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Neuropathy in multiple myeloma treated with thalidomide

A prospective study

From the Dipartimento di Neuroscienze, Unità Operativa di Neurologia, Ospedale Bellaria, Bologna, Italia (R.P., F.P., F.S., I.B., R.M., C.A.T.); Istituto di Ematologia e Oncologia Medica "Seràgnoli" (M.C., E.Z., P.T., D.C., P.T.) and Istituto di Cardiologia (E.P.), Ospedale S. Orsola-Malpighi, Università di Bologna, Italia.

Address correspondence and reprint requests to Dr. Rosaria Plasmati, Dipartimento di Neuroscienze, Unità Operativa di Neurologia, Ospedale Bellaria, Via Altura 3, 40100, Bologna, Italy rosaria.plasmati{at}ausl.bo.it

Background: Thalidomide is effective as a first-line therapy for the treatment of multiple myeloma (MM), but its use is limited by peripheral neurotoxicity.

Objective: To study the occurrence of both myeloma-related neuropathy and thalidomide-induced neuropathy in 31 patients with newly diagnosed MM.

Methods: Clinical and electrophysiologic examinations were performed in 31 patients with newly diagnosed MM before and after 4 months of therapy with thalidomide (200 mg/day, total dose: 21 g) aimed at debulking MM, before autologous transplantation. After transplantation, the patients took thalidomide, 200 mg/day for another 3 months (total dose over three months: 18 g) and then underwent a final clinical and electrophysiologic checkup.

Results: At baseline, four patients presented a mild sensorimotor peripheral neuropathy related to MM, which tended to worsen slightly during treatment with thalidomide. At the end of treatment, 83% of the patients had clinical and electrophysiologic evidence of a mild sensory rather than motor, axonal, length-dependent polyneuropathy, whereas 100% of the patients showed improvement to the basic pathology (partial response).

Conclusions: Peripheral neuropathy, sometimes subclinical, and mild in our patients, is a common, early side effect of thalidomide therapy. The high doses (21 g) used in all patients for a relatively short time (4 months) rule out any correlations between neuropathy, total dose, and duration of treatment.

Supplemental data at www.neurology.org

Disclosure: The authors report no conflicts of interest.

Received May 8, 2006. Accepted in final form March 8, 2007.

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