Neuropathy in multiple myeloma treated with thalidomide: a prospective study.
BACKGROUND
Thalidomide is effective as a first-line therapy for the treatment of multiple myeloma (MM), but its use is limited by peripheral neurotoxicity.


OBJECTIVE
To study the occurrence of both myeloma-related neuropathy and thalidomide-induced neuropathy in 31 patients with newly diagnosed MM.


METHODS
Clinical and electrophysiologic examinations were performed in 31 patients with newly diagnosed MM before and after 4 months of therapy with thalidomide (200 mg/day, total dose: 21 g) aimed at debulking MM, before autologous transplantation. After transplantation, the patients took thalidomide, 200 mg/day for another 3 months (total dose over three months: 18 g) and then underwent a final clinical and electrophysiologic checkup.


RESULTS
At baseline, four patients presented a mild sensorimotor peripheral neuropathy related to MM, which tended to worsen slightly during treatment with thalidomide. At the end of treatment, 83% of the patients had clinical and electrophysiologic evidence of a mild sensory rather than motor, axonal, length-dependent polyneuropathy, whereas 100% of the patients showed improvement to the basic pathology (>or=partial response).


CONCLUSIONS
Peripheral neuropathy, sometimes subclinical, and mild in our patients, is a common, early side effect of thalidomide therapy. The high doses (21 g) used in all patients for a relatively short time (4 months) rule out any correlations between neuropathy, total dose, and duration of treatment.
Plasmati
R
R
Dipartimento di Neuroscienze, Unità Operativa di Neurologia, Ospedale Bellaria, Bologna, Italy. rosaria.plasmati@ausl.bo.it
Pastorelli
F
F
Cavo
M
M
Petracci
E
E
Zamagni
E
E
Tosi
P
P
Cangini
D
D
Tacchetti
P
P
Salvi
F
F
Bartolomei
I
I
Michelucci
R
R
Tassinari
C A
CA
D000200:Action Potentials; D000328:Adult; D000368:Aged; D020533:Angiogenesis Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000601:surgery; D018908:Muscle Weakness / Q000139:chemically induced; D020360:Neoadjuvant Therapy; D009431:Neural Conduction; D010292:Paresthesia / Q000139:chemically induced; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced*; D011446:Prospective Studies; D012074:Remission Induction; D012720:Severity of Illness Index; D013792:Thalidomide / Q000009:adverse effects* / Q000627:therapeutic use; D014182:Transplantation, Autologous
D020533:Angiogenesis Inhibitors; D000970:Antineoplastic Agents; D013792:Thalidomide