The study was aimed to investigate the clinical efficacy and adverse reactions of different
thalidomide regimens in the treatment of
multiple myeloma (MM), and to explore the relationship between efficacy of
thalidomide and serum level of
TNF-alpha in MM patients. The 85 patients with MM were divided into 5 groups according to different combinations of
thalidomide. These 5 groups were following: group with the high dose (HD-T), group with thalidomide+VAD
chemotherapy (T-VAD), group with thalidomide+MP
chemotherapy (T-MP), group with
thalidomide plus
dexamethasone (TD), and group with low dose of
thalidomide (LD-T). Except 5 groups mentioned above, the group with conventional VAD
chemotherapy was served as the control. Clinical effects, adverse reactions, treatment-related mortality were observed. At the same time, serum levels of
TNF-alpha in 30 cases of MM treated with
thalidomide (15 cases effective and 15 cases ineffective) before and
after treatment were detected by double-antibody sandwich
enzyme-linked
immunosorbent assay (ELISA) and were compared with the clinical efficacy. The results showed that the efficient rate of HD-T, T-VAD, T-MP, TD, LD-T groups were 25.0%, 80.0%, 71.4%, 33.3%, 27.3% respectively; the efficacy of T-VAD, T-MP groups were significantly higher (p<0.05) than that of other groups and conventional VAD
chemotherapy group. The incidence of significant adverse reactions (
peripheral neuropathy,
fatigue, abdominal distension and
constipation,
rash,
edema, leukocyte and platelet decrease) in 5 groups were 75.0%, 30.0%, 28.6%, 14.3%, 9.1% respectively, no IV grade toxicity and
deep vein thrombosis were found. The treatment-related mortality was 0%. At the same time, it was found that the serum levels of
TNF-alpha in ineffective group treated with
thalidomide were 44.7+/-5.7 pg/ml and 46.3+/-4.0 pg/ml before and after
thalidomide treatment, and there was no significant difference (p>0.05). The serum levels of
TNF-alpha (27.3+/-6.4) pg/ml in the effective group
after treatment was significantly lower than that before treatment (49.2+/-7.3) pg/ml (p<0.05). It is concluded that compared with conventional
chemotherapy,
thalidomide is a effective drug for treating MM patients.
Thalidomide in combination with
chemotherapy (T-VAD, T-MP) may be one better therapeutic regimen with high efficiency and milder adverse reactions. Serum level of
TNF-alpha is an
indicator for finding effects of
thalidomide, and plays a role in the pathogenesis of MM.