ABSTRACT
Myeloma responds to thalidomide in 30 percent of patients who have already undergone chemotherapy, and in 60 percent of untreated patients when combined with dexamethasone. Thalidomide was used alone in 51 patients, with dexamethasone in eight, cyclophosphamide in three, cyclophosphamide and dexamethasone in thirteen, melphalan and dexamethasone in two, and in other combinations in two cases. Median follow-up was 9 months. Thalidomide was discontinued due to lack of effect in eight cases and adverse effects in 25. Clonal disease responses of greater than 50 percent were recorded in 39 out of 64 patients who were followed by serum free light chain measurements, and in 16 out of 49 patients who had paraproteins that were quantified conventionally. Thalidomide alone or in combination with other agents is probably as effective in AL amyloidosis as it is myeloma, but has frequent adverse effects.
