Successful treatment of multiple myeloma relapsing after high-dose therapyand autologous transplantation with thalidomide as a single agent

A 52-year-old dentist with kappa light chain multiple myeloma relapsed 6 mo nths after 180 mg/m(2) melphalan and an autograft. A partial remission had been attained after the autograft. Relapse occurred while he was on dexamet hasone maintenance therapy. Chemotherapy was not an option due to low blood counts. Thalidomide was administered at relatively high doses (escalated u p to 700 mg daily and continued for 4 months). There was a prompt decline i n urine protein from 6067 mg/day to 2177 mg/day within a month. The respons e continued to improve with achievement of near-complete remission within 6 months and a decline in urine protein to 413 mg/day. Subsequently, grade 3 neutropenia and peripheral neuropathy required dose reduction to 200 mg/da y, Disease activity parameters continued to improve on the lower dose of th alidomide. Nine months after starting thalidomide, the patient is in near-c omplete remission, enjoys an excellent quality of life, and has returned to work. We conclude that thalidomide can effectively control myeloma relapsi ng after high-dose chemotherapy, and may be especially useful in resistant cases or those unable to tolerate further chemotherapy.