Desirable and Adverse Reactions of
Thalidomide in Patients with Multiple Myeloma
Foldyna D., Kamelander J., Krejčí M., Hájek R.
Interní hematoonkologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Jiří Vorlíček, CSc. |
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Summary:
Thalidomide, an antiemetic administered in 60th of the 20th century to pregnant women, has
become notorious for a range of adverse effects which led to its taking off market. In recent years,
its antimyeloma effect was discovered. The aim of the work was to evaluate the incidence of
adverse reactions to thalidomide. Its therapeutic effect has not been assessed because of a short
period of monitoring and diversity of a sample. The assessed sample consisted of 17 patients with
diagnosis of multiple myeloma (10 men and 7 women). An average age of patients was 62.9 ± 9.4.
An average time elapsed from making the diagnosis to starting the treatment with thalidomide
was 51.0 ± 23.7 months. An average length of therapy was 20.1 ± 9.6 weeks. An average daily
maximum therapeutic dose was 138.3 ± 83.2 mg. Data were collected from outpatient physicians
reports, regular laboratory tests, and direct interviews with patients. To classify severity of adverse
drug effects (grades 0-4) we used WHO criteria, Cancer and Leukemia Group B criteria, and in
cases where certain adverse effects were not included in the above mentioned criteria, we defined
our own criteria. The most frequent adverse effects included: leucopenia or neutropenia in 12
(70.6 %) patients, altered state of consciousness in 11 (64.7 %) patients, obstipation in 10 (58.8 %)
patients, skin alterations in 9 (52.9 %) patients, dizziness in 8 (47.1 %) patients, peripheral neuropathy
in 7 (41.2 %) patients, spasms and spasmodic convulsions in 7 (41.2 %) patients, and altered
liver tests in 6 (35.3 %) patients. From the perspective of necessity to interrupt treatment or
reduce the dose the most severe disorders included: peripheral neuropathy in 2 patients (inability
to control lower extremities), altered consciousness in 1 patient (protracted somnolence during
a day), skin alteration in 1 patient (generalized toxoalergic reaction), leucopenia or neutropenia
in 1 patient (1.0 resp < 0.5 x 109/l), altered vision in 1 patient (blurred vision), hypothyroidism in 1
patient, and altered mood in 1 patient (subjective feeling of depression). This work proved thalidomide
to be beneficial for the patients with multiple myeloma but it also shoved necessity to
intensively monitor its adverse effects and to adjust its doses.
Key words:
Multiple myeloma - Thalidomide
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