Difference between revisions of "Smoldering multiple myeloma"
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''Note: This regimen is of historical significance'' | ''Note: This regimen is of historical significance'' | ||
− | ===Variant #1 | + | ===Variant #1, Six cycles of therapy {{#subobject:f71nh0|Variant=1}}=== |
− | |||
− | |||
{| class="wikitable" style="width: 100%; text-align:center;" | {| class="wikitable" style="width: 100%; text-align:center;" | ||
!style="width: 25%"|Study | !style="width: 25%"|Study | ||
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|} | |} | ||
+ | ''Note: Patients on the observation arm of this study received this regimen at progression to symptomatic MM'' | ||
====Chemotherapy==== | ====Chemotherapy==== | ||
*[[Melphalan (Alkeran)]] 0.21 mg/kg PO once per day on days 1 to 4 | *[[Melphalan (Alkeran)]] 0.21 mg/kg PO once per day on days 1 to 4 | ||
*[[Prednisone (Sterapred)]] 0.5 mg/kg PO once per day on days 1 to 10 | *[[Prednisone (Sterapred)]] 0.5 mg/kg PO once per day on days 1 to 10 | ||
− | '''42-day | + | '''42-day cycle for six cycles''' |
− | |||
− | |||
− | + | ===Variant #2, Indefinite therapy {{#subobject:f79d0f|Variant=1}}=== | |
− | ===Variant #2 | ||
− | |||
− | |||
{| class="wikitable" style="width: 100%; text-align:center;" | {| class="wikitable" style="width: 100%; text-align:center;" | ||
!style="width: 25%"|Study | !style="width: 25%"|Study | ||
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*[[Prednisone (Sterapred)]] 2 mg/kg PO once per day on days 1 to 4 | *[[Prednisone (Sterapred)]] 2 mg/kg PO once per day on days 1 to 4 | ||
− | '''42 day cycles, | + | '''42 day cycles''' |
+ | |||
+ | ===References=== | ||
+ | # Hjorth M, Hellquist L, Holmberg E, Magnusson B, Rödjer S, Westin J; Myeloma Group of Western Sweden. Initial versus deferred melphalan-prednisone therapy for asymptomatic multiple myeloma stage I--a randomized study. Eur J Haematol. 1993 Feb;50(2):95-102. [https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1600-0609.1993.tb00148.x link to original article] '''contains protocol''' [https://www.ncbi.nlm.nih.gov/pubmed/8440364 PubMed] | ||
+ | # '''MM87/MM90:''' Riccardi A, Mora O, Tinelli C, Valentini D, Brugnatelli S, Spanedda R, De Paoli A, Barbarano L, Di Stasi M, Giordano M, Delfini C, Nicoletti G, Bergonzi C, Rinaldi E, Piccinini L, Ascari E; Cooperative Group of Study and Treatment of Multiple Myeloma. Long-term survival of stage I multiple myeloma given chemotherapy just after diagnosis or at progression of the disease: a multicentre randomized study. Br J Cancer. 2000 Apr;82(7):1254-60. [https://www.nature.com/articles/6691087 link to original article] '''contains protocol''' [https://www.ncbi.nlm.nih.gov/pubmed/10755397 PubMed] | ||
+ | ==Observation== | ||
+ | {| class="wikitable" style="float:right; margin-left: 5px;" | ||
+ | |- | ||
+ | |[[#top|back to top]] | ||
+ | |} | ||
+ | |||
+ | ===Regimen=== | ||
+ | {| class="wikitable" style="width: 100%; text-align:center;" | ||
+ | !style="width: 25%"|Study | ||
+ | !style="width: 25%"|[[Levels_of_Evidence#Evidence|Evidence]] | ||
+ | !style="width: 25%"|Comparator | ||
+ | !style="width: 25%"|[[Levels_of_Evidence#Comparative_efficacy|Comparative Efficacy]] | ||
+ | |- | ||
+ | ||[https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1600-0609.1993.tb00148.x Hjorth et al. 1993] | ||
