Background Patients with myeloma who relapse after high-dosechemotherapy have few therapeutic options. Since increased bonemarrow vascularity imparts a poor prognosis in myeloma, we evaluatedthe efficacy of thalidomide, which has antiangiogenic properties,in patients with refractory disease.
Methods Eighty-four previously treated patients with refractorymyeloma (76 with a relapse after high-dose chemotherapy) receivedoral thalidomide as a single agent for a median of 80 days (range,2 to 465). The starting dose was 200 mg daily, and the dosewas increased by 200 mg every two weeks until it reached 800mg per day. Response was assessed on the basis of a reductionof the myeloma protein in serum or Bence Jones protein in urinethat lasted for at least six weeks.
Results The serum or urine levels of paraprotein were reducedby at least 90 percent in eight patients (two had a completeremission), at least 75 percent in six patients, at least 50percent in seven patients, and at least 25 percent in six patients,for a total rate of response of 32 percent. Reductions in theparaprotein levels were apparent within two months in 78 percentof the patients with a response and were associated with decreasednumbers of plasma cells in bone marrow and increased hemoglobinlevels. The microvascular density of bone marrow did not changesignificantly in patients with a response. At least one thirdof the patients had mild or moderate constipation, weaknessor fatigue, or somnolence. More severe adverse effects wereinfrequent (occurring in less than 10 percent of patients),and hematologic effects were rare. As of the most recent follow-up,36 patients had died (30 with no response and 6 with a response).After 12 months of follow-up, KaplanMeier estimates ofthe mean (±SE) rates of event-free survival and overallsurvival for all patients were 22±5 percent and 58±5percent, respectively.
Conclusions Thalidomide is active against advanced myeloma.It can induce marked and durable responses in some patientswith multiple myeloma, including those who relapse after high-dosechemotherapy.
Source Information
From the Myeloma and Lymphoma Program, South Carolina Cancer Center, University of South Carolina, Columbia (S.S., J.M.); the Myeloma and Transplantation Research Center, University of Arkansas for Medical Sciences, Little Rock (R.D., D.A., P.R., P.E., N.M., E.A., C.W., J.Z., B.B.); and the Laboratory of Cellular Physiology and Immunology, Rockefeller University, New York (M.D.). Other authors were David Siegel, M.D., Ph.D., University of Arkansas for Medical Sciences, Little Rock, and John Crowley, Ph.D., Fred Hutchinson Cancer Research Center, Seattle.
Address reprint requests to Dr. Barlogie at the Myeloma and Transplantation Research Center, University of Arkansas for Medical Sciences, 4301 W. Markham, Slot 623, Little Rock, AR 72205.
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(2005). Overview of drug therapy for multiple myeloma. J Oncol Pharm Pract
11: 83-100
[Abstract]
Vacca, A., Scavelli, C., Montefusco, V., Di Pietro, G., Neri, A., Mattioli, M., Bicciato, S., Nico, B., Ribatti, D., Dammacco, F., Corradini, P.
(2005). Thalidomide Downregulates Angiogenic Genes in Bone Marrow Endothelial Cells of Patients With Active Multiple Myeloma. JCO
23: 5334-5346
[Abstract][Full Text]
Prince, H M., Mileshkin, L., Roberts, A., Ganju, V., Underhill, C., Catalano, J., Bell, R., Seymour, J. F., Westerman, D., Simmons, P. J., Lillie, K., Milner, A. D., Iulio, J. D., Zeldis, J. B., Ramsay, R.
(2005). A Multicenter Phase II Trial of Thalidomide and Celecoxib for Patients with Relapsed and Refractory Multiple Myeloma. Clin. Cancer Res.
11: 5504-5514
[Abstract][Full Text]
Raje, N., Kumar, S., Hideshima, T., Roccaro, A., Ishitsuka, K., Yasui, H., Shiraishi, N., Chauhan, D., Munshi, N. C., Green, S. R., Anderson, K. C.
(2005). Seliciclib (CYC202 or R-roscovitine), a small-molecule cyclin-dependent kinase inhibitor, mediates activity via down-regulation of Mcl-1 in multiple myeloma. Blood
106: 1042-1047
[Abstract][Full Text]
Rajkumar, S. V.
(2005). Multiple myeloma: the death of VAD as initial therapy. Blood
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Gandara, D., Narayan, S., Lara, P. N. Jr., Goldberg, Z., Davies, A., Lau, D. H.M., Mack, P., Gumerlock, P., Vijayakumar, S.
(2005). Integration of Novel Therapeutics into Combined Modality Therapy of Locally Advanced Non-Small Cell Lung Cancer. Clin. Cancer Res.
11: 5057s-5062s
[Abstract][Full Text]
Cavo, M., Zamagni, E., Tosi, P., Tacchetti, P., Cellini, C., Cangini, D., de Vivo, A., Testoni, N., Nicci, C., Terragna, C., Grafone, T., Perrone, G., Ceccolini, M., Tura, S., Baccarani, M., for the writing committee of the Bologna 2002 stud,
(2005). Superiority of thalidomide and dexamethasone over vincristine-doxorubicindexamethasone (VAD) as primary therapy in preparation for autologous transplantation for multiple myeloma. Blood
106: 35-39
[Abstract][Full Text]
Dispenzieri, A.
