| Cycle length: 42 days (6 weeks). |
| Drug | Dose and route* | Administration | Given on days |
| Melphalan | 0.25 mg/kg by mouth | Take on an empty stomach (one hour prior to or two hours after meals). | Days 1 through 4, every six weeks |
| Prednisone | 2 mg/kg by mouth | Take with food (after meals or with food or milk) in the morning. | Days 1 through 4, every six weeks |
| Thalidomide¶ | 100 or 200 mg by mouthΔ | Take with water on an empty stomach at least one hour after the evening meal. | Daily continuously, with the final dose on day 4 of the last cycle |
| Pretreatment considerations: |
| Emesis risk | - LOW or VERY LOW.
- Refer to UpToDate topic on "Prevention and treatment of chemotherapy-induced nausea and vomiting in adults".
|
| Prophylaxis for thrombosis | - Without prophylaxis, the MPT regimen is associated with a 12% rate of thrombosis or embolism. As such, routine thromboprophylaxis is recommended for all patients.[2]
- Refer to UpToDate topic on "Multiple myeloma: Prevention of venous thromboembolism in patients receiving immunomodulatory drugs (thalidomide, lenalidomide, and pomalidomide)".
|
| Infection prophylaxis | - Primary prophylaxis with G-CSF is not indicated (rate of severe infection 13%).[1]
- Refer to UpToDate topic on "Use of granulocyte colony stimulating factors in adult patients with chemotherapy-induced neutropenia and conditions other than acute leukemia, myelodysplastic syndrome, and hematopoietic cell transplantation".
|
| Dose adjustment for baseline liver or renal dysfunction | - Reduction in the initial dose of melphalan is required for patients with moderate to severe renal insufficiency.[3,4] If myelotoxicity does not occur, the dose may be increased in subsequent courses. No dose adjustments are needed for liver dysfunction.
- Refer to UpToDate topic on "Chemotherapy nephrotoxicity and dose modification in patients with renal insufficiency: Conventional cytotoxic agents".
|
| Pregnancy warning¶ | - Thalidomide can result in severe, life-threatening human birth defects. Strict birth control regulations are in place for all patients taking thalidomide.[5] Pregnancy testing is required within 24 hours prior to initiation of thalidomide therapy.
|
| Monitoring parameters: |
- CBC with differential, serum electrolytes, and serum uric acid.
|
- Assess fluid status, blood pressure, and central nervous system status.
|
- Monitor for signs of neuropathy monthly for the first three months, then periodically thereafter. Neuropathic complications commonly include constipation. As such, many clinicians provide a prophylactic bowel regimen for patients taking thalidomide.
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- Pregnancy testing should be performed weekly during the first four weeks, and then every two to four weeks, depending on menstrual cycle regularity.
|
| Suggested dose modifications for toxicity: |
| Myelotoxicity | - Melphalan should be administered with caution if the ANC is <3000/microL or the platelet count is <100,000/microL. Thalidomide should be withheld if the absolute neutrophil count falls below 750/microL. Restart after ANC recovers to >1500/microL.
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| Hypersensitivity | - Hypersensitivity reactions are rare in patients receiving MPT. However, if they occur, especially if there are signs of anaphylaxis, they can recur with subsequent treatment. If a hypersensitivity reaction develops, MPT should not be administered again.
|
| Rash | - Thalidomide has been associated with rashes including Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). If a rash develops, thalidomide should be discontinued and the rash further evaluated. Thalidomide should not be administered again if the rash is exfoliative, purpuric, bullous, or if SJS or TEN is suspected.
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| Neuropathy | - Thalidomide should be discontinued or dose reduced if a patient develops parasthesias accompanied by pain, motor deficit, or interference with activities of daily living.
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| If there is a change in body weight of at least 10%, doses should be recalculated. |
