karina Aliaga Fernando Valencia Marco Villena Shirley Quintana Tatiana Vidaurre Luis Casanova |
| author_facet | Jule Vasquez Rossana Ruiz Karina Aliaga Fernando Valencia Marco Villena Shirley Quintana Tatiana Vidaurre Luis Casanova |
| author_sort | Jule Vasquez |
| collection | DOAJ |
| description | PURPOSEMajor progress has occurred in multiple myeloma (MM) treatment in recent years, but this is not seen in low- and middle-income countries.MATERIALS AND METHODSWe retrospectively assessed the efficacy and safety of cyclophosphamide, thalidomide, and dexamethasone (cyclophosphamide 400 mg/m2 for 5 days, thalidomide 100 mg once daily, if tolerated, and dexamethasone 40 mg once weekly; in 28-day cycles) in patients with newly diagnosed MM treated at our institution between April 2008 and December 2012. Survival outcomes were estimated by the Kaplan-Meier method.RESULTSFifty-nine patients were found to meet the selection criteria. Median age was 56 years (27-78). Fifty-nine percent (n = 35) were male. International Staging System three was found in 24%. The median number of treatment cycles was 11 (range 4-12). After a median of 81-month follow-up (range 5-138 months), the overall response rate was 69.5%. The complete response and very good partial response were 5% and 32%, respectively. Median progression-free survival (PFS) was 35 months (95% CI, 18 to 41). The 3-year PFS was 47.4% (95% CI, 34.5 to 59.6) and 5-year PFS was 24.9% (95% CI, 14.4 to 36.9). The median of overall survival (OS) was 81 months (95% CI, 33 to not reached). The 3-year OS was 63.4% (95% CI, 49.2 to 74.6), and 5-year OS was 57.5% (95% CI, 43.2 to 69.4). The most common adverse event was neutropenia (grade 3 and 4, 30.5%). Out of 23 patients eligible for stem-cell transplantation, 10 (43.5%) proceeded with autologous transplantation. Treatment-related deaths occurred in four patients (6.7%).CONCLUSIONCyclophosphamide, thalidomide, and dexamethasone achieves good response rates with tolerable toxicity, especially in patients age 65 years or younger representing a feasible approach for patients with MM in low-income health care settings. |
| first_indexed | 2024-12-18T10:17:51Z |
| format | Article |
| id | doaj.art-40fe7733e4d94cae8b8d109a8dbb7b18 |
| institution | Directory Open Access Journal |
| issn | 2687-8941 |
| language | English |
| last_indexed | 2024-12-18T10:17:51Z |
| publishDate | 2021-12-01 |
| publisher | American Society of Clinical Oncology |
| record_format | Article |
| series | JCO Global Oncology |
| spelling | doaj.art-40fe7733e4d94cae8b8d109a8dbb7b182022-12-21T21:11:13ZengAmerican Society of Clinical OncologyJCO Global Oncology2687-89412021-12-0171199120510.1200/GO.20.00665Cyclophosphamide, Thalidomide, and Dexamethasone as Initial Therapy for Patients With Newly Diagnosed Multiple Myeloma in a Middle-Income Country: 7-Year Follow-UpJule Vasquez0Rossana Ruiz1Karina Aliaga2Fernando Valencia3Marco Villena4Shirley Quintana5Tatiana Vidaurre6Luis Casanova7Instituto Nacional de Enfermedades Neoplásicas, Lima, PeruInstituto Nacional de Enfermedades Neoplásicas, Lima, PeruInstituto Nacional de Enfermedades Neoplásicas, Lima, PeruInstituto Nacional de Enfermedades Neoplásicas, Lima, PeruInstituto Nacional de Enfermedades Neoplásicas, Lima, PeruInstituto Nacional de Enfermedades Neoplásicas, Lima, PeruInstituto Nacional de Enfermedades Neoplásicas, Lima, PeruInstituto Oncológico Miraflores, Lima, PeruPURPOSEMajor progress has occurred in multiple myeloma (MM) treatment in recent years, but this is not seen in low- and middle-income countries.MATERIALS AND METHODSWe retrospectively assessed the efficacy and safety of cyclophosphamide, thalidomide, and dexamethasone (cyclophosphamide 400 mg/m2 for 5 days, thalidomide 100 mg once daily, if tolerated, and dexamethasone 40 mg once weekly; in 28-day cycles) in patients with newly diagnosed MM treated at our institution between April 2008 and December 2012. Survival outcomes were estimated by the Kaplan-Meier method.RESULTSFifty-nine patients were found to meet the selection criteria. Median age was 56 years (27-78). Fifty-nine percent (n = 35) were male. International Staging System three was found in 24%. The median number of treatment cycles was 11 (range 4-12). After a median of 81-month follow-up (range 5-138 months), the overall response rate was 69.5%. The complete response and very good partial response were 5% and 32%, respectively. Median progression-free survival (PFS) was 35 months (95% CI, 18 to 41). The 3-year PFS was 47.4% (95% CI, 34.5 to 59.6) and 5-year PFS was 24.9% (95% CI, 14.4 to 36.9). The median of overall survival (OS) was 81 months (95% CI, 33 to not reached). The 3-year OS was 63.4% (95% CI, 49.2 to 74.6), and 5-year OS was 57.5% (95% CI, 43.2 to 69.4). The most common adverse event was neutropenia (grade 3 and 4, 30.5%). Out of 23 patients eligible for stem-cell transplantation, 10 (43.5%) proceeded with autologous transplantation. Treatment-related deaths occurred in four patients (6.7%).CONCLUSIONCyclophosphamide, thalidomide, and dexamethasone achieves good response rates with tolerable toxicity, especially in patients age 65 years or younger representing a feasible approach for patients with MM in low-income health care settings.https://ascopubs.org/doi/10.1200/GO.20.00665 |
| spellingShingle | Jule Vasquez Rossana Ruiz Karina Aliaga Fernando Valencia Marco Villena Shirley Quintana Tatiana Vidaurre Luis Casanova Cyclophosphamide, Thalidomide, and Dexamethasone as Initial Therapy for Patients With Newly Diagnosed Multiple Myeloma in a Middle-Income Country: 7-Year Follow-Up JCO Global Oncology |
| title | Cyclophosphamide, Thalidomide, and Dexamethasone as Initial Therapy for Patients With Newly Diagnosed Multiple Myeloma in a Middle-Income Country: 7-Year Follow-Up |
| title_full | Cyclophosphamide, Thalidomide, and Dexamethasone as Initial Therapy for Patients With Newly Diagnosed Multiple Myeloma in a Middle-Income Country: 7-Year Follow-Up |
| title_fullStr | Cyclophosphamide, Thalidomide, and Dexamethasone as Initial Therapy for Patients With Newly Diagnosed Multiple Myeloma in a Middle-Income Country: 7-Year Follow-Up |
| title_full_unstemmed | Cyclophosphamide, Thalidomide, and Dexamethasone as Initial Therapy for Patients With Newly Diagnosed Multiple Myeloma in a Middle-Income Country: 7-Year Follow-Up |
| title_short | Cyclophosphamide, Thalidomide, and Dexamethasone as Initial Therapy for Patients With Newly Diagnosed Multiple Myeloma in a Middle-Income Country: 7-Year Follow-Up |
| title_sort | cyclophosphamide thalidomide and dexamethasone as initial therapy for patients with newly diagnosed multiple myeloma in a middle income country 7 year follow up |
| url | https://ascopubs.org/doi/10.1200/GO.20.00665 |
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