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Combination of pamidronate and thalidomide in the therapy of treatment-resistantmultiple myeloma.

Wojciech Baran, Hanna Ciepłuch, Andrzej Hellmann

Med Sci Monit 2002; 8(4): PI31-36

ID: 420859

Published:


BACKGROUND: Bisphosphonates inhibit the activity of osteoclasts and demonstrateantitumor effect, involving induction of plasmocyte apoptosis, blocking of angiogenesis, stimulationof Tgd lymphocytes and inhibition of metalloproteinases. Bisphosphonates combined with thalidomide, adrug possessing confirmed anti-myeloma activity, seem to have potential favorable effect in patientswith treatment-resistant multiple myeloma with advanced osteolytic lesions. MATERIAL/METHODS: 13 patientswith treatment-resistant multiple myeloma with advanced osteolytic lesions received combined pamidronateand thalidomide therapy. All the patients underwent detailed clinical and laboratory control once a month.Pamidronate was used at 90 mg i.v. dose administered at 4-week intervals, and thalidomide at doses escalatedfrom 200 mg/d in the first week to 400 mg/d after 3 weeks of the therapy. The mean duration of treatmentwas 12 weeks with a range of 3 to 36 weeks. RESULTS: 7 patients (53%) receiving pamidronate and thalidomidetherapy demonstrated good response involving at least 25% reduction of monoclonal protein levels in comparisonwith baseline. All these patients reported improvement of osteodynia symptoms, and 3 of them - theircomplete regression. 70% patients experienced side effects (dizziness, constipation, somnolence, polyneuropathy)due to thalidomide administration CONCLUSIONS: Good response to combined pamidronate and thalidomidetherapy can be expected in at least 50% of patients with treatment-resistant multiple myeloma with advancedosteolytic lesions.

Keywords: Adult, Aged, Aged, 80 and over, Angiogenesis Inhibitors, Antineoplastic Combined Chemotherapy Protocols, Constipation, Diphosphonates, Disorders of Excessive Somnolence, Dizziness, Drug Resistance, Neoplasm, Female, Humans, Male, Middle Aged, Multiple Myeloma, Myeloma Proteins, Osteolysis, Pain, Remission Induction, thalidomide, Treatment Outcome



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