DT-PACE

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Multiple Myeloma

CISplatin 10 mg/m2 (IV infusion) loaded with etoposide in 1000 mL sodium chloride 0.9% as a continuous infusion for 24 hours Days 1 to 4	Cycles  1, 2
Etoposide 40 mg/m2 (IV infusion) loaded with cisplatin in 1000 mL sodium chloride 0.9% as a continuous infusion for 24 hours Days 1 to 4 Cycles 1, 2
CYCLOphosphamide 400 mg/m2 (IV infusion) loaded with doxorubicin in 1000 mL sodium chloride 0.9% as a continuous infusion for 24 hours Days 1 to 4 Cycles 1, 2
DOXOrubicin 10 mg/m2 (IV infusion) loaded with cyclophosphamide in 1000 mL sodium chloride 0.9% as a continuous infusion for 24 hours	Days 1 to 4 Cycles 1, 2
Dexamethasone 40 mg (PO ) ONCE daily on days 1 to 4. Take in the morning with food. Days 1 to 4 Cycles 1, 2
THAlidomide 400 mg (PO ) ONCE daily continuously. Take in the evening at least one hour after food. (Consider a starting dose of 100mg daily and increase as tolerated)	 Days 1 to 28 Cycles 1, 2

Frequency: 28 days Cycles: 2 to 4 cycles

Reference

Lee CK, Barlogie B, Munshi N et al. (2003). DTPACE: an effective, novel combination chemotherapy with thalidomide for previously treated patients with myeloma. J Clin Oncol 21(14):2732-2739

Abstract
PURPOSE:
To improve outcome in previously treated patients (at least two cycles of standard therapy) with multiple myeloma, thalidomide was combined with cytotoxic chemotherapy as induction therapy.
PATIENTS AND METHODS:
The regimen consisted of 4-days of oral dexamethasone, daily thalidomide, and 4 days of continuous-infusion cisplatin, doxorubicin, cyclophosphamide, and etoposide (DTPACE). Response to two cycles of DTPACE for induction was evaluated in 236 patients. Before being treated with DTPACE, 148 patients (63%) had shown progressive disease while receiving standard chemotherapy, and 55 patients (23%) had chromosome 13 abnormalities.
RESULTS:
The partial remission rate (PR) after two cycles of DTPACE was 32%, with 16% attaining a complete remission (CR) or near-CR (nCR; defined as only immunofixation electrophoresis-positive). Patients with high lactate dehydrogenase (LDH; n = 98) showed a better response than those with normal LDH (n = 138): PR or better, 43% v 27% (P =.01); CR + nCR, 25% v 11% (P =.01). Patients with chromosome 13 abnormalities (n = 55) responded equally well as the other patients (n = 181): PR or better, 35% v 33% (P =.84); CR + nCR, 17% v 15% (P =.73). Patients who received 100% dose of DTPACE for two cycles (n = 115) achieved higher response rates than those with less than 100% dose (n = 121): PR or better, 49% v 17% (P <.0001); CR + nCR, 27% v 6% (P <.0001).
CONCLUSION:
Combination therapy of oral dexamethasone and thalidomide with infusional chemotherapy is effective as induction therapy before autotransplantation, especially in patients with high-risk features.