Thalidomide and its derivatives represent a new class of antineoplastic drugs (IMiDs), which has been especially effective in certain hematologic malignancies. These agents have anti-inflammatory, antiangiogenic, and immunomodulatory properties, and target tumor cells by direct cytotoxicity and indirectly by interfering with several components of the bone marrow microenvironment. Thalidomide analogs that retain antitumor activity equal to or greater than the parent compound, but with less toxicity, have been developed. This paper summarizes what is known about the mechanisms of action of these agents, and recent clinical results. The data suggest that thalidomide analogs will play a major role in the management of certain hematologic neoplasms in the near future.
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