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Continuous Low Dose of Melphalan and Prednisone in Patients with Multiple Myeloma of Very Old Age or Severe Associated Disease

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Abstract

Introduction and Objective

The management of elderly patients with multiple myeloma is a relevant problem because it concerns a great number of patients. Patients with multiple myeloma who are very old or who have severe associated diseases have a dismal outcome. For these patients we retrospectively evaluated the effect of a mild approach with continuous low-dose melphalan and prednisone (cMP).

Design and Methods

109 patients with multiple myeloma, observed between 1985 and 2000, were treated with cMP; 67 were treated at time of diagnosis (group A; median age 78 years) and 42 as a second or subsequent line of therapy (group B; median age 72 years). The toxicity of the treatment was compared with a control group of 29 patients aged over 70 years, treated in the same institution with the conventional cyclical melphalan/prednisone regimen.

Results

Major or minor responses were obtained in 32% of patients in group A and 13% of patients in group B. Disease was stabilised in 45% of group A and 47% of group B and progressed in 5 and 18%, respectively. Median survival was, respectively, 19 and 24 months in group A and B.

Among the 42 patients who received cMP as a second-line therapy (group B), 36 (86%) had previously been treated according to the standard cyclical melphalan/prednisone schedule; of these 12 (33%) obtained a better M protein reduction after cMP compared with the previous response to first-line cyclical melphalan/prednisone.

The cMP schedule was generally well tolerated, and the rate of haematological toxicity was lower than for a historical control group receiving cyclical melphalan/prednisone.

Conclusion

The cMP treatment schedule is well tolerated and results in a high proportion of patients with stable disease, with acceptable survival even in patients with advanced disease.

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Acknowledgements

We thank Professor Giuseppe Avvisati (Università Campus Bio-Medico, Roma) for his useful suggestions and his critical review of the manuscript. The study was supported by Associazione Italiana contro le Leucemie. No potential conflicts of interest exist between the authors and the contents of this study.

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Authors and Affiliations

  1. Department of Cellular Biotechnology and Hematology, “La Sapienza” University, Via Benevento 6, 00161, Rome, Italy

    Alessandro Pulsoni, Nicoletta Villivà, Elena Cavalieri, Paolo Falcucci, Giacinto La Verde, Roberta Matera, Maria Teresa Petrucci & Franco Mandelli

  2. Department of Epidemiology and Biostatistics, Istituto Superiore di Sanità, Rome, Italy

    Maria Elena Tosti

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  1. Alessandro Pulsoni
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  2. Nicoletta Villivà
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  3. Elena Cavalieri
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  4. Paolo Falcucci
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  5. Giacinto La Verde
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  6. Roberta Matera
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  7. Maria Teresa Petrucci
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  8. Maria Elena Tosti
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  9. Franco Mandelli
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Correspondence to Alessandro Pulsoni.

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Pulsoni, A., Villivà, N., Cavalieri, E. et al. Continuous Low Dose of Melphalan and Prednisone in Patients with Multiple Myeloma of Very Old Age or Severe Associated Disease. Drugs Aging 19, 947–953 (2002). https://doi.org/10.2165/00002512-200219120-00005

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  • DOI: https://doi.org/10.2165/00002512-200219120-00005

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