Novel induction regimens for non-transplant myeloma patients.
| Regimen . | Dosing and Schedule . | Reference . |
|---|---|---|
| Abbreviations: MDT, melphalan and dexamethasone with thalidomide; MP, melphalan and prednisone; MPT, melphalan and prednisone with thalidomide; R-MP, melphalan and prednisone with lenalidomide; ThaDD, thalidomide with pegylated liposomal doxorubicin and dexamethasone; VMP, melphalan and prednisone with bortezomib | ||
| MDT | Induction: Melphalan 8 mg/m2 orally on days 1–4 + Dexamethasone 12 mg/m2 orally on days 1–4 and 17–20 + Thalidomide 300 mg orally on days 1–4 and 17–20; Given on an every 5 week schedule for 3 cycles | 30 |
| Maintenance: Melphalan 8 mg/m2 orally on days 1–4 + Dexamethasone 12 mg/m2 orally on days 1–4 + Thalidomide 300 mg orally on days 1–4; Given every 5 weeks for 9 cycles | ||
| MPT | Italian Multiple Myeloma Network Phase II Study | 29 |
| Induction: Melphalan 4 mg/m2 orally on days 1–7 + Prednisone 40 mg/m2 orally on days 1–7 + Thalidomide 100 mg orally each day; Given on a monthly schedule for 6 months | ||
| Maintenance: Thalidomide 100 mg orally each day until progression | ||
| Supportive care: At physician’s discretion | ||
| Italian Multiple Myeloma Network Phase III Study | 31 | |
| Induction: Same as in phase II study above | ||
| Maintenance: Same as in phase II study above | ||
| Supportive care: Enoxaparin 40 mg subcutaneously each day during the first four cycles; Other agents at physician’s discretion | ||
| Intergroupe Francophone du Myélome Phase III Study | 32 | |
| Induction: 12 courses of standard MP at 6-week intervals with thalidomide at up to 400 mg daily | ||
| Maintenance: None; thalidomide was stopped at the end of therapy with MP | ||
| Supportive care: At physician’s discretion | ||
| R-MP | Induction: Melphalan 0.18 or 0.25 mg/kg orally on days 1–4 + Prednisone 2 mg/kg orally on days 1–4 + Lenalidomide 5 or 10 mg orally for 21 days; Given on an every 4–6 week schedule | 36 |
| Supportive care: Ciprofloxacin and aspirin | ||
| VMP | Induction: Melphalan 9 mg/m2 orally on days 1–4 + Prednisone 60 mg/m2 orally on days 1–4 + Bortezomib 1.0 or 1.3 mg/m2 intravenously days 1, 4, 8, 11, 22, 25, 29, and 32; Given on an every 6 week schedule for four cycles | 43 |
| Maintenance: Melphalan 9 mg/m2 orally on days 1–4 + Prednisone 60 mg/m2 orally on days 1–4 + Bortezomib 1.0 or 1.3 mg/m2 intravenously days 1, 8, 15, and 22; Given on an every 5 week schedule for five cycles | ||
| Supportive care: Intravenous bisphosphonates every 4 weeks; other measures at physician’s discretion | ||
| ThaDD | Induction: Thalidomide 100 mg orally each evening + pegylated liposomal doxorubicin 40 mg/m2 intravenously on day 1 + dexamethasone 40 mg orally on days 1–4 and 9–12, every 28 days | 49 |
| Supportive care: Warfarin 1.25 mg orally each day + vitamin B6 + ciprofloxacin 250 mg orally twice daily + intravenous zoledronate + erythropoietic and hypoglycemic agents as needed | ||
| Regimen . | Dosing and Schedule . | Reference . |
|---|---|---|
| Abbreviations: MDT, melphalan and dexamethasone with thalidomide; MP, melphalan and prednisone; MPT, melphalan and prednisone with thalidomide; R-MP, melphalan and prednisone with lenalidomide; ThaDD, thalidomide with pegylated liposomal doxorubicin and dexamethasone; VMP, melphalan and prednisone with bortezomib | ||
| MDT | Induction: Melphalan 8 mg/m2 orally on days 1–4 + Dexamethasone 12 mg/m2 orally on days 1–4 and 17–20 + Thalidomide 300 mg orally on days 1–4 and 17–20; Given on an every 5 week schedule for 3 cycles | 30 |
| Maintenance: Melphalan 8 mg/m2 orally on days 1–4 + Dexamethasone 12 mg/m2 orally on days 1–4 + Thalidomide 300 mg orally on days 1–4; Given every 5 weeks for 9 cycles | ||
| MPT | Italian Multiple Myeloma Network Phase II Study | 29 |
| Induction: Melphalan 4 mg/m2 orally on days 1–7 + Prednisone 40 mg/m2 orally on days 1–7 + Thalidomide 100 mg orally each day; Given on a monthly schedule for 6 months | ||
| Maintenance: Thalidomide 100 mg orally each day until progression | ||
| Supportive care: At physician’s discretion | ||
| Italian Multiple Myeloma Network Phase III Study | 31 | |
| Induction: Same as in phase II study above | ||
| Maintenance: Same as in phase II study above | ||
| Supportive care: Enoxaparin 40 mg subcutaneously each day during the first four cycles; Other agents at physician’s discretion | ||
| Intergroupe Francophone du Myélome Phase III Study | 32 | |
| Induction: 12 courses of standard MP at 6-week intervals with thalidomide at up to 400 mg daily | ||
| Maintenance: None; thalidomide was stopped at the end of therapy with MP | ||
| Supportive care: At physician’s discretion | ||
| R-MP | Induction: Melphalan 0.18 or 0.25 mg/kg orally on days 1–4 + Prednisone 2 mg/kg orally on days 1–4 + Lenalidomide 5 or 10 mg orally for 21 days; Given on an every 4–6 week schedule | 36 |
| Supportive care: Ciprofloxacin and aspirin | ||
| VMP | Induction: Melphalan 9 mg/m2 orally on days 1–4 + Prednisone 60 mg/m2 orally on days 1–4 + Bortezomib 1.0 or 1.3 mg/m2 intravenously days 1, 4, 8, 11, 22, 25, 29, and 32; Given on an every 6 week schedule for four cycles | 43 |
| Maintenance: Melphalan 9 mg/m2 orally on days 1–4 + Prednisone 60 mg/m2 orally on days 1–4 + Bortezomib 1.0 or 1.3 mg/m2 intravenously days 1, 8, 15, and 22; Given on an every 5 week schedule for five cycles | ||
| Supportive care: Intravenous bisphosphonates every 4 weeks; other measures at physician’s discretion | ||
| ThaDD | Induction: Thalidomide 100 mg orally each evening + pegylated liposomal doxorubicin 40 mg/m2 intravenously on day 1 + dexamethasone 40 mg orally on days 1–4 and 9–12, every 28 days | 49 |
| Supportive care: Warfarin 1.25 mg orally each day + vitamin B6 + ciprofloxacin 250 mg orally twice daily + intravenous zoledronate + erythropoietic and hypoglycemic agents as needed | ||