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KOS 2007: Impact of novel agents in patients with poor prognosis myeloma defined by unfavorable cytogenetics, high age, and renal failure
Heinz Ludwig, MD
Department of Medicine I
Center of Oncology and Hematology
Wilhelminenspital
Vienna, Austria
06.27.07



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AUTHORS: H. Ludwig1, N. Zojer,1 J. Drach2
1Department of Medicine I, Center of Oncology and Hematology, Wilhelminenspital,Vienna; 2Department of Medicine I, Division of Oncology, Medical Universityof Vienna, Austria

SUMMARY:
by Lynne Lederman, PhD

Bortezomib has been able to overcome several factors previously associated with poor risk, including deletion 13. Although bortezomib cannot overcome 1q21 amplification as a single agent, it appears to be able to do so in combination therapy. The combination of bortezomib and Doxil is able to restore renal function. Dr. Ludwig noted that a highly active regimen with a quick response is important in patients with renal dysfunction, and that bortezomib, which has a half-life independent of renal function, may reduce kidney inflammation. Two of three patients on dialysis were able to be taken off as a result of treatment. The combination of thalidomide plus dexamethasone in elderly patients is associated with faster and better response than melphalan plus prednisone, but does not lead to better overall survival due to increased toxicity. The follow-up time of comparing thalidomide plus interferon with interferon alone for maintenance therapy in this trial is too short to see any difference between groups. In this trial, as in others, the TE rate was higher in patients receiving thalidomide plus dexamethasone than in those receiving melphalan plus prednisone.


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