Introduction
Douglas E. Joshua
University of Sydney, Institute of Haematology, Royal Prince Alfred
Hospital, Sydney, Australia
Thalidomide represents a new milestone in the treatment of
multiple myeloma and an opportunity to move away from cytotoxic
agents toward an approach based on cellular signaling and cell-cell
interactions. Alone, thalidomide produces several immunomodulatory
effects that retard the progression of disease. In combination with
conventional treatments, however, thalidomide produces a
significant synergistic effect, resulting in improved treatment
response and survival rates.
The mechanism of action of thalidomide is complex. It impedes
angiogenesis, alters myeloma plasma cell adhesion, increases the
number of natural killer cells, and stimulates T-cell
proliferation. Thalidomide also appears to produce direct
anti-myeloma activity in vitro. [>Read
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