Thalidomide versus placebo in myeloid metaplasia with myelofibrosis: a prospective, randomized, double-blind, multicenter study.
OBJECTIVE
In non-randomized studies, thalidomide appeared to be effective in myeloid metaplasia with myelofibrosis (MMM). We compared thalidomide to placebo for treatment of anemia in MMM.


METHODS
A prospective phase II B, randomized double-blind multicenter trial comparing thalidomide 400 mg/d with placebo for 180 days was conducted in 52 anemic patients (hemoglobin pounds Sterling 9 g/dL or transfused). The main outcome measure was a 2 g/L increase in hemoglobin or 20% reduction in transfusions.


RESULTS
In the thalidomide group only 10 patients completed 6 months of treatment. At 180 days, in an intention-to-treat analysis, no difference was observed between the thalidomide and placebo groups as regards improvement of hemoglobin levels (one patient in each group) or reduction of red blood cell transfusions (three vs five patients, respectively). The spleen size, determined by ultrasonography, increased significantly less in the thalidomide group than in the placebo group (p < 0.05). Thalidomide had no apparent benefit on the Dupriez score, the severity score, survival, death, or any other clinical or biological parameter. Somnolence, gastro-intestinal signs, weight gain, and edema were significantly more frequent in the thalidomide group. Outpatient discontinuation of thalidomide was significantly correlated with a high severity score > 4 (odds ratio, OR = 16; p < 0.01), and g-glutamyl transferase levels > 40 IU/L (OR = 12; p < 0.05).


CONCLUSIONS
Thalidomide (200-400 mg/d) does not demonstrate substantial efficacy in anemic MMM patients. The natural history of disease in the placebo group revealed spontaneous periods of remission of anemia. Tolerance of thalidomide was significantly correlated wih the severity and liver involvement of the disease.
Abgrall
Jean-François
JF
Groupe Ouest-Est Leucémies et Maladies du Sang. jean-francois.abgrall@chu-brest.fr
Guibaud
Isabelle
I
Bastie
Jean-Noël
JN
Flesch
Michel
M
Rossi
Jean-François
JF
Lacotte-Thierry
Laurence
L
Boyer
Françoise
F
Casassus
Philippe
P
Slama
Borhane
B
Berthou
Christian
C
Rodon
Philippe
P
Leporrier
Michel
M
Villemagne
Bruno
B
Himberlin
Chantal
C
Ghomari
Kamel
K
Larosa
Fabrice
F
Rollot
Florence
F
Dugay
Jacqueline
J
Allard
Christian
C
Maigre
Michel
M
Isnard
Françoise
F
Zerbib
Robert
R
Cauvin
Jean-Michel
JM
D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D004311:Double-Blind Method; D005602:France; D006801:Humans; D010919:Placebos; D055728:Primary Myelofibrosis / Q000150:complications* / Q000188:drug therapy*; D015203:Reproducibility of Results; D012107:Research Design; D013792:Thalidomide / Q000627:therapeutic use* / Q000633:toxicity
D020533:Angiogenesis Inhibitors; D010919:Placebos; D013792:Thalidomide