Thalidomide in consecutive multiple myeloma patients: single‐center analysis on practical aspects, efficacy, side effects and prognostic factors with lower thalidomide doses

Abstract

The strategy to lower thalidomide doses seems a feasible and attractive approach in MM patients, this being currently tested in prospective randomized trials.

Consensus statement from European experts on the diagnosis, management, and treatment of multiple myeloma: from standard therapy to novel approaches

“…Maintenance doses of >200 mg were largely unachievable, and peripheral neuropathy was the main toxicity, whereas lower doses enabled more patients to stay on the drug for more prolonged periods of time with fewer side effects [89]. As anticipated with the lower doses as currently used (usually 50-200 mg/day), thalidomide was more effective when used for maintenance than for relapse [40,89]. Importantly, in this respect, two subsets of patients do not appear to benefit from thalidomide maintenance, those with 13q14 deletion (del13) and patients achieving a VGPR [40,91], which implies that for patients with del13, alternative strategies need to be developed and that thalidomide should be stopped with the achievement of a VGPR in order to reduce toxicity and the development of drug resistance.…”

“…Initially given in relapsed MM as a single agent, thalidomide has been shown to induce overall response rates (ORRs) of approximately 30% [39]; however, when combined with dexamethasone and/or alkylators, increased response rates are seen [40]. As thalidomide and its analogs are more effective with earlier treatment initiation, they have been included in a variety of induction schedules with substantially lower thalidomide doses (100-200 mg/day), thereby minimizing toxicity [40][41][42].…”

“…As thalidomide and its analogs are more effective with earlier treatment initiation, they have been included in a variety of induction schedules with substantially lower thalidomide doses (100-200 mg/day), thereby minimizing toxicity [40][41][42]. It is possible that this dose may be able to be lowered even further in newer combination strategies [40][41][42][43][44].…”

“…As thalidomide and its analogs are more effective with earlier treatment initiation, they have been included in a variety of induction schedules with substantially lower thalidomide doses (100-200 mg/day), thereby minimizing toxicity [40][41][42]. It is possible that this dose may be able to be lowered even further in newer combination strategies [40][41][42][43][44]. The OPTIMUM study compared the tolerability and efficacy of high-dose dexamethasone (Dex) vesus 100, 200, or 400 mg of thalidomide for up to 12 cycles in 499 patients with relapsed/refractory MM, and demonstrated an improved time to progression (TTP) and response duration with all three thalidomide doses when compared to high-dose dexamethasone [45,46].…”

Thalidomide plus chemotherapy exhibit enhanced efficacy in the clinical treatment of T-cell non-Hodgkin’s lymphoma: A prospective study of 46 cases

“…In the thalidomide group, thalidomide was synchronously administered orally every night during and after chemotherapy. The initial dose was 100 mg/day, increasing by 50 mg/day every week (21). The selection of the chemotherapeutic regimen and the management of chemotherapy-related side effects were similar to the control group.…”