Cyclophosphamide, thalidomide and dexamethasone (CTD) Infoguide

This Infoguide provides information about cyclophosphamide, thalidomide and dexamethasone (CTD) as a treatment combination for myeloma, answering some of the questions you may have about it and helping you to make informed decisions about the treatment options available to you.

CTD is an oral (tablet form) treatment combination for myeloma. It is often referred to as ‘chemotherapy’ or ‘chemo’, but it is actually a combination of three different types of drugs:

  • Cyclophosphamide – a chemotherapy drug;
  • Thalidomide – an immunomodulatory drug;
  • Dexamethasone – a steroid.

These three drugs have different but synergistic and complementary mechanisms of action. This means they
work in different ways but when given together they are much more effective at killing the myeloma cells than if they were given alone.

CTD has now become part of standard treatment as a result of the national MRC Myeloma IX clinical trial. It is an approved treatment option for myeloma as an initial treatment under the National Institute for Health and Care Excellence (NICE) recommendation that thalidomide is given in combination with an alkylating chemotherapy drug and a steroid. Since thalidomide was approved as part of a multiple technology assessment (MTA), this recommendation is also applicable in Scotland.

CTD can be an initial treatment option for older and/or less fit patients or as induction treatment prior to high-dose therapy and stem cell transplantation as part of initial treatment for younger and/or fitter patients.

Sometimes CTD may also be given at relapse, for example if you have not previously received CTD or if you responded very well to it in the past.