Thalidomide: a new old drug in the treatment of multiple myeloma

Thalidomide, a drug used initially as a sedative, was removed from widespread use since the early 1960s because of its teratogenic effect. It has now returned to clinical practice as an effective agent in the treatment of erythema nodosum leprosum. Activity has also been demonstrated in the treatment of inflammatory bowel disease and chronic graft - versus-host disease. More recently, the drug was found to have significant antiangiogenic and immunomodulatory effects. Clinical trials have demonstrated significant clinical response in the treatment of patients with relapsed or refractory multiple myeloma (MM). In combination with dexamethasone, thalidomide was found to be as effective as aggressive intravenous chemotherapy regimens used in the initial therapy for patients with newly diagnosed MM. Except for a high rate of venous thromboembolism, thalidomide's other toxicity is well tolerated. In this review, we will detail recently published clinical trials evaluating the use of thalidomide alone or in combination with dexamethasone to treat relapsed, refractory or newly diagnosed patients with MM.