Cyclophosphamide, thalidomide and dexamethasone (CTD) as first-line therapy in multiple myeloma patients : an experience in a clinical haematology centre in Dakar, Senegal

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 and 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 at the clinical haematology department of Dalal Jamm Hospital. 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 49 patients with MM treated during the period range from 01 September 2018 and 30 November 2021 with the CTD protocol of cyclophosphamide (500mg at D1, D8 and D15), dexamethasone (40mg weekly) and thalidomide (100mg/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 0.8. 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 48.9%, of which 30.6% were in very good partial remission and partial remission in 12.2% of cases. Progression was noted in 2% of cases. The median survival was 29 months with an overall survival of 78% at 39 months. Treatment-related side effects were mainly peripheral neuropathy in 2% and anaemia in 6%. The median PFS was 27 months with a 72% survival at 39 months. 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.