Cyclophosphamide thalidomide and dexamethasone combination chemotherapy in comparision with single-agent thalidomide in relapsed and refractory multiple myloma

Abstract：Objective This study was designed to compare the efficacy of thalidomide-based combination regimen (cyclophosphamide, thalidomide and dexamethasone) with that of thalidomide as a single agent in relapsed/refractory multiple myeloma(MM) ,and analyze their toxicities. Methods Twenty-six patients who had received thalidomide regimen were taken as a historical control group. 14 cases with replapsed/refractory multiple myeloma were treated with CTD regimen in a 28-day cycle. The patients received a median of 3 cycles(range, 1～20 cycles) of the treatment. Response to CTD was evaluated according to the criteria of European Group for Blood and Marrow Transplantation( EBMT); adverse events were graded according to the National Cancer Institute Common Toxicity Criteria. Results Overall response rates were 66.7% in cases with CTD.2 cases obtained near complete remission( nCR) ,2 had partial remission( PR) ,4 had minimal re-sponse(MR) and 2 were of no change(NC). CTD had higher efficacy and remission degree as second-line therapy compared with third-line therapy. The median initial effective time was 2 cycles and the median optimal efficacy time was 3 cycles. There was no significant difference in overall response rate between CTD and single-agent thalidomide. However, nCR occurred in 2 cases with CTD and no nCR was observed in single-agent thalidomide. Grade Ⅰ～ Ⅱ adverse events, including leucocytopenia(42.8% ) ,thrombocytopenia(21.4% ) .somnolence (35.7% ), abdominal distention and consti-pation(35.7% ) could be relieved by symptomatic treatment not influencing chemotherapy regimen. Conclusion CTD regimen was an effective and safe method in treating relapsed/refractory MM. CTD regimen was used conveniently and not expensive. It can be even applied in outpatient.