+ | | style="background-color:#1a9851" |Phase III (C) | ||
+ | |[[#MP|MP]] | ||
+ | | style="background-color:#ffffbf" |Seems not superior | ||
+ | |- | ||
+ | |[https://www.nature.com/articles/6691087 Riccardi et al. 2000 (MM87/MM90)] | ||
+ | | style="background-color:#1a9851" |Phase III (C) | ||
+ | |[[#MP|MP]] | ||
+ | | style="background-color:#ffffbf" |Seems not superior | ||
+ | |- | ||
+ | |[https://www.nature.com/articles/leu2012236 Witzig et al 2012 (MC0289)] | ||
+ | | style="background-color:#1a9851" |Phase III (C) | ||
+ | |[[#Thalidomide_monotherapy|Thalidomide]] | ||
+ | | style="background-color:#fc8d59" |Seems to have inferior TTP | ||
+ | |- | ||
+ | |[https://www.nejm.org/doi/full/10.1056/NEJMoa1300439 Mateos et al. 2013 (QUIREDEX)] | ||
+ | | style="background-color:#1a9851" |Phase III (C) | ||
+ | |[[#Rd|Rd]] | ||
+ | | style="background-color:#fc8d59" |Seems to have inferior OS | ||
+ | |- | ||
+ | |[https://ascopubs.org/doi/full/10.1200/JCO.19.01740 Lonial et al. 2019 (ECOG E3A06)] | ||
+ | | style="background-color:#1a9851" |Phase III (C) | ||
+ | |[[#Lenalidomide_monotherapy|Lenalidomide]] | ||
+ | | style="background-color:#d73027" |Inferior PFS | ||
+ | |- | ||
+ | |} | ||
+ | |||
+ | ''No treatment.'' | ||
===References=== | ===References=== | ||
− | # Hjorth M, Hellquist L, Holmberg E, Magnusson B, Rödjer S, Westin J. Initial versus deferred melphalan-prednisone therapy for asymptomatic multiple myeloma stage I--a randomized study | + | # Hjorth M, Hellquist L, Holmberg E, Magnusson B, Rödjer S, Westin J; Myeloma Group of Western Sweden. Initial versus deferred melphalan-prednisone therapy for asymptomatic multiple myeloma stage I--a randomized study. Eur J Haematol. 1993 Feb;50(2):95-102. [https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1600-0609.1993.tb00148.x link to original article] '''contains protocol''' [https://www.ncbi.nlm.nih.gov/pubmed/8440364 PubMed] |
− | # '''MM87/MM90:''' Riccardi A, Mora O, Tinelli C, Valentini D, Brugnatelli S, Spanedda R, De Paoli A, Barbarano L, Di Stasi M, Giordano M, Delfini C, Nicoletti G, Bergonzi C, Rinaldi E, Piccinini L, Ascari E. Long-term survival of stage I multiple myeloma given chemotherapy just after diagnosis or at progression of the disease: a multicentre randomized study | + | # '''MM87/MM90:''' Riccardi A, Mora O, Tinelli C, Valentini D, Brugnatelli S, Spanedda R, De Paoli A, Barbarano L, Di Stasi M, Giordano M, Delfini C, Nicoletti G, Bergonzi C, Rinaldi E, Piccinini L, Ascari E; Cooperative Group of Study and Treatment of Multiple Myeloma. Long-term survival of stage I multiple myeloma given chemotherapy just after diagnosis or at progression of the disease: a multicentre randomized study. Br J Cancer. 2000 Apr;82(7):1254-60. [https://www.nature.com/articles/6691087 link to original article] '''contains protocol''' [https://www.ncbi.nlm.nih.gov/pubmed/10755397 PubMed] |
+ | # '''MC0289:''' Witzig TE, Laumann KM, Lacy MQ, Hayman SR, Dispenzieri A, Kumar S, Reeder CB, Roy V, Lust JA, Gertz MA, Greipp PR, Hassoun H, Mandrekar SJ, Rajkumar SV. A phase III randomized trial of thalidomide plus zoledronic acid versus zoledronic acid alone in patients with asymptomatic multiple myeloma. Leukemia. 2013 Jan;27(1):220-5. Epub 2012 Aug 20 [https://www.nature.com/articles/leu2012236 link to original article] '''contains verified protocol''' [https://www.ncbi.nlm.nih.gov/pubmed/22902362 PubMed] | ||
