thalidomide working ?

[Neel]

My father has been taking thalidomide 100 mg for last 4 months (since 22 april, 2011). he was transfusion dependent when he started thalidomide, required both platelet and blood. After arnd 15 days of start of thalidomide , his counts stablized , there wasnt any marked improvement, but the counts were stable and remained so till today i.e. 17/8/11, i.e. Hb moved slowly till 11, Platelet rose staidly till 40000, then came back to 30000 and remained between 30000-40000, TLC arnd 2000-2400. Howeve todays report shows Hb and TLC as same i.e 10 and 2400 resp, however his platelet count has taken a beating i.e. 18000. Any inputs and what to do ?


Moreover he stopped taking thalidomide for arnd 1 week i.e. 3-8-11 till 10-8-11 due to extreme weakness caused by it. However he started it since 10-8-11.

Is the fall due to discontinuation of thalidomide ?

Has thalidomide stopped working ?

Will thalidomide show its effect later ?

regards,

neel

[Birgitta-A]

Hi Neel,
Too bad that your father is so weak! Many patients that can't tolerate Thalidomide 100mg/day get lower doses with good or better effect. I am taking 29mg/day (4 caps á 50mg/week) since July 2010 with positive effect - my WBCs decreased when I took 50mg/day.

As I have suggested before I think a low dose of Prednisone could increase your father's counts - especially the platelets. You know the platelets can fluctuate much. If they decrease from 30000 to 18000 they can increase next time. Do avoid everything that can decrease platelets like all types of pain killers.

I don't know if the lower counts depend on discontinuation of Thalidomide. The median response (50% of the responses) is 9 months so 4 months is a short response. There are a few patients who have responded several years - one study mentioned 6 years.

It is true that some patients respond several months after Thalidomide is stopped but I think it is better to cotinue with a lower dose.
Birgitta-A
72 yo, dx MDS Interm-1 2006, received 142 units of PRBCs, Thalidomide + Prednisone since June 2010 with positive effect, don't need iron chelation any longer, take one Neupogen injection/week instead of 2 for my low WBCs, last counts HGB 130, WBCs 4.8 and platelets 95.