Multiple Myeloma Clinical Trial
Official title:
Thalidomide-Dexamethasone for Multiple Myeloma
Objective is to assess the activity of the combination of thalidomide and dexamethasone in patients with previously untreated multiple myeloma.
This study will examine the potential efficacy of thalidomide-dexamethasone in the treatment
of patients with previously untreated multiple myeloma.
- Thalidomide is supplied as 50 mg capsules to be taken by mouth.
- Thalidomide 200 mg daily each evening at bedtime increasing by 100-200 mg increments
(according to patient tolerability) every 4 weeks.
For elderly patients, or those with poor performance status or comorbid conditions which may
affect tolerance of the thalidomide-dexamethasone combination, the initial dose may be
reduced by 50-100 mg decrements and escalated weekly by 50-100 mg increments to tolerance.
For patients who experience significant toxicity (> grade 2) or are otherwise unable to
tolerate this drug combination, the dose will be reduced by 50-100 mg decrements. For some
patients with > grade 2 toxicity, it may be necessary to hold the thalidomide dose until
improvement of the side effect with subsequent resumption of the dose after dose reduction as
outlined above.
Dexamethasone 20mg/m2 each morning after breakfast on days 1-4, 9-12, 17-20, with a repeat
cycle after a 1-2 week rest period. In case of partial remission, maintenance treatment with
thalidomide alone will be continued for as long as remission is sustained at a dose free of
side effects.
For patients achieving CR, consolidation with thalidomide-dexamethasone for 4-6 months
followed by follow-up without maintenance treatment. No maximum trial period is planned.
At relapse patients may be reinitiated on the original thalidomide-pulse dexamethasone
program and responding patients may be maintained on thalidomide alone (CR) or daily
thalidomide and dexamethasone (days 1-4) until relapse.
Patients who experience significant toxicity (grade 2 or more) at any time during therapy
will receive a lower dose after treatment is interrupted.
In an attempt to avoid deep venous thrombosis, all patients for whom anticoagulation is not
contraindicated will be offered therapeutic anticoagulation (INR 1.5-2.5) with coumadin or
therapeutic doses of low molecular weight heparin.
Patients must be willing to return for evaluation every 4 weeks since thalidomide may only be
prescribed for 28 day intervals.
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