+ | # '''QUIREDEX:''' Mateos MV, Hernández MT, Giraldo P, de la Rubia J, de Arriba F, López Corral L, Rosiñol L, Paiva B, Palomera L, Bargay J, Oriol A, Prosper F, López J, Olavarría E, Quintana N, García JL, Bladé J, Lahuerta JJ, San Miguel JF. Lenalidomide plus dexamethasone for high-risk smoldering multiple myeloma. N Engl J Med. 2013 Aug 1;369(5):438-47. [https://www.nejm.org/doi/full/10.1056/NEJMoa1300439 link to original article] '''contains verified protocol''' [https://www.ncbi.nlm.nih.gov/pubmed/23902483 PubMed] | ||
+ | # '''ECOG E3A06:''' Lonial S, Jacobus S, Fonseca R, Weiss M, Kumar S, Orlowski RZ, Kaufman JL, Yacoub AM, Buadi FK, O'Brien T, Matous JV, Anderson DM, Emmons RV, Mahindra A, Wagner LI, Dhodapkar MV, Rajkumar SV. Randomized trial of lenalidomide versus observation in smoldering multiple myeloma. J Clin Oncol. 2019 Oct 25:JCO1901740. [Epub ahead of print] | ||
==Rd {{#subobject:bec321|Regimen=3}}== | ==Rd {{#subobject:bec321|Regimen=3}}== | ||
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|} | |} | ||
− | ===Variant #1, 200 mg/d, indefinite therapy {{#subobject: | + | ===Variant #1, 200 mg/d, indefinite therapy {{#subobject:fabn70|Variant=1}}=== |
− | |||
{| class="wikitable" style="width: 100%; text-align:center;" | {| class="wikitable" style="width: 100%; text-align:center;" | ||
!style="width: 25%"|Study | !style="width: 25%"|Study | ||
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'''Continued indefinitely''' | '''Continued indefinitely''' | ||
− | ===Variant #2, 200 -> 600 mg/d, indefinite therapy {{#subobject: | + | ===Variant #2, 200 -> 600 mg/d, indefinite therapy {{#subobject:atn1d0|Variant=2}}=== |
− | |||
{| class="wikitable" style="width: 50%; text-align:center;" | {| class="wikitable" style="width: 50%; text-align:center;" | ||
!style="width: 25%"|Study | !style="width: 25%"|Study | ||
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|- | |- | ||
|} | |} | ||
− | + | ''Note: The median maximal tolerated dose in this study for patients with smoldering myeloma was 400 mg PO once per day'' | |
====Chemotherapy==== | ====Chemotherapy==== | ||
*[[Thalidomide (Thalomid)]] as follows: | *[[Thalidomide (Thalomid)]] as follows: | ||
**Cycle 1: Cycle 1: 200 mg PO once per day on days 1 to 7, then 300 mg PO once per day on days 8 to 14, then 400 mg PO once per day on days 15 to 21, then 500 mg PO once per day on days 22 to 29 | **Cycle 1: Cycle 1: 200 mg PO once per day on days 1 to 7, then 300 mg PO once per day on days 8 to 14, then 400 mg PO once per day on days 15 to 21, then 500 mg PO once per day on days 22 to 29 | ||
**Cycle 2 onwards: 600 mg PO once per day | **Cycle 2 onwards: 600 mg PO once per day | ||
− | |||
− | |||
'''Continued indefinitely''' | '''Continued indefinitely''' | ||
− | ===Variant #3, 200 -> 800 mg/d, indefinite therapy {{#subobject: | + | ===Variant #3, 200 -> 800 mg/d, indefinite therapy {{#subobject:fabc10|Variant=3}}=== |
− | |||
{| class="wikitable" style="width: 50%; text-align:center;" | {| class="wikitable" style="width: 50%; text-align:center;" | ||
!style="width: 25%"|Study | !style="width: 25%"|Study | ||
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|- | |- | ||
|} | |} | ||
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====Chemotherapy==== | ====Chemotherapy==== | ||
