The Scientific Research Driving CH5424802

Instead, in another study using patients aged 65�C75?yr, who received melphalan 100?mg/m2 or MP, ASCT was superior to MP only in terms of RR but not in terms of progression free-survival (PFS) and OS (38). In this last study, 37% of patients did not complete the assigned treatment. According to these data, the age of 70?yr should be considered as the age limit http://www.selleckchem.com/products/VX-770.html for intermediate-dose melphalan. In younger patients, high-dose therapy followed by ASCT is considered the gold standard for MM. In this subgroup, the objective of therapy is to achieve CR because this is the crucial step for a long-term outcome following ASCT (39). Moreover, the sensitivity to the initial induction therapy evaluated at the time of transplant is the most important predictor of CR after ASCT. Induction treatment included the administration of a limited number (from 3 to 6) of conventional chemotherapy courses to reduce tumor burden and collection of hematopoietic stem cells. Because melphalan was considered too toxic for stem cells, dexamethasone-based regimens were preferred prior ASCT. In fact, the VAD schedule (vincristine + doxorubicin and dexamethasone) was used for many years as pre-transplant induction therapy for patients considered candidates for ASCT. However, the CR rates achieved with this regimen prior to ASCT were low ( http://www.selleck.cn/products/Verteporfin(Visudyne).html mainly with double ASCT, was the first improvement to the regimen and resulted in a CR rate increase from 30% to 45% (35). The availability of new drugs such as thalidomide, lenalidomide and bortezomib has provided the framework for improving the results of ASCT. Thalidomide has been used for cancer treatment because of its anti-angiogenic and immunomodulating activity. The drug has been extensively investigated in patients with newly diagnosed, relapsed, and refractory MM, both before ASCT and as maintenance treatment after transplant. A case-matched, control Italian study showed that a significantly higher RR was achieved by thalidomide http://www.selleckchem.com/products/ch5424802.html and dexamethasone combination when compared to VAD (76 vs. 52%) (40). Three randomized trials of combination therapy in patients with newly diagnosed disease before ASCT have shown a higher RR with thalidomide and dexamethasone or thalidomide, dexamethasone, and doxorubicin than with conventional chemotherapy, such as VAD or high-dose dexamethasone (41�C43). In a phase III trial, Barlogie et?al. (44) have shown that the addition of thalidomide to tandem ASCT improved 5-year EFS (56% vs. 45%, P?=?0.0005) (Table?1). Based on the results of the ECOG randomized trial (40), thalidomide/dexamethasone was approved by the US Food and Drug Administration for use as pre-transplant induction regimen.