Blood, Vol. 92 No. 6 (September 15), 1998:
pp. 2184-2186
CORRESPONDENCE
The Italian Experience on Interferon as Maintenance Treatment in
Multiple Myeloma: Ten Years After
 |
LETTER |
To the Editor:
The role of interferon maintenance treatment in patients with multiple
myeloma (MM) is still debated. In 1990, the Italian Multiple Myeloma
Study Group published the results of the first randomized study on the
role of interferon a2-b (IFN) as maintenance treatment in patients
responding to induction therapy.1 One hundred one MM
patients responding to traditional first-line induction chemotherapy
were randomized to receive (n = 50) or not receive (n = 51) IFN
maintenance. Patients were recruited from a group of 202 symptomatic MM
patients observed in the three university institutions of Rome, Bari,
and Turin, Italy. The results originally demonstrated that a
maintenance treatment with IFN prolonged response and survival duration
in patients with MM who have responded to conventional induction
therapy.
After this experience, five large randomized studies were published
comparing IFN maintenance versus untreated control: two of them did not
demonstrate any advantage as for response and survival
duration2,3; one showed a clear advantage in response
duration but not in survival duration4; and two
demonstrated a significant improvement both in response duration and in
survival duration.5,6
The updated results of the Italian study 9 years after the
randomization of the last patient confirm a significant prolongation of
response duration in IFN maintained patients: the median response duration (from time of randomization to maintenance treatment) is 24 months in patients receiving IFN and 13 months in untreated patients
(P = .0016). The results in terms of prolongation of survival are less significant: the median overall survival is of 50 and
39 months, respectively (P = .21); among patients who had
an objective response to induction chemotherapy (>50% reduction in M
protein), the median survival was 50 and 35 months, respectively (P = .07; Fig 1). However, 9 patients are still alive and in response in the
IFN-maintained group versus 2 in the unmaintained group.
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| Fig 1.
Kaplan-Meier curves for response and survival after
randomization of patients to the interferon maintenance group or
control group.
|
|
In conclusion, the majority of randomized studies on IFN maintenance in
MM as well as our results demonstrate that IFN maintenance significantly prolongs the response duration phase in MM patients responsive to previous induction therapy, whereas the efficacy on
survival prolongation is less clear. Despite the uncertain effect on survival duration, IFN maintenance is still
appropriate in responding myeloma patients, because delaying relapse
appearance allows a higher quality of life in patients with
MM. Nevertheless, accurate quality of life evaluation is required in
these patients to confirm this
assumption.
Alessandro Pulsoni
Giuseppe Avvisati
Maria Teresa Petrucci
Franco Mandelli
Department
of Cellular Biotechnology and Hematology
"La Sapienza"
University
Rome, Italy
Diana Giannarelli
Biostatistical Unit
Regina Elena Cancer
Institute
Rome, Italy
Vito M. Lauta
Institute of
Medical Pathology
University of Bari
Bari, Italy
Maurizio Tribalto
Chair and Division of Hematology
"Tor Vergata"
University
S. Eugenio Hospital
Rome,
Italy
Alessandro Pileri
Section of
Hematology
Department of Medicine and Experimental
Oncology
University of Torino
Torino, Italy
| |
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