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Blood, 1 April 2007, Vol. 109, No. 7, pp. 2767-2772.
Prepublished online as a Blood First Edition Paper on December 5, 2006; DOI 10.1182/blood-2006-08-042275.
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Submitted August 21, 2006
Accepted November 13, 2006
Bortezomib, melphalan, prednisone and thalidomide for relapsed multiple myeloma
Antonio Palumbo*, Maria Teresa Ambrosini, Giulia Benevolo, Patrizia Pregno, Norbert Pescosta, Vincenzo Callea, Clotilde Cangialosi, Tommaso Caravita, Fortunato Morabito, Pellegrino Musto, Sara Bringhen, Patrizia Falco, Ilaria Avonto, Federica Cavallo, and Mario Boccadoro
Divisione di Ematologia dell'Universita di Torino, AO S. Giovanni Battista, Italy
Ematologia, Azienda Ospedaliera San Giovanni Battista, Italy
Divisione di Ematologia, Ospedale Centrale, Italy
Divisione di Ematologia, Ospedale Riuniti, Italy
Divisione di Ematologia e Trapianto di Midollo Osseo, Azienda Ospedaliera Cervello, Italy
Cattedra e Divisione di Ematologia, Universita Tor Vergata, Ospedale S. Eugenio, Italy
UOC di Ematologia, Azienda Ospedaliera di Cosenza, Italy
UOC di Ematologia e Trapianto di Cellule Staminali, CROB, Italy
* Corresponding author; email: appalumbo{at}yahoo.com.
In multiple myeloma (MM), the addition of thalidomide or bortezomib to the standard oral melphalan/prednisone combination significantly increased response rate and event-free survival. In this multicenter phase I/II trial, dosing, safety, and efficacy of the 4-drug combination, bortezomib (VELCADE®), melphalan, prednisone and thalidomide (VMPT) was determined. Bortezomib was administered at three dose levels (1.0 mg/m2, 1.3 mg/m2 or 1.6 mg/m2) on days 1, 4, 15, 22; melphalan at 6 mg/m2 on days 1-5, prednisone at 60 mg/m2 on days 1-5. Thalidomide was delivered at 50 mg on days 1-35. Each course was repeated every 35 days. The maximum tolerated dose of bortezomib was 1.3 mg/m2. Thirty patients with relapsed or refractory MM were enrolled: 20 patients (67%) achieved a partial response (PR) including 13 patients (43%) who achieved at least a very good partial response. Among 14 patients who received VMPT as second-line treatment, the PR rate was 79% and the immunofixation-negative complete response rate 36%. The 1-year progression-free survival was 61%, and the 1-year survival from study entry was 84%. Grade 3 nonhematologic adverse events included: infections (5 patients), fatigue (1), vasculitis (1) and peripheral neuropathy (2), no grade 4 toxicities were recorded. Initial results showed that VMPT is an effective salvage therapy with a very high proportion of responses. The incidence of neurotoxicities was unexpectedly low.

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