Newer IMiDs

With the advent of thalidomide, the treatment of multiple myeloma was revolutionized. The drug showed excellent response rates in both previously untreated and relapsed/refractory patients. However, treatment-related toxicities such as somnolence, constipation, and neuropathy were a major limitation to its use. Lenalidomide, a thalidomide analogue, was developed with the hope of improving both the efficacy and toxicity profile of thalidomide and has subsequently shown significant clinical activity in patients with multiple myeloma. Though approved only for relapsed/refractory patients till date, clinical trials using lenalidomide with or without combinations have shown great efficacy in newly diagnosed, as a maintenance therapy and even asymptomatic myeloma. The recent introduction of another thalidomide analogue-pomalidomide has shown significant activity and a great potential for use in relapsed/refractory myeloma including those refractory to lenalidomide and bortezomib.