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Maintenance therapy with alternate-day prednisone improves survival in multiple myeloma patients

Maintenance therapy with alternate-day prednisone improves survival in multiple myeloma patients,James R. Berenson,John J. Crowley,Thomas M. Grogan,Je

Maintenance therapy with alternate-day prednisone improves survival in multiple myeloma patients   (Citations: 51)
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The role of maintenance therapy in mul- tiple myeloma is controversial. Recent studies have shown an improvement in both progression-free and overall sur- vival for patients receiving maintenance treatment with a combination of inter- feron and glucocorticoids, compared with interferon alone. The role of glucocorti- coids alone as maintenance therapy has not been previously addressed. We com- pared alternate-day, oral prednisone at 2 different dose levels (10 mg versus 50 mg) for remission maintenance among previously untreated myeloma patients following a response to induction with standard-dose vincristine, doxorubicin, and dexamethasone with prednisone (VAD-P) or VAD-P plus quinine (VAD-P/Q). There were 250 eligible patients regis- tered on Southwest Oncology Group study 9210 and randomized to receive VAD-P or VAD-P/Q. There were 125 pa- tients achieving at least a 25% tumor reduction following induction therapy who were randomized to either physiologic (10 mg) or pharmacologic (50 mg) doses of alternate-day, oral prednisone until dis- ease progression. At the time of study entry, patient characteristics were similar in VAD-P and VAD-P/Q patients and in the 2 arms randomized to maintenance therapy. After a median follow-up of 53 months, there was no difference in either progression-free or overall survival be- tween the 2 induction regimens. However, from the time of maintenance randomiza- tion, both progression-free (14 versus 5 months; P.003) and overall survival (37 versus 26 months; P.05) were signifi- cantly improved in patients receiving 50 mg as compared with 10 mg alternate-day prednisone. There was no difference in treatment-related adverse events between the groups. Thus, 50 mg, oral, alternate- day prednisone is effective maintenance treatment for multiple myeloma patients who achieve a response to induction che- motherapy. (Blood. 2002;99:3163-3168)
Published in 2002.
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