Phase II study of cyclophosphamide, interferon-alpha and betamethasone (CIB) as induction therapy for patients 60-75 years of age with multiple myeloma stages II and III

• Published in: The hematology journal : the official journal of the European Haematology Association Vol. 4; no. 4; pp. 248 - 252
• Main Authors: Lundin, Jeanette, Osterborg, Anders, Björkholm, Magnus, Björkstrand, Bo, Celsing, Fredrik, Hjalmar, Viktoria, Linder, Olle, Luthman, Michaela, Merup, Mats, Tidefelt, Ulf, Mellstedt, Hakan
• Format: Journal Article
• Language: English
• Published: England 2003
• Subjects: Aged; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Antineoplastic Combined Chemotherapy Protocols - toxicity; Bence Jones Protein; Betamethasone - administration & dosage; Cyclophosphamide - administration & dosage; Female; Granulocyte-Macrophage Colony-Stimulating Factor - therapeutic use; Humans; Interferon-alpha - administration & dosage; Male; Medicin och hälsovetenskap; Middle Aged; Multiple Myeloma - complications; Multiple Myeloma - drug therapy; Multiple Myeloma - pathology; Neutropenia - chemically induced; Neutropenia - prevention & control; Probability; Remission Induction - methods; Sepsis - chemically induced
• ISSN: 1466-4860; 1476-5632
• DOI: 10.1038/sj.thj.6200301

Cyclophosphamide, interferon-alpha and betamethasone are all effective agents for the treatment of multiple myeloma (MM) with different mechanisms of action. The clinical effect of a combination of cyclophosphamide 725 mg/m(2) i.v. days 1 and 3, interferon-alpha 7 x 10(6) IE/m(2) s.c./day, days 1-4 and betamethasone 30 mg orally days 1-4 (CIB) was studied in patients aged 60-75 years with previously untreated MM stages II and III. Granulocyte-macrophage colony-stimulating factor (GM-CSF) 5 microg/kg/day s.c. was administered to all patients from day 5 until the day the granulocyte count exceeded 1.0 x 10(9)/l. CIB was repeated every fourth week. Interferon-alpha 3 x 10(6) IE s.c. t.i.w. was given as maintenance therapy in responding patients.A total of 28 patients (median age: 67 years) entered the study. In all, 12 patients had stage II and 16 had stage III MM. A total of 22 patients (79%) showed an objective response, including five complete remissions (CR) and 17 partial remissions (PR). All seven patients with Bence-Jones MM responded (five CR and two PR). The median response duration time was 14 months (range 5-38+). CIB was relatively well tolerated although febrile neutropenia or septicaemia occurred in 5% of the cycles and a dose-reduction of cyclophosphamide due to grade IV neutropenia was performed in 11% of the patients.CIB seems to be an effective regimen for remission induction in MM patients aged up to 75 years as an alternative to VAD (vincristine, doxorubicin, dexamethasone) if a regimen with intensity higher than that of oral melphalan/prednisone is warranted.