title: Tolerability and efficacy of thalidomide for the treatment of patients with light chain-associated (AL) amyloidosis.
abstract: Thalidomide is an effective therapy for multiple myeloma, although its mechanisms of action remain unclear. Light chain-associated (AL) amyloidosis is a plasma cell disorder related to multiple myeloma, but in AL amyloidosis, fibrillar tissue deposits of clonal immunoglobulin light chains produce organ dysfunction. To test the toxicity and efficacy of thalidomide in AL amyloidosis we initiated a phase I/II trial for patients with AL amyloidosis, most of whom had failed prior therapy with high-dose melphalan and autologous stem cell transplantation. This trial was designed as an individualized 6-month dose-escalation study with reevaluation of bone marrow plasmacytosis and serum and urine monoclonal proteins after 3 and 6 months. Sixteen patients were enrolled in the study with a median age of 62 years (range, 37-70 years). Fourteen patients had renal involvement, 4 had cardiac involvement, 4 had liver involvement, and 2 had predominant soft tissue or lymph node involvement. The median maximum tolerated dose was 300 mg, with fatigue and other central nervous system side effects being the major dose-limiting toxicities. Side effects not frequently reported for other patient populations included exacerbation of peripheral and pulmonary edema and worsening azotemia. In all, 50% of patients experienced grade 3/4 toxicity, and 25% had to discontinue the study drug. No complete hematologic responses were seen, but 25% of patients had a significant reduction in Bence-Jones proteinuria. Thus, while thalidomide has activity in AL amyloidosis, it also has significant toxicity in this patient population.
authors.affiliation: Boston University Medical Center, Boston Medical Center, MA, USA. dseldin@medicine.bu.edu
authors.forename: David C
authors.initials: DC
authors.lastname: Seldin
authors.forename: Elie B
authors.initials: EB
authors.lastname: Choufani
authors.forename: Laura M
authors.initials: LM
authors.lastname: Dember
authors.forename: Janice F
authors.initials: JF
authors.lastname: Wiesman
authors.forename: John L
authors.initials: JL
authors.lastname: Berk
authors.forename: Rodney H
authors.initials: RH
authors.lastname: Falk
authors.forename: Carl
authors.initials: C
authors.lastname: O'Hara
authors.forename: Salli
authors.initials: S
authors.lastname: Fennessey
authors.forename: Kathleen T
authors.initials: KT
authors.lastname: Finn
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Wright
authors.forename: Martha
authors.initials: M
authors.lastname: Skinner
authors.forename: Vaishali
authors.initials: V
authors.lastname: Sanchorawala
mesh_terms: D000328:Adult; D000368:Aged; D000686:Amyloidosis / Q000188:drug therapy* / Q000276:immunology; D005260:Female; D006801:Humans; D007147:Immunoglobulin Light Chains / Q000276:immunology*; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D020714:Maximum Tolerated Dose; D008875:Middle Aged; D010265:Paraproteinemias / Q000188:drug therapy* / Q000276:immunology; D011379:Prognosis; D011507:Proteinuria / Q000209:etiology; D016879:Salvage Therapy; D013792:Thalidomide / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D007147:Immunoglobulin Light Chains; D007166:Immunosuppressive Agents; D013792:Thalidomide