Dimopoulos M A, Tsatalas C, Zomas A, Hamilos G, Panayiotidis P, Margaritis D, Matsouka C, Economopoulos T, Anagnostopoulos N
Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece.
Semin Oncol. 2003 Apr;30(2):265-9. doi: 10.1053/sonc.2003.50079.
To evaluate the activity of thalidomide in Waldenstrom's macroglobulinemia (WM), 20 patients were treated on a dose schedule that escalated from 200 mg/d to 600 mg/d. On an intention-to-treat basis, five (25%) patients achieved a partial response, which was noted within 3 months of treatment. Adverse effects were common and prevented dose escalation of thalidomide in 75% of patients and led to premature discontinuation of treatment in 35%. We subsequently evaluated the oral combination of clarithromycin (500 mg twice per day), low-dose thalidomide (200 mg once daily), and dexamethasone (40 mg once per week). Our preliminary analysis on 12 previously treated patients indicate activity of this regimen in WM: three patients achieved a partial response and two patients demonstrated monoclonal protein reduction of greater than 25%. This combination was associated with a variety of side effects due not only to thalidomide, but also to corticosteroids and to clarithromycin. Our preliminary data indicate that this combination may be a useful salvage regimen for some patients with heavily pretreated macroglobulinemia.
为评估沙利度胺对华氏巨球蛋白血症（WM）的疗效，对20例患者采用剂量从200mg/天递增至600mg/天的给药方案进行治疗。基于意向性分析，5例（25%）患者获得部分缓解，均在治疗3个月内出现。不良反应常见，75%的患者因不良反应而无法增加沙利度胺剂量，35%的患者因不良反应而提前终止治疗。随后，我们评估了克拉霉素（每日2次，每次500mg）、低剂量沙利度胺（每日1次，每次200mg）和地塞米松（每周1次，每次40mg）的口服联合方案。我们对12例先前接受过治疗的患者进行的初步分析表明，该方案对WM有疗效：3例患者获得部分缓解，2例患者的单克隆蛋白减少超过25%。该联合方案不仅因沙利度胺，还因皮质类固醇和克拉霉素而出现多种副作用。我们的初步数据表明，该联合方案可能是一些经过大量预处理的巨球蛋白血症患者有用的挽救方案。