*[[Thalidomide (Thalomid)]] as follows: | *[[Thalidomide (Thalomid)]] as follows: | ||
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===References=== | ===References=== | ||
− | # | + | # Rajkumar SV, Dispenzieri A, Fonseca R, Lacy MQ, Geyer S, Lust JA, Kyle RA, Greipp PR, Gertz MA, Witzig TE. Thalidomide for previously untreated indolent or smoldering multiple myeloma. Leukemia. 2001 Aug;15(8):1274-6 [https://www.nature.com/articles/2402183 link to original article] '''contains protocol''' [https://www.ncbi.nlm.nih.gov/pubmed/11480571 PubMed] |
# Weber D, Rankin K, Gavino M, Delasalle K, Alexanian R. Thalidomide alone or with dexamethasone for previously untreated multiple myeloma. J Clin Oncol. 2003 Jan 1;21(1):16-9. [http://jco.ascopubs.org/content/21/1/16.full link to original article] '''contains protocol''' [https://www.ncbi.nlm.nih.gov/pubmed/12506164 PubMed] | # Weber D, Rankin K, Gavino M, Delasalle K, Alexanian R. Thalidomide alone or with dexamethasone for previously untreated multiple myeloma. J Clin Oncol. 2003 Jan 1;21(1):16-9. [http://jco.ascopubs.org/content/21/1/16.full link to original article] '''contains protocol''' [https://www.ncbi.nlm.nih.gov/pubmed/12506164 PubMed] | ||
− | |||
# Barlogie B, van Rhee F, Shaughnessy JD Jr, Epstein J, Yaccoby S, Pineda-Roman M, Hollmig K, Alsayed Y, Hoering A, Szymonifka J, Anaissie E, Petty N, Kumar NS, Srivastava G, Jenkins B, Crowley J, Zeldis JB. Seven-year median time to progression with thalidomide for smoldering myeloma: partial response identifies subset requiring earlier salvage therapy for symptomatic disease. Blood. 2008 Oct 15;112(8):3122-5. doi: 10.1182/blood-2008-06-164228. Epub 2008 Jul 31. [https://ashpublications.org/blood/article/112/8/3122/114933/Seven-year-median-time-to-progression-with link to original article] '''contains protocol''' [https://www.ncbi.nlm.nih.gov/pubmed/18669874?report=docsum&format=text PubMed] | # Barlogie B, van Rhee F, Shaughnessy JD Jr, Epstein J, Yaccoby S, Pineda-Roman M, Hollmig K, Alsayed Y, Hoering A, Szymonifka J, Anaissie E, Petty N, Kumar NS, Srivastava G, Jenkins B, Crowley J, Zeldis JB. Seven-year median time to progression with thalidomide for smoldering myeloma: partial response identifies subset requiring earlier salvage therapy for symptomatic disease. Blood. 2008 Oct 15;112(8):3122-5. doi: 10.1182/blood-2008-06-164228. Epub 2008 Jul 31. [https://ashpublications.org/blood/article/112/8/3122/114933/Seven-year-median-time-to-progression-with link to original article] '''contains protocol''' [https://www.ncbi.nlm.nih.gov/pubmed/18669874?report=docsum&format=text PubMed] | ||
+ | # '''MC0289:''' Witzig TE, Laumann KM, Lacy MQ, Hayman SR, Dispenzieri A, Kumar S, Reeder CB, Roy V, Lust JA, Gertz MA, Greipp PR, Hassoun H, Mandrekar SJ, Rajkumar SV. A phase III randomized trial of thalidomide plus zoledronic acid versus zoledronic acid alone in patients with asymptomatic multiple myeloma. Leukemia. 2013 Jan;27(1):220-5. Epub 2012 Aug 20 [https://www.nature.com/articles/leu2012236 link to original article] '''contains verified protocol''' [https://www.ncbi.nlm.nih.gov/pubmed/22902362 PubMed] | ||
[[Category:Smoldering multiple myeloma regimens]] | [[Category:Smoldering multiple myeloma regimens]] | ||
[[Category:Disease-specific pages]] | [[Category:Disease-specific pages]] | ||
