Summary of agents and grade of recommendation.
| Agent . | Study . | Results . | Recommendation . | Level of evidence . |
|---|---|---|---|---|
| PFS indicates progression-free survival; OS, overall survival; PAD, bortezomib, adriamycin, dexamethasone ; VAD, vincristine, adriamycin, dexamethasone | ||||
| Interferon | Mandelli et al5 | PFS and response duration were improved; but interferon decreased OS | Not recommended | Grade 2A |
| Prednisolone | SWOG study9 Spencer et al10 | High toxicity Thalidomide was superior | Recommended, but not used widely because of toxicity concerns. | Grade 2A |
| Thalidomide | IFM-99 0211 | 3 randomized studies showing benefit to thalidomide in PFS | Recommended but not used widely because of toxicity concerns. | Grade 2A |
| Lenalidomide | Ongoing studies | No data | Not recommended until data matures and results are available | Grade 1C |
| Bortezomib | HOVON14 Ongoing studies by Richardson et al and Kumar et al | Bortezomib had superior response and PFS in the PAD arm compared to thalidomide in the VAD arm. | Not widely used until data from ongoing studies are available | Grade 1B |
| Agent . | Study . | Results . | Recommendation . | Level of evidence . |
|---|---|---|---|---|
| PFS indicates progression-free survival; OS, overall survival; PAD, bortezomib, adriamycin, dexamethasone ; VAD, vincristine, adriamycin, dexamethasone | ||||
| Interferon | Mandelli et al5 | PFS and response duration were improved; but interferon decreased OS | Not recommended | Grade 2A |
| Prednisolone | SWOG study9 Spencer et al10 | High toxicity Thalidomide was superior | Recommended, but not used widely because of toxicity concerns. | Grade 2A |
| Thalidomide | IFM-99 0211 | 3 randomized studies showing benefit to thalidomide in PFS | Recommended but not used widely because of toxicity concerns. | Grade 2A |
| Lenalidomide | Ongoing studies | No data | Not recommended until data matures and results are available | Grade 1C |
| Bortezomib | HOVON14 Ongoing studies by Richardson et al and Kumar et al | Bortezomib had superior response and PFS in the PAD arm compared to thalidomide in the VAD arm. | Not widely used until data from ongoing studies are available | Grade 1B |