Thalidomide for treatment of multiple myeloma: 10 years later

Palumbo A, Facon T, Sonneveld P, Blade J, Offidani M, Gay F, Moreau P, Waage A, Spencer A, Ludwig H, Boccadoro M, Harousseau JL.

Division of Hematology, University of Torino, Azienda Ospedaliera San Giovanni Battista, Torino, Italy.

Thalidomide, bortezomib and lenalidomide have recently changed the treatment paradigm of myeloma. In young newly diagnosed patients, the combination of thalidomide and dexamethasone has been widely used as induction treatment before autologous transplant (ASCT). In two randomised studies, consolidation or maintenance with low-dose thalidomide has extended both progression-free and overall survival in patients who received ASCT at diagnosis. In elderly newly diagnosed patients, two independent randomised studies have reported that the oral combination of melphalan and prednisone plus thalidomide (MPT) is better than the standard melphalan and prednisone (MP). These studies have shown better progression-free survival, and two have shown improved overall survival for patients assigned to MPT. In refractory-relapsed disease, combinations including thalidomide with dexamethasone, melphalan, doxorubicin or cyclophosphamide have been extensively investigated. The risks of side-effects are greater when thalidomide is used in combination with other drugs. Thromboembolism and peripheral neuropathy are the major concern. The introduction of anticoagulant prophylaxis has reduced the rate of thromboembolism to less than 10%. Immediate thalidomide dose-reduction or discontinuation when paresthesia is complicated by pain or motor deficit has decreased the severity of neuropathy. Future studies will define the most effective or the best sequence of combinations which could improve life expectancy.

PMID: 18245666 [PubMed - as supplied by publisher]