Thalidomide Who Does it Work on
Prognosticators and the Prediction of Response to
The early studies from the university of Arkansas has shown that patients with
β2 microglobulin of 3gm/dl or less, normal cytogenetics and normal plasma cell
labeling index were the most sensitive to thalidomide therapy 1. In a phase II
evaluating the role and efficacy of thalidomide in combination with
Interferon-alpha-2B the only predictor for response was age 65 years or younger
(38% versus 17%; P =.043) 2. In this trial multivariate analysis for over all
survival demonstrated age exceeding 65 years (median, 9.2 months versus longer
than 26 months; P =.011), raised serum lactate dehydrogenase (P =.002), and
raised serum creatinine (P =.007) predicted inferior outcomes. Those factors
could have been influenced by the addition of interferon to the therapy.
Identifying such factors should guide study design for the future development of
thalidomide and its analogues.
Thalidomide Dose and Response to Therapy
The dose of thalidomide appears to possibly influence response rates as well as
over all survival in patients with advanced multiple myeloma 1. Of interest is
the importance of the total cumulative dose during the first three months as a
predictor of response and survival 1. Others have attempted lower dose
thalidomide in relapsed/refractory multiple myeloma patients with the results
suggesting that the response rates appear to be favorable and probably better
tolerated allowing for the use of the drug for longer periods of time 3. The
role of thalidomide in maintenance therapy is not defined; several studies are
currently being addressed.
1. Barlogie B, Desikan R, Eddlemon P et al. Extended survival in advanced and
refractory multiple myeloma after single-agent thalidomide: identification of
prognostic factors in a phase 2 study of 169 patients. Blood 2001;98:492-494.
2. Mileshkin L, Biagi JJ, Mitchell P et al. Multicenter phase 2 trial of
thalidomide in relapsed/refractory multiple myeloma: adverse prognostic impact
of advanced age. Blood 2003;102:69-77.
3. Palumbo A, Bertola A, Falco P et al. Efficacy of low-dose thalidomide and
dexamethasone as first salvage regimen in multiple myeloma. Hematol.J.