@article{Xenofon Papanikolaou_Jackie Szymonifka_Adam Rosenthal_Christoph J. Heuck_Alan Mitchell_Donald Johann_Jason Keller_Sarah Waheed_Saad Z. Usmani_Frits Van Rhee_Clyde Bailey_Nathan Petty_Antje Hoering_John Crowley_Bart Barlogie_2013, place={Pavia, Italy}, title={Metronomic therapy is an effective salvage treatment for heavily pre-treated relapsed/refractory multiple myeloma}, volume={98}, url={https://haematologica.org/article/view/6726}, DOI={10.3324/haematol.2013.085183}, abstractNote={Relapsed/refractory multiple myeloma represents a major challenge in multiple myeloma therapy. For patients with relapsed/refractory multiple myeloma, we developed a treatment schema of metronomically scheduled drug therapy. We identified 186 patients who had been treated with metronomic therapy between March 2004 and January 2012 with a median follow up of 24.2 months. Median age was 61 years (range 36–83). Median number of prior therapies was 14 (range 1–51). Median number of completed metronomic therapy cycles was 1 (range 1–5), while 45 of 186 (25%) received 2 or more cycles. Responses included complete remission in 11 of 186 patients (6%), very good partial remission in 12 of 186 (7%), partial remission in 65 of 179 (36%), and minimal response in 29 of 186 (16%), for an overall response rate of 63% (117 of 186). Median overall survival and progression-free survival were 11.2 and 3.6 months, respectively. Hematologic toxicity grading was problematic as 146 of 186 (78%) of patients presented with at least grade 2 thrombocytopenia within 90 days prior to starting metronomic therapy. Grade 4 leukopenia, anemia, and/or thrombocytopenia following metronomic therapy occurred in 108 of 186 (58%), 12 of 186 (6%), and 147 of 186 (79%) patients, respectively. Incidence of grade 3–4 neutropenic fever was 4 of 186 (2%). Most patients (177 of 186, 95%) were treated in an outpatient unit and secondary admissions due to regimen-related toxicity occurred in 37 of 186 (20%). Treatment-related mortality was evident in 2 of 186 (1%). In conclusion, metronomic therapy is an effective late salvage treatment in relapsed/refractory multiple myeloma, with a high overall response rate and a favorable toxicity profile.}, number={7}, journal={Haematologica}, author={Xenofon Papanikolaou and Jackie Szymonifka and Adam Rosenthal and Christoph J. Heuck and Alan Mitchell and Donald Johann and Jason Keller and Sarah Waheed and Saad Z. Usmani and Frits Van Rhee and Clyde Bailey and Nathan Petty and Antje Hoering and John Crowley and Bart Barlogie}, year={2013}, month={Jun.}, pages={1147-1153} }