Mieloma Múltiplo - Resenha / Multiple Myeloma - Review

ABSTRACT

Novel agents have provided a new foundation for multiple myeloma therapies. When combined with other anti-myeloma agents, these compounds significantly enhance clinical efficacy. High-dose steroids are frequently used in anti-myeloma combination regimens; however, the doses employed are often poorly tolerated, especially in patients with concurrent comorbid conditions. We hypothesized that a steroid-independent combination regimen could be developed without significant compromise of efficacy. The availability of such a regimen will be important for patients whose concurrent ailments make them poor candidates for steroid containing anti-myeloma regimens. A phase II single institute, non-randomized clinical trial was conducted to investigate a novel steroid-free three-drug combination of bortezomib (V), pegylated liposomal doxorubicin (D), and thalidomide (T), the VDT regimen. Forty-three newly diagnosed multiple myeloma patients requiring treatment were enrolled on this study. The overall response rate and complete response (CR) + near complete response (nCR) rate was 78% and 35%, respectively. Median time to progression was 29.5 months. Fatigue, rash, neuropathy, constipation and infections were the most common side effects. We concluded that VDT is a tolerable and an effective regimen capable of inducing high response rates and can be employed in patients considered to be poor candidates for steroid-based treatment regimens.

RESUMO

O mieloma mútliplo representa a segunda neoplasia hematológica mais frequente, cuja cura ainda permanece distante. A maioria dos esquemas para tratamento utiliza doses elevadas de corticoides que são altamente eficazes no controle da doença. No entanto, trata-se de doença que acomete preferencialmente idosos – população sujeita a apresentar comorbidades que limitam o uso dos esteroides.Esse estudo avalia um esquema de tratamento que utiliza drogas sabidamente efetivas contra o mieloma – bortezomibe, doxorrubicina lipossomal e talidomida – porém sem o uso associado de corticoide. Apesar de se tratar de estudo com número reduzido de pacientes – apenas 40 avaliados –, a taxa de resposta global (78%) e as taxas de resposta completa e quase completa (35%), além da média de tempo livre de progressão da doença (29,5 meses), são consideráveis. Um ponto a ser destacado é que a associação de duas drogas potencialmente neurotóxicas – bortezomibe e talidomida – não aumentou significativamente a incidência de neuropatia.