Thalidomide is the first in the class of drugs as an immune modulatory drugs (IMiDs). In vitro data suggest that the drug and its metabolites may inhibit angiogenesis, in addition it may modulate adhesion molecules of myeloma cells and their surrounding stroma,.The combination of thalidomide plus dexamethasone is a feasible and active regimen in the treatment of multiple myeloma as It emerge an oral alternative to infusional chemotherapy with vincristine, doxorubicin ,dexamethasone currently used as pretransplantation induction therapy for myeloma.
To assess the efficacy ,response rate and safety using the combination of thalidomide-dexamehasone as front line therapy and in relapsed , refractory cases of myeloma
MATERIAL AND METHODS:
Between February 2008 up to January 2010, thirty five cases of multiple myeloma received a combination of Thalidomide and Dexamethasone for 4 cycles. Those patients had been followed and evaluated at National Centre of Hematology.All cases of myeloma were staged at diagnosis according to Durie – Salmon Staging system. Response based on criteria by Chronic Leukemia and Myeloma Task force ( EBMT criteria ) as complete response (CR), good partial response(GPR) and no response(NR) .
After 4 cycles of therapy , 6(17%) patients achieved complete response,22( 62.9%) patients achieved good partial response, 3(8.6%) patients with minimal response and 4 ( 11.4% ) patients fail responded to treatment .Of those who failed treatment, three patients died two of them with heart failure and one with multi organ failure. Concerning the toxicity , The most common side effect was related to neurotoxcity in form of peripheral neuropathy and thromboembolic disease. Otherwise most of the remaining side effects were rated as mild to moderate
Thal-Dex is an effective myeloma treatment in terms of response , easy to use as outpatient clinic and avoid complications related to line access or cardiac toxicity that related to other treatments.