TY - JOUR
T1 - Thalidomide after allogeneic haematopoietic stem cell transplantation
T2 - Activity in chronic but not in acute graft-versus-host disease
AU - Kulkarni, S.
AU - Powles, R.
AU - Sirohi, B.
AU - Treleaven, J.
AU - Saso, R.
AU - Horton, C.
AU - Atra, A.
AU - Ortin, M.
AU - Rudin, C.
AU - Goyal, S.
AU - Sankpal, S.
AU - Meller, S.
AU - Pinkerton, C. R.
AU - Mehta, J.
AU - Singhal, S.
N1 - Funding Information:
This study was supported by the Bud Flanagan Leukaemia Fund, the David Adams Leukaemia Fund, the Cancer Research Campaign and the Institute of Cancer Research.
PY - 2003/7
Y1 - 2003/7
N2 - Thalidomide was used to treat acute (n = 21) or chronic (n = 59) graft-vs-host disease (GVHD) in 80 haematopoietic stem cell allograft recipients after failure to respond to the combination of cyclosporine and corticosteroids with or without other agents. The median time to onset of acute GVHD was 11 days, and thalidomide was started at a median of 48 days post transplant. In addition to corticosteroids and cyclosporine, 13 patients had also received other agents before thalidomide. None of the patients responded and all died of acute GVHD. For chronic GVHD (limited in 13, extensive in 46), thalidomide was started at a median of 385 days post transplant. In addition to corticosteroids and cyclosporine, 34 patients received azathioprine concomitantly. In all patients, thalidomide was added to the ongoing immunosuppressive regimen. The median duration of therapy with thalidomide was 60 days (range, 11-1210; <2 weeks in 11). In total, 13 patients (22%) had complete response, eight (14%) partial response and 38 (64%) no response. Response rates were comparable for limited (39%) and extensive (33%) chronic GVHD. At a median of 53 months, 19 patients are alive, 13 without evidence of chronic GVHD. Survival was significantly better in patients who responded to thalidomide. The principal causes of death were progressive chronic GVHD (n = 29) and relapsed leukaemia (n = 7). In conclusion, thalidomide has no activity in acute GVHD, but has some activity in chronic GVHD in combination with other agents.
AB - Thalidomide was used to treat acute (n = 21) or chronic (n = 59) graft-vs-host disease (GVHD) in 80 haematopoietic stem cell allograft recipients after failure to respond to the combination of cyclosporine and corticosteroids with or without other agents. The median time to onset of acute GVHD was 11 days, and thalidomide was started at a median of 48 days post transplant. In addition to corticosteroids and cyclosporine, 13 patients had also received other agents before thalidomide. None of the patients responded and all died of acute GVHD. For chronic GVHD (limited in 13, extensive in 46), thalidomide was started at a median of 385 days post transplant. In addition to corticosteroids and cyclosporine, 34 patients received azathioprine concomitantly. In all patients, thalidomide was added to the ongoing immunosuppressive regimen. The median duration of therapy with thalidomide was 60 days (range, 11-1210; <2 weeks in 11). In total, 13 patients (22%) had complete response, eight (14%) partial response and 38 (64%) no response. Response rates were comparable for limited (39%) and extensive (33%) chronic GVHD. At a median of 53 months, 19 patients are alive, 13 without evidence of chronic GVHD. Survival was significantly better in patients who responded to thalidomide. The principal causes of death were progressive chronic GVHD (n = 29) and relapsed leukaemia (n = 7). In conclusion, thalidomide has no activity in acute GVHD, but has some activity in chronic GVHD in combination with other agents.
KW - GVHD
KW - Thalidomide
KW - Transplantation
UR - http://www.scopus.com/inward/record.url?scp=10744230404&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=10744230404&partnerID=8YFLogxK
U2 - 10.1038/sj.bmt.1704033
DO - 10.1038/sj.bmt.1704033
M3 - Article
C2 - 12838281
AN - SCOPUS:10744230404
SN - 0268-3369
VL - 32
SP - 165
EP - 170
JO - Bone Marrow Transplantation
JF - Bone Marrow Transplantation
IS - 2
ER -