Total Therapy for myeloma – pro

Total Therapy is the name of an approach to therapy of which  several successive versions have been tested and reported by Dr. Bart Barlogie of the University of Arakansas. He continues to refine and develop the Total Therapy multi-drug approach and is now up to using Total Therapy 6.

Total Therapy 4 and Total Therapy 5, initiated in late 2008, use a risk-adapted approach based on a predictive model built from gene expression profiling data. Total Therapy 4 is designed for patients with low-risk multiple myeloma and aims to reduce side effects while maintaining the superb outcomes achieved with Total Therapy 3. For patients with high-risk multiple myeloma, he uses Total Therapy 5 in an attempt to prevent or delay the relapses.  Total Therapy 6 has also been presented at ASH in 2011 and elsewhere.

The term “total therapy” as applied to multiple myeloma means the application at any given time of all agents and modalities that show efficacy against the disease, with the goal of reducing tumor burden maximally up front. The projections for Total Therapy 3 included a greater-than-50% 10-year event-free survival rate and a greater-than-60% 10-year continuing complete response rate. The incorporation, therefore, of novel therapies into the total therapy paradigm has overcome adverse cytogenetics and achieved results heretofore not observed in multiple myeloma.

The newest is Total Therapy 6,which is based on the TT3 and which is in a phase II trial:

Total Therapy 6

Title:   UARK 2008-03, TOTAL THERAPY 6: Phase II Trial for Patients not qualifying for TT4 and TT5, Protocols because of Prior Therapy (no prior transplant) 
Sponsor:  UAMS/ MIRT 

Still, none of these regimens have been prospectively studied and none are recommended in standard guidelines, including NCCN,  the myeloma guideline.

M. Lazarus, G. L. Phillips, R. H. Herzig, D. D. Hurd, S. N. Wolff, and G. P. Herzig
High-Dose Melphalan and the Development of Hematopoietic Stem-Cell Transplantation: 25 Years Later
J. Clin. Oncol., May 10, 2008; 26(14): 2240 – 2243.

Joan Bladé and Laura Rosiñol Refining “total therapy” for myeloma Blood May 27, 2010 vol. 115 no. 21 4152-4153, 2011

Rajkumar SV. Treatment of multiple myeloma. Nat Rev Clin Oncol 2011; 8:479.

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