Naše zkušenosti s léčbou myelomu thalidomidem

Our Experience with Treatment of Myeloma with Thalidomide

Introduction.
The number of reports concerning the treatment of myeloma with thalidomide is increasing in the last two years. The mechanistu of the activity of thalidomide is probably complex, consisting in the direct effect on myeloma cells, the antiangiogenic effect, the interference with the production of cytokines and in the immunomodulatory effect. The remission induction (a partial remission in the majority of cases) is observed in 25 % - 45 % patients treated with thalidomide slone and in more than 50 % patients treated with the combination of thalidomide and dexamethasone. Material and results. Eleven patients with myeloma resistant to conventional therapy were included in the study. The usual initial dole of thalidomide was 300 - 400 mg/day untill remission induction and then decreased to 100 mg/day. Patients treated with the thalidomide slone did not tolerate dosel higher than 600 mg/day. The dole of thalidomide used in combination with dexamethasone was smaller and did not exceed 300 mg/day. The hrst effect of thalidomide in favorably responding patients was the decrease of paraproteinemia and the increase of the hemoglobin level, the improvement of bone parol followed later. The remission was induced in a total of 48 % patients. Undesirable side-effects were observed by all patients in particular by those treated with combination therapy with dexamethasone. The treatment failed in two patients with severe osteolytic lesions. One female patient developed acute myeloid leukemia during remission, however, the association with thalidomide might be accidental. Conclusion. Thalidomide proves to be a promising new drug for the treatment of resistant cases of stage II myeloma. The treatment is convenient for the patient as it is administered per os. However, the therapy is associated with a number of undesirable side-effects. A sufficient number of studies evaluating the effect of thalidomide as a first line therapy in myeloma is missing so far. The studies in a larger number of patients will demonstrate if it is better to start the therapy with combination of thalidomide and dexamethason or to add the dexamethasone only if the effect of thalidomide is inadequate.

Key words:
multiple myeloma, resistant myeloma, treatment, thalidomide