[[Category:Plasma cell dyscrasias]] | [[Category:Plasma cell dyscrasias]] | ||
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Revision as of 16:33, 7 November 2019
Page editor | Section editor | ||
---|---|---|---|
Samuel M. Rubinstein, MD Vanderbilt University Nashville, TN ![]() |
Andrew J. Cowan, MD University of Washington Seattle, WA ![]() |
4 regimens on this page
7 variants on this page
|
All lines of therapy
Lenalidomide monotherapy
back to top |
Regimen
Study | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|
Lonial et al. 2019 (ECOG E3A06) | Phase III (E) | Observation | Superior PFS |
Chemotherapy
- Lenalidomide (Revlimid) 25 mg PO once per day on days 1 to 21
Supportive medications
- Aspirin 325 mg PO once per day
28-day cycles
References
- ECOG E3A06: Lonial S, Jacobus S, Fonseca R, Weiss M, Kumar S, Orlowski RZ, Kaufman JL, Yacoub AM, Buadi FK, O'Brien T, Matous JV, Anderson DM, Emmons RV, Mahindra A, Wagner LI, Dhodapkar MV, Rajkumar SV. Randomized trial of lenalidomide versus observation in smoldering multiple myeloma. J Clin Oncol. 2019 Oct 25:JCO1901740. [Epub ahead of print] link to original article contains verified protocol PubMed
MP
back to top |
MP: Melphalan & Prednisone
Note: This regimen is of historical significance
Variant #1, Six cycles of therapy
Study | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|
Riccardi et al. 2000 (MM87/MM90) | Phase III (E) | Observation | Seems not superior |
Note: Patients on the observation arm of this study received this regimen at progression to symptomatic MM
Chemotherapy
- Melphalan (Alkeran) 0.21 mg/kg PO once per day on days 1 to 4
- Prednisone (Sterapred) 0.5 mg/kg PO once per day on days 1 to 10
42-day cycle for six cycles
Variant #2, Indefinite therapy
Study | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|
Hjorth et al. 1993 | Phase III (E) | Observation | Seems not superior |
Chemotherapy
- Melphalan (Alkeran) 0.25 mg/kg PO once per day on days 1 to 4
- Prednisone (Sterapred) 2 mg/kg PO once per day on days 1 to 4
42 day cycles
References
- Hjorth M, Hellquist L, Holmberg E, Magnusson B, Rödjer S, Westin J; Myeloma Group of Western Sweden. Initial versus deferred melphalan-prednisone therapy for asymptomatic multiple myeloma stage I--a randomized study. Eur J Haematol. 1993 Feb;50(2):95-102. link to original article contains protocol PubMed
- MM87/MM90: Riccardi A, Mora O, Tinelli C, Valentini D, Brugnatelli S, Spanedda R, De Paoli A, Barbarano L, Di Stasi M, Giordano M, Delfini C, Nicoletti G, Bergonzi C, Rinaldi E, Piccinini L, Ascari E; Cooperative Group of Study and Treatment of Multiple Myeloma. Long-term survival of stage I multiple myeloma given chemotherapy just after diagnosis or at progression of the disease: a multicentre randomized study. Br J Cancer. 2000 Apr;82(7):1254-60. link to original article contains protocol PubMed
Observation
back to top |
Regimen
Study | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|
Hjorth et al. 1993 | Phase III (C) | MP | Seems not superior |
Riccardi et al. 2000 (MM87/MM90) | Phase III (C) | MP | Seems not superior |
Witzig et al 2012 (MC0289) | Phase III (C) | Thalidomide | Seems to have inferior TTP |
Mateos et al. 2013 (QUIREDEX) | Phase III (C) | Rd | Seems to have inferior OS |
Lonial et al. 2019 (ECOG E3A06) | Phase III (C) | Lenalidomide | Inferior PFS |
No treatment.
