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| |  ASCO: Dexamethasone, Thalidomide plus PACE Effective in Multiple Myeloma By Peggy Peck ORLANDO, FL -- May 23, 2002 -- Dexamethasone plus thalidomide combined with cisplatin, Ara-C, and 5-flourouracil (DT-PACE) as salvage therapy for multiple myeloma patients prior to mini-allogeneic transplantation demonstrates excellent efficacy, according to a small pilot study. Steven Larsen, MD, of the Institute of Haematology, Royal Prince Alfred Hospital, in Sydney, Australia, presented the findings at the 38th Annual Meeting of the American Society of Clinical Oncology (ASCO). Salvage treatment with DT-PACE in multiple myeloma patients without prior autologous transplant has shown promising results in the literature, Dr. Larsen said. This suggested that there would be a therapeutic benefit for DT-PACE in post-autologous transplant patients with heavily-pre-treated multiple myeloma, prior to undergoing mini-allogeneic transplantation (MAT), he added. Three patients (ages 39, 45, and 52 years) with advanced multiple myeloma, preparing for MAT and having previously relapsed after at least six courses of combination chemotherapy -- including prednisone, cyclophosphamide, adriamycin plus BCNU (PCAB); vincristine, adriamycin plus dexamethasone (VAD); and PCM -- and at least one autologous transplant, were treated with two courses of DT-PACE. This regimen consisted of dexamethasone 40 mg/day plus thalidomide 400 mg/day, with a continuous infusion of cisplatin 10 mg/mē/day, cyclophosphamide 400 mg/mē/day, doxorubicin 10 mg/mē/day, and etoposide 40 mg/mē/day for four days. There was a four-week interval between courses. After two courses of DT-PACE, the paraprotein decreased from pretreatment levels of 2.0, 5.8, and 9.1 g/L to undetectable levels in all patients. Pretreatment plasma cell concentrations in bone marrow of 90, 80, and 90 percent decreased to less than 5, 3, and 15 percent, respectively, after DT-PACE and to less than 1 percent in all patients after MAT, Dr. Larsen noted. Bence Jones protein levels fell from pretreatment levels of 0.01, 0.24, and 2.82 g/dL to undetectable levels after DT-PACE. DT-PACE was very well tolerated, Dr. Larsen added. Mean number of days to neutrophil recovery (>1 x 109/L) ranged from 14-15 days in the three patients. Complications associated with DT-PACE therapy included febrile neutropenia in two patients, with no life-threatening infections. At 12 months, 10 months, and two months, respectively, all patients remain in complete remission. Graft versus host disease occurred in one patient after MAT, Dr. Larsen said. Based on the "excellent efficacy demonstrated in this small study," DT-PACE should be studied in larger trials, he concluded.
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