title: The combination of thalidomide and intermediate-dose dexamethasone is an effective but toxic treatment for patients with primary amyloidosis (AL).
abstract: 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.
authors.affiliation: Center for Amyloidosis, Biotechnology Research Laboratories, IRCCS--Policlinico San Matteo, Viale Golgi, 19-27100 Pavia, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Palladini
authors.forename: Vittorio
authors.initials: V
authors.lastname: Perfetti
authors.forename: Stefano
authors.initials: S
authors.lastname: Perlini
authors.forename: Laura
authors.initials: L
authors.lastname: Obici
authors.forename: Francesca
authors.initials: F
authors.lastname: Lavatelli
authors.forename: Riccardo
authors.initials: R
authors.lastname: Caccialanza
authors.forename: Rosangela
authors.initials: R
authors.lastname: Invernizzi
authors.forename: Benedetto
authors.initials: B
authors.lastname: Comotti
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Merlini
mesh_terms: 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
chemical_list: D000893:Anti-Inflammatory Agents; D007147:Immunoglobulin Light Chains; D007166:Immunosuppressive Agents; D013792:Thalidomide; D003907:Dexamethasone