title: Thalidomide for treatment of multiple myeloma: 10 years later.
abstract: Thalidomide, bortezomib, and lenalidomide have recently changed the treatment paradigm of myeloma. In young, newly diagnosed patients, the combination of thalidomide and dexamethasone has been widely used as induction treatment before autologous stem cell transplantation (ASCT). In 2 randomized studies, consolidation or maintenance with low-dose thalidomide has extended both progression-free and overall survival in patients who underwent ASCT at diagnosis. In elderly, newly diagnosed patients, 3 independent randomized studies have reported that the oral combination of melphalan and prednisone plus thalidomide (MPT) is better than the standard melphalan and prednisone (MP). These studies have shown better progression-free survival, and 2 have shown improved overall survival for patients assigned to MPT. In refractory-relapsed disease, combinations including thalidomide with dexamethasone, melphalan, doxorubicin, or cyclophosphamide have been extensively investigated. The risks of side effects are greater when thalidomide is used in combination with other drugs. Thromboembolism and peripheral neuropathy are the major concern. The introduction of anticoagulant prophylaxis has reduced the rate of thromboembolism to less than 10%. Immediate thalidomide dose reduction or discontinuation when paresthesia is complicated by pain or motor deficit has decreased the severity of neuropathy. Future studies will define the most effective or the best sequence of combinations which could improve life expectancy.
authors.affiliation: Division of Hematology, University of Torino, Azienda Ospedaliera S Giovanni Battista, Torino, Italy. appalumbo@yahoo.com
authors.forename: Antonio
authors.initials: A
authors.lastname: Palumbo
authors.forename: Thierry
authors.initials: T
authors.lastname: Facon
authors.forename: Pieter
authors.initials: P
authors.lastname: Sonneveld
authors.forename: Joan
authors.initials: J
authors.lastname: Bladè
authors.forename: Massimo
authors.initials: M
authors.lastname: Offidani
authors.forename: Francesca
authors.initials: F
authors.lastname: Gay
authors.forename: Philippe
authors.initials: P
authors.lastname: Moreau
authors.forename: Anders
authors.initials: A
authors.lastname: Waage
authors.forename: Andrew
authors.initials: A
authors.lastname: Spencer
authors.forename: Heinz
authors.initials: H
authors.lastname: Ludwig
authors.forename: Mario
authors.initials: M
authors.lastname: Boccadoro
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Harousseau
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D004335:Drug and Narcotic Control; D006801:Humans; D009101:Multiple Myeloma / Q000188:drug therapy*; D033581:Stem Cell Transplantation; D013792:Thalidomide / Q000009:adverse effects / Q000737:chemistry / Q000494:pharmacology / Q000627:therapeutic use*
chemical_list: D000970:Antineoplastic Agents; D013792:Thalidomide