Pegylated liposomal doxorubicin, melphalan and prednisone therapy for elderly patients with multiple myeloma

Abstract

Melphalan&Prednisone (MP) is considered as the standard therapy for Multiple Myeloma (MM) patients not eligible for high-dose therapy. Here, we report the results of a phase I–II study to evaluate the feasibility and efficacy of the association of PLDto the conventionalMP regimen during the first six cycles of the front-line therapy for untreatedMMpatients older than 70. Thirty patients were included in the study with a median age of 77 years (71–84) and a M/F ratio of 17/13. The phase I of the study demonstrated that the maximum tolerable dose of PLD in this setting was 30mg/m2, so itwas the final dose evaluated in the study. Twenty-nine patients were valuable for response, which was: complete in 4 (14%) partial in 15 (52%) minor/ no changes in 7 (24%) and progressive in 3 (10%). The median progression free survival (PFS) was 24 months. The median overall survival (OS) has not been reached yet, with a 3-year probability for OS and PFS of 52 and 37%, respectively. Haematological toxicity was frequent but usually weak/moderate (grades 1&2 of theWHOscale) and itwas resolved only with dose delays. Infection was a relatively frequent event (30%of patients), but only in 4 cases it was of grade 3. No cases of palmar-plantar erythrodysesthesia were observed. In conclusion, pegylated liposomal doxorubicin can be safely added to the other chemotherapeutic drugs in the treatment of elderly MM patients, which can be very useful for patients in whomnovel agents are not tolerated or inefficient.