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Blood, 1 July 2005, Vol. 106, No. 1, pp. 35-39.
Prepublished online as a Blood First Edition Paper on March 10, 2005; DOI 10.1182/blood-2005-02-0522.


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CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS

Superiority of thalidomide and dexamethasone over vincristine-doxorubicindexamethasone (VAD) as primary therapy in preparation for autologous transplantation for multiple myeloma

Michele Cavo, Elena Zamagni, Patrizia Tosi, Paola Tacchetti, Claudia Cellini, Delia Cangini, Antonio de Vivo, Nicoletta Testoni, Chiara Nicci, Carolina Terragna, Tiziana Grafone, Giulia Perrone, Michela Ceccolini, Sante Tura, Michele Baccarani, for the writing committee of the Bologna 2002 study

From the Institute of Hematology and Medical Oncology "Seràgnoli," University of Bologna, Italy.

The aim of the present study was to compare thalidomide-dexamethasone (Thal-Dex) and vincristine-doxorubicin-dexamethasone (VAD) as primary therapy in preparation for autologous peripheral blood stem-cell (PBSC) transplantation for multiple myeloma (MM). For this purpose, we performed a retrospective matched case-control analysis of 200 patients who entered 2 consecutive studies from 1996 to 2004 and received Thal-Dex (n = 100) or VAD (n = 100) administered for 4 months before collection of PBSCs and autologous transplantation. Matching criteria included age, clinical stage, and serum {beta}2-microglobulin levels. In comparison with VAD, Thal-Dex resulted in a significantly higher response rate (52% versus 76%, respectively; P < .001) and effected more profound reduction in myeloma cell mass of both immunoglobulin G (IgG; P = .02) and IgA (P = .03) type. More frequent toxicities included nonfatal deep vein thrombosis with Thal-Dex (15%) and granulocytopenia with VAD (12%). In each of the 2 treatment groups, 91% of patients proceeded to PBSC mobilization. The median number of collected CD34+ cells was 7.85 x 106/kg in the Thal-Dex group and 10.5 x 106/kg in the control group. Thal-Dex may be considered an effective and relatively well-tolerated oral alternative to the more complex VAD regimen as front-line therapy for MM patients who are candidates for subsequent autologous transplantation.


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Find additional patient-related information at:

New Drug Combo Shows Promise for Multiple Myeloma - 4/15/05

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