Combination of pamidronate and thalidomide in the therapy of treatment-resistant multiple myeloma.
BACKGROUND
Bisphosphonates inhibit the activity of osteoclasts and demonstrate antitumor effect, involving induction of plasmocyte apoptosis, blocking of angiogenesis, stimulation of Tgd lymphocytes and inhibition of metalloproteinases. Bisphosphonates combined with thalidomide, a drug possessing confirmed anti-myeloma activity, seem to have potential favorable effect in patients with treatment-resistant multiple myeloma with advanced osteolytic lesions.


METHODS
13 patients with treatment-resistant multiple myeloma with advanced osteolytic lesions received combined pamidronate and thalidomide therapy. All the patients underwent detailed clinical and laboratory control once a month. Pamidronate was used at 90 mg i.v. dose administered at 4-week intervals, and thalidomide at doses escalated from 200 mg/d in the first week to 400 mg/d after 3 weeks of the therapy. The mean duration of treatment was 12 weeks with a range of 3 to 36 weeks.


RESULTS
7 patients (53%) receiving pamidronate and thalidomide therapy demonstrated good response involving at least 25% reduction of monoclonal protein levels in comparison with baseline. All these patients reported improvement of osteodynia symptoms, and 3 of them - their complete regression. 70% patients experienced side effects (dizziness, constipation, somnolence, polyneuropathy) due to thalidomide administration


CONCLUSIONS
Good response to combined pamidronate and thalidomide therapy can be expected in at least 50% of patients with treatment-resistant multiple myeloma with advanced osteolytic lesions.
Ciepłuch
Hanna
H
Department of Hematology, Institute of Internal Diseases, Medical University of Gdańsk, Poland. ciepluch@amg.gda.pl
Baran
Wojciech
W
Hellmann
Andrzej
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D003248:Constipation / Q000139:chemically induced; D004164:Diphosphonates / Q000008:administration & dosage / Q000009:adverse effects; D006970:Disorders of Excessive Somnolence / Q000139:chemically induced; D004244:Dizziness / Q000139:chemically induced; D019008:Drug Resistance, Neoplasm; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D009194:Myeloma Proteins / Q000032:analysis; D010014:Osteolysis / Q000188:drug therapy* / Q000209:etiology; D010146:Pain / Q000188:drug therapy; D000077268:Pamidronate; D012074:Remission Induction; D013792:Thalidomide / Q000008:administration & dosage / Q000009:adverse effects; D016896:Treatment Outcome
D020533:Angiogenesis Inhibitors; D004164:Diphosphonates; D009194:Myeloma Proteins; D013792:Thalidomide; D000077268:Pamidronate