4.7 Article

Maintenance therapy with alternate-day prednisone improves survival in multiple myeloma patients

Journal

BLOOD
Volume 99, Issue 9, Pages 3163-3168

Publisher

AMER SOC HEMATOLOGY
DOI: 10.1182/blood.V99.9.3163

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Funding

  1. NCI NIH HHS [CA35119, CA35128, CA45377, CA45560, CA35176, CA35178, CA35192, CA35261, CA20319, CA52386, CA35262, CA12213, CA12644, CA35281, CA13612, CA35090, CA42777, CA04920, CA04919, CA22433, CA27057, CA32102, CA52654, CA58348, CA58416, CA58861, CA63845, CA38926, CA45807, CA46113, CA16385, CA67663, CA37981, CA46136, CA14028, CA46441, CA96429, CA35431, CA76462, CA76447, CA46282] Funding Source: Medline

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The role of maintenance therapy in multiple myeloma is controversial. Recent studies have shown an improvement in both progression-free and overall survival for patients receiving maintenance treatment with a combination of interferon and glucocorticoids, compared with interferon alone. The role of glucocorticoids alone as maintenance therapy has not been previously addressed. We compared alternate-day, oral prednisone at 2 different dose levels (10 mg versus 50 mg) for remission maintenance among previously untreated myeloma patients following a response to induction with standard-dose vincristine, doxorubicin, and dexamethasone with prednisone (VAD-P) or VAD-P plus quinine (VAD-P/Q). There were 250 eligible patients registered on Southwest Oncology Group study 9210 and randomized to receive VAD-P or VAD-P/Q. There were 125 patients achieving at least a 25% tumor reduction following induction therapy who were randomized to either physiologic (10 mg) or pharmacologic (50 mg) doses of alternate-day, oral prednisone until disease progression. At the time of study entry, patient characteristics were similar in VAD-P and VAD-P/Q patients and in the 2 arms randomized to maintenance therapy. After a median follow-up of 53 months, there was no difference in either progression-free or overall survival between the 2 induction regimens. However, from the time of maintenance randomization, both progression-free (14 versus 5 months; P = .003) and overall survival (37 versus 26 months; P = .05) were significantly improved in patients receiving 50 mg as compared with 10 mg alternate-day prednisone. There was no difference in treatment-related adverse events between the groups. Thus, 50 mg, oral, alternate-day prednisone is effective maintenance treatment for multiple myeloma patients who achieve a response to induction chemotherapy. (C) 2002 by The American Society of Hematology.

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