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Thalidomide
Source: Plasma Cell Neoplasms (Including Multiple Myeloma) Treatment (PDQ®)–Health Professional Version, National Cancer Institute.
Source updated: April 25, 2025 · Captured 2026-09-09.
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Thalidomide is a first-generation immunomodulatory agent that is not often used because of its sedative and constipating effects, its significant and potentially debilitating neuropathy, and its thrombogenic effect (thromboprophylaxis is required).[69,70] Very little myelosuppression is seen with this agent.
Late in the disease course, when all other options have failed, thalidomide can be employed, sometimes with durable responses.[71] By using a low dose (50 mg by mouth every day), significant sedation, constipation, and neuropathy may be avoided. Thromboprophylaxis with aspirin, warfarin, or low-molecular-weight heparin is required; the choice of therapy depends on preexisting risk factors.[62]
Evidence (thalidomide):
A meta-analysis of 1,685 previously untreated patients considered six prospective randomized trials comparing thalidomide, melphalan, and prednisone versus melphalan and prednisone alone.[72]
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A meta-analysis of 1,685 previously untreated patients considered six prospective randomized trials comparing thalidomide, melphalan, and prednisone versus melphalan and prednisone alone.[72]
The addition of thalidomide improved median OS from 32.7 months to 39.3 months (HR, 0.83; 95% CI, 0.73–0.94; P = .004).[72][Level of evidence A1]
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Preserved source evidence · Not medical advice