Thal/Dex

Multiple Myeloma

Thalidomide ((Thalomid) 100-200 mg po qd
Dexamethasone (Decadron) 40 mg po qd d1-4, 9-12, 17-20 for odd cycles and d1-4 only for even cycles q4w

Thal-Dex was planned to be administered for 4 months in an attempt to reduce tumor cell mass before collection of PBSCs and subsequent autologous transplantation.
Thalidomide was given orally at the starting dose of 100 mg/d for 14 days and then increased to the dose of 200 mg/d.
Pulsed dexamethasone combined with thalidomide was administered at the dose of 40 mg/d on days 1 to 4, 9 to 12, and 17 to 20 (odd cycles) and 40 mg/d for 4 days on even cycles, repeated monthly.
Patients who proceeded to PBSC collection received high-dose cyclophosphamide (HD-CTX; 7 g/m2) and granulocyte-colony stimulating factor (G-CSF; 5 µg/kg/d, starting 48 hours after HD-CTX infusion and continuing until completion of PBSC collection).
Thalidomide was discontinued the day before administration of HD-CTX.
Fixed low-dose prophylactic warfarin (1.25 mg/d) for DVT prevention.

References

• Rajkumar, SV et al. Combination therapy with thalidomide plus dexamethasone for newly diagnosed myeloma. J Clin Oncol 2002; 20:4319
  
• Weber, D et al. Thalidomide alone or with dexamethasone for previously untreated multiple myeloma. J Clin Oncol 2003; 21:16
  
• Michele Cavo et al, Superiority of thalidomide and dexamethasone over vincristine-doxorubicindexamethasone (VAD) as primary therapy in preparation for autologous transplantation for multiple myeloma. From the Institute of Hematology and Medical Oncology "Seràgnoli," University of Bologna, Italy.Blood, 1 July 2005, Vol. 106, No. 1, pp. 35-39.