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200 mg/m2 melphalan – the goldstandard for multiple myeloma ➜ Sergio Giralt
Palumbo and co-authors report on the results of a randomised trial comparing two doses of melphalan in patients with symptomatic multiple myeloma. Overall complete response rates, median progression-free survival and projected five-year overall survival were significantly higher among patients receiving the higher melphalan dose. These results confirm that for this patient population melphalan 200 mg/m2 should remain the gold standard conditioning regimen.
Despitemultipleattemptstodesign andimprovedprogression-freesurvival However,almosttwiceasmanypatients achieved a complete remission in the mel- melphalan remains the standard of care for body irradiation. Palumbo et al.1 hypothe- transplant-eligible patients with multiple sised that similar disease control could be (15% vs 8%; P=0.07). These results stand in contrast with the data from the studies al.1 reports on the results of a randomised trial that assessed treatment with two doses of melphalan in patients with newly diag- this was an interesting question; however, since the initiation of the trial in 2001 the formed at Italian institutions from 2001 to strate a 20% improvement in survival with accrual only 298 patients participated in considered one of the most important sur- the trial.1 This is the second randomised some features of the recent Palumbo trial trial to confirm that melphalan 200 mg/m2 are worth mentioning. First, all patients control, studies that do not include modern should continue to be considered the gold standard conditioning regimen for patients induction therapy with almost three quar- ters of the patients achieving at least a al.1 study is still important because it exam- partial response after tandem transplants, regardless of the randomisation group.
This article was first published in Nature Reviews Clinical Oncology 2010 vol.7 no.9, and is republished with
permission. 2010 Nature Publishing Group. doi:10.1038/nrclinonc.2010.104, www.nature.com/nrclinonc
52 ■ CANCER WORLD ■ NOVEMBER/DECEMBER 2010
POST-TRANSPLANT BEST RESPONSE IN PATIENTS RECEIVING MELPHALAN CONDITIONING THERAPY
Induction
Conditioning
Complete
Very good
remission (%)
partial remission
remission (%)
or better (%)
reduction. In this study, the 50% reduction their disease. A variety of strategies have regimen for multiple myeloma autografts.
plant-related mortality (3% in each group), results of high-dose melphalan, including this patient population the role of single or hospitalisation after engraftment or dura- tandem transplants in the context of borte- tion of severe (grade 3–4) neutropenia.
with cytoprotectants, such as amifostine.8,9 Of these, only tandem transplantation has tropenia and infections were higher in the been demonstrated in randomised trials to improve outcomes; however, more recently, incidence of at least one nonhaematologic the addition of post-transplant therapies grade 3 or 4 adverse event, this difference also demonstrated efficacy and a potential group. Therefore, strategies to reduce the burden of treatment that occurs with high- between the ages of 60 and 65 years is not supported by the data provided. This rec- Details of the references cited in this article can be ciated with similar toxic effects but a much post hoc analysis of a subgroup consisting of trol rate), but rather look at other novel Practice point
anti-interleukin-6 blockade treatment.6,7 question of the ideal post-induction ther- apy for patients over 60 years of age. In tinues to be the gold standard conditioning Author affiliation: Adult Bone Marrow Transplant Service, Memorial Sloan-Kettering Cancer Center, New York, USACompeting interests: The author has acted as a consultant for and received honoraria from the following companies: Celgene, Genzyme, Millenium Pharmaceuticals and Novartis CANCER WORLD ■ NOVEMBER/DECEMBER 2010 ■ 53

Source: http://www.cancerworld.org/pdf/9086_pagina_52-53_impactfactor1.pdf