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Answer 2
  1. MP-T. MP is an oral regimen combining an alkylating agent (melphalan) and a glucocorticoid (prednisone) that has been used to treat MM for over 3 decades, particularly in patients who are not candidates for autologous stem cell transplantation (ASCT). Because melphalan-containing regimens may impact stem cell mobilization and collection, they should be avoided in patients who could potentially be treated with ASCT. Approximately 50% of patients with newly diagnosed MM will have a major clinical response when treated with MP. VAD (an anthracycline-containing regimen administered via continuous infusion) and TD (an oral immunomodulatory regimen) are associated with somewhat higher response rates than MP (range, 60%-70%). Less than 10% of patients treated with MP, VAD, or TD achieve a complete response. Recently, 2 large randomized studies comparing MP-T with MP have been completed, and both demonstrated that MP-T therapy is associated with a higher response rate, higher complete response rate, and longer time to disease progression.3,4 Although neither of these studies compared MP-T with VAD or TD, the clinical efficacy of MP-T in both studies appears superior to what could be expected with VAD or TD based on previously reported experience with these regimens.

    3. Facon T, Mary JY, Harousseau JL, et al. Superiority of melphalan-prednisone (MP) + thalidomide (THAL) over MP and autologous stem cell transplantation in the treatment of newly diagnosed elderly patients with multiple myeloma [abstract]. J Clin Oncol 2006;24(Suppl 18S):1S.

    4. Palumbo A, Bringhen S, Caravita T, et al. Oral melphalan and prednisone chemotherapy plus thalidomide compared with melphalan and prednisone alone in elderly patients with multiple myeloma: randomised controlled trial. Lancet 2006;367:825-31.

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