Thalidomide versus placebo in myeloid metaplasia with myelofibrosis: a prospective, randomized, double-blind, multicenter study
Abgrall, J-François.; Guibaud, I.; Bastie, J-Noël.; Flesch, M.; Rossi, J-François.; Lacotte-Thierry, L.; Boyer, Fçoise.; Casassus, P.; Slama, B.; Berthou, C.; Rodon, P.; Leporrier, M.; Villemagne, B.; Himberlin, C.; Ghomari, K.; Larosa, F.; Rollot, F.; Dugay, J.; Allard, C.; Maigre, M.; Isnard, Fçoise.; Zerbib, R.; Cauvin, J-Michel.
Haematologica 91(8): 1027-1032
2006
ISSN/ISBN: 0390-6078 PMID: 16885042 Document Number: 598306
Background and Objectives. In non-randomized studies, thalidomide appeared to be effective in myeloid metaplasia with myelofibrosis (MMM). We compared thalidomide to placebo for treatment of anemia in MMM.Design and Methods. A prospective phase 11 B, randomized double-blind multicenter trial comparing thaliclomicle 400 mg/d with placebo for 180 days was conducted in 52 anemic patients (hemoglobin <= 9 g/dL or transfused). The main outcome measure was a 2 g/L increase in hemoglobin or 20% reduction in transfusions.Results. In the thalidomide group only 10 patients completed 6 months of treatment. At 180 days, in an intention-to-treat analysis, no difference was observed between the thalidomide and placebo groups as regards improvement of hemoglobin levels (one patient in each group) or reduction of red blood cell transfusions (three vs five patients, respectively). The spleen size, determined by ultrasonography, increased significantly less in the thaliclomide group than in the placebo group (p < 0.05). Thalidomide had no apparent benefit on the Dupriez score, the severity score, survival, death, or any other clinical or biological parameter. Somnolence, gastro-intestinal signs, weight gain, and edema were significantly more frequent in the thaliclomicle group. Outpatient discontinuation of thaliclomicle was significantly correlated with a high severity score > 4 (odds ratio, OR = 16; p < 0.01), and gamma-glutamyl transferase levels > 40 IU/L (OR=12; p < 0.05).Interpretation and Conclusions. Thalidomide (200-400 mg/d) does not demonstrate substantial efficacy in anemic MMM patients. The natural history of disease in the placebo group revealed spontaneous periods of remission of anemia. Tolerance of thalidomide was significantly correlated wih the severity and liver involvement of the disease.