Cyrille Hulin et al. Melphalan-prednisone-thalidomide (MP-T) demonstrates a significant survival advantage in elderly patients ≥ 75 years with multiple myeloma compared with melphalan-prednisone (MP) in a randomized, double-blind, placebo-controlled trial, IFM 01/01. Proc ASH 2007. Abstract 75

FACULTY COMMENTS

arrow DR ORLOWSKI: In the Hulin study, they examined a truly nontransplant-eligible population — patients age 75 or older — and showed major advantages for MP-T, even in this older patient population. The overall survival was 45 months with MPT versus approximately 28 months with MP. I believe anytime we can increase overall survival by 18 months or so, that’s a dramatic benefit.

They also collected data about the efficacy of the next therapy these patients received after progression. Most of the patients on the MP arm received thalidomide, whereas patients on the MP-T arm received a variety of therapies, some with more thalidomide, some with bortezomib.

In both groups the median survival after relapse was approximately nine months. That tells me that what we do second line is less important than what we do first line and suggests that we need to go with our best therapy up front.

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