(2005). Bortezomib for Myeloma -- Much Ado about Something. NEJM
352: 2546-2548
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Ladetto, M., Vallet, S., Trojan, A., Dell'Aquila, M., Monitillo, L., Rosato, R., Santo, L., Drandi, D., Bertola, A., Falco, P., Cavallo, F., Ricca, I., De Marco, F., Mantoan, B., Bode-Lesniewska, B., Pagliano, G., Francese, R., Rocci, A., Astolfi, M., Compagno, M., Mariani, S., Godio, L., Marino, L., Ruggeri, M., Omede, P., Palumbo, A., Boccadoro, M.
(2005). Cyclooxygenase-2 (COX-2) is frequently expressed in multiple myeloma and is an independent predictor of poor outcome. Blood
105: 4784-4791
[Abstract][Full Text]
Koh, K.-R., Janz, M., Mapara, M. Y., Lemke, B., Stirling, D., Dorken, B., Zenke, M., Lentzsch, S.
(2005). Immunomodulatory derivative of thalidomide (IMiD CC-4047) induces a shift in lineage commitment by suppressing erythropoiesis and promoting myelopoiesis. Blood
105: 3833-3840
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Hsu, C., Chen, C.-N., Chen, L.-T., Wu, C.-Y., Hsieh, F.-J., Cheng, A.-L.
(2005). Effect of Thalidomide in Hepatocellular Carcinoma: Assessment with Power Doppler US and Analysis of Circulating Angiogenic Factors. Radiology
235: 509-516
[Abstract][Full Text]
Zhang, H., Vakil, V., Braunstein, M., Smith, E. L. P., Maroney, J., Chen, L., Dai, K., Berenson, J. R., Hussain, M. M., Klueppelberg, U., Norin, A. J., Akman, H. O., Ozcelik, T., Batuman, O. A.
(2005). Circulating endothelial progenitor cells in multiple myeloma: implications and significance. Blood
105: 3286-3294
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Park, J.-H., Liu, L., Kim, I.-H., Kim, J.-H., You, K.-R., Kim, D.-G.
(2005). Identification of the Genes Involved in Enhanced Fenretinide-Induced Apoptosis by Parthenolide in Human Hepatoma Cells. Cancer Res.
65: 2804-2814
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Palladini, G., Perfetti, V., Perlini, S., Obici, L., Lavatelli, F., Caccialanza, R., Invernizzi, R., Comotti, B., Merlini, G.
(2005). The combination of thalidomide and intermediate-dose dexamethasone is an effective but toxic treatment for patients with primary amyloidosis (AL). Blood
105: 2949-2951
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Podar, K., Anderson, K. C.
(2005). The pathophysiologic role of VEGF in hematologic malignancies: therapeutic implications. Blood
105: 1383-1395
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Amato, R. J.
(2005). Renal cell carcinoma: review of novel single-agent therapeutics and combination regimens. Ann Oncol
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Richardson, P. G., Kassarjian, A., Jing, W.
(2004). Case 38-2004 - A 40-Year-Old Man with a Large Tumor of the Skull. NEJM
351: 2637-2645
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Stewart, A. K., Chen, C. I., Howson-Jan, K., White, D., Roy, J., Kovacs, M. J., Shustik, C., Sadura, A., Shepherd, L., Ding, K., Meyer, R. M., Belch, A. R.
(2004). Results of a Multicenter Randomized Phase II Trial of Thalidomide and Prednisone Maintenance Therapy for Multiple Myeloma after Autologous Stem Cell Transplant. Clin. Cancer Res.
10: 8170-8176
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PAGNUCCO, G., CARDINALE, G., GERVASI, F.
(2004). Targeting Multiple Myeloma Cells and Their Bone Marrow Microenvironment. Ann. N. Y. Acad. Sci.
1028: 390-399
[Abstract][Full Text]
Kroger, N., Shimoni, A., Zagrivnaja, M., Ayuk, F., Lioznov, M., Schieder, H., Renges, H., Fehse, B., Zabelina, T., Nagler, A., Zander, A. R.
(2004). Low-dose thalidomide and donor lymphocyte infusion as adoptive immunotherapy after allogeneic stem cell transplantation in patients with multiple myeloma. Blood
104: 3361-3363
[Abstract][Full Text]
Kyle, R. A., Rajkumar, S. V.
(2004). Multiple Myeloma. NEJM
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Podar, K., Shringarpure, R., Tai, Y.-T., Simoncini, M., Sattler, M., Ishitsuka, K., Richardson, P. G., Hideshima, T., Chauhan, D., Anderson, K. C.
(2004). Caveolin-1 Is Required for Vascular Endothelial Growth Factor-Triggered Multiple Myeloma Cell Migration and Is Targeted by Bortezomib. Cancer Res.
64: 7500-7506
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Kaufmann, H., Raderer, M., Wohrer, S., Puspok, A., Bankier, A., Zielinski, C., Chott, A., Drach, J.
(2004). Antitumor activity of rituximab plus thalidomide in patients with relapsed/refractory mantle cell lymphoma. Blood
104: 2269-2271
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Teo, S. K., Denny, K. H., Stirling, D. I., Thomas, S. D., Morseth, S., Hoberman, A. M.
(2004). Effects of Thalidomide on Developmental, Peri- and Postnatal Function in Female New Zealand White Rabbits and Offspring. Toxicol Sci
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Chung, F., Lu, J., Palmer, B. D., Kestell, P., Browett, P., Baguley, B. C., Tingle, M., Ching, L.-M.
(2004). Thalidomide Pharmacokinetics and Metabolite Formation in Mice, Rabbits, and Multiple Myeloma Patients. Clin. Cancer Res.
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Richardson, P., Anderson, K.
(2004). Immunomodulatory Analogs of Thalidomide: An Emerging New Therapy in Myeloma. JCO
22: 3212-3214
[Full Text]