A phase 2 trial of combination low-dose thalidomide and prednisone for the treatment of myelofibrosis with myeloid metaplasia.
Single-agent thalidomide (THAL) at "conventional" doses (> 100 mg/d) has been evaluated in myelofibrosis with myeloid metaplasia (MMM) based on its antiangiogenic properties and the prominent neoangiogenesis that occurs in MMM. THAL monotherapy at such doses produces approximately a 20% response rate in anemia but is poorly tolerated (an adverse dropout rate of > 50% in 3 months). To improve efficacy and tolerability, we prospectively treated 21 symptomatic patients (hemoglobin level < 10 g/dL or symptomatic splenomegaly) with MMM with low-dose THAL (50 mg/d) along with a 3-month oral prednisone (PRED) taper (beginning at 0.5 mg/kg/d). THAL-PRED was well tolerated in all enrolled patients, with 20 patients (95%) able to complete 3 months of treatment. An objective clinical response was demonstrated in 13 (62%) patients, all improvements in anemia. Among 10 patients who were dependent on erythrocyte transfusions, 7 (70%) improved and 4 (40%) became transfusion independent. Among 8 patients with thrombocytopenia (platelet count < 100 x 10(9)/L), 6 (75%) experienced a 50% or higher increase in their platelet count. In 4 of 21 patients (19%), spleen size decreased by more than 50%. Responses observed were mostly durable after discontinuation of the PRED. The dose of THAL in this study (50 mg/d) was better tolerated than the higher doses used in previous studies. Adverse events associated with corticosteroid therapy were mild and transient. Clinical responses did not correlate with improvements in either intramedullary fibrosis or angiogenesis. THAL-PRED is well tolerated and preliminarily appears to be a promising drug regimen for treating cytopenias in patients with MMM.
Mesa
Ruben A
RA
Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA.
Steensma
David P
DP
Pardanani
Animesh
A
Li
Chin-Yang
CY
Elliott
Michelle
M
Kaufmann
Scott H
SH
Wiseman
Gregory
G
Gray
Leigh A
LA
Schroeder
Georgene
G
Reeder
Terra
T
Zeldis
Jerome B
JB
Tefferi
Ayalew
A
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000633:toxicity; D000368:Aged; D000740:Anemia / Q000188:drug therapy / Q000209:etiology; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage / Q000633:toxicity; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage / Q000633:toxicity; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000633:toxicity; D005260:Female; D006411:Hematopoiesis, Extramedullary / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D010198:Pancytopenia / Q000188:drug therapy / Q000209:etiology; D011241:Prednisone / Q000008:administration & dosage / Q000633:toxicity; D055728:Primary Myelofibrosis / Q000150:complications* / Q000188:drug therapy*; D013163:Splenomegaly / Q000188:drug therapy / Q000209:etiology; D013671:Technetium Tc 99m Sulfur Colloid; D013792:Thalidomide / Q000008:administration & dosage / Q000633:toxicity; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D020533:Angiogenesis Inhibitors; D018931:Antineoplastic Agents, Hormonal; D013792:Thalidomide; D013671:Technetium Tc 99m Sulfur Colloid; D011241:Prednisone