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Cyclophosphamide-containing regimen (TCD) is superior to melphalan-containing regimen (MPT) in elderly multiple myeloma patients with renal impairment

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Author(s)
Moo-Kon SongJoo-Seop ChungHo-Jin ShinJoon-Ho MoonJe-Jung LeeSung-Soo YoonJin-Seok KimJeong-Ok LeeYoung-Rok DoHo-Sup LeeEun-Kyung Park
Keimyung Author(s)
Do, Young Rok
Department
Dept. of Internal Medicine (내과학)
Journal Title
Annals of Hematology
Issued Date
2012
Volume
91
Issue
6
Abstract
Renal impairment (RI) is a frequent complication
with higher incidence of infections and an important prognostic
factor for survival. Melphalan clearance is renal function
dependent whereas cyclophosphamide is renal function
independent. We investigated which combination regimen
should be selected between melphalan-combining regimen
(MPT) or cyclophosphamide-combining regimen (TCD) in
elderly multiple myeloma (MM) patients with RI. Between
2005 and 2009, 157 newly diagnosed MM patients with RI
were included comparing MPT with TCD therapy as initial
treatment. Seventy-four patients were given MPT regimen,
and 83 patients were given TCD regimen. Baseline characteristics
were similar between the MPT and TCD groups.
Analysis of different cutoff levels between 25% and 75%
quartiles using log-rank test determined that glomerular
filtration rate (GFR), 40 ml/min/1.73 m2 as the cutoff point,
yielded the highest difference in event-free survival (EFS)
and overall survival (OS). The MPT subgroup with low
GFR (GFR <40 ml/min/1.73 m2) had poorer response rates
than others. The incidence of neutropenia and infection with
febrile neutropenia were higher in the MPT subgroup with
low GFR than the others (p00.016, p<0.001). Furthermore,
mortality due to the infection was higher in the MPT subgroup
with low GFR than the others (p<0.001). EFS was
lower in the MPT subgroup with low GFR than the others (p
<0.001). OS was lower in the MPT subgroup with low GFR
than the others (p<0.001). In newly diagnosed elderly MM
patients with RI, TCD regimen would be an effective andtolerable treatment option due to the combination of cyclophosphamide
independent to renal function and dexamethasone
effective for RI
Keywords Multiple myeloma . Melphalan .
Cyclophosphamide
Keimyung Author(s)(Kor)
도영록
Publisher
School of Medicine
Citation
Moo-Kon Song et al. (2012). Cyclophosphamide-containing regimen (TCD) is superior to melphalan-containing regimen (MPT) in elderly multiple myeloma patients with renal impairment. Annals of Hematology, 91(6), 889–896. doi: 10.1007/s00277-011-1401-2
Type
Article
ISSN
0939-5555
Source
https://link.springer.com/article/10.1007%2Fs00277-011-1401-2
DOI
10.1007/s00277-011-1401-2
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/34969
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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