References
- Hjorth M, Hellquist L, Holmberg E, Magnusson B, Rödjer S, Westin J; Myeloma Group of Western Sweden. Initial versus deferred melphalan-prednisone therapy for asymptomatic multiple myeloma stage I--a randomized study. Eur J Haematol. 1993 Feb;50(2):95-102. link to original article contains protocol PubMed
- MM87/MM90: Riccardi A, Mora O, Tinelli C, Valentini D, Brugnatelli S, Spanedda R, De Paoli A, Barbarano L, Di Stasi M, Giordano M, Delfini C, Nicoletti G, Bergonzi C, Rinaldi E, Piccinini L, Ascari E; Cooperative Group of Study and Treatment of Multiple Myeloma. Long-term survival of stage I multiple myeloma given chemotherapy just after diagnosis or at progression of the disease: a multicentre randomized study. Br J Cancer. 2000 Apr;82(7):1254-60. link to original article contains protocol PubMed
- MC0289: Witzig TE, Laumann KM, Lacy MQ, Hayman SR, Dispenzieri A, Kumar S, Reeder CB, Roy V, Lust JA, Gertz MA, Greipp PR, Hassoun H, Mandrekar SJ, Rajkumar SV. A phase III randomized trial of thalidomide plus zoledronic acid versus zoledronic acid alone in patients with asymptomatic multiple myeloma. Leukemia. 2013 Jan;27(1):220-5. Epub 2012 Aug 20 link to original article contains verified protocol PubMed
- QUIREDEX: Mateos MV, Hernández MT, Giraldo P, de la Rubia J, de Arriba F, López Corral L, Rosiñol L, Paiva B, Palomera L, Bargay J, Oriol A, Prosper F, López J, Olavarría E, Quintana N, García JL, Bladé J, Lahuerta JJ, San Miguel JF. Lenalidomide plus dexamethasone for high-risk smoldering multiple myeloma. N Engl J Med. 2013 Aug 1;369(5):438-47. link to original article contains verified protocol PubMed
- ECOG E3A06: Lonial S, Jacobus S, Fonseca R, Weiss M, Kumar S, Orlowski RZ, Kaufman JL, Yacoub AM, Buadi FK, O'Brien T, Matous JV, Anderson DM, Emmons RV, Mahindra A, Wagner LI, Dhodapkar MV, Rajkumar SV. Randomized trial of lenalidomide versus observation in smoldering multiple myeloma. J Clin Oncol. 2019 Oct 25:JCO1901740. [Epub ahead of print]
Rd
back to top |
Regimen
Study | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|
Mateos et al. 2013 (QUIREDEX) | Phase III (E) | Observation | Seems to have superior OS |
Note: QUIREDEX did not require modern imaging modalities (such as MRI) to rule out active myeloma, and therefore it is probable that many patients on this study had active as opposed to smoldering multiple myeloma.
