Extramedullary multiple myeloma escapes the effect of thalidomide.
OBJECTIVE
Thalidomide is an antiangiogenic drug that produces a response rate ranging from 32 to 64% in patients with refractory/relapsed multiple myeloma (MM). However, the efficacy of thalidomide in patients with soft-tissue plasmacytomas is controversial. The aim of this study was to assess the response rate to thalidomide in patients with advanced MM and to correlate the response rate with the presence of extramedullary involvement.


METHODS
Thirty-eight patients with refractory/relapsed MM were treated with thalidomide. Eleven patients had extramedullary involvement when therapy was initiated. The response rate was evaluated according to the criteria of the European Group for Blood and Marrow Transplantation.


RESULTS
Sixteen of the 38 patients (42%) responded to thalidomide. The response rate was significantly higher in patients without extramedullary involvement (59% vs 0%, p=0.0006). Although four of the 11 patients with extramedullary involvement had a serological response, a progression of the soft-tissue masses was observed in all of them.


CONCLUSIONS
Thalidomide is effective in patients with advanced MM. However, extramedullary disease does not respond to thalidomide, as delivered in this series. The mechanisms to explain different response to therapy depending on tumor homing warrant further investigation.
Rosiñol
Laura
L
Institute of Hematology and Oncology, Hematology Department, Institut d' Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, Barcelona, Spain.
Cibeira
Ma Teresa
MT
Bladé
Joan
J
Esteve
Jordi
J
Aymerich
Marta
M
Rozman
María
M
Segarra
Marta
M
Cid
Maria C
MC
Filella
Xavier
X
Montserrat
Emili
E
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D019046:Bone Marrow Neoplasms / Q000188:drug therapy* / Q000473:pathology; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000473:pathology; D009361:Neoplasm Invasiveness; D012983:Soft Tissue Neoplasms / Q000188:drug therapy* / Q000473:pathology; D013792:Thalidomide / Q000627:therapeutic use*
D020533:Angiogenesis Inhibitors; D013792:Thalidomide