Low-dose thalidomid in refractory and relapsing multiple myeloma

Authors: J. Radocha;  V. Maisnar
Authors‘ workplace: Oddělení klinické hematologie II. interní kliniky Lékařské fakulty UK a FN, Hradec Králové, přednosta prof. MUDr. Jaroslav Malý, CSc.
Published in: Vnitř Lék 2007; 53(2): 129-164
Category: Original Contributions


Thalidomide is one of the novel agents used in the therapy of multiple myeloma. Its immunomodulatory activity and several other effects have been recently shown to be highly effective in the treatment of refractory and advanced disease. However the best way of using this drug has yet to be estimated.

Patients and methods:
We retrospectively evaluated 59 patients who were treated for multiple myeloma with Thalidomide (median dose 100 mg daily) as monotherapy or in combination with corticosteroids from 2000 to 2005. The primary goal was to compare the overall response to Thalidomide in various settings. The response to therapy was estimated according to EBMT standards.

Thalidomide was used as the second line treatment (first relapse or primary resistance to convetional chemotherapy) in 59 % of patients (35 patients), as the third line (second relapse) in 37 % of patients (22 patients). 2 patients recieved Thalidomide as the fourth line treatment. No patient recieved Thalidomide in previous therapy. In the first relapse the overall response rate (complete remissions - CR, partial remissions - PR and minimal response - MR) was reached in 64 % of patients (21 patients), 1 patient (3 %) reached CR, 12 patients PR (35 %) and 6 patients (17 %) reached MR. In the second relapse the overall response rate was 45 % with 14 % of CR (3 patients), 5 % PR (1 patient) and 23 % (5 patients) reached MR (5 patients). We observed that in the second relapse group there was higher rate of progressive disease during treatment compared to first relapse group (32 % vs. 14 %). 2 patients who recieved Thalidomide for third relapse shown either progressive disease or short stable disease with soon progression. Only 5 % of patients (3 patients) from all groups had to withdraw treatment with Thalidomide because of sevsere adverse reactions (grade III and IV neuropathy, allergic reaction, neutropenia). Follow-up of Thalidomide use was 3 - 62 months (median 10), in the 1st relapse group 3 - 60 months (median 12) and in the 2nd relapse group 3 - 57 months (median 6). No statistical differences were found in response rate and effect duration between first and second relapse group.

Thalidomide is very promising agent for therapy of multiple myeloma. The higher response rate in the first relapse group also indicates, that the profit from using Thalidomide is comparable regardless the course of the disease. Lower doses of Thalidomide show similar efficiency when compared with the data from other studies using higher doses. Also less adverse reactions occur in the group of patients recieving lower doses of Thalidomide.

Key words:
thalidomide - low dose - multiple myeloma - relapsing - therapy


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