Low-dose thalidomide plus dexamethasone is an effective salvage therapy for advanced myeloma

Background and Objectives, The immunomodulatory drug thalidomide can inhibi t angiogenesis and induce apoptosis in experimental models, It can also ind uce marked and durable response in advanced myeloma patients, Thalidomide h as been used at doses ranging from 200 to 800 mg with significant toxicity, No data are available on the impact of low-dose thalidomide plus dexametha sone as salvage therapy for relapsed patients. Design and Methods. To address this issue, myeloma patients were treated wi th 100 mg/day thalidomide continuously and dexamethasone 40 mg, days 1-4, e very month, Between June 1999 and August 2000, 77 patients (median age 65 y ears) who had relapsed or were refractory to chemotherapy were treated with thalidomide plus dexamethasone. Results, After a minimum of 3 months of treatment, 14 patients (18%) showed a myeloma protein reduction of 75%-100%, 18 patients (23%) showed a respon se of 50-75%, 19 patients (25%) a response of 25-50% and 26 patients (34%) a response of <25% or disease progression, After a median follow-up of 8 mo nths, median progression-free survival was 12 months. Thalidomide was well tolerated. Constipation (12%) and sedation (6%) were mild, Tingling or numb ness were present in 17% of patients, discontinuation of treatment was requ ired in 10% of patients. Interpretation and Conclusions, The association of low-dose thalidomide plu s dexamethasone is active against advanced myeloma, A significant proportio n of patients benefit from this treatment as a salvage therapy postponing t he delivery of chemotherapy. <(c)> 2001, Ferrata Storti Foundation.