In a randomized trial, MP has been compared. MD), or high- dose dexamethasone or high- dose dexamethasone plus interferon- . Improvement. in progression- free survival (PFS) was reported in patients receiving melphalan as part of the induction treatment (both MP. MD) but not in those receiving high- dose dexamethasone only. These findings suggest the need to incorporate an alkylating agent in combination regimens including new drugs. A randomized. study comparing MP with thalidomide plus dexamethasone (TD) in patients with a median age of 7. TD resulted. in a higher proportion of at least very good partial response (VGPR) (2. Presidente del CdA di Biancamano SpA, fondata con il fratello PierPaolo, ex di Barbara D'urso. Di battista silvia: dir.med. P = . 0. 06) and partial response (PR) (6. P = . 0. 02) than did MP. Time to progression (TTP) (2. P = . 2) and PFS were similar (1. Istituto per i Polimeri, Compositi e Biomateriali (IPCB). Istituto per i Polimeri, Compositi e.P = . 1), but overall survival (OS) was significantly shorter in the TD group than in the MP group (4. P = . 0. 24). Toxicity was higher with TD, especially in patients older than 7. During the. first 1. TD group. compared with those given MP. In another study undertaken in younger patients (median age 6. TD showed clear benefit in terms of both PR rate (6. P < . 0. 01) and TTP (2. P < . 0. 01) compared with high- dose dexamethasone alone. Grade 3–4 adverse events were most frequent with TD (7. P < . 0. 01). 1. Thalidomide improves the clinical efficacy of dexamethasone, but high- dose dexamethasone is too toxic in elderly patients. In all studies MPT resulted in higher PR (4. VGPR or near- CR (n. CR) rate (1. 5%–4. PFS (1. 4–2. 7. 5 vs 1. MP. 1. 8–2. 3 However, only two studies reported improved OS with MPT (4. These data lend support to the use of MPT as the standard of care. Thalidomide therapy was generally well tolerated, even. MPT regimen was associated with a significantly higher incidence of grade 3–4 non- hematologic adverse events. DVT). After the introduction. DVT was substantially lowered from 2. Antithrombotic prophylaxis is recommended when MPT is used, although which is the best thromboprophylaxis to use in these. To address this issue, the Italian Myeloma Network GIMEMA designed a phase III study to prospectively. LMWH), low- fixed- dose warfarin (1. VTE) in newly diagnosed patients with MM, who were randomly assigned. Patients at risk of VTE were excluded from the. The risk of VTE was 3. LMWH, and 5. 5% with aspirin. No significant relation. Antonio Palumbo, Direttore Clinical. AOU San Giovanni Battista (TO) Roberto Messina. VTE and thromboprophylaxis, induction treatments, or age of patients. In patients at. standard risk of VTE, LMWH, warfarin, and aspirin are likely to be an effective thromboprophylaxis. The duration of MP treatment should be limited to 6 to 9 cycles; prolonged exposure to melphalan induces thrombocytopenia. This superiority was also recorded in patients older than 7. The incidence of peripheral. VMP than with. MP. The number of patients with herpes zoster infection was also higher in patients given VMP than in those given MP (1. In a study comparing VMP with the regimen of bortezomib, thalidomide, and prednisone (VTP), PR, TTP, and OS did not differ. VTP had more grade 3–4 non- hematologic adverse events than did VMP, including cardiac toxicity (8. P < . 0. 01), thromboembolic events (4% vs < 1%, P = not significant . Patients given VMP had a higher rate of neutropenia (3. Giovanni Battista Tiepolo Gle Affreschi Di Wurzburg Download Giovanni Battista Tiepolo Gle Affreschi Di Wurzburg in pdf, reading online Giovanni. P = . 0. 03), thrombocytopenia (2. P = . 0. 3), and infections (7% vs < 1%, P = . VTP. 2. 7 Although equally effective, VMP was better tolerated than was VTP. The incidence. of the most common adverse events (neutropenia, thrombocytopenia, peripheral neuropathy, and infections) was similar in both. When the standard twice- weekly infusion of bortezomib (1. VMPT. group and from 1. VMP group; the incidence of CR was reduced from 2. VMP group but not in the. VMPT group (3. 6% vs 3. If longer follow- up proves no decrease in survival despite dose reduction, the once- weekly infusion may be considered an. In the Medical Research Council. MRC) Myeloma IX trial, the combination of cyclophosphamide (5. TD (CTD) was compared. MP in 9. 00 patients. Patients given CTD showed higher rates of PR (8. CR (2. 3% vs 6%) than did those. MP. Unfortunately, data for PFS duration are not yet available because of the short follow- up of the trial. If PFS is. better with CTD than with MP, CTD should be regarded as an alternative standard of care for elderly patients. The combination of melphalan, prednisone, and lenalidomide (MPR) has been investigated in a phase I/II study. Patients given. the maximum tolerated dose (MTD: 0. PR rate of 8. 1%. VGPR and 2. 4% CR; median TTP and PFS were 2. OS was 9. 0. 5%. 3. Grade 3 or 4 neutropenia was reported in 5. G- CSF). Grade 3 and 4 non- hematologic adverse effects were mild and included febrile neutropenia (9. This combination is being assessed in an international randomized trial comparing. MPR with MP. If this study reports improvement in PFS, another standard of care will be available for elderly patients. Efficacy of regimens used as front- line treatment in elderly patients with multiple myeloma. Table 3. Safety (grade 3–4 adverse events) of regimens used as front- line treatment in elderly patients with multiple myeloma. Reduced- intensity Transplantation in Elderly Patients. Elderly patients or patients with significant comorbidities are generally not eligible for standard melphalan 2. ASCT. Two randomized studies compared intermediate Mel. ASCT with MP. In one study including. ASCT was better than was MP in terms of both event- free survival (EFS) and OS. In another study, including patients aged 6. ASCT induced a response rate better than MP and. MPT, with no difference for PFS and OS. MPT was associated with a significant improvement in survival and. ASCT. 2. 1 These data suggest that patients aged 6. Mel. 10. 0, but this regimen is too toxic. MPT would be more effective. The CR rate was 1. PAD, 4. 3% after Mel. LP- L consolidation- maintenance. These data suggest that this approach, incorporating bortezomib as induction and lenalidomide as consolidation- maintenance. Infections were the most. PAD induction (1. Mel. 10. 0 transplantation (2. Giovan Battista synonyms, Giovan Battista antonyms. Galileo fra gli astrologi.
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November 2017
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