t better – at 39 percent – with pamidronate alone. The addition of thalidomide significantly improved these odds to 51 percent.

(b)The use of pamidronate did not decrease the number of bone events as anticipated, and there was no significant difference in the number of these events between the three treatment groups.

(c)The chance of overall survival four years after study enrollment in the pamidronate-thalidomide group was 87 percent. Patients in the pamidronate-alone arm had a 74 percent survival probability compared with those not receiving therapy at 77 percent. Thalidomide, however, is not for everyone. The drug was originally dosed at 400 mg per day, but after 15 months, the median dose was decreased by half because of drug-related toxicity. Thalidomide was discontinued in 39 percent of the patients due to side effects such as numbness, tingling, or pain in the hands and feet, fatigue, and constipation. In contrast, only 4 percent of patients discontinued pamidronate.

Patients most likely to benefit from the addition of thalidomide to maintenance therapy were those whose responses to the original chemotherapy were not as successful, and those who did not have a chromosome 13 deletion.This chromosomal abnormality is found in about 15-20 percent of patients with multiple myeloma and is associated with a poorer prognosis.

'Thalidomide shows great promise for keeping multiple myeloma in check after chemotherapy,' said Michael Attal, MD, PRD, lead author of the study and Head of the Department of Hematology at H?pital Purpan in Toulouse, France. 'If measures can be taken to mediate the toxicity of the drug, or if only those who would get the most benefit from it are treated, this could be an effective long-term therapy for many patients.'

Source-Eurekalert
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