Thalidomide dosing in patients with relapsed or refractory multiple myeloma.
OBJECTIVE
To evaluate the literature regarding the dosing of thalidomide in multiple myeloma.


METHODS
A MEDLINE search (1990-February 2003) using the search terms thalidomide and multiple myeloma was performed to identify clinical trials and abstracts. Identified literature was then cross-referenced for further pertinent data.


RESULTS
Patients with relapsed or refractory multiple myeloma have few therapeutic options. Thalidomide is a promising agent, although many dose-related issues are still in question. Starting doses studied ranged from 50 to 200 mg/d, usually given at bedtime. Gradual dose escalation up to 800 mg/d has been studied, with some evidence of improved outcome with doses of 400-600 mg/d, while thalidomide appears to be best tolerated at doses </=400 mg/d.


CONCLUSIONS
A reasonable approach for use of thalidomide in multiple myeloma is to initiate therapy at 50-100 mg nightly and escalate every 2 weeks in 50- to 100-mg increments as tolerated. Efforts should be made to titrate the dose to 400-600 mg/d, especially in patients with poor prognostic features. Efficacy should be assessed at approximately 8 weeks and the dose maintained if desired response is achieved.
Thompson
Jennifer L
JL
School of Pharmacy, Virginia Commonwealth University Health System/Medical College of Virginia Hospitals and Physicians, Richmond, VA 23298, USA.
Hansen
Lea Ann
LA
D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D004305:Dose-Response Relationship, Drug; D006801:Humans; D009101:Multiple Myeloma / Q000188:drug therapy*; D012008:Recurrence; D013792:Thalidomide / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*
D000970:Antineoplastic Agents; D013792:Thalidomide