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Comment on thalidomide usage
in myeloma
B. Myers
Department of Haematology, Queen's Medical Centre, University
Hospital, UK.
Corresponding author: Dr. B. Myers, Department of Haematology,
Queen's Medical Centre, University Hospital, Lenton Boulevard,
Nottingham, NG7 2UH, UK. bmyers@hospital-doctor.net
There are increasing concerns over the use of thalidomide in the
treatment of myeloma, in particular with regards to its
relationship to venous thromboembolism as reported in the
editorial
of the April issue of
Haematologica. The conclusion was that although thalidomide is of
potential benefit in the treatment of myeloma, it should be
administered with caution.
We have recently reported on a series of 30 patients receiving
thalidomide for up to 22 months (Br J Haematol, 2002, in print).
The patientss were all relapsed or refractory to other treatments.
The majority received thalidomide alone, and at a low dosage
(maximum of 200mg.) because of the older age-group ( median 72
yrs., range 51-90 yrs.), and limited tolerability of higher
dosage. In 10 patients, dexamethasone was added to assist response
(4 mg. daily reducing over 2-3 months.) With thalidomide alone,
37% of patients had at least a 50% response, with a median
duration of 16 months (range 3-22 months). There were a further 7
responses with the addition of dexamethasone, ( median duration
7.5 months, range 3-12 months ), making a total response rate of
63%.
With this modest regime we achieved a significant and durable
response for the majority of patients, whilst minimising the
toxicity. Three patients (10%), developed venous thromboembolism
after a median of 1 year on treatment, two of whom were receiving
dexamethasone in addition. The other troublesome side-effect was
peripheral neuropathy, which the majority developed in at least a
mild form after one year's treatment. However, in this group of
refractory patients, often with grossly raised paraprotein levels,
a reasonable quality of life was achieved for a median time of 16
months prior to relapse. Whilst we accept that the toxicity of
thalidomide is not negligible, especially when used in combination
with chemotherapy, it should be considered as a valuable addition
to our limited treatment armamentarium in the relapsed setting in
this most unpleasant of diseases, while we await the advent of
less toxic analogues, and other novel agents.
