THALIDOMIDE IN RELAPSED LYMPHOMA: 5 YEARS OF EXPERIENCE FROM SOUTHEND UNIVERSITY HOSPITAL NHS FOUNDATION TRUST

Abstract

Introduction: Thalidomide is an immunomodulatory and anti-inflammatory drug with well-documented efficacy in the treatment of multiple myeloma, both as initial therapy and in relapsed disease. Known side effects include venous thrombosis, fatigue, peripheral neuropathy and constipation. However as an oral drug with minimal myelosuppression, thalidomide is suitable for patients unable to tolerate more conventional chemotherapy or for whom regular hospital attendances are too demanding.Data from clinical trials and case series in a range of both B- and T-lymphoproliferative disorders show broad efficacy of thalidomide. The unusual and multiple modes of action of thalidomide suggest potential in treating disease resistant or refractory to conventional chemotherapy. This is further supported by exceptional case studies such as a refractory AITL patient achieving CR with thalidomide/dexamethasone and a post-allograft DLBCL patient achieving CR on thalidomide/rituximab.We have been using Thalidomide in relapsed and frail lymphoma patients at Southend for a number of years with anecdotally good outcomes. We decided to conduct a retrospective study of lymphoma patients treated with thalidomide to assess the rates of response and overall survival, as well as examining the side effect profile. Methods: Data from 2012 to 2016 were collected retrospectively from pharmacy records for all lymphoma patients treated with thalidomide. The majority of these patients were multiply relapsed. Patients were all started on 50 mg daily, with dose escalation to 200 mg daily as tolerated, in addition to pulsed dexamethasone. Results: 27 patients were treated: - 11 DLBCL (2 transformed lowgrade) - 3 Follicular lymphoma- 2 B-NHL unspecified- 3 Hodgkin's disease-2 Waldenström's macroglobulinaemia- 1 mantle cell- 5 angioimmunoblastic T cell- Age range of patients 52-58 (median age 75)- Line of treatment was 1-5 (median 2)- 17/27 patients were treated for >4 weeks (others stopped due to SEs or early relapse/ death)- 7 of those 17 achieved disease control for >6 months. Conclusion: The patients examined in this study were all multiply relapsed and/or too frail for conventional chemotherapy. Prognosis in such a cohort is very poor and, unsurprisingly, many of the cases we looked at died shortly after starting treatment. However, a subset of these patients achieved long disease control-one patient is still alive 5 years after starting thalidomide. Thalidomide has a variety of mechanisms including immunomodulatory and anti-angiogenic properties so it is a logical choice of treatment in chemotherapy-resistant cases. Given the generally well-tolerated side effect profile and low cost of thalidomide not to mention the ease of administration, a trial of thalidomide is worth considering when no other options remain, where it may buy precious months, or even years, of life.