TITLE:
Cyclophosphamide, Thalidomide and Dexamethasone (CTD) as First-Line Therapy in Multiple Myeloma Patients: An Experience in a Clinical Haematology Centre in Dakar, Senegal
AUTHORS:
El Hadji Daouda Niang, Seynabou Fall, Khadim Sarr, Marième Lolita Camara, Aminata Dakono, Awa Ndiaye, Modou Moustapha Ciss, Amy Thiam, Serge Mwamba, Fatou Samba Diago Ndiaye
KEYWORDS:
Myeloma, Chemotherapy, Survival
JOURNAL NAME:
Open Journal of Blood Diseases,
Vol.13 No.1,
March
10,
2023
ABSTRACT: Introduction: Induction therapy followed by high-dose chemotherapy with autologous stem
cell transplantation remains the gold standard for myeloma patients who can
tolerate this treatment approach. In a developing country setting, in the absence of availability of bone marrow
transplantation, the CTD protocol is an accessible treatment regimen whose
efficacy and lower toxicity compared to the Melphalan Prednisone protocol has
been reported. This protocol has been administered since 2018 in first line.
It’s against this backdrop we perform this study to assess the efficacy of this
CTD protocol in first line therapy. Methods: We conducted a descriptive
and analytical study including clinical, paraclinical and evolutionary data of
50 patients with MM treated during the period range from 01 September 2018 and
01 July 2022 with the CTD protocol of cyclophosphamide (500 mg at D1, D8 and D15),
dexamethasone (40 mg
weekly) and thalidomide (100 mg/day)
in 28-day cycles. Survival outcomes were estimated by the Kaplan-Meier method. Results: The mean age was 62.3 ± 9.1 years and the
sex ratio was 0.7. An advanced prognostic score at diagnosis was found in 73.5%
of patients according to the Salmon and Durie score and in 32% according to the
ISS. Overall remission was noted in 64%, of which 34% were in very good partial
remission and partial remission in 12% of cases. Progression was noted in 4
patients. Treatment-related side effects were mainly peripheral neuropathy and
anaemia in 3 patients respectively. The median survival was 38.4 months.
The progression-free survival was 60%. An advanced age (≥65 years) is
correlated with negative impact on survival (p = 0.04). Conclusion: Cyclophosphamide, thalidomide and dexamethasone
give good outcome with less toxicity. Thus, it remains a first-line treatment
alternative for newly diagnosed and low-income
patients.