The combination of thalidomide and intermediate-dose dexamethasone is an effective but toxic treatment for patients with primary amyloidosis (AL).
Based on the efficacy of thalidomide in multiple myeloma and on its synergy with dexamethasone on myeloma plasma cells, we evaluated the combination of thalidomide (100 mg/d, with 100-mg increments every 2 weeks, up to 400 mg) and dexamethasone (20 mg on days 1-4) every 21 days in 31 patients with primary amyloidosis (AL) whose disease was refractory to or had relapsed after first-line therapy. Eleven (35%) patients tolerated the 400 mg/d thalidomide dose. Overall, 15 (48%) patients achieved hematologic response, with 6 (19%) complete remissions and 8 (26%) organ responses. Median time to response was 3.6 months (range, 2.5-8.0 months). Treatment-related toxicity was frequent (65%), and symptomatic bradycardia was a common (26%) adverse reaction. The combination of thalidomide and dexamethasone is rapidly effective and may represent a valuable second-line treatment for AL.
Palladini
Giovanni
G
Center for Amyloidosis, Biotechnology Research Laboratories, IRCCS--Policlinico San Matteo, Viale Golgi, 19-27100 Pavia, Italy.
Perfetti
Vittorio
V
Perlini
Stefano
S
Obici
Laura
L
Lavatelli
Francesca
F
Caccialanza
Riccardo
R
Invernizzi
Rosangela
R
Comotti
Benedetto
B
Merlini
Giampaolo
G
D000328:Adult; D000368:Aged; D000686:Amyloidosis / Q000188:drug therapy*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000009:adverse effects; D003907:Dexamethasone / Q000008:administration & dosage* / Q000009:adverse effects; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007147:Immunoglobulin Light Chains; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012074:Remission Induction; D013792:Thalidomide / Q000008:administration & dosage* / Q000009:adverse effects
D000893:Anti-Inflammatory Agents; D007147:Immunoglobulin Light Chains; D007166:Immunosuppressive Agents; D013792:Thalidomide; D003907:Dexamethasone