publicado em 07/03/2014 às 11h51:00
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Combined use of thalidomide and dexamethasone is effective against multiple myeloma

Research shows that drugs helped prevent disease progression in patients undergoing bone marrow transplant

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A study conducted by Brazilian researchers showed that the combined use of drugs thalidomide and dexamethasone in multiple myeloma patients undergoing autologous bone marrow transplantation was more effective in slowing the progression of the disease than the single use of dexamethasone.

After 27 months of follow up, 30% of patients receiving dexamethasone were still free of disease. In the group receiving the combination of thalidomide and dexamethasone, the number was 64% - more than double. The results were published in American Journal of Hematology.

The study used 213 volunteers assisted in four institutions: the Federal University of Rio de Janeiro (UFRJ), Faculty of Medical Sciences of Santa Casa de São Paulo, Universidade Estadual de Campinas (UNICAMP) and Universidade de São Paulo (USP) in Ribeirão Preto.

According to the teacher and the UFRJ study's lead author, Angelo Maiolino, myeloma, today, has the prospect of becoming a chronic disease. There is still no cure, but new treatments are getting increasingly slow the progression of cancer, he says.

The treatment is currently considered the gold standard, the researcher explains, involves chemotherapy and anticancer drugs such as bortezomib, and autologous bone marrow transplantation - the one made with the patient's own cells - and a maintenance therapy with drugs that modulate the immune system such as steroids and thalidomide.

<b> Survival </ b>

According to the researcher, at the time the study was designed, some ten years, yet it was common to administer maintenance therapy after transplantation. Thalidomide was used only in cases of relapse of the disease. Our goal was to investigate whether it would benefit also used to delay the recurrence of cancer, he said.

During the period of the project, six other studies were published in several countries evaluating the efficacy of thalidomide as maintenance therapy. Some compared it to other corticosteroids such as prednisone, other interferon, and others with placebo. All concluded that thalidomide increased survival free of disease progression, Maiolino said.

Use of thalidomide <b> </ b>

Besides acting directly on plasma cells, preventing remain adhered to the bone marrow, the drug inhibits the formation of blood vessels that supply the malignant cells which eventually die.

Thanks to new drug combinations, it was possible to increase the median survival free of disease progression from three to eight years in the last decade. It seems little, but it is a considerable jump when it comes to cancer, Maiolino said.

According to the researcher, the trend for the future is that thalidomide is replaced by maintenance therapy lenalidomide, a drug of the same class, but the second generation and fewer side effects.

Sooner or later, all of which make extensive use of thalidomide suffer from peripheral neuropathy, a nerve inflammation that limits the use of the drug. As this does not happen with lenalidomide, it can be used any longer. But unfortunately, this drug is not approved in Brazil, Maiolino said.

Multiple Myeloma

Multiple myeloma is a cancer that develops within the bone marrow due to the uncontrolled growth of plasma cells, cells responsible for antibody production. The disease hinders the production of red blood cells, causing anemia, and favors the release of substances that make the bones brittle.

Only 30% of patients, however, are suitable for transplantation - recommended for people up to 65 years. The other 70% need to be treated with medicines, Maiolino said.

Acesse a íntegra do estudo.

With information from FAPESP <i> </ i>

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