Multiple Myeloma Research Center

Home Research Education Resources Support Group


Actimid (CC4047) Amyloidosis BMT Bone Disease Diagnosis & Treatment Dental Care Drug Resistance Fatigue Glossary Interferon Immunomodulators Kyphoplasty Lenalidomide Multiple Myeloma Questions & Answers Revlimid Thalidomide Thalidomide Response Thalidomide Safety Update Thalidomide Toxicity Vitamins & Anemia Neovastat Opioid Therapy Vitamins Drug Info

Back Home Next

Thalidomide Who Does it Work on Best

Prognosticators and the Prediction of Response to Thalidomide Therapy
Traditional Prognosticators
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.

Reference List

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. 2004;5:318-324.

 
Home Up
Phone: 216-445-6830
Fax: 216-445-3434

Maps & Directions

 Cleveland Clinic Home  |   Contact Us  |   Disclaimer  |   Privacy Statement
 Cleveland Clinic 2005

Page Last Updated 02/06/2006 06:56:53 PM