Chemotherapy
- Lenalidomide (Revlimid) 25 mg PO once per day on days 1 to 21
- Dexamethasone (Decadron) 20 mg PO once per day on days 1 to 4, 12 to 15
Supportive medications
- Aspirin 100 mg PO once per day
28-day cycle for 9 cycles
Subsequent treatment
References
- QUIREDEX: Mateos MV, Hernández MT, Giraldo P, de la Rubia J, de Arriba F, López Corral L, Rosiñol L, Paiva B, Palomera L, Bargay J, Oriol A, Prosper F, López J, Olavarría E, Quintana N, García JL, Bladé J, Lahuerta JJ, San Miguel JF. Lenalidomide plus dexamethasone for high-risk smoldering multiple myeloma. N Engl J Med. 2013 Aug 1;369(5):438-47. link to original article contains verified protocol PubMed
Thalidomide monotherapy
back to top |
Variant #1, 200 mg/d, indefinite therapy
Study | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|
Witzig et al. 2012 (MC0289) | Phase III (E) | Observation | Seems to have superior TTP |
Barlogie et al. 2008 | Phase II |
Note: Zoledronic acid was received in both the control and experimental arms.
Chemotherapy
- Thalidomide (Thalomid) 200 mg PO once per day
Supportive medications
- Zoledronic acid (Zometa) 4 mg IV once every three months
Continued indefinitely
Variant #2, 200 -> 600 mg/d, indefinite therapy
Study | Evidence |
---|---|
Weber et al. 2003 | Phase II |
Note: The median maximal tolerated dose in this study for patients with smoldering myeloma was 400 mg PO once per day
Chemotherapy
- Thalidomide (Thalomid) as follows:
- Cycle 1: Cycle 1: 200 mg PO once per day on days 1 to 7, then 300 mg PO once per day on days 8 to 14, then 400 mg PO once per day on days 15 to 21, then 500 mg PO once per day on days 22 to 29
- Cycle 2 onwards: 600 mg PO once per day
Continued indefinitely
Variant #3, 200 -> 800 mg/d, indefinite therapy
Study | Evidence |
---|---|
Rajkumar et al. 2001 | Phase II |
Chemotherapy
- Thalidomide (Thalomid) as follows:
- Cycle 1: Cycle 1: 200 mg PO once per day on days 1 to 14, then 400 mg PO once per day on days 15 to 28, then 600 mg PO once per day on days 29 to 42
- Cycle 2 onwards: 800 mg PO once per day
Continued indefinitely
References
- Rajkumar SV, Dispenzieri A, Fonseca R, Lacy MQ, Geyer S, Lust JA, Kyle RA, Greipp PR, Gertz MA, Witzig TE. Thalidomide for previously untreated indolent or smoldering multiple myeloma. Leukemia. 2001 Aug;15(8):1274-6 link to original article contains protocol PubMed
- Weber D, Rankin K, Gavino M, Delasalle K, Alexanian R. Thalidomide alone or with dexamethasone for previously untreated multiple myeloma. J Clin Oncol. 2003 Jan 1;21(1):16-9. link to original article contains protocol PubMed
- Barlogie B, van Rhee F, Shaughnessy JD Jr, Epstein J, Yaccoby S, Pineda-Roman M, Hollmig K, Alsayed Y, Hoering A, Szymonifka J, Anaissie E, Petty N, Kumar NS, Srivastava G, Jenkins B, Crowley J, Zeldis JB. Seven-year median time to progression with thalidomide for smoldering myeloma: partial response identifies subset requiring earlier salvage therapy for symptomatic disease. Blood. 2008 Oct 15;112(8):3122-5. doi: 10.1182/blood-2008-06-164228. Epub 2008 Jul 31. link to original article contains protocol PubMed
- MC0289: Witzig TE, Laumann KM, Lacy MQ, Hayman SR, Dispenzieri A, Kumar S, Reeder CB, Roy V, Lust JA, Gertz MA, Greipp PR, Hassoun H, Mandrekar SJ, Rajkumar SV. A phase III randomized trial of thalidomide plus zoledronic acid versus zoledronic acid alone in patients with asymptomatic multiple myeloma. Leukemia. 2013 Jan;27(1):220-5. Epub 2012 Aug 20 link to original article contains verified protocol PubMed