Tolerability and efficacy of thalidomide for the treatment of patients with light chain-associated (AL) amyloidosis

被引:107
作者
Seldin, DC [1 ]
Choufani, EB [1 ]
Dember, LM [1 ]
Wiesman, JF [1 ]
Berk, JL [1 ]
Falk, RH [1 ]
O'Hara, C [1 ]
Fennessey, S [1 ]
Finn, KT [1 ]
Wright, DG [1 ]
Skinner, M [1 ]
Sanchorawala, V [1 ]
机构
[1] Boston Univ, Boston Med Ctr, Boston, MA 02118 USA
来源
CLINICAL LYMPHOMA | 2003年 / 3卷 / 04期
关键词
autologous stem cell transplantation; immunoglobulin light chain; immunomodulatory therapy; melphalan; multiple myeloma; plasma cell dyscrasia;
D O I
10.3816/CLM.2003.n.005
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Thalidomide is an effective therapy for multiple myeloma, although its mechanisms of action remain unclear. Light chain-associated (AL) amyloidosis is a plasma cell disorder related to multiple myeloma, but in AL amyloidosis, fibrillar tissue deposits of clonal immunoglobulin light chains produce organ dysfunction. To test the toxicity and efficacy of thalidomide in AL amyloidosis we initiated a phase I/II trial for patients with AL amyloidosis, most of whom had failed prior therapy with high-dose melphalan and autologous stem cell transplantation. This trial was designed as an individualized 6-month dose-escalation study with reevaluation of bone marrow plasmacytosis and serum and urine monoclonal proteins after 3 and 6 months. Sixteen patients were enrolled in the study with a median age of 62 years (range, 37-70 years). Fourteen patients had renal involvement, 4 had cardiac involvement, 4 had liver involvement, and 2 had predominant soft tissue or lymph node involvement. The median maximum tolerated dose was 300 mg, with fatigue and other central nervous system side effects being the major dose-limiting toxicities. Side effects not frequently reported for other patient populations included exacerbation of peripheral and pulmonary edema and worsening azotemia. In all, 50% of patients experienced grade 3/4 toxicity, and 25% had to discontinue the study drug. No complete hematologic responses were seen, but 25% of patients had a significant reduction in Bence-Jones proteinuria. Thus, while thalidomide has activity in AL amyloidosis, it also has significant toxicity in this patient population.
引用
收藏
页码:241 / 246
页数:6
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