THALIDOMIDE AS SALVAGE THERAPY FOR CHRONIC GRAFT-VERSUS-HOST DISEASE

Thalidomide has been reported to be an effective agent for treatment o f chronic graft-versus-host disease (CGVHD), To determine the efficacy of this agent in patients with refractory CGVHD a total of 80 patient s who failed to respond to prednisone (PSE) or PSE and cyclosporine (C SA) were treated with thalidomide, Sixteen patients (20%) had a sustai ned response, 9 with a complete remission and 7 with a partial respons e. Twenty-nine patients (36%) had thalidomide discontinued because of side effects, which included sedation, constipation, neuritis, skin ra sh, and neutropenia. Side effects were reversible with drug discontinu ation except for mild residual neuritis in one case, Rashes and neutro penia have not previously been reported as thalidomide side effects wh en used for CGVHD treatment. We conclude thalidomide is immunosuppress ive and active in the treatment of CGVHD. A high incidence of reversib le side effects limited dose intensity and reduced the number of patie nts who could benefit from treatment. (C) 1995 by The American Society of Hematology.