Thalidomide analogs

Thalidomide-based regimens have shown remarkable activity in relapsed-refractory multiple myeloma (MM) so that their use has been successfully extended to newly diagnosed patients. Thalidomide-dexamethasone combination has demonstrated to be superior to VAD in terms of both response rate and relative reduction of serum or urine M component,1 and these results are being confirmed in multicenter randomised ongoing trials.2 A major drawback of thalidomide is represented by its side effects; more than half of the patients complain about lethargy and constipation, deep venous thromboses occur in up to 15-20% of newly diagnosed patients treated with thalidomide-dexamethasone unless a proper prophylaxis is performed3-4 grade ≥2 WHO peripheral neuropathy is reported in 60% of the patients treated longer than 1 year;5 the incidence and extent of side effects limit the usage of thalidomide in other hematological conditions such as Waldenstrom macroglobulinemia, AL amyloidosis and, above all, myelofiblosis.1