Intermittent Low Doses of Thalidomide in the Maintenance Treatment of Multiple Myeloma.

BACKGROUND: Despite recent advances multiple myeloma remains an incurable plasma cell malignancy. Thalidomide has recently been recognized as an effective agent for previously untreated, refractory or relapsed myeloma.

DESIGN AND METHODS: Thirty patients with refractory/relapsed MM (22 females, 8 males) aged from 53 to 81yrs : 18 MM IgG(k), 3 MM IgA(k), 6 MM IgG(l), 2 MM IgA(l) an MM (l) were treated with thalidomide in combination with high doses (40 mg monthly) of dexamethasone and monthly zolendronate( 4 mg).All patients were treated with conventional escalated dose of thalidomide every 2 weeks starting from 100 mg daily to max tolerated dose. Of the 30 patients 19 (63 %) responded to therapy with a monoclonal reduction of more than 50% ( 4 acheived CR). Among the responders those with polineurophaty documented as a subjective simptom and with electrophysiologic objective parameters alteration entered in a reduced thalidomide schedule of 100 mg daily 10 days a month. The follow up of these patients actually ranges between 2 to 21 months, 1 patient progressed and 2 patients discontinued treatment because of a subjective progression of neurological simptoms but without electrophysiologic alterations.

RESULTS: None of the patients treated with intermittent low doses of Thalidomide developped an increase of neurophaty. Intermittent low doses of THAL may be applicable in the maintenance treatment of myeloma patients.

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