Thalidomide and dexamethasone therapy of myeloma in a patient with previously untreated B-chronic lymphocytic leukemia.

A 67-year-old woman with previously untreated lambda-positive B-chronic lymphocytic leukemia (CLL) had kappa-positive myeloma develop that was treated with daily thalidomide and intermittent dexamethasone. After 4 months, there was a marked reduction in marrow plasmacytosis, urine kappa chains, and peripheral blood and marrow lymphocytosis. She reduced her thalidomide (but not dexamethasone) doses after 6 months, because she had symptoms of peripheral neuropathy. Although blood lymphocyte concentrations remained normal, she had progression of myeloma and died. Thalidomide and dexamethasone therapy similar to that administered for myeloma alone may be effective treatment for myeloma in patients with preexisting B-CLL and may also have anti-B-CLL activity.