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Blood, 15 November 2006, Vol. 108, No. 10, pp. 3289-3294.
Prepublished online as a Blood First Edition Paper on July 27, 2006; DOI 10.1182/blood-2006-05-022962.
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Submitted May 25, 2006
Accepted July 6, 2006
Maintenance therapy with thalidomide improves survival in
multiple myeloma patients
Michel Attal*, Jean-Luc Harousseau, Serge Leyvraz, Chantal Doyen, Cyrille Hulin, Lofti Benboubker, Ibrahim Yakoub Agha, Jean-Henri Bourhis, Laurent Garderet, Brigitte Pegourie, Charles Dumontet, Marc Renaud, Laurent Voillat, Christian Berthou, Gerald Marit, Mathieu Monconduit, Denis Caillot, Bernard Grobois, Herve Avet-Loiseau, Philippe Moreau, and Thierry Facon
hopital purpan, Toulouse
Hotel Dieu, Nantes
centre hospitalier universitaire, Lausanne
cliniques universitaires de Mont-Godinne, Yvoir
centre hospitalier du Brabois, Nancy
hopital Bretonneau, Tours
hopital Huriez, Lille
institut Gustave Roussy, villejuif
hopital Saint-antoine, Paris
hopital albert Michallon, Grenoble
hopital edouard Herriot, Lyon
centre hospitalier la Mileterie, Poitiers
hopital jean Minjoz, Besancon
Hopital Morvan, Brest
hopital Haut-Leveque, Bordeaux
Centre henri Becquerel, Rouen
centre hospitalier Le Bocage, Dijon
hopital Sud, Rennes
* Corresponding author; email: attal.m{at}chu-toulouse.fr.
Newer chemotherapeutic protocols as well as high dose
chemotherapy have increased the response rate in myeloma.
However, these treatments are not curative. Effective
maintenance strategies are now required to prolong the
duration of response. We conducted a randomized trial of
maintenance treatment with thalidomide and pamidronate.
Two months after high dose therapy, 597 patients under the
age of 65 years were randomly assigned to receive no
maintenance (arm A), pamidronate (arm B), or pamidronate
plus thalidomide (arm C). A complete or very good partial
response was achieved by 55% of patients in arm A, 57% in
arm B, and 67% in arm C (P=0.03). The 3-year
post-randomization probability of event-free-survival was
36% in arm A, 37% in arm B, and 52% in arm C (P<0.009).
The 4-year post-diagnosis probability of survival was 77%
in arm A, 74% in arm B, and 87% in arm C (P<0.04). The
proportion of patients who had skeletal events was 24% in
arm A, 21% in arm B, and 18% in arm C (P=0.4). Thalidomide
is an effective maintenance therapy in patients with
multiple myeloma. Maintenance treatment with pamidronate
does not decrease the incidence of bone events.

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